Processo de trabalho de enfermagem na interiorização dos cuidados intensivos no período transpandêmico

Abstract

This research aimed to study the nursing work process in a General ICU recently implemented in a rural city during the trans-pandemic period. It aimed to promote improvements and innovations in the nursing work process in a General ICU recently implemented in a rural city during the trans-pandemic period. This is a qualitative study, based on the methodological framework of Convergent-Care Research. The study was developed in a General ICU of a medium-sized philanthropic hospital, located in the interior region of the state of Rio Grande do Sul, Brazil. Everyone who met the following inclusion criteria was invited to participate in the study: being a mid-level or higher-level nursing worker and working in the institution's General ICU. In total, 20 workers participated in this study. Data production was made possible through three techniques: structured participant observation, semi-structured interview and Convergence group. The data production period took place from May to September 2023. For data analysis, the examination of the results obtained through of techniques (observation, interviews and data from the convergence group) were subjected to analysis according to four processes: apprehension, synthesis, theorization and transfer. The theoretical-philosophical framework that guided this stage was based on Marxist and Gramscian conceptions of the work process. The research was approved by the local Research Ethics Committee. The study made it possible to raise historical and political questions about the process of implementing intensive care beds in an inland municipality in the state of Rio Grande do Sul, as a deployment of a COVID-19 ICU under a context of great expectation on the part of the local population. This event marked and transformed the nursing work process in this institution. The experience in the COVID-19 ICU and the transition process to the General ICU was marked by feelings of fear and lack of knowledge about clinical cases, unpreparedness of teams to work in complex units, in addition to still insufficient physical and structural aspects. The following were highlighted as weaknesses in the nursing work process: lack of management references for night shift workers; inadequacy of physical space; difficulties related to the Hospital Admissions Management system (Gerint); unavailability of semi-intensive beds; communication noise and interpersonal problems in the team; turnover in the sector; need for institutional actions for permanent and continuing education; need to promote mental health and humanization actions at work; and political and economic issues. The following stand out as potentialities: telehealth (qualifying the clinical round); management of friction and relationships in the nursing team; cooperative relationships within the nursing team and with the multidisciplinary team; professional satisfaction; professional growth and development; and standardization of procedures. The Convergence group was the trigger for the care practice of this study, providing a space for deeper analytical analysis for the participants regarding their work process and providing the construction of an improvement plan that, if put into practice, will favor process innovation of nursing work in the sector.