Percepção de profissionais de saúde relativamente ao trabalho em equipa, em Unidades de Internamento da Rede Nacional de Cuidados Continuados Integrados
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2014
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Introdução: O trabalho em equipa é em si mesmo um estilo de organização de trabalho, fundamental para a efectividade dos cuidados continuados integrados. Apesar de a evidência apontar para uma associação entre esta forma de organização entre profissionais e a melhoria de qualidade dos cuidados de saúde, não é fácil criar e manter uma cultura de trabalho em equipa em unidades de cuidados de saúde, principalmente devido a hábitos tradicionais de trabalho individualizado. A Rede Nacional de Cuidados Continuados Integrados pretende dar maior e melhor resposta aos utentes ao nível da saúde, criando unidades de convalescença, de média e longa duração, e de cuidados paliativos, que permitem aos utentes não permanecerem internados em hospital de agudos quando os cuidados que necessitam não são de natureza intensiva, e evitam que vão para a comunidade ainda em fase de potencial recuperação.
Objectivos: Este estudo teve como objectivo principal caracterizar as percepções, por parte dos profissionais de saúde das unidades de internamento, no que se refere à forma de organização do trabalho das equipas de saúde.
Métodos: O estudo seguiu um desenho observacional transversal, sendo a recolha de dados realizada através da auto-administração de um questionário online a profissionais de saúde que trabalham em unidades de cuidados continuados integrados. A escolha das unidades de saúde foi feita por conveniência e mediante autorização das respectivas direcções.
Resultados: A amostra é constituída por 27 profissionais de saúde que se encontram distribuídos por unidades de internamento da RNCCI da seguinte forma: 15 (55,6%) pertencem a uma Unidade de Convalescença, 4 (14,8%) a uma Unidade de Média Duração e Manutenção, 7 (25,9%) a uma Unidade de Longa Duração e Manutenção e 1 (3,7%) a uma Unidade de Cuidados Paliativos. Relativamente à sua distribuição por profissão temos 17 (62,9%) enfermeiros, 3 (11,1%) fisioterapeutas, 1 (3,7%) psicólogo, 2 (7,4%) assistentes sociais, 2 (7,4%) terapeutas ocupacionais e 2 (7,4%) participante que se desconhece a sua categoria profissional. Os participantes trabalham em equipas jovens. Todos os participantes referem a existência de reuniões de equipa, com periodicidade tendencialmente semanal. É evidente a importância atribuída às reuniões de equipa (média de respostas de 9,15 numa escala de 0 a 10). De acordo com as percepções dos participantes, as diferentes categorias profissionais têm hábitos distintos de reunião: na perspectiva dos profissionais, a maior parte das categorias profissionais tende a reunir de forma semanal, sendo os enfermeiros o grupo profissional que é encarado como tendo hábitos de reunião mais frequentes. As reuniões de equipa são principalmente utilizadas para o planeamento de intervenções clínicas futuras. Para além das reuniões onde os objectivos são definidos, os profissionais não realizam encontros (51,9% de respostas entre “nunca” e “raramente”) para reflectir e analisar o desempenho individual, estabelecer empatia e flexibilidade, e criar o ambiente seguro, necessário ao desempenho eficaz da equipa. Os profissionais sentem ter espaço para expressarem as suas ideias (ao resto da equipa), mas sentem que nem sempre as suas opiniões são tidas em conta (37% de respostas em “raramente” e “por vezes”). Existe a noção, quase unânime, de que em equipa se atingem resultados que não seriam capazes de obter de forma isolada. Todos os profissionais de saúde consideram o trabalho em equipa fundamental para uma prestação de cuidados holísticos aos doentes e suas famílias, e a maioria considera o feedback entre os diferentes elementos da equipa como um factor para o bom funcionamento dos serviços. Relativamente à liderança dentro das UI, os profissionais sentem que o seu líder raramente defende os valores da equipa ou que tenha capacidade para motivar os restantes elementos da equipa para a prestação de cuidados
Conclusão: As unidades de cuidados continuados, no contexto da RNCCI, são relativamente novas. Esta nova realidade organizacional explica em parte o facto de as equipas estejam ainda em fase de desenvolvimento e de maturação. Neste contexto, importa manter aspectos que, de acordo com o presente estudo, são promotores de trabalho de equipa interdisciplinar, como sejam a percepção da importância de reuniões e de comunicação contínua entre os elementos da equipa. Por outro lado, importa corrigir aspectos que podem corroer a evolução do trabalho em equipa. Nomeadamente, os aspectos de liderança, que devem promover, incentivar e utilizar as ideias e contributos relevantes dos vários elementos da equipa. Importa continuar a investigar a qualidade do trabalho em equipa nas unidades de CCI, nomeadamente através de construção e validação de instrumentos que permitam caracterizar de forma adequada as equipas de saúde e, dessa forma, compreender quais as modalidades de trabalho em equipa que mais qualidades em saúde proporcionam.
