Revista de Administração em Saúde
UTI humanizada: estratégias empregadas e perspectiva profissional
Resumo
RESUMO
Introdução: A unidade de terapia intensiva (UTI) tornou-se, inevitavelmente, um dos ambientes mais hostis para o paciente e equipe de saúde. Objetivo: Descrever as estratégias adotadas em uma UTI humanizada, bem como avaliar a percepção da equipe de saúde acerca deste modelo de serviço. Métodos: Estudo observacional, transversal, descritivo. Foi descrito a UTI humanizada do local de estudo e aplicado um questionário para 35 profissionais, com respostas descritas em frequências absolutas. Resultados: A UTI humanizada apresenta leitos separados por paredes, quadros com características e desejos dos pacientes, além da possibilidade de acompanhante em tempo integral. A maioria dos entrevistados concordou que a presença de acompanhante em tempo integral, bem como a presença de paredes separando leitos, melhoram o bem-estar do paciente. Além disso, concordaram que as características da UTI humanizada afetam positivamente o prognóstico e a saúde mental do doente. No entanto, os profissionais acreditam que a presença do acompanhante poderia aumentar os riscos de infecção hospitalar. A maioria discordou que a presença de acompanhante 24 horas por dia afeta negativamente o trabalho da equipe, que se sente desconfortável realizando o cuidado com a presença da família no leito, que a presença da família reduz a carga de trabalho e que a separação por leitos reduz a capacidade de monitoração dos leitos. Conclusão: Estratégias como as descritas tornam a UTI mais humanizada. A maioria dos profissionais entrevistados acredita que este modelo apresenta benefícios importantes, como a melhora do bem-estar do paciente e impacto positivo sobre seu prognóstico.
Palavras-chave: Unidades de Terapia Intensiva; Equipe de Assistência ao Paciente; Assistência Centrada no Paciente; Qualidade da Assistência à Saúde; Gestão de Cuidados ao Paciente
Humanized ICU: strategies employed and professional perspective
ABSTRACT
Introduction: The Intensive Care Unit (ICU) has inevitably become one of the most hostile environments for the patient and the healthcare team. Objective: To describe the strategies adopted in a humanized ICU, as well as to evaluate the perception of the health team about this service model. Methods: Observational, cross-sectional, descriptive study. The humanized ICU at the study site was described and a questionnaire was applied to 35 professionals, with responses described in absolute frequencies. Results: The humanized ICU has beds separated by walls, pictures with characteristics and wishes of patients, in addition to the possibility of a full-time companion. Most respondents agreed that the presence of a full-time companion, as well as the presence of walls separating beds, improve the patient's well-being. In addition, they agreed that the characteristics of the humanized ICU positively affect the patient's prognosis and mental health. However, professionals believe that the presence of a companion could increase the risk of hospital infection. The majority disagreed that the presence of a companion 24 hours a day negatively affects the work of the team, that they feel uncomfortable performing care with the presence of the family in the bed, that the presence of the family reduces the workload and that the separation by beds reduces the monitoring capacity of beds. Conclusion: Strategies such as those described make the ICU more humanized. Most professionals interviewed believe this model has important benefits, such as improving patient well-being and having a positive impact on their prognosis.
Keywords: Intensive care unit; Patient Care Team; Patient-Centered Care; Quality of Health Care; Patient Care Management.
Referências
Souza M, Possari JF, Mugaiar KHB. Humanização da abordagem nas unidades de terapia intensiva. Rev Paul Enferm. 1985 abr; 5(2):77-9.
Silva RC da, Ferreira M de A. Clínica do cuidado de enfermagem na terapia intensiva: aliança entre técnica, tecnologia e humanização. Revista da Escola de Enfermagem da USP. 2013 dez 1;47(6):1325-32. https://doi.org/10.1590/S0080-623420130000600011.
Arias-Rivera S, M. Sánchez-Sánchez M. ¿Es necesario “humanizar” las Unidades de Cuidados Intensivos en España? Enfermería Intensiva. 2017 jan;28(1):1-3. https://doi.org/10.1016/j.enfi.2017.02.002.
Alonso-Ovies Á, Heras La Calle G. ICU: a branch of hell? Intensive Care Medicine. 2015 set 4;42(4):591-2. https://doi.org/10.1007/s00134-015-4023-7.
