Navegação de pacientes oncológicos: benefícios e desafios para a prática de enfermeiros assistenciais
Data
2023-02-15
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Universidade Estadual Paulista (Unesp)
Resumo
Introdução: o primeiro programa de navegação de pacientes foi desenvolvido em 1990, no Harlem, Nova York, pelo médico estadunidense Harold Freeman, surgindo a figura do enfermeiro navegador, como profissional indicado para assegurar o continuum da assistência, junto à equipe multidisciplinar. Objetivo geral: apreender os benefícios e os desafios para a prática de enfermeiros assistenciais na navegação de pacientes oncológicos. Métodos: realizou-se, inicialmente, revisão de literatura que objetivou analisar pesquisas que adotaram como objeto de estudo os benefícios do programa navegação de pacientes e a assistência de enfermagem em serviços de oncologia, utilizando a estratégia PICO para a elaboração da pergunta a ser respondida pela literatura: “Quais benefícios a navegação de pacientes contribui para melhoria e qualidade da assistência de enfermagem abordados pela literatura científica?”. Foram buscados artigos publicados em periódicos na modalidade open acess, em periódicos incluídos nas bases de dados LILACS, Medline, IBECS, BDENF e SCIELO, entre 2015 e 2020, sendo os resultados sistematizados com o apoio do software Rayyan Systems Inc. Com base nos achados dessa revisão, foi realizado estudo de abordagem qualitativa, conduzido após aprovação por comitê de ética em pesquisa local, que contou com a participação de seis enfermeiros assistenciais atuantes em ambulatório de oncologia de um hospital público do interior paulista. A análise dos depoimentos, coletados por entrevistas semiestruturadas, foi realizada por meio de técnicas de análise de conteúdo, vertente temática, segundo Bardin, considerando os nove princípios da navegação de pacientes oncológicos de Harold Freeman. Resultados: a revisão integrativa de 11 artigos permitiu sistematizar os benefícios relativos à inserção do programa de navegação de pacientes e da enfermagem em serviços de oncologia em três categorias: reestruturação da assistência, buscando padronização e diretrizes; agilidade no tratamento; e empoderamento da família/cliente no seguimento dos processos/tratamentos. A literatura revisada mostrou promissores benefícios ao cliente/família e à instituição, além da agilidade nos processos inerentes ao tratamento. O segundo estudo, que teve como objetivo: Compreender experiências de enfermeiros assistenciais segundo os princípios da navegação de pacientes oncológicos propostos por Harold Freeman, possibilitou sistematizar cinco categorias no atendimento aos pacientes: fluidez na assistência; integração entre as equipes; vínculo com pacientes, seus familiares e os enfermeiros; delimitação de competências dos enfermeiros assistenciais na navegação de pacientes oncológicos; e valorização e facilidades no treinamento das equipes. Considerações finais: a revisão integrativa de literatura revelou a importância dos enfermeiros navegadores de paciente oncológicos, tanto para os próprios pacientes e suas famílias, quanto para a organização da assistência prestadas a eles. Em complementação, o segundo estudo permitiu considerar que, mesmo sem especialização específica e sem implantação institucional do programa de navegação de pacientes oncológicos, os enfermeiros têm seguido alguns dos princípios propostos por Harold Freeman, contribuindo para a qualificação dos cuidados prestados. Espera-se que esses estudos ressaltem a importância da atuação de enfermeiros navegadores em oncologia e estimulem esses e demais profissionais envolvidos com essa assistência, a implementarem, institucionalmente, programa de navegação de pacientes com câncer.
