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Percepção de profissionais de saúde sobre o processo de tomada de decisão na assistência a pacientes pediátricos / Health professionals' perceptions about the decision-making process in the care of pediatric patients
Trotta, Eliana de Andrade; Scarpa, Fernanda Cristina; Halal, Michel George El; Goldim, José Roberto; Carvalho, Paulo Roberto Antonacci.
Affiliation
  • Trotta, Eliana de Andrade; Universidade Federal do Rio Grande do Sul. Faculdade de Medicina. Porto Alegre. BR
  • Scarpa, Fernanda Cristina; Universidade Federal do Rio Grande do Sul. Faculdade de Medicina. Porto Alegre. BR
  • Halal, Michel George El; Universidade Federal do Rio Grande do Sul. Faculdade de Medicina. Porto Alegre. BR
  • Goldim, José Roberto; Universidade Federal do Rio Grande do Sul. Faculdade de Medicina. Porto Alegre. BR
  • Carvalho, Paulo Roberto Antonacci; Universidade Federal do Rio Grande do Sul. Faculdade de Medicina. Porto Alegre. BR
Rev. bras. ter. intensiva ; 28(3): 335-340, jul.-set. 2016. tab
Article in Pt | LILACS | ID: lil-796149
Responsible library: BR1.1
RESUMO
RESUMO

Objetivo:

Avaliar as percepções de médicos, enfermeiros e técnicos de enfermagem sobre sua participação no processo de tomada de decisão de limitação de suporte de vida, em pacientes pediátricos terminais, comparando por categoria profissional.

Métodos:

Estudo transversal realizado em unidade de terapia intensiva pediátrica de hospital público universitário, terciário, com a participação de médicos, enfermeiros e técnicos de enfermagem. Foi usada a Escala de Voz da MacArthur Admission Experience Survey para avaliar e quantificar a percepção dos profissionais que assistiram 17 pacientes pediátricos em limitação de suporte de vida, nas primeiras 24 horas após o desfecho de cada paciente. Todos os profissionais que atuavam na unidade (n=117), potencialmente elegíveis para a pesquisa, receberam o Termo de Consentimento Livre e Esclarecido previamente à ocorrência dos casos.

Resultados:

Participaram 25/40 (62,5%) médicos, 10/17 (58,8%) enfermeiros e 41/60 (68,3%) técnicos de enfermagem, representando 65% dos profissionais elegíveis. A taxa de devolução dos questionários pelos médicos foi maior que a dos técnicos (p = 0,0258). Houve registro de percepção de falta de voz nas três categorias profissionais, em taxas variáveis, porém menos percebida pelos médicos do que pelos enfermeiros e técnicos (p < 0,00001); entre estes últimos, não houve diferença (p = 0,7016). Nas três categorias profissionais, foram assinalados os três itens que compõem a subescala. Em duas das três afirmativas, houve diferença significativa entre médicos e enfermeiros (p = 0,004), e entre médicos e técnicos (p = 0,001). Em uma das afirmativas, não houve diferença entre as três categorias profissionais.

Conclusão:

Houve percepção de falta de voz no processo de tomada de decisão, em taxas variáveis, nas três categorias de profissionais que assistiram pacientes pediátricos terminais em limitação de suporte de vida, sendo os médicos os que expressaram menor percepção de coerção.
ABSTRACT
ABSTRACT

Objective:

To evaluate the perceptions of physicians, nurses and nursing technicians of their participation in the decision-making process surrounding life support limitation in terminally ill pediatric patients, with comparisons by professional category.

Methods:

A cross-sectional study was conducted in the pediatric intensive care unit of a tertiary public university hospital with the participation of physicians, nurses and nursing technicians. The MacArthur Admission Experience Survey Voice Scale was used to assess and quantify the perceptions of professionals who assisted 17 pediatric patients with life support limitation within 24 hours after the outcome of each patient was determined. All professionals working in the unit (n = 117) who were potentially eligible for the study received a free and informed consent form prior to the occurrence of the cases studied.

Results:

Study participants included 25/40 (62.5%) physicians, 10/17 (58.8%) nurses and 41/60 (68.3%) nursing technicians, representing 65% of the eligible professionals identified. The questionnaire return rate was higher for physicians than technicians (p = 0.0258). A perceived lack of voice was reported in all three professional categories at varying rates that were lower for physicians than for nurses and nursing technicians (p < 0.00001); there was no difference between the latter (p = 0.7016). In the three professional categories studied, three subscale items were reported. For two of the three statements, there were significant differences between physicians and nurses (p = 0.004) and between physicians and nursing technicians (p = 0.001). For one of the statements, there was no difference among the three professional categories.

Conclusion:

Respondents perceived a lack of voice in the decision-making process at varying rates across the three categories of studied professionals who assisted terminally ill pediatric patients with life support limitation, with physicians expressing lowered rates of perceived coercion.
Subject(s)
Key words

Full text: 1 Collection: 01-internacional Database: LILACS Main subject: Decision Making / Medical Staff, Hospital / Nursing Assistants / Nursing Staff, Hospital Type of study: Observational_studies / Prevalence_studies / Prognostic_studies / Qualitative_research / Risk_factors_studies Aspects: Ethics Limits: Child / Child, preschool / Female / Humans / Infant / Male Language: Pt Journal: Rev. bras. ter. intensiva Journal subject: TERAPIA INTENSIVA Year: 2016 Document type: Article Affiliation country: Brazil Country of publication: Brazil

Full text: 1 Collection: 01-internacional Database: LILACS Main subject: Decision Making / Medical Staff, Hospital / Nursing Assistants / Nursing Staff, Hospital Type of study: Observational_studies / Prevalence_studies / Prognostic_studies / Qualitative_research / Risk_factors_studies Aspects: Ethics Limits: Child / Child, preschool / Female / Humans / Infant / Male Language: Pt Journal: Rev. bras. ter. intensiva Journal subject: TERAPIA INTENSIVA Year: 2016 Document type: Article Affiliation country: Brazil Country of publication: Brazil