Cultura de seguridad del paciente en el servicio de atención a domicilio

Oliveira, Patrícia Conceição; Santos, Odeony Paulo dos; Villela, Edlaine Faria de Moura; Barros, Patrícia de Sá

doi:10.1590/S1980-220X2018040703586

Brasil

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ORIGINAL ARTICLE • Rev. esc. enferm. USP 54 • 2020 • https://doi.org/10.1590/S1980-220X2018040703586 linkcopiar

Cultura de seguridad del paciente en el servicio de atención a domicilio

Autoría SCIMAGO INSTITUTIONS RANKINGS

Resumen

OBJETIVO Verificar las percepciones del equipo de salud sobre la cultura de seguridad del paciente en la atención domiciliar en un municipio de grande porte en la región Centro-Oeste del Brasil.

MÉTODO Estudio tipo Survey, con aplicación del Cuestionario de Actitudes de Seguridad y perfil profesional.

RESULTADOS De los 37 profesionales, la mayoría era del sexo femenino (n=32, 86,5%), vivía con su cónyuge (n=25, 67,6%), laboraba en régimen de trabajo supeditado al código de los funcionarios públicos (n=29; 78,4%) y tenía vínculo laboral (n=23; 62,2%). Se han verificado mayor puntaje mediano para satisfacción en el trabajo (80,0) y menor para percepción de la gerencia (31,8). Hubo una correlación negativa entre la carga horaria semanal y el trabajo en equipo (p=0,02). El clima de seguridad fue significativamente mayor entre profesionales supeditados a la Consolidación de Leyes Laborales en los dominios: clima de seguridad (p=0,001) y global (p=0,005). Los médicos presentaron mayor percepción del clima en el dominio seguridad cuando comparados a los profesionales de otras categorías (p=0,005). La edad fue positivamente asociada al clima en los dominios de seguridad (p=0,002), condiciones de trabajo (p=0,03) y global (p=0,04).

CONCLUSIÓN El trabajo en equipo y la satisfacción en el trabajo fueron puntuados como positivos y las acciones gerenciales, consideradas las principales fragilidades de la cultura de seguridad.

Descriptores: Seguridad del Paciente; Servicios de Atención de la Salud a Domicilio Cultura Organizacional; Servicios de Atención de la Salud a Domicilio; Administración de la Seguridad; Calidad de la Atención de Salud

Questions	SD/PD		N	PA/TA
Questions	n	%	n	%	n	%
Teamwork climate
1. Nurse input is well received in this service.	1	2.7	5	13.5	31	83.8
2. (R) It is difficult to speak openly in this service if I perceive a problem with patient care.	16	43.2	3	8.1	18	48.6
3. Disagreements are appropriately resolved in this service.	7	18.9	1	2.7	29	78.4
4. I have the support I need from other staff members to care for patients.	1	2.7	1	2.7	35	94.6
5. It is easy for professionals working in this service to ask questions when there is something they do not understand.	4	10.8	2	5.4	31	83.8
6. The physicians and nurses here work together as a well-coordinated team.	6	16.2	1	2.7	30	81.1
Safety climate
7. I would feel safe being treated here as a patient.	10	27.0	2	5.4	25	67.6
8. Medical errors are handled appropriately in this service.	6	16.2	8	21.6	23	62.2
9. I know the proper channels to direct questions regarding patient safety in this service.	21	56.8	3	8.1	13	35.1
10. I receive appropriate feedback about my performance.	22	59.5	3	8.1	12	32.4
11. (R) It is difficult to discuss errors in this service.	14	37.8	3	8.1	20	54.1
12. I am encouraged by my colleagues to report any patient safety concerns I may have.	7	18.9	2	5.4	28	75.7
13. The culture in this service makes it easy to learn from the errors of others.	12	32.4	1	2.7	24	64.9
Job satisfaction
15. I like my job.	2	5.4	1	2.7	34	91.9
16. Working here is like being part of a family.	2	5.4	2	5.4	33	89.2
17. This is a good place to work.	5	13.5	3	8.1	29	78.4
18. I am proud to work in this service.	4	10.8	1	2.7	32	86.5
19. Morale in this service is high.	20	54.1	5	13.5	12	32.4
Stress Recognition
20. When my workload becomes excessive, my performance is impaired.	8	21.6	-	-	29	78.4
21. I am less effective at work when fatigued.	3	8.1	-	-	34	91.9
22. I am more likely to make errors in tense or hostile situations.	5	13.5	-	-	32	86.5
23. Fatigue impairs my performance during emergency situations.	14	37.8	1	2.7	22	59.5
Perception of Unit/Municipal Health Secretary (SMS) Management
24. Unit - The administration supports my daily efforts.	16	43.2	5	13.5	16	43.2
24. SMS - The administration supports my daily efforts.	24	63.9	8	21.6	5	13.5
25. Unit - The administration doesn’t knowingly compromise patient safety.	17	45.9	5	13.5	15	40.5
25. SMS - The administration doesn't knowingly compromise patient safety.	20	54.1	7	18.9	10	27.0
26. Unit - The administration is doing a good job.	17	45.9	8	21.6	12	32.4
26. SMS - The administration is doing a good job.	27	73.0	5	13.5	5	13.5
27. Unit - Problematic professionals of the team are dealt with constructively.	24	64.9	9	24.3	4	10.8
27. SMS - Problematic professionals of the team are dealt with constructively.	25	67.6	9	24.3	3	8.1
28. Unit - I get adequate, timely information and opportunities about events which might affect my work from unit management.	25	67.9	2	5.4	10	27.0
28. SMS - I get adequate, timely information and opportunities about events which might affect my work from SMS.	27	73.0	4	10.8	6	16.2
29. The levels of staffing in this service are sufficient to handle the number of patients.	21	56.8	5	13.5	11	29.7
Working conditions
30. This service does a good job of training new team members.	23	62.2	5	13.5	9	24.3
31. All the necessary information for diagnostic and therapeutic decisions is routinely available to me.	20	54.1	1	2.7	16	43.2
32. Trainees in my profession are adequately supervised.	28	75.7	1	2.7	8	21.6
33. I experience good collaboration with the nurses in this service.	4	10.8	1	2.7	32	86.5
Separate items
14. My safety suggestions would be put into action if I expressed them to administration.	25	67.6	7	18.9	5	13.5
34. I have a good collaboration with the medical team in this service.	4	10.8	1	2.7	32	86.5
35. I experience good collaboration with the pharmacists in this service.	3	8.1	5	13.5	29	78.4
36. (R) Communication failures which lead to delays in care are common.	6	16.2	2	5.4	29	78.4

