Alterações estruturais para o enfrentamento da COVID-19 em hospitais universitários
Data
2023-03-13
Autores
Lima, Thainara Adrielli Bezerra 
Orientadores
Cunha, Isabel Cristina Kowal Olm
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Objetivos: Analisar as alterações estruturais para o enfrentamento da covid-19 em hospitais universitários, por meio da identificação da estrutura física, recursos humanos, materiais e financeiros. Métodos: Pesquisa de estudo de caso misto com a estratégia de triangulação concomitante. Pesquisa quantitativa com abordagem descritiva e a pesquisa qualitativa com abordagem exploratória descritiva. Os dados foram coletados no período de abril de 2021 a abril de 2022, no Banco de Dados do Projeto Multicêntrico “Avaliação do cuidado de enfermagem a pacientes com COVID 19 em hospitais universitários brasileiros” e diziam respeito a dois hospitais universitários vinculados a Universidades Públicas Federais. Na etapa quantitativa foram analisados documentos primários e secundários em duas etapas: leitura com o descarte de alguns e leitura e interpretação dos dados. Na etapa qualitativa foram analisadas as entrevistas de duas pessoas da alta gestão de cada hospital. As entrevistas foram processadas no software IRaMuTeQ (Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires). O processo de análise dos dados na etapa mista seguiu a estratégia de triangulação concomitante, comparando os dados quantitativos com os dados qualitativos, buscando confirmar os resultados. Resultados: Na etapa quantitativa identificaram-se 5 categorias: 1-Estrutura física; 2-Recursos humanos; 3-Recursos materiais; 4-Recursos financeiros e 5-Fluxos. Na etapa qualitativa foram identificadas 6 Classes: 1-Capacitação de novos profissionais e implementação de estratégias de educação permanente; 2-Desafios relacionados ao quantitativo de recursos humanos nos setores de COVID-19; 3-Reestruturação do serviço hospitalar diante dos diferentes cenários da pandemia; 4-Recursos material, humano e financeiro nos hospitais universitários; 5-Organização do serviço hospitalar no período da pandemia e 6-Plano de contingência/plano de ação e Comitê de Crise diante da emergência de COVID-19. Na integração dos dados, foi identificado que houveram diversas correlações entre as categorias e as classes, evidenciando que os hospitais reorganizaram seus recursos físicos, humanos, materiais, financeiros e seus fluxos de atendimento. As classes que não apresentaram correlações com as categorias, contudo, demonstraram que os hospitais conduziram de forma diferente a gestão da 1ª e 2ª onda da pandemia e não produziram um plano de contingência para todos os serviços do hospital, mas nas reuniões do gabinete de crise organizavam as ações, realizavam monitoramento diário e avaliavam nas reuniões. Conclusão: Ambos os hospitais se organizaram desde o início da pandemia para atender as demandas da pandemia. A análise da estrutura mostrou que estes organizaram setores com leitos específicos para o atendimento na pandemia; realizaram contratação de profissionais, organizaram educações permanentes; receberam recursos financeiros, mas diante do cenário da pandemia apresentaram dificuldades na compra de insumos; realizaram modificações nos fluxos de atendimento e organizaram um gabinete de crise. Foram referência no cuidado desses pacientes e seguiram ações semelhantes às de outras instituições de saúde no contexto nacional e internacional. Ainda, os dados demonstraram quanto a necessidade destes hospitais na realização de um plano de contingência para emergências em saúde pública.
