Promoção da saúde em ambiente hospitalar e as práticas de cuidado de enfermeiros

Abstract

Health promotion is a process of empowering the community to work on improving their quality of life and health, including greater participation and control of users. The adoption of the hospital scenario as an inducer of health promotion implies incorporating an expanded concept of health and care. In this study, the promotion of patient care quality is expressed in many ways, including the elements of communication, health education, respect for beliefs, skills and care directed to the needs of the patient regarding their illness. So that, this study is guided by the question: What care actions performed by nurses represent actions to promote health in the hospital context according to the Budapest Declaration guideline? The aim of the research is to analyze nurse's care practices regarding the health promotion actions in the context of teaching hospitals. Mixed research type study, carried out in 3 teaching hospitals in Recife-PE, including a sample of 68 nurses from medical and surgical clinic wards. A Likerttype questionnaire identifying health promotion actions in a hospital environment was constructed and validated by judges. The questionnaire identified the prevalence of the domain D "quality and offer of information and communication with the patient" among the actions most performed by the hospital nurse. Based on the findings of the questionnaire, focus groups were conducted and three categories were identified: "Hospital environment: limiting factors for health promotion"; "Teamwork and the nurse as a mediator" and "The promotion of health and the nurse in the hospital environment." The actions carried out by nurses referred to the stimulation of the active role of the patient, multidisciplinary attention and quality of communication and information which refers to the role of mediator attributed to nurses in the hospital environment. Creating supportive environments was not widely mentioned in the study as a part of the patient care. The work overload and the lack of materials were highlighted on the nurses' speeches, demonstrating the impact of hospital management on patient care. Leadership, autonomy, empowerment, and decision making were valued by nurses as attributes of their work. The nursing care does not represent deliberate actions based on knowledge and skills supported by the precepts of health promotion in the hospital context. These actions are focused on patient’s disease recovering. It is important to develop education plans in vocational training that covers health promotion at all levels of care, since it is not limited to the field of primary care. The continuous education program in the hospitals should include discussions about competences and abilities of nurses and other professionals for health promotion in hospital context.