Support for learning in the perspective of patient safety in primary health care 1

ABSTRACT Objective: to analyze the support for learning, in the perspective of patient safety, offered in the work environment, according to health professionals working in primary care. Method: a transversal study, held with 86 health professionals working in primary care. A validated instrument was used, applied via the Internet. Descriptive statistical analysis was undertaken with a presentation of median, mean, standard deviation and coefficient of variation. Results: points which are favorable to supporting learning were evidenced, such as mutual respect, autonomy for organizing the work and valorization of new ideas, which obtained means above 7.0. The variables which hinder the process of learning in the work environment, perceived by the professionals, were: resistance to changes, and excess of work impeding reflection on how to improve the work, with means above 6.0. Conclusion: the study found evidence of indicators related to the process of staff development in the area of health and indicates the influence of support for learning for the improvement of the work processes and of patient safety. It is necessary that a culture involving the systematic assessment of educational interventions in health should be established, the aim being to diagnose actions which are more incisive for changing health professionals' attitude and, therefore, clinical practice.

total of 501 questionnaires were sent, and returns were received from 86 professionals, corresponding to an acceptability of 17.2%.
The Internet questionnaire was made up of two parts. The first investigated the health professionals' profile, was made by the researchers, and was assessed for clarity and objectivity. The second was a validated assessment scale (8) , which investigates the support for learning perceived in the work unit, encouraged by the immediate managers and by the work colleagues.
On a scale of 0 to 10, the professionals judged 38 statements related to the support offered for learning, in which 0 corresponded to 'never', and 10, to 'always'.
The higher the score attributed, the greater was the

Results
A total of 86 professionals, from various professions linked to the health services of the PHS, participated in the study. Table 1 presents this population's general characteristics.
Paranaguá TTB, Bezerra ALQ, Tobias GC, Ciosak SI. ** Due to low salaries, it is common for health professionals in Brazil to work in more than one job. Translator's note.  their scores obtained means of 5.9 and 5.8, respectively.
The mean of 6.5 was obtained in the item evaluating openness to criticism when somebody applies new skills, and indicated a movement towards the existence of support for learning in the work environment.     In the assessment of the support for learning can create tensions among those involved (13) . It is ascertained that curricular training in patient safety on undergraduate courses in health occurs in a fragmented way, limited to specific skills, and clashes with traditional proposals, requiring a great need to elaborate methods and develop exclusive professional competences to reduce and prevent errors in health (13)(14) .
With weaknesses which originated since qualification, education at work, in the context of patient safety, becomes a challenge and must be encouraged so as to resolve gaps in the knowledge. The development of efficacious knowledge management in the health services is advised, so as to transfer to the professionals' context the best scientific evidence which can ensure the improvement of the clinical practice (15) . is associated with undertaking activities efficiently, meeting the organizational expectations (16) . Emphasis is placed, therefore, on the positive influence between the variables of support offered to learning and the impact of the educational interventions in the work environment, which reinforces the power of the organizational context in the process of staff development.
The component of autonomy is considered one of the most important for promoting satisfaction among the professionals (17) . As a result, it is possible that the professional who perceives her autonomy in the work environment can become a proactive agent, capable of creating, reporting, discussing and, consequently, valuing quality care.
In relation to the support for learning offered by the managers, a mean of 6. The best care practices are directly related to the success and to the effectiveness in the training and empowerment of the health professionals (20) . It is argued that the development of educational interventions is more significant when the processes which facilitate the learning in the work environment are understood (7) .
In dealing with learning for the prevention of incidents, at all levels of healthcare, it is necessary to take a broader view, beyond one's own professional work, and to pay attention to the multiple factors which place at risk the safety of the patient in the process of being cared for. This requires a feasible plan for the improvement of the quality of the care, as well as the extending of the culture of safety in the PHS, with a view to training not only the health professionals, but also the patients, to recognize and manage the risks, providing an opportunity for the shared ability to deal with change in the context of healthcare (1) .
The present study indicates that the organizational structure influences the learning and is able to promote It is hoped that this study may awaken interest in deepening scientific knowledge on this issue, so as to produce evidence for clinical practice, in particular, for those responsible for managing the process of staff development.

Conclusion
Among the variables favorable to support for learning, emphasis is placed on mutual respect, autonomy, the valuing of new ideas, encouragement on