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Publication
Biossegurança do enfermeiro obstetra durante a pandemia Covid-19 em contexto hospitalar
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| 7.79 MB | Adobe PDF |
Authors
Advisor(s)
Abstract(s)
Enquadramento: Atualmente somos confrontados com uma realidade que
desconhecíamos até então. A pandemia Covid-19 exigiu uma colaboração e
cooperação de suporte, sem precedentes a um nível global, sobre questões de
saúde relacionadas com a segurança. As vulnerabilidades dos profissionais de
saúde, incluindo os Enfermeiros Especialistas em Enfermagem de Saúde
Materna e Obstétrica (EEESMO) associadas à prática clínica tornaram-se mais
evidentes. Por essa razão, urge refletir sobre as questões que afetam a
biossegurança dos EEESMO em contexto hospitalar.
Objetivos: O presente relatório reflete o meu percurso e apresenta dois objetivos
gerais: Relatar o percurso de desenvolvimento de competências comuns e
específicas de enfermeiro especialista nos vários contextos de aprendizagem;
Descrever a investigação realizada relativamente às estratégias implementadas
para aumentar a biossegurança do EEESMO, em contexto de Bloco de Partos,
durante a pandemia de Covid-19.
Metodologia: Estudo Exploratório Descritivo. Para a colheita de dados foi
utilizado um instrumento (questionário) e a observação durante a interação de
cuidados. Numa primeira fase, efetuou-se uma Revisão Scoping, que me
permitiu mapear o conhecimento científico sobre a temática, posteriormente, a
minha observação durante o estágio no contexto de Bloco de Partos foi
fundamental para conhecer o contexto de cuidados, tomar conhecimento do
Plano de Contingência e identificar os recursos humanos e materiais disponíveis.
Na terceira fase aplicou-se o questionário construído no Google Forms e
acessível nas redes sociais, a uma amostra de 32 EEESMO que exercem
funções em Blocos de Parto. Na quarta fase, após análise e reflexão sobre os
resultados, apresento algumas sugestões para aumentar a biossegurança do
enfermeiro obstetra e iniciei a divulgação de resultados.
Resultados: O Plano de Contingência é do conhecimento da quase totalidade
dos participantes, contudo no que diz respeito ao procedimento de testagem dos
acompanhantes das parturientes, cerca de metade dos respondentes
7
desconhecem-no. Relativamente às medidas implementadas para controle
ambiental, a grande maioria dos EEESMO conhecem e aderiram às medidas
promotoras da segurança do ambiente de trabalho, porém a utilização de roupa
descartável durante a prestação de cuidados à parturiente suspeita ou infetada
é a medida em que se observou menor adesão. Quanto à gestão de casos
suspeitos, os EEESMO conhecem e aplicam o definido no “Fluxograma de
Atuação”, mas alguns consideram que não está disponível para consulta rápida
em todos os locais de atendimento das parturientes. Na gestão dos recursos
humanos, os participantes consideram que existem profissionais de saúde
suficientes para garantir os cuidados diretos à grávida suspeita ou infetada, mas
quando inquiridos relativamente à disponibilidade de EEESMO para esse efeito,
já consideram esse recurso limitado. Outro aspeto critico nesta dimensão é o
facto de nem sempre estarem disponíveis profissionais experientes para ajudar
com a colocação e remoção do EPI nas zonas de isolamento, porém consideram
que os materiais se encontram disponíveis e acessíveis nos locais definidos para
a sua colocação e manuseamento. Alguns enfermeiros assumem que não
cumprem criteriosamente os “5 momentos” para a higiene das mãos.
A programação de atividades que promovem a formação e treino de
procedimentos técnicos, que visam minimizar grau de risco e exposição foi
considerada insuficiente.
Conclusões: Embora não se conheça a real dimensão dos profissionais de
saúde infetados durante a pandemia Covid-19, é determinante a sua formação
para lidar com os riscos presentes no seu ambiente de trabalho e a
implementação de medidas que garantam a biossegurança dos enfermeiros, no
exercício da sua prática clínica.