Introduction: the first patient navigation program was developed in 1990, in Harlem, New York, by the American physician Harold Freeman, with the emergence of the navigator nurse as a professional indicated to ensure the continuum of care, along with the multidisciplinary team. Objective: to learn the benefits and challenges for the practice of clinical nurses in the navigation of cancer patients. Methods: First of all, a literature review was carried out with the aim of analyzing studies that adopted as an object of study the benefits of the patient navigation program and nursing care in oncology services, using the PICO strategy for the elaboration of the question to be answered by the literature: “What benefits does patient navigation contribute to the improvement and quality of nursing care addressed by the scientific literature?”. Articles published in journals in the open access modality, in journals included in the LILACS, Medline, IBECS, BDENF and SCIELO databases, between 2015 and 2020, were searched, and the results were systematized with the support of the software Rayyan Systems Inc. Based on the findings of this review, a study with a qualitative approach was carried out, conducted after approval by the local research ethics committee, with the participation of six clinical nurses working in an oncology outpatient clinic of a public hospital in the countryside of São Paulo. The analysis of the testimonies, collected through semi-structured interviews, was carried out using content analysis techniques, thematic approach, according to Bardin, considering Harold Freeman's nine principles of navigation for cancer patients. Results: the integrative review of 11 articles allowed systematizing the benefits related to the insertion of the patient and nursing navigation program in oncology services into three categories: restructuring of care, seeking standardization and guidelines; agility in the treatment; and empowerment of the family/client following the processes/treatments. The reviewed literature showed promising benefits for the client/family and the institution, and the agility in the processes inherent to the treatment as well. The second study, which aimed to: Understand the experiences of clinical nurses according to the principles of navigation for cancer patients proposed by Harold Freeman, made it possible to systematize five categories in patient care: fluidity in care; integration between teams; bond with patients, their families and nurses; delimitation of competences of clinical nurses in navigating cancer patients; and valuation and facilities in the training of teams. Final considerations: the integrative literature review revealed the importance of oncology patient navigator nurses, both for the patients themselves and their families, and for the organization of care provided to them. In addition, the second study allowed us to consider that, even without specific specialization and without institutional implementation of the navigation program for cancer patients, nurses have followed some of the principles proposed by Harold Freem an, contributing to the qualification of the care provided. It is expected d that these studies highlight the importance of the role of navigator nurses in oncology and encourage these and other professionals involved with this assistance to institutionall y implement a navigation program for cancer patients.
Introduction: the first patient navigation program was developed in 1990, in Harlem, New York, by the American physician Harold Freeman, with the emergence of the navigator nurse as a professional indicated to ensure the continuum of care, along with the multidisciplinary team. Objective: to learn the benefits and challenges for the practice of clinical nurses in the navigation of cancer patients. Methods: First of all, a literature review was carried out with the aim of analyzing studies that adopted as an object of study the benefits of the patient navigation program and nursing care in oncology services, using the PICO strategy for the elaboration of the question to be answered by the literature: “What benefits does patient navigation contribute to the improvement and quality of nursing care addressed by the scientific literature?”. Articles published in journals in the open access modality, in journals included in the LILACS, Medline, IBECS, BDENF and SCIELO databases, between 2015 and 2020, were searched, and the results were systematized with the support of the software Rayyan Systems Inc. Based on the findings of this review, a study with a qualitative approach was carried out, conducted after approval by the local research ethics committee, with the participation of six clinical nurses working in an oncology outpatient clinic of a public hospital in the countryside of São Paulo. The analysis of the testimonies, collected through semi-structured interviews, was carried out using content analysis techniques, thematic approach, according to Bardin, considering Harold Freeman's nine principles of navigation for cancer patients. Results: the integrative review of 11 articles allowed systematizing the benefits related to the insertion of the patient and nursing navigation program in oncology services into three categories: restructuring of care, seeking standardization and guidelines; agility in the treatment; and empowerment of the family/client following the processes/treatments. The reviewed literature showed promising benefits for the client/family and the institution, and the agility in the processes inherent to the treatment as well. The second study, which aimed to: Understand the experiences of clinical nurses according to the principles of navigation for cancer patients proposed by Harold Freeman, made it possible to systematize five categories in patient care: fluidity in care; integration between teams; bond with patients, their families and nurses; delimitation of competences of clinical nurses in navigating cancer patients; and valuation and facilities in the training of teams. Final considerations: the integrative literature review revealed the importance of oncology patient navigator nurses, both for the patients themselves and their families, and for the organization of care provided to them. In addition, the second study allowed us to consider that, even without specific specialization and without institutional implementation of the navigation program for cancer patients, nurses have followed some of the principles proposed by Harold Freem an, contributing to the qualification of the care provided. It is expected d that these studies highlight the importance of the role of navigator nurses in oncology and encourage these and other professionals involved with this assistance to institutionall y implement a navigation program for cancer patients.
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Palavras-chave
Navegação de pacientes, Enfermagem, Oncologia, Pesquisa qualitativa, Patient navigation, Nursing, Oncology, Qualitative research