Objectives: To analyze the structural changes to face covid-19 in university hospitals, by identifying the physical structure, human, material and financial resources. Methods: Mixed case study research with concomitant triangulation strategy. Quantitative research with a descriptive approach and qualitative research with an exploratory descriptive approach. Data were collected from April 2021 to April 2022, in the Database of the Multicentric Project “Assessment of nursing care for patients with COVID 19 in Brazilian university hospitals” and related to two university hospitals linked to Federal Public Universities . In the quantitative stage, primary and secondary documents were analyzed in two steps: reading with discarding some and reading and interpretation of data. In the qualitative stage, the interviews of two people from the top management of each hospital were analyzed. The interviews were processed using the IRaMuTeQ software (Interface de R pour les Analyzes Multidimensionnelles de Textes et de Questionnaires). The data analysis process in the mixed stage followed the concomitant triangulation strategy, comparing quantitative data with qualitative data, seeking to confirm the results. Results: In the quantitative stage, 5 categories were identified: 1-Physical structure; 2-Human resources; 3-Material resources; 4-Financial Resources and 5-Flows. In the qualitative stage, 6 Classes were identified: 1-Training of new professionals and implementation of permanent education strategies; 2-Challenges related to the quantity of human resources in the COVID-19 sectors; 3-Restructuring of the hospital service in the face of different pandemic scenarios; 4-Material, human and financial resources in university hospitals; 5-Hospital service organization during the pandemic period and 6-Contingency plan/action plan and Crisis Committee in the face of the COVID-19 emergency. In data integration, it was identified that there were several correlations between categories and classes, showing that hospitals reorganized their physical, human, material, financial resources and their service flows. The classes that did not show correlations with the categories, however, demonstrated that the hospitals managed the 1st and 2nd wave of the pandemic differently and did not produce a contingency plan for all hospital services, but in the crisis cabinet meetings they organized the actions, carried out daily monitoring and evaluated in the meetings. Conclusion: Both hospitals organized themselves since the beginning of the pandemic to meet the demands of the pandemic. The analysis of the structure showed that they organized sectors with specific beds for assistance during the pandemic; hired professionals, organized permanent education; received financial resources, but faced with the pandemic scenario, they had difficulties in purchasing inputs; they made changes to the service flows and organized a crisis office. They were a reference in the care of these patients and followed actions similar to those of other health institutions in the national and international context. Furthermore, the data demonstrated the need for these hospitals to carry out a contingency plan for public health emergencies.
Objectives: To analyze the structural changes to face covid-19 in university hospitals, by identifying the physical structure, human, material and financial resources. Methods: Mixed case study research with concomitant triangulation strategy. Quantitative research with a descriptive approach and qualitative research with an exploratory descriptive approach. Data were collected from April 2021 to April 2022, in the Database of the Multicentric Project “Assessment of nursing care for patients with COVID 19 in Brazilian university hospitals” and related to two university hospitals linked to Federal Public Universities . In the quantitative stage, primary and secondary documents were analyzed in two steps: reading with discarding some and reading and interpretation of data. In the qualitative stage, the interviews of two people from the top management of each hospital were analyzed. The interviews were processed using the IRaMuTeQ software (Interface de R pour les Analyzes Multidimensionnelles de Textes et de Questionnaires). The data analysis process in the mixed stage followed the concomitant triangulation strategy, comparing quantitative data with qualitative data, seeking to confirm the results. Results: In the quantitative stage, 5 categories were identified: 1-Physical structure; 2-Human resources; 3-Material resources; 4-Financial Resources and 5-Flows. In the qualitative stage, 6 Classes were identified: 1-Training of new professionals and implementation of permanent education strategies; 2-Challenges related to the quantity of human resources in the COVID-19 sectors; 3-Restructuring of the hospital service in the face of different pandemic scenarios; 4-Material, human and financial resources in university hospitals; 5-Hospital service organization during the pandemic period and 6-Contingency plan/action plan and Crisis Committee in the face of the COVID-19 emergency. In data integration, it was identified that there were several correlations between categories and classes, showing that hospitals reorganized their physical, human, material, financial resources and their service flows. The classes that did not show correlations with the categories, however, demonstrated that the hospitals managed the 1st and 2nd wave of the pandemic differently and did not produce a contingency plan for all hospital services, but in the crisis cabinet meetings they organized the actions, carried out daily monitoring and evaluated in the meetings. Conclusion: Both hospitals organized themselves since the beginning of the pandemic to meet the demands of the pandemic. The analysis of the structure showed that they organized sectors with specific beds for assistance during the pandemic; hired professionals, organized permanent education; received financial resources, but faced with the pandemic scenario, they had difficulties in purchasing inputs; they made changes to the service flows and organized a crisis office. They were a reference in the care of these patients and followed actions similar to those of other health institutions in the national and international context. Furthermore, the data demonstrated the need for these hospitals to carry out a contingency plan for public health emergencies.