O Acompanhante na maternidade: concepções dos profissionais de saúde

Abstract

Trata-se de um estudo exploratório-descritivo desenvolvido no cenário obstétrico de uma maternidade pública estadual de Santa Catarina. Teve como objetivos identificar e analisar as concepções dos profissionais de saúde acerca da presença do acompanhante. Os sujeitos foram 47 profissionais de saúde que atuavam nos setores de alojamento conjunto e bloco cirúrgico, englobando 6 enfermeiros, 6 médicos obstetras, 7 médicos pediatras, 7 técnicos e 21 auxiliares de enfermagem. A coleta de dados ocorreu no período de fevereiro a junho de 2009, utilizando-se a entrevista semiestruturada. A análise dos dados foi realizada seguindo quatro processos genéricos: apreensão, síntese, teorização e transferência. Desta análise emergiram cinco categorias que representam as concepções dos profissionais: 1) Conhecimento sobre a legislação que envolve o acompanhante no parto e nascimento; 2) Vantagens/justificativas para a presença do acompanhante; 3) Características do acompanhamento; 4) Dificuldades para a inclusão do acompanhante; e 5) Sugestões para a inclusão do acompanhante. Os resultados apontaram que a maioria dos profissionais não se considera conhecedor da legislação que envolve o acompanhante no processo do nascimento. Ao mesmo tempo em que os profissionais identificam efeitos positivos do acompanhamento às mulheres, aos recém-nascidos, aos próprios profissionais e no sentido de propiciar a reflexão do parto como um evento sócio-cultural. As características que os mesmos consideram como sendo apropriadas para a pessoa que fará o acompanhamento é conflitante com tais benefícios, pois indicam um sujeito quase irreal, residindo apenas no imaginário dos profissionais. As dificuldades para a inserção do acompanhante residem na resistência de alguns profissionais médicos e da equipe de enfermagem de nível médio, interferindo na concretização desta presença na instituição, revelando a existência de conflitos entre os profissionais de saúde; na persistência do modelo assistencial centrado na biomedicina; também na estrutura física da instituição que não é considerada inteiramente 8 adequada. Para a superação dessas dificuldades sugerem que sejam realizadas mudanças institucionais, adequando as instalações físicas, estruturais e administrativas para viabilizar a elaboração de normas e rotinas que permitam a plena inserção do acompanhante. Do mesmo modo, sugeriram modificações na conduta profissional, reforçando a necessidade de participação mais ativa nas discussões coletivas, visando reflexões sobre as concepções vigentes com relação ao acompanhante e o real desempenho de uma prática voltada à efetiva participação do acompanhante, como componente essencial para a mudança do paradigma assistencial. Também recomendaram que o acompanhante fosse #orientado# para que sua participação seja efetiva. Isso, por um lado, se constitui num benefício, mas, por outro, assinala uma temeridade, pela possibilidade de se constituir em mais uma forma de impedimento para o acompanhamento. A compreensão sobre as concepções, que os profissionais de saúde possuem a respeito da presença do acompanhante no parto e no nascimento institucionalizado, contribui para a elaboração de estratégias, as quais podem auxiliar na concretização das premissas da humanização da assistência ao parto e nascimento. Tal postura garantirá que os direitos sociais, legais, afetivos e existenciais dos usuários sejam respeitados.

