Iatrogenesis in Intensive Care Units: dramatization of Contemporary Bio/Ethical Problems

Abstract

This qualitative investigation, based in Foucauldian analysis with approximations to the post-structuralism theoretical framework, explores iatrogenesis as one of the tensions in the nursing to do/to know which can be discursively articulated to bioethics and to technobiomedicine. The documentary sources and intensive interviews with nurses, permitted the activation of a reflection on the act of the nurse in a context permeated by the ever-present possibility of failure in both the procedure and in the conduct and, from this possibility, they should meet their obligation to correct this failure not so much or not only in knowledge, not so much or not only in law but in practice itself. Iatrogenias nas unidades de terapia intensiva: dramaticidade dos problemas bio/éticos contemporâneosEsta é uma investigação qualitativa, balizada na analítica foucaultiana com aproximações ao referencial teórico pós-estruturalista, explora as iatrogenias como uma das tensões no fazer/saber enfermagem que podem ser discursivamente articuladas à bioética e à tecnobiomedicina. As fontes documentais e de entrevistas com enfermeiros(as) intensivistas permitiram ativar reflexão sobre o agir do(a) enfermeiro(a) em contexto permeado pela possibilidade, sempre latente, de falhar tanto no procedimento como na conduta, e, a partir dessa possibilidade, ele(a) encontra sua obrigação de corrigir essa falha não tanto ou não apenas no conhecimento, não tanto ou não apenas na lei, mas na prática de si mesmo.Descritores: Unidades de Terapia Intensiva; Enfermagem; Bioética; Ética; Doença Iatrogênica. Las iatrogenias en las unidades de terapia intensiva: lo dramático de los problemas bioéticos contemporáneosSe trata de una investigación cualitativa, fundamentada en la perspectiva foucaultiana con aproximaciones en el referencial teórico post-estructuralista, explora las iatrogenias como una de las tensiones en el hacer/saber enfermería que pueden ser discursivamente articuladas a la bioética y a la tecnobiomedicina. Las fuentes documentales y de entrevistas con enfermeros intensivistas permitieron activar una reflexión sobre el actuar del enfermero en un contexto impregnado por la posibilidad siempre latente de fallar tanto en el procedimiento, como en la conducta y, a partir de esta posibilidad, estos profesionales encuentra que es su obligación corregir esta falla no tanto o no apenas en el conocimiento, no tanto o no apenas en la ley, pero más bien en la práctica de sí mismo.

Evaluating the intervening factors in patient safety: focusing on hospital nursing staff

“…Thus, all of the nurses' efforts for confronting these occurrences are insufficient if a process of partnership between the institution and these professionals is absent, in the sense of there being an ethical commitment and the creation of institutional goals with the aim of prizing the patient's safety and integrity (19) .…”

Nursing ethical processes in the State of Santa Catarina: characterization of factual elements

“…Iatrogenic events can be considered ethical incidents, adverse events, negative critical incidents and errors, due to risks caused by procedures and bad information interpretation, related to imprudence or incompetence; omission or negligence, in case of bad assessment of the potential risk an action entails (14) .…”

“…As opposed to denying the benefits of care, the study of iatrogenic incidents has contributed to work towards the continuous improvement of nursing service quality, in an inseparable pair: the safety of who delivers care and who receives care (15) . The terms technical failure, related to technical or procedure errors, and conduct failure, characterized by errors in one's attitude, behavior, interpersonal or interprofessional approach, can be expressed in the discussion of iatrogenic events and in establishing the concepts of ethical-legal infractions that cause patient harm (16) . Therefore, permanent education is a fundamental instrument for personal qualification and development, through technical training and the acquisition of new knowledge and concepts, which should be translated into attitudes, closely related with the education and work process (17) .…”

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“…It is noteworthy that [6] amidst the adversities presented when granting a patient care [15,19] scientific vestments in the hospital [9] especially in intensive care centers [7] useful for the prevention of unfavorable fall-related indicators [9]. Another positive point that we can highlight [4] is the use of protocol in surgical procedures where 114 (69.9%) (Table 2) of the respondents answered [22] that they use as a way to guarantee a safe surgery [7]. Its use is promising and guarantees [12] the patient's follow-up during their hospitalization for surgery [9].…”

“…It is worth mentioning that dietary administration [3] can be performed in the intensive care of the following enteral routes [22]: Nasoentérica [11], oroentérica [12], jejunostomy [13], gastronomy [7] or venous [11] called parenteral route [15] the importance of care is reinforced and it becomes [8] important for caregivers to have the necessary knowledge [12] to administer the diet and to be able to observe the patient's capacity [9] regarding their clinical aspect and their limitations [12]. res adopted [12] will be effective for the prevention [4] of new drug incidents [9].…”