Ortiz LMP, Moncada YAH, Morales JMM, Plata GZ, Sánchez C. Latido de vida: vivencias del paciente con enfermedad cardiovascular en una unidad de cuidado intensivo.: Life heartbeat: experiences of patients with cardiovascular disease in an intensive care unit. Revista Ciencia y Cuidado [Internet]. 2019 mai;16(2):46-58. https://doi.org/10.22463/17949831.1607.
Wilson ME, Beesley S, Grow A, Rubin E, Hopkins RO, Hajizadeh N, et al. Humanizing the intensive care unit. Critical Care. 2019 jan 28;23(1). https://doi.org/10.1186/s13054-019-2327-7.
Holanda Peña MS, Ots Ruiz E, Domínguez Artiga MJ, García Miguelez A, Ruiz Ruiz A, Castellanos Ortega A, et al. Medición de la satisfacción de los pacientes ingresados en unidad de cuidados intensivos y sus familiares. Medicina Intensiva [Internet]. 2015 Jan 1;39(1):4-12. https://doi.org/10.1016/j.medin.2013.12.008.
Lombardo V, Vinatier I, Baillot M-L, Franja V, Bourgeon-Ghittori I, Dray S, et al. How caregivers view patient comfort and what they do to improve it: a French survey. Annals of Intensive Care. 2013;3(1):19. https://doi.org/10.1186/2110-5820-3-19.
Jones C, Griffiths RD, Humphris G, Skirrow PM. Memory, delusions, and the development of acute posttraumatic stress disorder-related symptoms after intensive care. Critical Care Medicine. 2001 mar;29(3):573-80. https://doi.org/10.1097/00003246-200103000-00019.
Davydow DS, Gifford JM, Desai SV, Bienvenu OJ, Needham DM. Depression in general intensive care unit survivors: a systematic review. Intensive Care Medicine. 2009 jan 23;35(5):796-809. https://doi.org/10.1007/s00134-009-1396-5.
Mezomo JA. O que é humanização no hospital? Circular 02/80 apresentada no 1º Congresso Brasileiro de Humanização do Hospital e da Saúde; 1980; São Paulo (SP), Brasil.
Vila V da SC, Rossi LA. O significado cultural do cuidado humanizado em unidade de terapia intensiva: “muito falado e pouco vivido.” Revista Latino-Americana de Enfermagem [Internet]. 2002 abr;10(2):137-44.
Biancofiore G, Bindi LM, Barsotti E, Menichini S, Baldini S. Open intensive care units: a regional survey about the beliefs and attitudes of healthcare professionals. Minerva Anestesiologica [Internet]. 2010 fev 1;76(2):93-9. https://pubmed.ncbi.nlm.nih.gov/20150849/.
Giannini A. The “open” ICU: not just a question of time. Minerva Anestesiologica [Internet]. 2010 fev 1;76(2):89-90. https://pubmed.ncbi.nlm.nih.gov/20150847/.
Escudero D, Martín L, Viña L, Quindós B, Espina MJ, Forcelledo L, et al. Política de visitas, diseño y confortabilidad en las unidades de cuidados intensivos españolas. Revista de Calidad Asistencial [Internet]. 2015 set 1;30(5):243-50. https://doi.org/10.1016/j.cali.2015.06.002.
Likert, R. A technique for the measurement of attitudes. Archives of Psychology. 1932; 140, 5-55.
Ning J, Cope V. Open visiting in adult intensive care units - A structured literature review. Intensive and Critical Care Nursing [Internet]. 2019 out;102763. https://doi.org/10.1016/j.iccn.2019.102763.
Burchardi H. Let’s open the door! Intensive Care Medicine. 2002 out 1;28(10):1371-2. https://doi.org/10.1007/s00134-002-1401-8.
Berwick DM, Kotagal M. Restricted Visiting Hours in ICUs. JAMA. 2004 ago 11;292(6):736. https://doi.org/10.1001/jama.292.6.736.
Calle GHL, Martin MC, Nin N. Seeking to humanize intensive care. Revista Brasileira de Terapia Intensiva. 2017;29(1). https://doi.org/10.5935/0103-507X.20170003.
Riley BH, White J, Graham S, Alexandrov A. Traditional/Restrictive vs Patient-Centered Intensive Care Unit Visitation: Perceptions of Patients’ Family Members, Physicians, and Nurses. American Journal of Critical Care. 2014 jul 1;23(4):316-24. https://doi.org/10.4037/ajcc2014980.
