Avaliação do sofrimento nos Enfermeiros em Cuidados de Saúde Primários
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2019-03-27
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Os enfermeiros são profissionais de saúde que, pela inerência das suas funções, lidam diariamente com o sofrimento e até perda de vida daqueles que cuidam. O cuidar, em enfermagem, pressupõe uma relação empática que se torna essencial ao longo de todo o processo, pois o enfermeiro, ao colocar-se no lugar do outro, poderá percecionar e compreender mais facilmente as necessidades e o sofrimento das pessoas ao seu cuidado. Os enfermeiros são os elementos da equipa multidisciplinar que permanecem mais tempo em contacto com o doente e a família e acompanham integralmente as situações de dor e sofrimento. Esta exposição intensa e contínua pode desencadear níveis elevados de sofrimento e angústia nestes profissionais, visto que existe uma relação inseparável entre o sofrimento do doente e o sofrimento do profissional, sendo que, nesta relação interpessoal, cada parte é vulnerável à outra. As consequências que esta exposição ao sofrimento do doente/família tem nos enfermeiros ainda são pouco conhecidas. Neste sentido, este estudo tem como objetivo geral avaliar o sofrimento nos enfermeiros em Cuidados de Saúde Primários (CSP) num Agrupamento de Centros de Saúde do interior Norte de Portugal. Para a sua concretização, delineamos os seguintes os objetivos específicos: i) adaptar e validar a Caregiver Grief Scale (CGS), para os enfermeiros portugueses em CSP, previamente validada para a população portuguesa em cuidadores formais e informais por Vasconcelos-Raposo, Teixeira, Ribeiro, Silva e Santos (2017); ii) caracterizar, em termos sociodemográficos e profissionais, a amostra em estudo; iii) conhecer o sofrimento dos enfermeiros em CSP nas diferentes dimensões (Dor Emocional, Perda Relacional e Evitamento) em função das variáveis referidas. Face aos objetivos definidos, delineamos uma metodologia de natureza quantitativa. Inicialmente, procedemos à validação da CGS para os enfermeiros portugueses em CSP e seguidamente procedemos à avaliação do sofrimento com recurso à escala previamente validada para a amostra em estudo. Na recolha de dados foi aplicado um questionário de autopreeenchimento aos referidos profissionais (n=100) e para a avaliação do sofrimento foi aplicada a CGS. A recolha de dados decorreu entre 19 de fevereiro e 05 de março de 2018. O tratamento dos mesmos foi efetuado através do Statistical Package for the Social Sciences (SPSS), versão 24, e do Analysis of Moments Structures (AMOS), versão 25, com recurso a estatística descritiva e inferencial. Como principais conclusões salientam-se: a validação da CGS para os enfermeiros portugueses em CSP com um modelo multifatorial de três fatores (Dor Emocional, Perda Relacional e Evitamento), revelando boa fiabilidade compósita(0.923) e validade discriminante, sendo os valores encontrados suficientemente robustos para a realização de estudos nomotéticos nos enfermeiros em CSP. De um modo geral, o sofrimento é maior nos profissionais do sexo feminino, sobretudo nos que têm filhos, com companheiro, sem especialização em enfermagem e com mais tempo de serviço. No sexo masculino, as médias mais elevadas verificam-se nos enfermeiros sem filhos, sem companheiro, com especialização em enfermagem e que têm mais tempo de serviço. O sofrimento nos enfermeiros advém da prestação de cuidados ao doente/família em sofrimento e de fatores oriundos das organizações de saúde e condições de trabalho. Verifica-se, também, médias mais elevadas de sofrimento nos enfermeiros que: frequentemente, prestam cuidados a pessoas em fase terminal/cuidados paliativos; lidam com a morte dos seus doentes; transmitem a informação da morte à família/cuidador; nunca lidam com situações de urgência/emergência; nunca prestam cuidados a pessoas em sofrimento; trabalham nas Unidade de Cuidados de Saúde Personalizados, com carga horária de 35 horas semanais e desempenham o papel de cuidadores informais no seio familiar. A excessiva carga de trabalho e a prática de horários rígidos são também fontes de sofrimento nos enfermeiros em CSP.
