Avaliação dos serviços de atendimento móvel de urgência da rede de urgência e emergência da rede de atenção a saúde- 09: estudo multimétodos
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2022-02-24
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Universidade Estadual Paulista (Unesp)
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O presente trabalho teve por objetivo avaliar os Serviços de Atendimento Móvel de Urgência da Rede de Atenção à Saúde - 09 em relação ao preconizado nas políticas públicas nacionais com bases legais. Estudo transversal, multimétodos, foi conduzido em duas etapas. A primeira etapa (desenho quantitativo) consistiu na avaliação e descrição da estrutura dos Serviços de Atendimento Móvel de Urgência regionais, tendo sido baseada no referencial metodológico de Donabedian. Diferentes estratégias de coleta de informações foram empregadas: análise documental de manuais, portarias, deliberações e resoluções ministeriais; revisão sistematizada de artigos, teses e dissertações, escalas de trabalho, anotações em livros de relatórios; e entrevista com informantes-chaves, como enfermeiros coordenadores regionais; observação direta nas centrais de regulação regionais; e observação sistemática não participante nas viaturas. A coleta de dados consistiu em um roteiro de entrevista contendo duas partes. A parte I consistiu de um checklist e perguntas objetivas, preenchidos pelos entrevistados, cujas variáveis foram: recursos humanos, materiais tecnológicos de informação e as ferramentas de gestão. A segunda etapa do estudo (delineamento qualitativo) constituiu na parte II do roteiro respondido por escrito pelos gestores locais participantes, a partir de quatro perguntas norteadoras. Discursos do Sujeito Coletivo foi o referencial metodológico, cujo processamento das informações, análise e elaboração se deram por meio do programa Qualiquantisoft, fundamentado na Teoria das Representações Sociais. A estrutura das ambulâncias estava adequada, com equipamentos novos e em bom funcionamento, porém a manutenção preventiva não é realizada em todas. Todos os locais analisados apresentavam materiais além do que é preconizado pelo Ministério da Saúde, eventualmente com falta de eletrodos ou algum outro item. Há rotinas e protocolos implantados na maior parte dos municípios, os quais estão acessíveis aos profissionais por meio de documentos impressos, pela internet, via e-mail, em murais, dentre outros. Quanto aos recursos humanos, foram evidenciadas: equipes completas, mas sem reserva técnica; jornada de trabalho exaustiva, cuja cobertura se dá com realização de horas extras; taxa de rotatividade baixa dos funcionários (contratos de regime estatutário ou celetista). Para os cargos de gestão, as trocas de funcionários são frequentes, o que prejudica a administração pública, a continuidade e a efetividade da proposição, implantação e resolução de problemas. Houve dificuldades de comunicação à central de regulação; ausência de periodicidade nas manutenções das ambulâncias, principalmente nas bases descentralizadas; desconhecimento da população a respeito da missão do SAMU; solicitações de material ou manutenção não atendidas; falta de capacitação e melhores condições de trabalho e salariais. Conclui-se que não há integração dos serviços de atendimento móvel com outros sistemas, o que dificulta o acesso às unidades de referência aos leitos de internação geral e especializada, como em terapia intensiva. Os serviços de atendimento móvel estão restritos às ações de operacionalização do atendimento pré-hospitalar, à decisão pelo despacho de ambulâncias, ao suporte técnico às equipes assistenciais e à decisão de destino do paciente conforme pactuação. As unidades pactuadas apresentam resistência para o recebimento de pacientes, por problemas estruturais na rede de serviços, e não pela desconsideração da regulação.
