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Desafios da reanimação intra-hospitalar : Perceção das dificuldades dos enfermeiros no internamento e da equipa da emergência médica intra-hospitalar
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Abstract(s)
Desafios da Reanimação Intra-hospitalar
Enquadramento:
Avaliar a autoeficácia de enfermeiros ao longo das práticas é fundamental à prestação de cuidados e à gestão das organizações de saúde, melhorando o desempenho profissional, a qualidade e segurança dos cuidados e os ganhos em saúde (Carvalho e Lucas, 2020; Soar et al, 2021).
Objetivo:
Identificar as dificuldades percecionadas pelos enfermeiros em contexto de internamento perante situações de paragem cardiorrespiratória (PCR). Analisar a perceção da equipa de emergência interna sobre as dificuldades dos enfermeiros perante situações de Reanimação Cardiopulmonar (RCP). Analisar os aspetos comuns ou que carecem de intervenção de melhoria.
Metodologia:
O estudo 1 trata-se de um estudo quantitativo, transversal, cuja colheita de dados decorreu através de questionário aos enfermeiros de um hospital português, que trabalham em serviços médico-cirúrgicos de adultos, com aplicação da Escala de Perceção de Dificuldades na Assistência à Paragem Cardiorrespiratória Intra-Hospitalar [EPDAPI] (Catalão e Gaspar, 2017), entre agosto e dezembro de 2024.
O estudo 2 é de abordagem qualitativa, descritiva e exploratória, através de entrevistas semiestruturas aos elementos da equipa de emergência intra-hospitalar da mesma ULS entre setembro e novembro do mesmo ano. O estudo obteve parecer favorável de comissão de ética.
Resultados:
No estudo 1, os 74 participantes relataram maior dificuldade no fator Atuação em RCP e menor dificuldade nos fatores Resposta em Tempo Útil à Paragem Cardiorrespiratória (PCR) e Ativação da Ajuda Diferenciada à PCR. A média ponderada total da EPDAPI foi de 4.01±0.34. Verificaram-se diferenças estatisticamente significativas relativamente ao fator Competência para a Tomada de Decisão com pontuações inferiores (maior dificuldade) nos enfermeiros com menor experiência (p=0.004) e com curso de Suporte Avançado de Vida há mais de 5 anos (p=0.005). No fator Resposta em Tempo Útil à PCR existiu diferença estatisticamente significativa, com pontuações inferiores, nos enfermeiros na faixa etária dos 30 aos 39 anos comparando com enfermeiros com 50 ou mais anos (p=0.001) e com enfermeiros dos 40 aos 49 anos (p=0.010). No fator Ativação da Ajuda Diferenciada à PCR existiu diferença estatisticamente significativa, com pontuação inferior, nos enfermeiros licenciados comparando com os mestres (p=0.022).
No estudo 2 emergiram um conjunto de áreas temáticas como: Critérios de Ativação, Preparação Material, Comunicação, Gestão de emoções, Trabalho de equipa, Formação Contínua e Execução Prática, cada uma delas com subcategorias, com os profissionais a mencionarem fatores dificultadores e/ou fatores facilitadores perante uma prática de Reanimação.
Conclusão:
Os resultados do estudo 1 permitiram identificar aspetos percecionados como de menor dificuldade na reanimação intra-hospitalar, relacionados com a resposta em tempo útil à PCR, a ativação da ajuda, deteção, alerta e resposta à PCR. As principais dificuldades reportam aos fatores de atuação durante a PCR e à competência para a tomada de decisão em RCP, evidenciando a necessidade de implementar estratégias de melhoria.
No estudo 2, as entrevistas à EEMI vão ao encontro das dificuldades da EPDAPI, na Deteção sugerem introdução de sistemas de alerta precoce, na Ativação mencionam benefícios na linguagem estruturada, na Prática clínica reconhecem dificuldades na execução prática por conhecimento desatualizado dos algoritmos como por ausência de familiarização com o carro de emergência, emergindo a definição de papeis e a Formação Contínua como necessidade inequívoca de melhoria contínua.
Palavras-chave: Enfermagem de Cuidados Críticos; Reanimação Cardiopulmonar; Competência Clínica; Formação Contínua.