Introduction: Teamwork is a style of work organization, critical to the effectiveness of integrated continuous care. Despite the evidence pointing to an association between this form of organization among professionals and improving quality of health care, it is not easy to create and maintain a culture of teamwork in healthcare units, mainly due to the traditional individualized work habits. The National Network for Integrated Continuous Care seeks to provide greater and better answer to the users in terms of health, creating units of convalescence, medium and long term, and palliative care, which does not allow users to remain hospitalized in acute hospital care when requiring non-intensive care, and avoid going to the community still in recovery potential. Objectives: This study's main objective was to characterize the perceptions on the part of health professionals from inpatient units, with regard to the form of organization on work of health teams. Methods: The study followed a cross-sectional observational design, and data collection performed by self-administering an online questionnaire to health professionals working in units of integrated continuous care. The choice of the sample was selected by convenience and after the permission of the respective directions. Results: The sample consisted of 27 health professionals who are housed in inpatient units RNCCI as follows: 15 (55,6%) belong to a unit Convalescence, 4 (14,8%) to a unit average Duration and Maintenance, 7 (25,9%) to a Unit and Long Term Maintenance and 1 (3,7%) to a Palliative Care Unit. Regarding its distribution by occupation have 17 (62,9%) nurses, 3 (11,1%) physiotherapists, 1 (3,7%) psychologist, 2 (7,4%) social workers, 2 (7,4%) occupational therapists, and 2 (7,4%) participants who were unaware of their profession. Participants work in youth teams. All participants report the existence of team meetings, tended to be weekly. Clearly the importance attributed to team meetings (average responses of 915 on a scale of 0 to 10). According to the perceptions of the participants, the different professional categories have different habits of meeting : the perspective of professionals , most professional groups tend to meet weekly, but with nurses professional group is seen as having habits of meeting more frequently. Team meetings are mainly used for the planning of future clinical interventions. The meetings are where the goals are defined, the professionals do not realize encounters (51,9% of responses from "never " and " rarely") to reflect and analyze individual performance, establish empathy and flexibility, and create the safe environment necessary for the effective performance of the team. Professionals feel they have room to express their ideas (to the rest of the team), but do not always feel that their opinions are taken into account (37% of responses "rarely" and "sometimes"). There is the notion, almost unanimously, that the team reach results that are not able to obtain in isolation. All health professionals consider the work fundamental to the provision of holistic patient care team and their families, and most consider the feedback between the different members of the team as a factor for the smooth running of the service. Regarding leadership within the UI, professionals feel that their leader rarely defends the values of the team or has the capacity to motivate other team members to provide care Conclusion: The continuing care units, in the context of RNCCI, are relatively new. This new organizational reality partly explains the fact that the teams are still in development and maturation. In this context it is important to keep aspects that, according to this study, developers are working in an interdisciplinary team such as the perception of the importance of meetings and continuous communication between the team members. Particular aspects of leadership, which should promote, encourage and utilize the ideas and relevant contributions of the various team members. Should continue to investigate the quality of teamwork in units of CCI, notably through development and validation of tools to adequately characterize the health teams and thus understand the modalities of teamwork that most quality healthcare provide.