Domains	Mean (SD)	95% CI	Median	IQR	Min.-Max.	Cronbach’s Alpha†
Domain 1: Teamwork climate	75.3 (16.5)	69.8-80.8	79.2	25.0	29.2-100.0	0.65
Domain 2: Safety climate	55.5 (16.9)	49.8-61.1	53.6	21.4	17.9-89.3	0.56
Domain 3: Job satisfaction	72.6 (23.3)	64.8-80.3	80.0	25.0	0.0-100.0	0.88
Domain 4: Stress recognition	75.0 (22.2)	75.0-82.4	75.0	34.4	12.5-100.0	0.71
Domain 5: Perception of unit/SMS management	32.4 (18.5)	26.3-38.6	31.8	32.8	2.3-70.5	0.79
Domain 6: Working conditions	42.2 (20.7)	35.2-49.1	42.2	34.4	0.0-81.2	0.40
Overall	58.8 (9.8)	55.6-62.1	59.4	11.4	25.6-77.4	0.80

Variables	N	Teamwork		Safety climate		Job satisfaction		Stress recognition		Perception of management		Working conditions		Overall
Variables	N	Mean (SD)	p- value	Mean (SD)	p- value	Mean (SD)	p- value	Mean (SD)	p- value	Mean (SD)	p- value	Mean (SD)	p- value	Mean (SD)	p- value
Gender
Male	5	70.8 (25.7)	0.52	57.1 (24.9)	0.79	57.0 (34.2)	0.10	67.5 (34.6)	0.42	37.7 (20.9)	0.48	45.0 (30.4)	0.74	55.9 (17.1)	0.49
Female	32	76.0 (15.1)	0.52	55.2 (15.9)	0.79	75.0 (20.8)	0.10	76.2 (20.2)	0.42	31.6 (18.3)	0.48	41.8 (19.4)	0.74	59.3 (8.5)	0.49
Work regime
CLT	8	79.2 (8.9)	0.29	71.9 (12.0)	0.001*	74.4 (15.2)	0.80	72.6 (28.5)	0.73	40.9 (13.0)	0.08	49.2 (22.0)	0.27	64.8 (4.2)	0.05*
Statutory	29	74.3 (18.1)	0.29	51.0 (15.3)	0.001*	72.1 (25.3)	0.80	75.6 (20.7)	0.73	30.1 (19.3)	0.08	40.3 (20.3)	0.27	57.2 (10.4)	0.05*
Employment
One	23	77.9 (12.5)	0.29	56.2 (16.5)	0.77	75.2 (15.7)	0.46	79.3 (20.6)	0.12	32.6 (19.0)	0.93	40.5 (19.7)	0.51	60.3 (6.9)	0.25
Two	14	71.1 (21.5)	0.29	54.3 (18.3)	0.77	68.2 (32.4)	0.46	67.8 (23.6)	0.12	32.1 (18.3)	0.93	45.1 (22.6)	0.51	56.5 (13.3)	0.25
Workload
Nursing team	15	76.4 (15.0)	0.60	51.4 (15.1)	0.005*	73.3 (25.2)	0.93	78.7 (17.6)	0.70	33.8 (20.7)	0.18	28.7 (19.2)	0.50	58.7 (8.6)	0.11
Medical team	8	79.2 (8.9)		71.9 (12.0)		74.4 (15.2)		72.6 (28.5)		40.9 (13.0)		49.2 (22.0)		64.7 (4.2)
Others	14	75.3 (16.5)		50.5 (16.2)		70.7 (26.2)		72.3 (23.7)		26.1 (17.5)		42.0 (22.0)		55.6 (12.1)

