Lifelong learning in the reorganization of work in an emergency department: an exploratory study


Fabíola Chaves Fernandes1, Elaine Antunes Cortez1

1Universidade Federal Fluminense


Research has revealed a close relationship between oral health and individual well-being. To achieve comprehensive care in an emergency department it is necessary that its team understand the role of the dentist, in order to make them the authors of change as part of a lifelong learning proposal.
Aim: to use lifelong learning to reorganize the work process in an emergency department.
Method: A descriptive and exploratory study involving convergent analysis and a qualitative methodological approach. For data collection, participant observation, semi-structured questionnaires and workshops will be used. The meetings will be recorded through the use of notes, photographs and filming. Participants will be personnel from the emergency department of an emergency room unit. Inclusion criteria are as follows: the professionals who refer patients for dental treatment, selected according to their availability for participation. The processing of information will be made using Bardin analysis and Augustine of Hippo’s theoretical reference. After this, study results will be displayed in such a way as to allow a discussion of the importance of continuing education.
Descriptors: Dentists; Education, Continuing; Emergency Medical Services; Professional Role.



Multidisciplinary care has become necessary for a better understanding of the health problems of patients and to ensure their better resolution. Empowered, the participants become authors of the processes of change proposed as part of lifelong learning. This difference between continuing education and lifelong learning is not clear to personnel in an emergency mobile service, and is still criticized in terms of its educational process(1), which demonstrates the relevance of such a study. The lifelong learning process in health education offers a strategy that puts medical personnel in charge of their training.  It has the aims of achieving individual and collective competence, as well as strengthening professional categories and the health team as a whole(2). However, often the team is not prepared to handle such a demand because they do not understand the role of the dental professionals in hospitals, even though they know that they are in an ideal position to identify physical abuse in elderly patients in that the dental team is attentive to the appearance of the elderly and any physical signs of aggression(3). Thus, we understand this as being relevant to the investigation of the object under consideration. Because it is a recent theme, the legislation on the subject is still being developed and the role of the dentist is expanding as comprehensive care becomes a reality, and as multidisciplinary teams are consolidated within Public Health System (SUS) units.



The following hypotheses were formulated: the work process regarding the referral of patients to the emergency dental service is not clear to medical personnel, in terms of the dentists’ role and their assignments; there is no proposal in terms of health as part of the lifelong learning process nor is it collectively elaborated based on the demands found.  Consequently, it has not been used as a device for institutional change.



To use lifelong learning to organize the work process in the emergency service; to identify and describe the work process associated with referring patients to the emergency dental service; to provide specific about the emergency department and emergency dental service to professional staff; to describe the dentist's duties in the emergency department; and to develop products to collaborate in the ongoing education of staff involved in patient care, according to specific legislation, for the sake of the integrity of emergency medical assistance.



This is a descriptive exploratory study using convergent analysis as part of a qualitative approach.  The study will take place in a municipal emergency room in São Gonçalo, Rio de Janeiro state, which deals with spontaneous and trauma demands. The sample was chosen based on the data available on the National Register of Health Facilities (CNES), and is estimated at 111 participants.

The criteria were as follows: clinic and trauma room physicians, orthopedists, general surgeons, nurses, personnel in charge of risk classification; and reception staff who refer patients to the emergency dental service, regardless of their training. Professionals who are on leave or on vacation during any of the steps will be excluded from the research.

For data collection as part of the first stage, that occurred in August-September, 2015 using participant observation, we aimed to identify and describe the organization of the work process associated with referring patients to the emergency dental service in order to start designing a flow for this service to be analyzed as part of the second stage of the research and also to be a product of the study. During this stage, the researcher analyzed the medical care bulletins, seeking to identify any course of action whose solving is beyond the scope of the work of the dental staff. In the second stage, planned for September-October 2015 interviews was carried out using semi-structured questionnaire. The results will be analyzed by making use of Bardin’s perspective, and they will be used as reflection in the workshops which will take place in October-November 2015, to be carried out according to instructions by emergency department directors, in order to highlight the convergence between the logic of health care and research, using the theoretical framework of Augustine of Hippo. The meetings will be recorded through notes, photographs and filming. At that time, the material collected in the first stage as cases were discussed and analyzed by the team, and the team will make use of lifelong learning concepts to suggest solutions to the difficulties encountered as part of the work process. The comments of those in the workshops will be transcribed immediately after the meeting in order to make a record of all the information obtained.

This study was approved by the Research Ethics Committee of the Medical School of the Fluminense Federal University, under opinion number 1210223 of 01/09/2015.



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2. Santos CM, Marchi RJ, Martins AB, Hugo FN, Padilha DMP, Hilgert JB. The prevalence of elder abuse in the Porto Alegre metropolitan area. Braz. oral res.  [ Internet ]. 2013  June [ cited  2015  May  07 ]  27(3): 197-202. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1806-83242013000300197&lng=en. Epub Apr 19, 2013.  http://dx.doi.org/10.1590/S1806-83242013005000011.

3. Ferreira GSM, Ponte KMA, Aragão AEA, Arruda LP, Ferreira FIS. Continuos education of professionals in the hospital environment: An exploratory study - preliminary note. Online braz j nurs [ Internet ]. 2012 Oct [ cited 2015 May 7 ] 11 (2): 488-91. Available from: http://www.objnursing.uff.br/index.php/nursing/article/view/3874 . doi: http://dx.doi.org/10.5935/1676-4285.2012S017



All authors participated in the phases of this publication in one or more of the following steps, in According to the recommendations of the International Committee of Medical Journal Editors (ICMJE, 2013): (a) substantial involvement in the planning or preparation of the manuscript or in the collection, analysis or interpretation of data; (b) preparation of the manuscript or conducting critical revision of intellectual content; (c) approval of the versión submitted of this manuscript. All authors declare for the appropriate purposes that the responsibilities related to all aspects of the manuscript submitted to OBJN are yours. They ensure that issues related to the accuracy or integrity of any part of the article were properly investigated and resolved. Therefore, they exempt the OBJN of any participation whatsoever in any imbroglios concerning the content under consideration. All authors declare that they have no conflict of interest of financial or personal nature concerning this manuscript which may influence the writing and/or interpretation of the findings. This statement has been digitally signed by all authors as recommended by the ICMJE, whose model is available in http://www.objnursing.uff.br/normas/DUDE_eng_13-06-2013.pdf



Received: 09/15/2015
Approved:  11/23/2015