Athanasiou A, Papathanassoglou EDE, Patiraki E, McCarthy MS, Giannakopoulou M. Family Visitation in Greek Intensive Care Units: Nurses’ Perspective. American Journal of Critical Care [Internet]. 2014 jul 1;23(4):326-33. https://doi.org/10.4037/ajcc2014986.
Fumagalli S, Boncinelli L, Lo Nostro A, Valoti P, Baldereschi G, Di Bari M, et al. Reduced Cardiocirculatory Complications With Unrestrictive Visiting Policy in an Intensive Care Unit. Circulation. 2006 fev 21;113(7):946-52. https://doi.org/10.1161/CIRCULATIONAHA.105.572537.
Adam EK. Emotion-cortisol transactions occur over multiple time scales in development: implications for research on emotion and the development of emotional disorders. Monographs of the Society for Research in Child Development. 2012 mai 17;77(2):17-27. https://doi.org/10.1111/j.1540-5834.2012.00657.x.
Fantidis P, Eladio S, Ibrahim T, Tomas P, Antonio CJ, Ramón GJ. Is there a Role for Cortisol in the Accumulation of Lipids in the Intima a Crucial Step of Atherogenesis? Current Vascular Pharmacology [Internet]. 2015;13(5):587-93. https://doi.org/10.2174/1570161112666141127163307.
Suarez MG, Stack M, Hinojosa-Amaya JM, Mitchell MD, Varlamov EV, Yedinak CG, et al. Hypercoagulability in Cushing Syndrome, Prevalence of Thrombotic Events: A Large, Single-Center, Retrospective Study. Journal of the Endocrine Society. 2019 dez 15;4(2). https://doi.org/10.1210/jendso/bvz033.
Matt B, Schwarzkopf D, Reinhart K, König C, Hartog CS. Relatives’ perception of stressors and psychological outcomes - Results from a survey study. Journal of Critical Care. 2017 jun;39:172-7. https://doi.org/10.1016/j.jcrc.2017.02.036.
Fumis RRL, Ferraz AB, de Castro I, Barros de Oliveira HS, Moock M, Junior JMV. Mental health and quality of life outcomes in family members of patients with chronic critical illness admitted to the intensive care units of two Brazilian hospitals serving the extremes of the socioeconomic spectrum. PloS One [Internet]. 2019;14(9):e0221218. https://doi.org/10.1371/journal.pone.0221218.
Navratilova E, Morimura K, Xie JY, Atcherley CW, Ossipov MH, Porreca F. Positive emotions and brain reward circuits in chronic pain. Journal of Comparative Neurology. 2016 fev 3;524(8):1646-52. https://doi.org/10.1002/cne.23968.
Oishi Y, Lazarus M. The control of sleep and wakefulness by mesolimbic dopamine systems. Neuroscience Research. 2017 mai;118:66-73. https://doi.org/10.1016/j.neures.2017.04.008.
Voigt J-P, Fink H. Serotonin controlling feeding and satiety. Behavioural brain research [Internet]. 2015;277:14-31. https://doi.org/10.1016/j.bbr.2014.08.065.
Al Mutair A, Plummer V, Paul O’Brien A, Clerehan R. Attitudes of healthcare providers towards family involvement and presence in adult critical care units in Saudi Arabia: a quantitative study. Journal of Clinical Nursing. 2013 dez 20;23(5-6):744-55. https://doi.org/10.1111/jocn.12520.
Kozub E, Scheler S, Necoechea G, OʼByrne N. Improving Nurse Satisfaction with Open Visitation in an Adult Intensive Care Unit. Critical Care Nursing Quarterly. 2017;40(2):144-54. https://doi.org/10.1097/CNQ.0000000000000151.
DOI: http://dx.doi.org/10.23973/ras.88.331
Apontamentos
- Não há apontamentos.
_______________________________________________
Revista de Administração em Saúde
ISSN 2526-3528 (online)
Associação Brasileira de Medicina Preventiva e Administração em Saúde
Avenida Brigadeiro Luis Antonio, 278 - 7o andar
CEP 01318-901 - São Paulo-SP
Telefone: (11) 3188-4213 - E-mail: ras@apm.org.br