To evaluate the Mobile Emergency Care Services of the Health Care Network - 09 in relation to what is recommended in national public policies with legal bases. A cross-sectional, multi-method study carried out in two stages. The first quantitative design stage refers to the evaluation and description of the structure of the regional Mobile Emergency Care Services, based on Donabedian's methodological framework. The information was obtained from different collection strategies: document analysis of manuals, ordinances, deliberations and ministerial resolutions; systematic review of articles, theses and dissertations; work schedules, notes in report books and interviews with key informants, regional nurse coordinators; direct observation in regional regulation centers, systematic non-participant observation in vehicles; the data collection instrument was an interview script containing two parts: part I, containing a checklist and objective questions, filled in by the interviewees. The variables were human resources; materials; information technology and management tools. The second stage, of qualitative design, consisted of part II of the script answered in writing by the participating local managers from four guiding questions. The methodological framework used was the Discourses of the Collective Subject and for the processing of information, analyze the elaboration of Discourses of the Collective Subject, we used the Qualiquantisoft program, based on the Theory of Social Representations. The structure of the ambulances was adequate, preventive maintenance is not carried out in all, showing good general condition, with new and in good working order. All the analyzed sites had materials beyond what is recommended by the Ministry of Health, possibly lacking electrodes or some item. There are routines and protocols implemented in most municipalities, which are accessible to professionals through printed documents, on the internet, via e-mail, on bulletin boards, among other means of communication. The results related to human resources showed: complete teams, but no technical reserve; exhaustive working hours with overtime coverage; low turnover rate of employees who make up the service with statutory or CLT contracts. For management positions, employee changes are frequent, which harms public administration, the continuity and effectiveness of the proposition, implementation and resolution of problems. Regarding the perspective of the nurse manager, after analyzing the data, the following themes emerged: difficulties in communication with the regulation center; lack of periodicity in ambulance maintenance, especially in decentralized bases; ignorance of the population about the mission of SAMU; unmet material or maintenance requests; lack of training and better working and salary conditions. There is no integration of mobile care services with other systems, which makes it difficult to access reference units, general and specialized hospitalization beds, such as in intensive care. Mobile care services are restricted to the actions of operationalization of pre-hospital care, the decision to dispatch ambulances, technical support to care teams and the decision of the patient's destination according to the agreement; however, the agreed units present resistance to receiving patients, due to structural problems that the service network presents and not due to the disregard of regulation.
To evaluate the Mobile Emergency Care Services of the Health Care Network - 09 in relation to what is recommended in national public policies with legal bases. A cross-sectional, multi-method study carried out in two stages. The first quantitative design stage refers to the evaluation and description of the structure of the regional Mobile Emergency Care Services, based on Donabedian's methodological framework. The information was obtained from different collection strategies: document analysis of manuals, ordinances, deliberations and ministerial resolutions; systematic review of articles, theses and dissertations; work schedules, notes in report books and interviews with key informants, regional nurse coordinators; direct observation in regional regulation centers, systematic non-participant observation in vehicles; the data collection instrument was an interview script containing two parts: part I, containing a checklist and objective questions, filled in by the interviewees. The variables were human resources; materials; information technology and management tools. The second stage, of qualitative design, consisted of part II of the script answered in writing by the participating local managers from four guiding questions. The methodological framework used was the Discourses of the Collective Subject and for the processing of information, analyze the elaboration of Discourses of the Collective Subject, we used the Qualiquantisoft program, based on the Theory of Social Representations. The structure of the ambulances was adequate, preventive maintenance is not carried out in all, showing good general condition, with new and in good working order. All the analyzed sites had materials beyond what is recommended by the Ministry of Health, possibly lacking electrodes or some item. There are routines and protocols implemented in most municipalities, which are accessible to professionals through printed documents, on the internet, via e-mail, on bulletin boards, among other means of communication. The results related to human resources showed: complete teams, but no technical reserve; exhaustive working hours with overtime coverage; low turnover rate of employees who make up the service with statutory or CLT contracts. For management positions, employee changes are frequent, which harms public administration, the continuity and effectiveness of the proposition, implementation and resolution of problems. Regarding the perspective of the nurse manager, after analyzing the data, the following themes emerged: difficulties in communication with the regulation center; lack of periodicity in ambulance maintenance, especially in decentralized bases; ignorance of the population about the mission of SAMU; unmet material or maintenance requests; lack of training and better working and salary conditions. There is no integration of mobile care services with other systems, which makes it difficult to access reference units, general and specialized hospitalization beds, such as in intensive care. Mobile care services are restricted to the actions of operationalization of pre-hospital care, the decision to dispatch ambulances, technical support to care teams and the decision of the patient's destination according to the agreement; however, the agreed units present resistance to receiving patients, due to structural problems that the service network presents and not due to the disregard of regulation.
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Palavras-chave
Enfermagem, Emergência, SAMU, Serviços, Saúde, Pré- hospitalar, Nursing, Health services