Entre protocolos e sujeitos: qualidade do cuidado hospitalar em um serviço de hematologia

Abstract

The article presents partial results of a study at Hospital Edgar Santos, Universidade Federal da Bahia (HUPES), Brazil, analyzing the service's experience with improvement in quality of care within a context of hospital accreditation. The article focuses on the hematology service and specifically its quality of care and intersubjective processes. The study adopted a qualitative approach, using interviews and observation. From the theoretical point of view, the work of Campos, Cecílio, and Merhy acknowledge healthcare's complex nature and micropolitical and intersubjective dimension and the capacity of health professionals to produce meanings and practice creativity. To understand the health professionals' processes of psychosocial linkage and subjective mobilization, we drew on concepts from the French school of psychosociology (Enriquez) and Dejours' psychodynamics of work. The analysis was organized along three lines: psychosocial linkage and the imaginary of self-management; bonding and affect: singularity of the subject's care and clinical case; real work and the healthcare team. One of the main conclusions is the building of a self-management imaginary, expressed in shared projects, expectations, and some forms of interpreting and operating reality, based on affectively invested representations of autonomy and unity. Alongside technical elements such as protocols, the article highlights professional judgment, proper to the intersubjective dimension, fostering the singularity of care. In our view, the real work in the patient care scene is traversed by adjustments that demonstrate team cooperation.

Transfer of Pre-Hospital Care and Its Potential Risks for Patient Safety

“…The use of clinical-care protocols contributes to improving the quality of patient care. 25 A systematic literature review, performed in emergency services, addresses that, to improve patient safety, care practices must be based on evidence and use a multidisciplinary approach in order to guarantee standardized care. 26 Thus, it is evident that the lack of standardization of protocols for continuity of care represents an important risk to patient safety, leading to errors and weakening the crucial communication in the transfer of care.…”

Atuação Da Gestão Institucional Na Prevenção Das Infecções Primárias Da Corrente Sanguínea

“…Entende-se que os profissionais envolvidos no cuidado estão suscetíveis aos erros por problemas no planejamento organizacional e falhas nos processos técnicos. Por isso, faz-se necessária a realização de uma prática baseada na utilização de protocolos e diretrizes clínicas (3,17,18) . Assim, além do envolvimento da equipe e da construção dos protocolos, é de fundamental importância para a aproximação e a participação dos profissionais no desempenho das atividades de planejamento e construção desses protocolos que serão por eles executados.…”

Procesos de atención y cuidado desde la perspectiva de los trabajadores una meta-etnografía en hospitales de Latinoamérica

“…En este apartado, indagamos en aquellos estudios realizados en hospitales de América Latina, los cuales son presentados por un lado, los que se centran en las perspectivas de los usuarios de los servicios de atención y por otro lado, los que refieren al punto de vista de los TraSa. 24 Moglia B. Procesos de atención y cuidado desde la perspectiva de los trabajadores: una metaetnografía en hospitales de Latinoamérica. [Tesis de maestría].…”

“…Con enfermería, observamos que tenemos relaciones muy duras. Aquí y en varios hospitales, la enfermera está tomando un papel muy imperativo y muy agresivo con el médico 24 (Azevedo et al, , p. 1997). 21 Traducción libre de la autora: Quando o paciente (...) está bem, o profissional de enfermagem conversa.…”