This is an exploratory-descriptive study developed in the obstetric setting of a public maternity in the state of Santa Catarina that aimed to identify and analyze the concepts of health professionals about the presence of the companion. The subjects were 47 health professionals who worked in the fields of rooming-in and the surgical room set, composed by 6 nurses, 6 obstetricians 7 pediatricians, 7 technicians and 21 nursing assistants. The data collection happened from February to June 2009, using a semi-structured interview. The data analysis was performed following four generic processes: apprehension, synthesis, theory and transfer. In a from that analysis five categories representing the point of views of health care professionals occured: 1) Knowledge of the legislation about the companion during parturition and birth, 2) Advantages / justifications for the presence of the companion, 3) Companion#s characteristics; 4) Difficulties for the inclusion of a companion , and 5) Suggestions for the inclusion of a companion. The results showed that the majority of the professionals is not considered knowledgeable for the legislation involving the companion during the birth process. While the professionals identify positive effects of the accompaniment for women, for the newborn for the health professionals and to promote reflection about birth as a socio-cultural event, the characteristics that they believe to be appropriate for the person who Will be the companion generates conflicts with such benefits, because these characteristics indicate a subject almost unreal, living only in the imagination of the professionals. The difficulties in the practice of including the companion resides in the resistance of some medical professionals and staff of nursing assistants, interfering in the implementation of this presence in the institution, and revealing the existence of conflicts among health care professionals, in the persistence of the health care model centered on biomedicine, and in the physical structure of the institution is not considered entirely appropriate. To overcome these difficulties they suggested that institutional changes would be made, enhancing the physical, structural and administrative, facilities in order to make it the elaboration of rules and routines that 10 will allow full insertion of an accompanying. Similarly, suggested changes in professional behavior, reinforcing the need for more active participation in collective discussions, looking up for comments on the prevailing concepts of the companion and the actual performance of a practice dedicated to the effective participation of a partner as an essential component for change in the health care paradigm. Also recommended that the accompanying was "oriented" so that their participation would be more "effective." This, constitutes a benefit, but on the other hand, indicates a fear, the possibility that it can constitute another form of being unable to follow. The understanding of the concepts that health care professionals have about the presence of a companion during parturition and birth institutionalized contributes to the development of strategies that can assist in achieving the premises of humanization of parturition and birth, and ensure that the social rights, legal, in to emotional and existential feelings of the users are respected.This is an exploratory-descriptive study developed in the obstetric setting of a public maternity in the state of Santa Catarina that aimed to identify and analyze the concepts of health professionals about the presence of the companion. The subjects were 47 health professionals who worked in the fields of rooming-in and the surgical room set, composed by 6 nurses, 6 obstetricians 7 pediatricians, 7 technicians and 21 nursing assistants. The data collection happened from February to June 2009, using a semi-structured interview. The data analysis was performed following four generic processes: apprehension, synthesis, theory and transfer. In a from that analysis five categories representing the point of views of health care professionals occured: 1) Knowledge of the legislation about the companion during parturition and birth, 2) Advantages / justifications for the presence of the companion, 3) Companion#s characteristics; 4) Difficulties for the inclusion of a companion , and 5) Suggestions for the inclusion of a companion. The results showed that the majority of the professionals is not considered knowledgeable for the legislation involving the companion during the birth process. While the professionals identify positive effects of the accompaniment for women, for the newborn for the health professionals and to promote reflection about birth as a socio-cultural event, the characteristics that they believe to be appropriate for the person who Will be the companion generates conflicts with such benefits, because these characteristics indicate a subject almost unreal, living only in the imagination of the professionals. The difficulties in the practice of including the companion resides in the resistance of some medical professionals and staff of nursing assistants, interfering in the implementation of this presence in the institution, and revealing the existence of conflicts among health care professionals, in the persistence of the health care model centered on biomedicine, and in the physical structure of the institution is not considered entirely appropriate. To overcome these difficulties they suggested that institutional changes would be made, enhancing the physical, structural and administrative, facilities in order to make it the elaboration of rules and routines that 10 will allow full insertion of an accompanying. Similarly, suggested changes in professional behavior, reinforcing the need for more active participation in collective discussions, looking up for comments on the prevailing concepts of the companion and the actual performance of a practice dedicated to the effective participation of a partner as an essential component for change in the health care paradigm. Also recommended that the accompanying was "oriented" so that their participation would be more "effective." This, constitutes a benefit, but on the other hand, indicates a fear, the possibility that it can constitute another form of being unable to follow. The understanding of the concepts that health care professionals have about the presence of a companion during parturition and birth institutionalized contributes to the development of strategies that can assist in achieving the premises of humanization of parturition and birth, and ensure that the social rights, legal, in to emotional and existential feelings of the users are espected.