Narratives of Health Professionals Relating to Scarce Resources in an Urgency Service

Abstract

This study aimed to analyze the narratives of health professionals working in a Emergency Care Unit that deal with decision making in situations of scarce resources. An exploratory research, of a qualitative nature, was carried out through a narrative interview technique with 25 professionals. Three categories emerged from the study: Decision making in the face of scarce resources; Ethical conflicts; Academic p reparation for confrontation and the sentimental framework. Prioritization of patients is a reality in this health service. The prevalent problems are the scarcity of materials and medicines and the lack of human resources. The discourse preached the lack of ethical preparation of the academy for decision making. Most of the interviewees believe that they had little preparation to face the reality of the service. Some interviewees showed feelings of regret, impotence, insecurity, desire to abandon service, anguish and personal conflicts in the face of the wear and tear caused by the situation. It is necessary to invest in constant dialogues, health education and awareness-raising strategies in order to contribute to consensual actions that best subsidize dec ision-making in situations of scarce resources and that favor equitable health care in order to maximize benefits and reorient processes job.

Allocation of resources for health care in COVID-19 pandemic times: integrative review

“…Studies indicate that decision making for resource allocation is somewhat conflicting and health professionals do not always feel prepared to do it (1,6) . Pandemic events require serenity, teamwork and technical-scientific preparation of professionals in order to optimize the use of existing resources, which are generally scarce (11) .…”

“…The need to allocate inputs, equipment, beds, drugs and human resources in pandemic situations can generate ethical and moral conflicts for decision makers, resulting in physical and/or mental illness (1) . Decision-making can be understood as a process permeated by ethical deliberations involving individualized selection of people.…”

“…The fragility to make decisions about the best equipment allocation ratifies the unpreparedness of professionals when allocating resources, since this decision should not be anchored in pandemic control measures, but in pre-established criteria, which would allow the allocation of the best available resource to meet a given population reality (11)(12) . As guidelines for the definition of these criteria (1,7,12) , previous analyses suggest the use of bioethics principles, which are: beneficence; non-maleficence; autonomy; and justice (14) .…”

“…The allocation of resources in the health field is an issue in evidence that deserves the expansion of discussions and the constant training of professionals for assertive decision making, with maximum certainty about the adequacy of investments. Thus, reasoned criteria need to be used for the best possible distribution of resources, taking into account the specificities of each country and therefore the regional, demographic and epidemiological differences of its population (1) . In this sense, the appropriate allocation of resources is desirable, especially in situations of pandemics, such as that of COVID-19 in 2020.…”

“…In Brazil, there is an almost permanent shortage of resources in the health area, which makes it essential to make assertive decisions in order to increase the necessary actions. In pandemic situations, the phenomenon worsens, which can be an element that increases the risk of a collapse of the health system (1)(2)(6)(7) .…”