O gerenciamento do processo assistencial das gestantes durante a pandemia da COVID-19: uma análise a partir do pensamento complexo

• Autor(a) principal: Santana, Claudia da Silva Teixeira de
• Data de Publicação: 2023
• Outros Autores: [e-mail]
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: Biblioteca Digital de Teses e Dissertações da UERJ
• Texto Completo: http://www.bdtd.uerj.br/handle/1/20386
• topic: Health Services Administration; Maternity Hospital; Pregnant Women; Complex Adaptive System; COVID-19; Administração dos cuidados; Maternidades; Gestantes; Sistema Adaptativo Complexo; COVID-19; CIENCIAS DA SAUDE::ENFERMAGEM

The context of the pandemic has demanded changes in the assistential care for pregnant women at the hospitals, but rights restrictions, complications, and maternal deaths due to COVID-19 have been reported. The research's objective was to discuss the management of the process of healthcare assistance for pregnant women during the COVID-19 pandemic from the perspective of healthcare workers. The specific objectives were: describing the management experiences and strategies of pregnant women during the COVID-19 pandemic, according to healthcare workers; identifying the challenges and potentialities of healthcare assistance management during the pandemic from said professionals' perspective. An exploratory descriptive qualitative research was conducted with 19 nurses and doctors who were on the COVID-19 Frontline for obstetrician healthcare in metropolitan region of the state of Rio de Janeiro. The interviews were semi-structured, with 18 of them being in person and one of them being online, from March to July 2022. The thematic analysis was based on the theoretical assumption of complex thinking and a complex adaptive system. The study met the ethical laws of research with human beings. Three theme categories were built: experiences of healthcare workers with the COVID-19 pandemic; management strategies to handle the pandemic; and challenges and potentialities of healthcare assistance management during COVID-19. The interviewees initially feared the virus due to their lack of knowledge about the disease and the high risk of contagion. The management strategies were: creating and implementing protocols; qualifying the staff; using group chats and educational videos; organizing adapted environments for suspected and confirmed cases; adapting processes and resources; planning for the contingency of resources and individual protection equipment and providing incentives for the use of protective measures by the team and clients. The challenges faced were: inadequate infrastructure; unprepared professionals, limited adherence to protective measures, especially after the vaccination against COVID-19, increased demand for healthcare, and work overload. The potentialities identified were: standardization of procedures, self-organization of the institution, and improvements in cohesion, cooperation, communication, and feedback from agents. The management of the healthcare assistance process performed adaptations, improvisations, and feed-back of the maternal care system due to the unpredictability caused by the pandemic, configuring a complex adaptive system that provided adaptability, self-organization, and learning for the institution and the agents, but some changes were not permanent. The management of health and care has to invest in the capacity of maternal care for situations of disaster and sanitary crisis in order to improve maternal healthcare skills and the system's responses to these situations, reducing damages and deaths and obtaining more effective and safer results for pregnant women.