Abstract Challenges of In-Hospital Resuscitation Background: Assessing nurses' self-efficacy throughout their practices is fundamental to the provision of care and management of healthcare organizations, improving professional performance, quality and safety of care, and health gains (Carvalho e Lucas, 2020; Soar et al, 2021). Objective: Identify the difficulties perceived by nurses in the context of the ward when faced with situations of cardiorespiratory arrest. Analyze the perception of the internal emergency team regarding the difficulties faced by nurses, in situations of Cardiopulmonary Resuscitation (CPR). Analyze common areas or areas that require improvement intervention. Methodology: Study 1 is a quantitative, cross-sectional study, whose data collection was carried out through a questionnaire administered to nurses at a Portuguese hospital, who work in adult medical-surgical services, using the Scale for the Perception of Difficulties in Assistance to Intra-Hospital Cardiopulmonary Arrest [EPDAPI] (Catalão e Gaspar, 2017), between August and December 2024. Study 2 is a qualitative, descriptive and exploratory study, through semi-structured interviews with members of the hospital emergency team of the same ULS between September and November of the same year. This study received a favorable opinion from the ethics committee. Results: In study 1, the 74 participants reported greater difficulty in the CPR Performance factor and less difficulty in the Timely Response to Cardiopulmonary Arrest (CPA) and Activation of Differentiated Aid to CPA factors. The total weighted mean of the EPDAPI was 4.01±0.34. Statistically significant differences were found in the Decision-Making Competence factor, with lower scores (greater difficulty) in nurses with less experience (p=0.004) and with an Advanced Life Support course for more than 5 years (p=0.005). In the Timely Response to CPA factor, there was a statistically significant difference, with lower scores, in nurses in the age group of 30 to 39 years compared to nurses aged 50 or over (p=0.001) and nurses aged 40 to 49 years (p=0.010). In the factor Activation of Differentiated Assistance for CPA, there was a statistically significant difference, with a lower score, for nurses with a degree compared to those with a master's degree (p=0.022). In study 2, a set of thematic areas emerged, such as: Activation Criteria, Material Preparation, Communication, Emotion Management, Teamwork, Continuous Training and Practical Execution, each with subcategories, with professionals mentioning hindering factors and/or facilitating factors when faced with a Resuscitation practice. Conclusion: The results of study 1 allowed us to identify aspects perceived as less difficult in in-hospital resuscitation, related to the timely response to CPA, activation of aid, detection, alert and response to CPA. The main difficulties relate to the factors of action during CPA and the competence for decision-making in CPR, highlighting the need to implement improvement strategies. In study 2, the interviews with EEMI meet the difficulties of EPDAPI, in Detection they suggest the introduction of early warning systems, in Activation they mention benefits in structured language, in Clinical practice they recognize difficulties in practical execution due to outdated knowledge of algorithms and lack of familiarity with the emergency vehicle, emerging the definition of roles and Continuous Training as an unequivocal need for continuous improvement. Keywords: Critical Care Nursing; Cardiopulmonary Resuscitation; Clinical Competence, Continuous Training.
Abstract Challenges of In-Hospital Resuscitation Background: Assessing nurses' self-efficacy throughout their practices is fundamental to the provision of care and management of healthcare organizations, improving professional performance, quality and safety of care, and health gains (Carvalho e Lucas, 2020; Soar et al, 2021). Objective: Identify the difficulties perceived by nurses in the context of the ward when faced with situations of cardiorespiratory arrest. Analyze the perception of the internal emergency team regarding the difficulties faced by nurses, in situations of Cardiopulmonary Resuscitation (CPR). Analyze common areas or areas that require improvement intervention. Methodology: Study 1 is a quantitative, cross-sectional study, whose data collection was carried out through a questionnaire administered to nurses at a Portuguese hospital, who work in adult medical-surgical services, using the Scale for the Perception of Difficulties in Assistance to Intra-Hospital Cardiopulmonary Arrest [EPDAPI] (Catalão e Gaspar, 2017), between August and December 2024. Study 2 is a qualitative, descriptive and exploratory study, through semi-structured interviews with members of the hospital emergency team of the same ULS between September and November of the same year. This study received a favorable opinion from the ethics committee. Results: In study 1, the 74 participants reported greater difficulty in the CPR Performance factor and less difficulty in the Timely Response to Cardiopulmonary Arrest (CPA) and Activation of Differentiated Aid to CPA factors. The total weighted mean of the EPDAPI was 4.01±0.34. Statistically significant differences were found in the Decision-Making Competence factor, with lower scores (greater difficulty) in nurses with less experience (p=0.004) and with an Advanced Life Support course for more than 5 years (p=0.005). In the Timely Response to CPA factor, there was a statistically significant difference, with lower scores, in nurses in the age group of 30 to 39 years compared to nurses aged 50 or over (p=0.001) and nurses aged 40 to 49 years (p=0.010). In the factor Activation of Differentiated Assistance for CPA, there was a statistically significant difference, with a lower score, for nurses with a degree compared to those with a master's degree (p=0.022). In study 2, a set of thematic areas emerged, such as: Activation Criteria, Material Preparation, Communication, Emotion Management, Teamwork, Continuous Training and Practical Execution, each with subcategories, with professionals mentioning hindering factors and/or facilitating factors when faced with a Resuscitation practice. Conclusion: The results of study 1 allowed us to identify aspects perceived as less difficult in in-hospital resuscitation, related to the timely response to CPA, activation of aid, detection, alert and response to CPA. The main difficulties relate to the factors of action during CPA and the competence for decision-making in CPR, highlighting the need to implement improvement strategies. In study 2, the interviews with EEMI meet the difficulties of EPDAPI, in Detection they suggest the introduction of early warning systems, in Activation they mention benefits in structured language, in Clinical practice they recognize difficulties in practical execution due to outdated knowledge of algorithms and lack of familiarity with the emergency vehicle, emerging the definition of roles and Continuous Training as an unequivocal need for continuous improvement. Keywords: Critical Care Nursing; Cardiopulmonary Resuscitation; Clinical Competence, Continuous Training.
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Keywords
Atitude do pessoal de saúde Competência clínica Competência profissional Enfermagem de cuidados críticos Paragem cardíaca Reanimação cardiopulmonar Attitude of health personnel Cardiopulmonary resuscitation Clinical competence Critical care nursing Heart arrest Professional competence
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