Da fragilidade à identidade profissional transitória do enfermeiro perioperatório na pandemia: liderança como componente transformacional: liderança transformacional
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Data
2023-02-24
Autores
Alcântara, Léia Regina de Souza
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Universidade Estadual Paulista (Unesp)
Resumo
Introdução: em 30 de janeiro de 2020, a Organização Mundial de Saúde (OMS) declarou emergência em Saúde Pública, em face de a pandemia Corona Virus Disease (COVID-19). Doença infectocontagiosa que na sua forma grave evolui para a síndrome respiratória aguda, demandando reservas de leitos e de recursos humanos para atendimento desses pacientes, nas emergências e em unidades de terapia intensiva. Contexto este que obrigou a Agência Nacional de Vigilância Sanitária, por meio da nota técnica nº 04/2020, recomendar a suspensão das cirurgias eletivas. Objetivos: Compreender a experiência do trabalho do enfermeiro do bloco cirúrgico (BC) no início da pandemia COVID-19 e elaborar um modelo teórico representativo dessa experiência. Método: trata-se de estudo qualitativo, no referencial metodológico da Teoria Fundamentada nos Dados em sua vertente Straussiana e o Interacionismo Simbólico como referencial teórico. Utilizou-se as diretrizes do o Consolidated criteria for reporting qualitative research (COREQ) para garantir a qualidade metodológica do estudo. Incluiu-se enfermeiros que estavam atuando no Bloco Cirúrgico (BC), minimamente, há um ano. Eles foram localizados a partir de pesquisa prévia conduzida pelas autoras. A saturação teórica deu-se a partir da análise da 19ª entrevista não diretiva, tendo como disparador: Conte-me como é o seu processo de trabalho e como você o vivencia, neste momento pandêmico, na unidade de BC. As entrevistas foram audiogravadas, com duração entre 40 a 90 minutos e após transcritas na íntegra, em documentos do Microsoft Word e depois importados para o software de apoio ATLAS.ti versão 9.0. Essa análise deu-se segundo as etapas do referencial metodológico da Teoria Fundamentada nos Dados: codificação aberta, que envolve a microanálise do texto; codificação axial para o agrupamento dos dados com a finalidade de explicar o fenômeno estudado e codificação seletiva, quando há o refinamento das categorias abstraídas, analisadas, refletidas e sistematizadas para a extração da categoria central. Resultados: os atores provem de instituições públicas, privadas e filantrópicas, de cidades das regiões Norte, Nordeste, Sudeste e Sul do Brasil. A maioria do sexo feminino, com médias respectivas de idade e tempo de trabalho de 42,5 e de 16 anos respectivamente. A análise segundo o referencial metodológico permitiu estabelecer relações teóricas entre os componentes (subprocessos, categorias, subcategorias e elementos), por meio de processo explicativo e analítico das ações e interações referentes à experiência, representado pela categoria central intitulada: “Da fragilidade à superação transitória do protagonismo épico do enfermeiro no BC, durante a pandemia COVID-19: a liderança transformacional como componente interveniente para a identidade profissional”. Esse processo desdobrou-se em três subprocessos, a saber: enfermeiro deparando-se, inicialmente, com a autoconfiança abalada para o exercício profissional no ambiente cirúrgico não preparado para a pandemia COVID-19 (A); enfermeiro irrompendo como protagonista da liderança transformacional do processo de trabalho e de sua identidade profissional (B); enfermeiro ponderando o impacto no processo de trabalho e na sua identidade profissional enquanto perdurar a pandemia (C). Discussão e considerações finais: Analisando o movimento da experiência de enfermeiros do BC, empreendido no início da pandemia COVID-19, abstraído no modelo teórico segundo o Interacionismo Simbólico, verificou-se o profissional utilizando-se de ações relativas à liderança transformacional para enfrentamento de sofrimento mental como protagonista simbólico de drama épico. Neste contexto, não só por almejar o reordenamento de trabalho mais seguro nos âmbitos: informacional, de recursos humanos e materiais, mas também engendrar identidade profissional, em face de o incômodo de se perceber aclamado pela mídia/sociedade como um protagonista épico e não profissional na linha de frente da batalha pandêmica, com necessidades de melhores condições trabalhistas. Considerações finais: Diante da identidade profissional estabelecida pela liderança transformacional que se opõe ao herói épico, nossos atores, ao ponderar os desfechos do controle da pandemia, mostram-se pouco confiantes e até temerosos. Consideram a visibilidade profissional e reconhecimento social como sendo passageiros. Desta forma, o modelo teórico abstraído da experiência de enfermeiros do bloco cirúrgico, durante o início da pandemia COVID-19, ampliou a compreensão de sua experiência, muito além de expor a precarização das condições de trabalho que a equipe de enfermagem vinha tendo, mas também demonstrou capacidade preditiva, por sinalizar a perspectiva da liderança transformacional como instrumento para o alcance do reconhecimento social da identidade do enfermeiro como líder de sua equipe.