Nurses are health professionals who, through their inherent functions, deal daily with the suffering and even loss of life of those who care. Nursing care presupposes an empathic relationship that becomes essential throughout the whole process, because the nurse, putting himself in the place of the other, can more easily perceive and understand the needs and the suffering of the people in his care. Nurses are the elements of the multidisciplinary team that stay in contact with the patient and the family for the longest time and fully accompany the situations of pain and suffering. This intense and continuous exposure can trigger high levels of suffering and distress in these professionals, since there is an inseparable relationship between the suffering of the patient and the suffering of the professional, and in this interpersonal relationship, each part is vulnerable to the other. The consequences that this exposure to patient / family suffering has on nurses are still poorly understood. In this sense, this study has as general objective to evaluate the suffering in nurses in Primary Health Care (CSP) in a Grouping of Health Centers in the interior of Northern Portugal. In order to achieve this, we outlined the following specific objectives: i) to adapt and validate the Caregiver Grief Scale (CGS) for Portuguese nurses in CSP, previously validated for the Portuguese population in formal and informal caregivers by Vasconcelos-Raposo, Teixeira, Ribeiro, Silva e Santos (2017); ii) characterize the study sample in sociodemographic and professional terms; iii) to know the suffering of CSP nurses in the different dimensions (Emotional Pain, Relational Loss and Avoidance) as a function of the mentioned variables. In view of the defined objectives, we outline a methodology of quantitative nature. Initially we proceeded to validate the CGS for Portuguese nurses in CSP and then proceeded to the evaluation of the suffering using the previously validated scale for the study sample. In the collection of data, a questionnaire was applied to self-sufficiency to these professionals (n=100) and to the evaluation of the suffering was applied to CGS. The data collection took place between February 19 and March 5, 2018. The treatment was done through SPSS, version 24, and AMOS, version 25, using descriptive and inferential statistics. The main conclusions are: the validation of the GSB for the Portuguese nurses in CSP with a multifactorial model of three factors (Emotional Pain, Relational Loss and Avoidance), revealing good composite reliability (0.923) and discriminant validity, being the values found sufficiently robust for the accomplishment of nomothetic studies in the nurses in CSP. In general, the suffering is greater in female professionals, especially in those who have children, with partners, without specialization in nursing and with more time of service. In males, the highest means are found in nurses without children, without partners, with specialization in nursing and who have more time of service. Suffering in nurses comes from caring for the suffering patient/family and factors from health organizations and working conditions. There is also higher means of suffering in nurses who: often provide care for terminally ill persons / palliative care; deal with the death of their sick; transmit the death information to the family / caregiver; never deal with emergency/emergency situations; never caring for people in distress; work in the Personalized Health Care Unit, with a workload of 35 hours per week and play the role of informal caregivers within the family. Excessive workload and the practice of rigid hours are also sources of suffering in CSP nurses.
Nurses are health professionals who, through their inherent functions, deal daily with the suffering and even loss of life of those who care. Nursing care presupposes an empathic relationship that becomes essential throughout the whole process, because the nurse, putting himself in the place of the other, can more easily perceive and understand the needs and the suffering of the people in his care. Nurses are the elements of the multidisciplinary team that stay in contact with the patient and the family for the longest time and fully accompany the situations of pain and suffering. This intense and continuous exposure can trigger high levels of suffering and distress in these professionals, since there is an inseparable relationship between the suffering of the patient and the suffering of the professional, and in this interpersonal relationship, each part is vulnerable to the other. The consequences that this exposure to patient / family suffering has on nurses are still poorly understood. In this sense, this study has as general objective to evaluate the suffering in nurses in Primary Health Care (CSP) in a Grouping of Health Centers in the interior of Northern Portugal. In order to achieve this, we outlined the following specific objectives: i) to adapt and validate the Caregiver Grief Scale (CGS) for Portuguese nurses in CSP, previously validated for the Portuguese population in formal and informal caregivers by Vasconcelos-Raposo, Teixeira, Ribeiro, Silva e Santos (2017); ii) characterize the study sample in sociodemographic and professional terms; iii) to know the suffering of CSP nurses in the different dimensions (Emotional Pain, Relational Loss and Avoidance) as a function of the mentioned variables. In view of the defined objectives, we outline a methodology of quantitative nature. Initially we proceeded to validate the CGS for Portuguese nurses in CSP and then proceeded to the evaluation of the suffering using the previously validated scale for the study sample. In the collection of data, a questionnaire was applied to self-sufficiency to these professionals (n=100) and to the evaluation of the suffering was applied to CGS. The data collection took place between February 19 and March 5, 2018. The treatment was done through SPSS, version 24, and AMOS, version 25, using descriptive and inferential statistics. The main conclusions are: the validation of the GSB for the Portuguese nurses in CSP with a multifactorial model of three factors (Emotional Pain, Relational Loss and Avoidance), revealing good composite reliability (0.923) and discriminant validity, being the values found sufficiently robust for the accomplishment of nomothetic studies in the nurses in CSP. In general, the suffering is greater in female professionals, especially in those who have children, with partners, without specialization in nursing and with more time of service. In males, the highest means are found in nurses without children, without partners, with specialization in nursing and who have more time of service. Suffering in nurses comes from caring for the suffering patient/family and factors from health organizations and working conditions. There is also higher means of suffering in nurses who: often provide care for terminally ill persons / palliative care; deal with the death of their sick; transmit the death information to the family / caregiver; never deal with emergency/emergency situations; never caring for people in distress; work in the Personalized Health Care Unit, with a workload of 35 hours per week and play the role of informal caregivers within the family. Excessive workload and the practice of rigid hours are also sources of suffering in CSP nurses.
Descrição
Dissertação de Mestrado em Enfermagem Comunitária
Palavras-chave
Sofrimento , Enfermeiros , Cuidados de Saúde Primários , Validação