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Access, suspension of elective care, and emergency prioritization
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Understanding the suspension of elective care and prioritization of emergencies (1) |
My difficulty is dealing with patients who don't understand what urgent and emergency cases are and want to carry out elective treatment anyway. And sometimes we're judged by them who think we don't want to provide care (R. 27). |
| Distance between health units and people's homes (1) |
The lack of understanding on the part of the population, which does not accept the discontinuation of elective care, the displacement of patients for care far from their reference units. The lack of physical structure and the lack of haste on the part of the service in adapting these structures to resume care (R. 2146). |
| feeling of powerlessness (2) |
The biggest dilemma is the feeling of putting out a fire, the desire to get back to treating all the individual's needs and not just that day's complaint. I feel that the pandemic has brought back a bit of that SUS of the INSS, which treats little, just “wipes ice” so that in a little while, when it returns to “normal”, it can extract those teeth that are now not being treated (R. 182). |
| Prioritization of cases and definition of urgency (2) |
When at that moment it's not an emergency, but, from clinical experience, the urgency will become real in a few days. Should I put myself or other members of the team at risk? (R. 110). |
| Misunderstanding and prejudice (2) |
A dental appointment without a procedure, for many professionals and patients, means that we have done nothing. Unconcealed demands for fewer clinical procedures (R. 188)”. “Discrimination from society for working; lack of awareness on the part of patients; unethical propaganda that we are vectors of Covid-19 (R. 59). |
| Worsening conditions or complexity of treatment (2) |
Not carrying out certain procedures so as not to expose myself or patients to risk and to deal with the possibility of worsening oral health problems, unrelated to the pandemic (R. 33). |
| Conflict over whether or not to provide elective care (2) |
Not seeing patients who don't qualify as urgent, according to the recommendations, and knowing that they may present an emergency until the end of the pandemic because I'm not treating the non-urgent case at the moment (R. 184). |
| Public demands (3) |
[...] the mental strain of hearing from some patients that the dentist doesn't want to work [...] (R. 80). |
| Fear of the pandemic situation (3) |
The uncertainty of information about Covid-19, together with the slowness of the dental service in times of pandemic, generates great anxiety. Especially about the future and when we will return to a possible “normal” or new normal... (R. 277). |
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Biosafety protocols and standards
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Definition of biosafety protocols (1) |
I believe that the greatest difficulty is the uncertainty of correctly conducting evidence-based care, due to the large amount of information (sometimes contradictory) and the unreliability of the sources (or the difficulty of finding the source and having sufficient knowledge to interpret whether the research or source is reliable) (R. 38). |
| Implementation of biosafety protocols (1) |
The biggest difficulty is that you try to impose safety protocols based on evidence, and colleagues and/or your boss don't care. This was the main reason I was off work for 42 days, but due to the financial situation, it was necessary to return to work and deal with these practices taking all due care at least in the individual sphere, since the collective is in chaos, which is to be expected as a reflection of the current political leadership in Brazil (R. 98). |
| Careless professionals or not following regulations (2) |
Some professionals making serious mistakes in relation to the protocols, some professionals on the team who don't take care of themselves or think this pandemic is a joke (R. 47). |
| Increased risks (2) |
Continuing to treat patients in the Covid-19 risk group (elderly people over 60) (R. 396). |
| Heterogeneous conduct (2) |
My main dilemma is that I have taken care of biosafety in every way and I hear that this is not necessary because other dentists are not doing it. I know of several colleagues who don't even use N95s, nor do they take time apart. They are working normally without any concern. I feel like reporting them... (R. 383). |
| Exhaustion from work (3) |
[...] the exhausting work of changing protective barriers, sanitizing and disinfecting the office between appointments; the discomfort in using the new PPE (the N95 mask has already ulcerated my nose) [....] (R. 80). |
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Contamination
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Care of contaminated patients (1) |
Seeing patients with respiratory symptoms, they don't stay at home, they come for care and the clinics force the CD to see them (R. 96). |
| Time between treatments (1) |
The waiting time for each patient to be seen. To avoid possible contamination (R. 07). |