Introduction: due to the pandemic Corona Virus Disease, the World Health Organization (WHO) declared a Public Health Emergency on January 30, 2020. (COVID-19). Acute respiratory syndrome develops from this infectious disease in its severe form, necessitating bed and health care personnel reserves in order to assist patients in emergency and critical care units. The National Sanitary Surveillance Agency was compelled by this situation to suggest the suspension of elective procedures in technical note no. 04/2020. Objectives: To undesrtand how nurses in operating rooms (OR) felt about the work process during the start of the COVID-19 pandemic and to create a theoretical model that reflects what they experienced. Method: This is a qualitative study that was approved by the Research Ethics Committee and conducted in accordance with the consolidated criteria for reporting qualitative research (COREQ). After the 19th non-directive interview, theoretical saturation took place with the following trigger: Tell me about your work procedure and how you perceive it in the OR during this pandemic. Nurses who had worked in the operating room for at least a year were included. They were reached out using the researchers' contact list. The interviews were audiorecorded for 40 to 90 minutes, then transcribed in full in Microsoft Word documents and put onto the support software ATLAS.ti, version 9.0. This analysis adhered to the steps of the Grounded Theory methodological framework: open coding, which involves microanalysis of the text; axial coding, which groups the data with the goal of describing the phenomenon under study; and selective coding, which involves a fine-tuning of the abstracted, analysed, reflected, and systematised categories for the extraction of a central category. Results: Through an explanatory and analytical process of the actions and interactions pertaining to the experience, represented by the central category entitled: "From fragility to transitional overcoming of the epic protagonism of nurses in the OR during the COVID-19 pandemic: transformational leadership as an intervening component for professional Identity". This process unfolded in three subprocesses, namely: nurses initially facing a shaken self-confidence for professional practice in a surgical environment unprepared for the COVID-19 pandemic (A); nurses emerging as protagonists of transformational leadership of the work process and of their professional identity (B); nurses pondering the impact on the work process and on their professional identity while the pandemic lasts (C). Ongoing discussion and final considerations: analyzing the movement of the BC nurses' experience, conducted at the beginning of the COVID-19 pandemic, abstracted in the theoretical model according to Symbolic Interactionism, it was verified that such actors performed according to transformational leadership to face mental suffering as a symbolic protagonist of epic drama. In this context, not only by aiming for the reordering of safer work in the areas of information, human resources, and materials, but also to build a professional identity, due to the discomfort of perceiving oneself acclaimed by the media/society as an epic protagonist and not as a professional in the front line of the pandemic battle in need of better working conditions. Final considerations: faced with the professional identity established by the transformational leadership that opposes the epic hero, the actors, when considering the outcomes of controlling the pandemic, show little confidence and even fear. They consider professional visibility and social recognition to be passengers. In this way, the theoretical model abstracted from the experience of nurses in the operating room, during the beginning of the COVID-19 pandemic, broadened the understanding of their experience, far beyond exposing the precariousness of the working conditions that the nursing team had been having, but it also demonstrated predictive capacity, by signaling the perspective of transformational leadership as an instrument for achieving social recognition of the nurse's identity as the leader of their team.
Introduction: due to the pandemic Corona Virus Disease, the World Health Organization (WHO) declared a Public Health Emergency on January 30, 2020. (COVID-19). Acute respiratory syndrome develops from this infectious disease in its severe form, necessitating bed and health care personnel reserves in order to assist patients in emergency and critical care units. The National Sanitary Surveillance Agency was compelled by this situation to suggest the suspension of elective procedures in technical note no. 04/2020. Objectives: To undesrtand how nurses in operating rooms (OR) felt about the work process during the start of the COVID-19 pandemic and to create a theoretical model that reflects what they experienced. Method: This is a qualitative study that was approved by the Research Ethics Committee and conducted in accordance with the consolidated criteria for reporting qualitative research (COREQ). After the 19th non-directive interview, theoretical saturation took place with the following trigger: Tell me about your work procedure and how you perceive it in the OR during this pandemic. Nurses who had worked in the operating room for at least a year were included. They were reached out using the researchers' contact list. The interviews were audiorecorded for 40 to 90 minutes, then transcribed in full in Microsoft Word documents and put onto the support software ATLAS.ti, version 9.0. This analysis adhered to the steps of the Grounded Theory methodological framework: open coding, which involves microanalysis of the text; axial coding, which groups the data with the goal of describing the phenomenon under study; and selective coding, which involves a fine-tuning of the abstracted, analysed, reflected, and systematised categories for the extraction of a central category. Results: Through an explanatory and analytical process of the actions and interactions pertaining to the experience, represented by the central category entitled: "From fragility to transitional overcoming of the epic protagonism of nurses in the OR during the COVID-19 pandemic: transformational leadership as an intervening component for professional Identity". This process unfolded in three subprocesses, namely: nurses initially facing a shaken self-confidence for professional practice in a surgical environment unprepared for the COVID-19 pandemic (A); nurses emerging as protagonists of transformational leadership of the work process and of their professional identity (B); nurses pondering the impact on the work process and on their professional identity while the pandemic lasts (C). Ongoing discussion and final considerations: analyzing the movement of the BC nurses' experience, conducted at the beginning of the COVID-19 pandemic, abstracted in the theoretical model according to Symbolic Interactionism, it was verified that such actors performed according to transformational leadership to face mental suffering as a symbolic protagonist of epic drama. In this context, not only by aiming for the reordering of safer work in the areas of information, human resources, and materials, but also to build a professional identity, due to the discomfort of perceiving oneself acclaimed by the media/society as an epic protagonist and not as a professional in the front line of the pandemic battle in need of better working conditions. Final considerations: faced with the professional identity established by the transformational leadership that opposes the epic hero, the actors, when considering the outcomes of controlling the pandemic, show little confidence and even fear. They consider professional visibility and social recognition to be passengers. In this way, the theoretical model abstracted from the experience of nurses in the operating room, during the beginning of the COVID-19 pandemic, broadened the understanding of their experience, far beyond exposing the precariousness of the working conditions that the nursing team had been having, but it also demonstrated predictive capacity, by signaling the perspective of transformational leadership as an instrument for achieving social recognition of the nurse's identity as the leader of their team.
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Palavras-chave
Covid-19 (Doença), Pandemias, Processo de trabalho, Processo de enfermagem, Liderança, Enfermagem cirúrgica, Enfermagem perioperatória, Enfermeiros