Análise institucional da prática profissional da enfermagem em cena a segurança do paciente na administração de medicamentos na psiquiatria

Abstract

Introduction: Medication administration is the responsibility of the nursing team and requires specific knowledge in observing all stages of its process. When carried out in a compliant and pertinent manner, following the good practices established for this care, it allows quality care, free from damage and with a favorable and safe care outcome for the patient. Objective: This research aimed to analyze the professional practice of the nursing team related to medication administration, in a psychiatric unit of a public general hospital in Belo Horizonte, Minas Gerais. Methodology: This is an intervention research with a qualitative approach, based on the principles of the theoretical framework of Institutional Analysis, in its socio-clinical aspect for analyzing professional practice. This research was carried out in a public hospital in Belo Horizonte, Minas Gerais, with a capacity for 249 beds. The study setting was the psychiatric unit with capacity for 20 patients and the participants in the research were 19 professionals from the unit's nursing team. In order to produce the data, ten socio-clinical meetings were held from May 23rd to June 21st 2023 and one restitution meeting With the aim of operationalizing these meetings, a device was created using the professional practice analysis technique called GEASE (Groupe Entrainement de Analyse de Situations Éducatives), which was adapted for this research. Furthermore, the researcher's diary also served as a technique for data production. The socio-clinical meetings lasted an average of 80 minutes, and a total time of 13 hours and 26 minutes. The collected data were transcribed and organized based on an approach to the main concepts of AI and the 8 characteristics of the Institutional Socioclinic, in order to understand the organizational aspects regarding the medication administration process and understand the professional practice of the nursing team. The Ethics and Research Committees of the Federal University of Minas Gerais (COEP/UFMG) and the hospital where the study was carried out approved this project under the protocol number 5.783.237. Results and Discussion: The order for this research was corroborated by the demands brought by the participants in the socio-clinical meetings, who were interested in intervention research due to the possibility of producing knowledge and transformations in professional and collective practice. The process of analyzing implications led the group to talk about their feelings of fear, frustration, embarrassment, traumatic situations and discomfort that were revealed in contexts related to professional practice, their values and affections, beyond their limits as human beings. In this investigation, two analyzers emerged: “Hospital Pharmacy and its processes” and “Management Model established in the unit”, which revealed institutional contradictions in the medication dispensing process, emphasizing power relations, the centralized management mode, the lack of effective communication and mobilization of nursing categories to fight for their rights and the valorization of the profession. The hospital context in which the psychiatric unit is located and its interference with nursing work are revealed as conditions that contribute to the possibility of errors and failures in the medication administration process such as the team profile, staff shortages, impersonality in the interpersonal relationships and communication between doctors and nurses, inadequate working environment conditions, fear of punishment in communicating and notifying the occurrence of events/incidents related to health care and the lack of specific training that meets the specific demands of the unit. Final considerations: The technical product constitutes the intervention research itself, based on the knowledge produced collectively with the nursing team, as a possibility of transforming the reality perceived by everyone involved in the study, in the search for safe care for patients. Furthermore, a Technical Report was prepared to support the unit's coordination in understanding and analyzing the results obtained, highlighting the demands presented by the nursing team and the proposals produced collectively together with the researcher.