Introduction: Teamwork is a style of work organization, critical to the effectiveness of integrated continuous care. Despite the evidence pointing to an association between this form of organization among professionals and improving quality of health care, it is not easy to create and maintain a culture of teamwork in healthcare units, mainly due to the traditional individualized work habits. The National Network for Integrated Continuous Care seeks to provide greater and better answer to the users in terms of health, creating units of convalescence, medium and long term, and palliative care, which does not allow users to remain hospitalized in acute hospital care when requiring non-intensive care, and avoid going to the community still in recovery potential. Objectives: This study's main objective was to characterize the perceptions on the part of health professionals from inpatient units, with regard to the form of organization on work of health teams. Methods: The study followed a cross-sectional observational design, and data collection performed by self-administering an online questionnaire to health professionals working in units of integrated continuous care. The choice of the sample was selected by convenience and after the permission of the respective directions. Results: The sample consisted of 27 health professionals who are housed in inpatient units RNCCI as follows: 15 (55,6%) belong to a unit Convalescence, 4 (14,8%) to a unit average Duration and Maintenance, 7 (25,9%) to a Unit and Long Term Maintenance and 1 (3,7%) to a Palliative Care Unit. Regarding its distribution by occupation have 17 (62,9%) nurses, 3 (11,1%) physiotherapists, 1 (3,7%) psychologist, 2 (7,4%) social workers, 2 (7,4%) occupational therapists, and 2 (7,4%) participants who were unaware of their profession. Participants work in youth teams. All participants report the existence of team meetings, tended to be weekly. Clearly the importance attributed to team meetings (average responses of 915 on a scale of 0 to 10). According to the perceptions of the participants, the different professional categories have different habits of meeting : the perspective of professionals , most professional groups tend to meet weekly, but with nurses professional group is seen as having habits of meeting more frequently. Team meetings are mainly used for the planning of future clinical interventions. The meetings are where the goals are defined, the professionals do not realize encounters (51,9% of responses from "never " and " rarely") to reflect and analyze individual performance, establish empathy and flexibility, and create the safe environment necessary for the effective performance of the team. Professionals feel they have room to express their ideas (to the rest of the team), but do not always feel that their opinions are taken into account (37% of responses "rarely" and "sometimes"). There is the notion, almost unanimously, that the team reach results that are not able to obtain in isolation. All health professionals consider the work fundamental to the provision of holistic patient care team and their families, and most consider the feedback between the different members of the team as a factor for the smooth running of the service. Regarding leadership within the UI, professionals feel that their leader rarely defends the values of the team or has the capacity to motivate other team members to provide care Conclusion: The continuing care units, in the context of RNCCI, are relatively new. This new organizational reality partly explains the fact that the teams are still in development and maturation. In this context it is important to keep aspects that, according to this study, developers are working in an interdisciplinary team such as the perception of the importance of meetings and continuous communication between the team members. Particular aspects of leadership, which should promote, encourage and utilize the ideas and relevant contributions of the various team members. Should continue to investigate the quality of teamwork in units of CCI, notably through development and validation of tools to adequately characterize the health teams and thus understand the modalities of teamwork that most quality healthcare provide.
Descrição
Orientação: Maria do Céu Costa ; co-orientação: Osvaldo Santos
Palavras-chave
CUIDADOS CONTINUADOS, REDE NACIONAL DE CUIDADOS CONTINUADOS INTEGRADOS, PROFISSIONAIS DE SAÚDE, TRABALHO DE EQUIPA, CONTINUING CARE, NATIONAL NETWORK FOR INTEGRATED CONTINUOUS CARE, HEALTH CARE PROFESSIONALS, TEAM WORK, MESTRADO EM CUIDADOS CONTINUADOS INTEGRADOS