Framework: Currently, we are facing a reality so far unknown for all of us. The Covid-19 pandemic has required an unprecedent collaboration and support cooperation about health issues related to safety at a global level. The healthcare professional’s vulnerabilities, including Specialist Nurses in Maternal and Obstetric Health (EEESMO) have become increasingly more evident on their daily practice. For that reason, is urgent to reflect about the questions that affect the biosafety of EEESMO in a hospital context. Objectives: The developed report reflects my path and has two main goals: to describe the development and improvement of specific and common skills of the EEESMO in all grounds of their apprenticeship; account the different strategies implemented in a Labour Ward in order to improve the EEESMO’s biosafety during the Covid-19 pandemic. Methodology: Descriptive Exploratory Research. It was taken a questionnaire for data collection as well my perception through observation during the healthcare provision. On a first stage, a Scoping Review was carried out, which allowed me to map the acknowledgment and the scientific evidence, during care interaction. Later, on a second stage, my observation was paramount to acknowledge the context of care, to become aware of the Contingency Plan and to identify the human and material resources. On a third stage, the questionnaire built with the help of Google Forms and available on social networks, was applied to a convenience sample of 32 EEESMO, which perform their duties on Labour Wards. On the fourth stage, after proper analysis and reflexion, I present some suggestions to maximize the EEESMO biosafety and started a disclosure for results. Results: The contingency plan for the Obstetrics and Gynaecology Urgent Care Department is recognized by the majority of the intervenients, however, regarding the testing procedure for both parturient and companion almost half of the participants are unaware of it. In regard to the implemented measures for 9 environmental control, the vast majority of nurses is aware of them and adhered to the work environment safety measures. However, the use of disposable clothing worn during the delivery of care to a suspected or infected parturient is the most missed measure. Considering the management of suspicious cases, the EEESMO knows and apply the defined in the Action Flowchart, but some consider that is not available for rapid consultation in every parturient services location. In the management of human resources, the inquired people acknowledged that there are enough healthcare professionals to ensure direct care for suspected and infected pregnant women, but when inquired about the availability of EEESMO for that same purpose, they already recognize it as a limited resource. Another critical aspect in this extent is that experienced healthcare professionals are not always available to help with the donning and the doffing of PPE in critical isolation areas, but the fact that these materials are available and ready to use in the designated areas is widely recognized. Some nurses assume that they don’t meticulously follow the “5 Moments” to the hand sanitizing procedure. The programming for activities that promote this training and technical procedures, aiming to reduce the risk level and exposure was considered insufficient. Conclusion: Although is yet unknown the real dimension of healthcare professionals infected during Covid-19 pandemic, the training compliance is mandatory to cope with the risk and hazards involved on their work environment and the implementation of measures to guarantee the biosafety of nurses in the exercise of their clinical practice.
Framework: Currently, we are facing a reality so far unknown for all of us. The Covid-19 pandemic has required an unprecedent collaboration and support cooperation about health issues related to safety at a global level. The healthcare professional’s vulnerabilities, including Specialist Nurses in Maternal and Obstetric Health (EEESMO) have become increasingly more evident on their daily practice. For that reason, is urgent to reflect about the questions that affect the biosafety of EEESMO in a hospital context. Objectives: The developed report reflects my path and has two main goals: to describe the development and improvement of specific and common skills of the EEESMO in all grounds of their apprenticeship; account the different strategies implemented in a Labour Ward in order to improve the EEESMO’s biosafety during the Covid-19 pandemic. Methodology: Descriptive Exploratory Research. It was taken a questionnaire for data collection as well my perception through observation during the healthcare provision. On a first stage, a Scoping Review was carried out, which allowed me to map the acknowledgment and the scientific evidence, during care interaction. Later, on a second stage, my observation was paramount to acknowledge the context of care, to become aware of the Contingency Plan and to identify the human and material resources. On a third stage, the questionnaire built with the help of Google Forms and available on social networks, was applied to a convenience sample of 32 EEESMO, which perform their duties on Labour Wards. On the fourth stage, after proper analysis and reflexion, I present some suggestions to maximize the EEESMO biosafety and started a disclosure for results. Results: The contingency plan for the Obstetrics and Gynaecology Urgent Care Department is recognized by the majority of the intervenients, however, regarding the testing procedure for both parturient and companion almost half of the participants are unaware of it. In regard to the implemented measures for 9 environmental control, the vast majority of nurses is aware of them and adhered to the work environment safety measures. However, the use of disposable clothing worn during the delivery of care to a suspected or infected parturient is the most missed measure. Considering the management of suspicious cases, the EEESMO knows and apply the defined in the Action Flowchart, but some consider that is not available for rapid consultation in every parturient services location. In the management of human resources, the inquired people acknowledged that there are enough healthcare professionals to ensure direct care for suspected and infected pregnant women, but when inquired about the availability of EEESMO for that same purpose, they already recognize it as a limited resource. Another critical aspect in this extent is that experienced healthcare professionals are not always available to help with the donning and the doffing of PPE in critical isolation areas, but the fact that these materials are available and ready to use in the designated areas is widely recognized. Some nurses assume that they don’t meticulously follow the “5 Moments” to the hand sanitizing procedure. The programming for activities that promote this training and technical procedures, aiming to reduce the risk level and exposure was considered insufficient. Conclusion: Although is yet unknown the real dimension of healthcare professionals infected during Covid-19 pandemic, the training compliance is mandatory to cope with the risk and hazards involved on their work environment and the implementation of measures to guarantee the biosafety of nurses in the exercise of their clinical practice.
Description
Keywords
Enfermagem obstétrica Pandemias COVID-19 Contenção de riscos biológicos Hospitais