Dissertação de Mestrado
A desospitalização em um hospital público geral de Minas Gerais: inicio da atenção domiciliar
Fecha
2016-03-09Autor
Wesley Souza Castro
Institución
Resumen
The aim of the present study was to analyse the process of de-hospitalization at a public general hospital in the state of Minas Gerais from the perspective of managers, health professionals, service users and their families. This is a descriptive exploratory qualitative study using a dialectical methodology. Study participants were two directors, ten nurses, two social workers, eight doctors and two health care coordinators working at the clinical care unit of a public medium sized teaching hospital in the city of Belo Horizonte. Interviews to directors aimed at identifying the hospitals policies and strategies for de-hospitalization and their relationship with the Health Care System (RAS). Nurses, social workers and doctors are responsible for the process and the interviews carried out with them aimed at recognising how existing de-hospitalization procedures were applied. Fifteen relatives of users in the process of being de-hospitalized and referred totake part in a continuity of care programme through the Home Care Service (SAD) also participated in the study. The objective of the interviews with this group was to assess both the obstacles to the process of de-hospitalization and the potentialities. Fieldwork began in 2015 at the hospitals general medicine clinic that caters for users coming from surgical and neurological units, as well as emergencyservices. The researcher collected data through semi-structured interviews that were audio recorded. This allowed the author to identify the respondents perspectives on de-hospitalization and their expectations regarding home care. A field diary was used to record observations during field work. Data was analysed according to Bardins (2008) thematic content analysis. Three empirical categories emerged from the analysis: de-hospitalization: institutional perspective; supportto family members regarding de-hospitalization process; organization of the family of de-hospitalized user. Data analysis revealed several institutional policies geared towards de-hospitalization. The discourse of the health professionals demonstrated that family members were told and received training in the hospital about how to guarantee a comprehensive care programme and how to promote continuity of care at home. The researcher detected resistance amongst the families of care dependents, mainly amongst the relatives of debilitated users with nasoenteric tube wearing adult nappies who had been tracheotomised and had undergone surgery. The social worker was the professional responsible for contacting the Home Care Program (PAD) the day before hospital discharge. In conclusion, de-hospitalization is an important process and all professionals involved in it should ensure that comprehensive care and continuity of care are provided within the hospital and home environments. In the present study setting, this was an ongoing process that displayed the usual potentialities and challenges.