| Patients who lie (2) |
Patients who omit having symptoms or contact with positive people, the asymptomatic and the lack of knowledge about the virus, where everything is still inconclusive (R. 701). |
| Careless patients (2) |
The lack of respect that the population has for us health professionals, often knowing that they are testing positive, they come to the clinic for a consultation in all sectors and then say that they are positive, so we are insecure (R. 333). |
| Spread and cross-contamination (2) |
Insecurity of being contaminated and passing it on (R. 524). |
| Fear of contamination (3) |
I feel afraid of contamination and I've already been away from work for 10 days due to anxiety symptoms (R. 753). |
| Post-care behavior (3) |
Fear of passing the disease on to my family, especially those in the risk group (R. 698). |
| Apprehension about their own health (3) |
Due to my risk condition, I became more anxious and worried, thinking about my family and my own health, and the concern to make the work environment the best it can be, so that patients and colleagues also have confidence in me, and that the Municipality can also count on my work in health (R. 250). |
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Work management
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Human resources (1) |
Adapting to the new routines: not being able to do the procedures that generate aerosol, doing them manually generates a lot more time, physical wear and tear and doesn't look as good; working without an ASB because she has been off work since the beginning of the pandemic because she belongs to the risk group (the manager hasn't replaced her with another professional); [. ...] not having any kind of guidance from the municipal management on how we should proceed (there is only one dentist colleague passing on the guidelines from the SES - Oral Health technical area) (R. 80). |
| Maintaining quality of care (1) |
Being able to provide good care without both parties being dissatisfied (R. 15). |
| Physical structure (1) |
Lack of physical structure in the dental office (very cramped and poorly ventilated, makeshift furniture, compressor that doesn't work properly and no vacuum pump), inadequate cleaning and garbage collection in the office (some days the cleaning lady doesn't clean the floor and doesn't collect the garbage), difficulty in getting more high- and low-rotation pens in adequate quantities to be able to treat all patients with sterilized pens, difficulty in getting enough isolation materials for all treatments, technical difficulty on the part of the assistant in how to treat safely without contaminating everything around during treatment and in dressing/dressing (R. 75). |
| Collaboration and teamwork (1) |
Dealing with multi-professionalism (R. 27). |
| Availability of material and structure for biosafety (1) |
Lack of absolute isolation material, having to reuse PPE (lab coats), providing elective and emergency care, the lack of PPE is one of the main difficulties I've encountered, as well as a poorly ventilated and small care room, making the disinfection process difficult. There is also a lack of training for general service professionals in cleaning the room between urgent and emergency care. Lack of PPE for urgent and emergency care (R. 61). |
| Cost, lack or inadequate use of PPE (2) |
Having to provide care with the same PPE because the suppliers don't produce or deliver it, thus having to reuse some PPE for a longer period of time, which creates a feeling of insecurity (R. 415). |
| Negligence or inadequate action by management towards workers (2) |
Disregard for the oral health professional, who is often ignored as a health professional (R. 139). |
| Conduct of the national government (2) |
Disagreement with the guidelines provided by governments, especially the Federal Government, which are often at odds with scientific evidence (R. 724). |
| Colleagues' neglect of patients (2) |
The laziness of some professionals who treat patients with disregard (R. 345). |
| Workers not informing on contaminated patients (2) |
The nursing team doesn't inform us of the names of users infected with Covid-19, so we often end up seeing or having contact with people who should be isolated and aren't (R. 407). |
| Misunderstandings or disagreements within the team (2) |
Pressure from other employees, from other categories not understanding the dental service and comparing it to medical consultations (R. 237). |
| Sufferings associated with the organization of work and the context of the pandemic (3) |
Anxiety, insomnia, frequent panic attacks, bouts of crying, not wanting to get out of bed to work (R.,178).” “It's more accurate to say that my work affects my emotional condition, because not being able to continue with the appointments has left me fragile. When I'm able to take care of a patient in a resolutive way, I'm fine. The fact that there is no vaccine or medicine for Covid-19 has made us very afraid to see patients at the unit. Professionals wear PPE and, in theory, know how to protect themselves, but the patients who come to us may not have the necessary information or understand it (R. 300). |