	Teamwork climate		Safety climate		Job satisfaction		Stress recognition		Perception of management		Working conditions		Overall
	r²	p	r²	p	r²	p	r²	p	r²	p	r²	p	r²	p
Age (years)	0.23	0.15	0.20	0.22	0.02	0.88	0.07	0.65	-0.03	0.85	0.24	0.13	0.24	0.15
Weekly workload (hours)	-0.36	0.02*	-0.05	0.74	-0.09	0.57	-0.19	0.24	0.17	0.28	-0.04	0.79	-0.18	0.26
Time in the specialization	0.18	0.26	-0.15	0.35	0.04	0.78	-0.07	0.65	-0.18	0.27	-0.05	0.73	-0.08	0.63

Domains	β¹	95% CI	p-value
Teamwork climate
Age	0.35	-0.19; 0.90	0.194
Gender
Male (R)
Female	1.60	-19.15; 22.35	0.876
Weekly workload	-0.53	-0.99; -0.07	0.025
F-value (p-value): 2.89 (0.049); R ²: 0.189
Safety climate
Age	0.78	0.31; 1.24	0.002
Gender
Male (R)
Female	12.12	-2.52; 26.76	0.102
Work regime (R)
CLT
Statutory	-34.29	-47.23; -21.24	< 0.001
Position
Nursing team (R)
Medical team	34.07	20.25; 47.89	< 0.001
Others	-0.38	-10.13; 9.36	0.936
F-value (p-value): 8.01 (< 0.001); R ²: 0.517
Job satisfaction
Age	-0.23	-1.26; 0.79	0.64
Gender
Male (R)
Female	20.78	-10.06; 51.63	0.18
F-value (p-value): 0.94 (0.400); R ²: 0.08
Stress recognition
Age	0.13	-0.50; 0.77	0.67
Gender
Male (R)
Female	9.75	-24.20; 43.71	0.56
F-value (p-value): 0.91 (0.44); R ²: 0.09
Perception of management
Age	0.17	-0.55; 0.90	0.62
Gender
Male (R)
Female	-0.92	-19.90; 18.05	0.92
Position
Medical team	8.37	-7.86; 24.61	0.30
Others	-7.79	-22.93; 7.35	0.30
Work regime (R)
CLT
Statutory	-12.64	-27.56; 2.28	0.09
F-value (p-value): 1.36 (0.269);R ²: 0.10
Working conditions
Age	0.83	0.07 1.59	0.033
Gender
Male (R)
Female	-1.97	-33.95; 30.01	0.901
Work regime (R)
CLT
Statutory	-16.30	-46.06; 13.44	0.273
F-value (p-value): 4.62 (0.004);R ²: 0.159
Overall
Age	0.38	0.02; 0.74	0.040
Gender
Male (R)
Female	9.60	-4.44; 23.66	0.174
Work regime (R)
CLT
Statutory	-15.72	-26.18; -5.26	0.004
Position
Nursing team (R)
Medical team	14.27	4.21; 24.33	0.007
Others	-2.64	-9.22; 3.94	0.420
F-value (p-value): 3.25 (0.024); R ²: 0.359

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Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
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[TFN1] ^Note:
SD: Strongly disagree; PD: Partially disagree; N: Neutral; PA: I partially agree; TA: I totally agree; R: Reversed questions. SMS: Municipal Health Secretariat. Note: (n= 37).