Estudo sobre a presença de espaços propícios à comunicação de más notícias em hospitais escola do estado de São Paulo
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Data
2017-11-10
Autores
Silva, Nathalia de Lima
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Universidade Estadual Paulista (Unesp)
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Introdução: A comunicação de más notícias envolve situações como a comunicação sobre diagnósticos que ameaçam a vida, a deterioração clínica ou mesmo a morte de um paciente. A forma como esse tipo de informação é transmitido pode ter um impacto profundo na compreensão dos pacientes e de seus familiares sobre a doença, sobre sua capacidade de lidar com a nova situação e pode amplificar ou diminuir o seu sofrimento. Várias pesquisas relativas à comunicação de más notícias nos cuidados de saúde enfatizam a importância de um ambiente físico apropriado para a condução desse processo. Todavia não foram encontrados estudos que tenham avaliado os espaços físicos onde essa comunicação se dá. Portanto, propôs-se o presente projeto de pesquisa com o objetivo de avaliar a presença e as características de ambientes apropriados para a comunicação de más notícias em hospitais escola do estado de São Paulo. Métodos: Todos os hospitais de ensino elegíveis foram convidados a participar do projeto. Uma vez que os hospitais aceitassem participar, era agendada uma visita guiada aos seguintes setores de cada hospital: Unidades de Terapia Intensiva (UTI), antessalas do centro cirúrgico, enfermarias de clínica médica, cirurgia, oncologia, neurologia, geriatria, pediatria e cuidados paliativos. Resultados: Foram convidados 30 hospitais para o estudo, dos quais 15 concordaram em participar. De 156 setores hospitalares visitados havia apenas 15 (9,6%) com salas para comunicação privada entre profissionais de saúde e pacientes/familiares. Em 98 (62,8%) dos setores visitados não havia sequer salas improvisadas que poderiam ser utilizadas para tais comunicações. Conclusão: Na maioria dos setores dos hospitais de ensino visitados há carência de espaços apropriados para comunicação de más notícias ou conversas privadas sobre questões sensíveis com pacientes ou familiares. A ausência de tais ambientes impõe barreiras à comunicação efetiva e empática entre profissionais de saúde e pacientes/familiares. O ambiente físico dos hospitais de ensino transmite mensagens importantes e silenciosas aos alunos, profissionais de saúde e pacientes sobre o que é valorizado ou não dentro dessas instituições. Refletir de forma crítica sobre a forma como os hospitais organizam seu espaço pode inspirar a reestruturação desses ambientes de acordo com os valores e metas pretendidas dessas instituições.
Introduction: The breaking of bad news involves situations such as the communication about life-threatening diagnoses, the clinical deterioration or even the demise of a patient. The way in which those types of information are conveyed may have profound impact in the under-standing of patients and families about the illness, in their ability to cope with the new situa-tion, and may amplify or lessen their suffering. Several guidelines concerning the communi-cation of bad news in healthcare emphasize the importance of an appropriate physical envi-ronment for the conduction of that process. However there are no studies about the physical environments where such communication processes take place. Therefore we proposed the present research to assess the presence and the characteristics of appropriate places for the communication of bad news within teaching hospitals in the state of Sao Paulo. Methods: All eligible teaching hospitals of state of São Paulo were invited to participate in the project. Once one of those hospitals accepted to participate, we scheduled a guided visit to the following sectors of each hospital: Intensive Care Units (ICU), access points to operating suites, Internal Medicine, General Surgery, Oncology, Neurology, Geriatrics, Pediatrics, and Palliative Care wards. Results: Thirty teaching hospitals were invited for the study and 15 agreed to participate. Out of 156 hospital sectors visited there were only 15 (9.6%) rooms for private communications between professionals and patients/families. In 98 (62.8%) of the visited sectors there were not even improvised rooms available for such communications. Conclusion: Our results show that within most sectors of the teaching hospitals that we visited there is a lack of appropriate spaces for the breaking of bad news and other conversations about sensitive issues with patients or their family members. The absence of such rooms imposes barriers to effective and empathetic communication between healthcare professionals and patients and/or their families. The physical environment of teaching hospitals conveys im-portant soundless messages to students, healthcare professionals and patients about what is valued or not within those institutions. Reflecting critically about the way hospitals organize their space may inspire the redesign of those environments according to the intended values and goals of those institutions.
Introduction: The breaking of bad news involves situations such as the communication about life-threatening diagnoses, the clinical deterioration or even the demise of a patient. The way in which those types of information are conveyed may have profound impact in the under-standing of patients and families about the illness, in their ability to cope with the new situa-tion, and may amplify or lessen their suffering. Several guidelines concerning the communi-cation of bad news in healthcare emphasize the importance of an appropriate physical envi-ronment for the conduction of that process. However there are no studies about the physical environments where such communication processes take place. Therefore we proposed the present research to assess the presence and the characteristics of appropriate places for the communication of bad news within teaching hospitals in the state of Sao Paulo. Methods: All eligible teaching hospitals of state of São Paulo were invited to participate in the project. Once one of those hospitals accepted to participate, we scheduled a guided visit to the following sectors of each hospital: Intensive Care Units (ICU), access points to operating suites, Internal Medicine, General Surgery, Oncology, Neurology, Geriatrics, Pediatrics, and Palliative Care wards. Results: Thirty teaching hospitals were invited for the study and 15 agreed to participate. Out of 156 hospital sectors visited there were only 15 (9.6%) rooms for private communications between professionals and patients/families. In 98 (62.8%) of the visited sectors there were not even improvised rooms available for such communications. Conclusion: Our results show that within most sectors of the teaching hospitals that we visited there is a lack of appropriate spaces for the breaking of bad news and other conversations about sensitive issues with patients or their family members. The absence of such rooms imposes barriers to effective and empathetic communication between healthcare professionals and patients and/or their families. The physical environment of teaching hospitals conveys im-portant soundless messages to students, healthcare professionals and patients about what is valued or not within those institutions. Reflecting critically about the way hospitals organize their space may inspire the redesign of those environments according to the intended values and goals of those institutions.
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Palavras-chave
Comunicação, Más notícias, Cuidados Paliativos, Hospitais de Ensino, Communication, Bad News, Palliative Care, Teaching Hospitals