A percepção do fisioterapeuta sobre as barreias à mobilização precoce em unidade de terapia intensiva
Data
2021-02-22
Autores
Capozzoli, Bruna 
Orientadores
Yamauchi, Liria Yuri
Tipo
Trabalho de conclusão de curso
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Pacientes internados em unidade de terapia intensiva (UTI) geralmente ficam restritos ao leito, o que leva à imobilidade e suas consequências, como alterações sistêmicas e fraqueza muscular, incluindo a musculatura respiratória, muitas vezes dependente de ventilação mecânica (VM). A mobilização precoce (MP) é caracterizada pela prática de exercícios ativos ou utilização de estimulação elétrica neuromuscular nos primeiros dois a cinco dias após a admissão na unidade. Essa mobilização no paciente crítico é comprovadamente segura e eficaz, prevenindo complicações e diminuindo o tempo de permanência deste no hospital. Apensar disso, na prática clínica são encontradas diversos fatores limitantes e barreiras para a realização da MP, podendo essas ser classificadas como barreiras institucionais, profissionais ou relacionadas ao paciente. Tendo em vista essas informações, esse estudo tem como objetivo primário identificar essas barreiras em hospitais nas cidades de Santos e São Paulo, e como objetivo secundário, fazer uma comparação de ambas as cidades. Trata-se de um estudo transversal realizado por meio de entrevistas de fisioterapeutas que trabalham em UTI em hospitais públicos e privados das cidades citadas. Para entrevistá-los foi elaborado um questionário autoexplicativo, com glossário e questões de múltipla escolha. Os fisioterapeutas foram convidados a participar da pesquisa em seu próprio local de trabalho, sem avisos prévios. Aos que aceitaram participar, foi lhes explicado sobre do que se tratava a entrevista e uma breve contextualização da mesma. No total, quarenta e sete fisioterapeutas atuantes em UTI de quatro hospitais foram entrevistados, a maioria dos participantes foi do sexo feminino, jovens, especialistas ou residentes. A grande maioria dos profissionais tem uma visão positiva sobre a MP, entendendo seus benefícios e conceitos. Classificamos as barreiras como relacionadas à instituição, à equipe multiprofissional ou ao paciente. A barreira percebida mais prevalente, em ambas as cidades, foi a instabilidade clínica. Como barreiras institucionais os pedidos rotineiros de repouso e a falta de equipamentos foram os principais apontamentos em Santos e São Paulo, respectivamente. As barreiras relacionadas à equipe multidisciplinar foram classificadas de acordo com a perspectiva do fisioterapeuta de como cada membro da equipe colaborava para a existência da mesma. As preocupações com a segurança da MP foi identificada como barreira relacionada a todos os profissionais. Concluímos que a principal barreira encontrada nesse estudo foi a instabilidade clínica, independente do local. Para os santistas, pedidos rotineiros de repouso, preocupações com a segurança e falta de prioridade e comunicação limitam o trabalho do fisioterapeuta, enquanto para os paulistanos, os equipamentos insuficientes, o risco de deslocamento de dispositivos ou acessos e a falta de prioridade para mobilização desses pacientes são as barreiras mais apontadas.
Patients in the intensive care unit (ICU) are usually restricted to the bed, which leads to immobility and its consequences, such as systemic changes and muscle weakness, including respiratory musculature, often dependent on mechanical ventilation (MV). Early mobilization (EM) is characterized by the practice of active exercises or the use of neuromuscular electrical stimulation in the first two to five days after admission to the unit. Critically ill patients’ mobilization is proven to be safe and effective, preventing complications and decreasing their length of staying in the hospital. However, in clinical practice are found several limiting factors and barriers to the realization of the EM, which can be classified as institutional, professional, or patient barriers. Thus, this study presents two goals. The first one is to identify these barriers at hospitals in the cities of Santos and São Paulo, and the second one is to make a comparison of both cities. It is a cross-sectional study conducted through interviews with physiotherapists (PT) who work in the ICU at public and private hospitals in the cities mentioned. In order to interview them, a self-explanatory survey was developed, with a glossary and multiple-choice questions. Those who agreed to participate were explained what the interview was about and its brief contextualization. In total, forty-seven PT working in the ICU from four hospitals were interviewed, most of the participants were female, young, specialists, or residents. The vast majority of professionals have a positive view on EM, understanding its benefits and concepts. The barriers were classified as related to the institution, the multidisciplinary team, or the patient. The most prevalent noted barrier in both cities was clinical instability. As institutional barriers, routine rest requests and lack of equipment were the main points in Santos and São Paulo, respectively. The barriers related to the multidisciplinary team were classified according to the PT's perspective of how each team member contributes to its existence. Concerns about EM security were identified as a barrier related to all professionals. It was concluded that the main barrier found in this study was clinical instability, regardless of location. For Santos’ PT, routine rest requests, safety concerns, and lack of priority and communication limit the PT's work. On the other hand, for São Paulo’s PT, the lack of equipment, the risk of displacement of devices or accesses and priority for mobilizing these patients are the most noted barriers.
Patients in the intensive care unit (ICU) are usually restricted to the bed, which leads to immobility and its consequences, such as systemic changes and muscle weakness, including respiratory musculature, often dependent on mechanical ventilation (MV). Early mobilization (EM) is characterized by the practice of active exercises or the use of neuromuscular electrical stimulation in the first two to five days after admission to the unit. Critically ill patients’ mobilization is proven to be safe and effective, preventing complications and decreasing their length of staying in the hospital. However, in clinical practice are found several limiting factors and barriers to the realization of the EM, which can be classified as institutional, professional, or patient barriers. Thus, this study presents two goals. The first one is to identify these barriers at hospitals in the cities of Santos and São Paulo, and the second one is to make a comparison of both cities. It is a cross-sectional study conducted through interviews with physiotherapists (PT) who work in the ICU at public and private hospitals in the cities mentioned. In order to interview them, a self-explanatory survey was developed, with a glossary and multiple-choice questions. Those who agreed to participate were explained what the interview was about and its brief contextualization. In total, forty-seven PT working in the ICU from four hospitals were interviewed, most of the participants were female, young, specialists, or residents. The vast majority of professionals have a positive view on EM, understanding its benefits and concepts. The barriers were classified as related to the institution, the multidisciplinary team, or the patient. The most prevalent noted barrier in both cities was clinical instability. As institutional barriers, routine rest requests and lack of equipment were the main points in Santos and São Paulo, respectively. The barriers related to the multidisciplinary team were classified according to the PT's perspective of how each team member contributes to its existence. Concerns about EM security were identified as a barrier related to all professionals. It was concluded that the main barrier found in this study was clinical instability, regardless of location. For Santos’ PT, routine rest requests, safety concerns, and lack of priority and communication limit the PT's work. On the other hand, for São Paulo’s PT, the lack of equipment, the risk of displacement of devices or accesses and priority for mobilizing these patients are the most noted barriers.
Descrição
Citação
CAPOZZOLI, Bruna. A percepção do fisioterapeuta sobre as barreias à mobilização precoce em unidade de terapia intensiva. 2021. 37f. Trabalho de conclusão de curso de graduação (Fisioterapia) - Instituto de Saúde e Sociedade, Universidade Federal de São Paulo, Santos, 2021.