Aspectos relacionales y funcionales de la seguridad para pacientes y cuidadores en cuidados intensivos: revisión del alcance

Santana, Maria Aparecida Pereira dos Santos; Fonseca, Eliana Rosa da; Roque, Keroulay Estebanez; Figueiredo, Tony de Oliveira; Souza, Valentina Maria Dias de; Stipp, Marluci Andrade Conceição; Trotte, Liana Amorim Correa

doi:10.1590/1983-1447.2024.20230212.en

Brasil

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Scoping Review • Rev. Gaúcha Enferm. 45 • 2024 • https://doi.org/10.1590/1983-1447.2024.20230212.en linkcopiar

Aspectos relacionales y funcionales de la seguridad para pacientes y cuidadores en cuidados intensivos: revisión del alcance

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivo: Analizar los aspectos relacionales y funcionales de la seguridad del paciente a través de experiencias relatadas por el paciente o sus cuidadores en unidades de cuidados intensivos.

Método: revisión de alcance desarrollada con búsquedas, en septiembre de 2021 y actualizada en noviembre de 2022, en las bases de datos: Biblioteca Virtual en Salud, considerando únicamente las bases de datos LILACS, BDENF, IBECS, ColecionaSUS; SCIELO, PSYCINFO, EMBASE, COCHRANE, CINAHL, SCOPUS y Web of Science.

Resultados: la selección final incluyó 14 artículos que destacaron la comunicación como factor relacional esencial para la seguridad del cuidado y los aspectos funcionales más predominantes fueron: el ambiente físico del cuidado, los protocolos estructurados, la actuación de los profesionales en el proceso de cuidar.

Conclusión: Los procesos de comunicación predominaron en los aspectos relacionales y fueron decisivos para los aspectos funcionales, con énfasis en el factor desempeño de los profesionales en el proceso de cuidar. Fueron utilizados instrumentos desarrollados para analizar procesos de calidad, en la mayoría de los estudios.

Descriptores: Seguridad del Paciente; Adulto; Unidad de Terapia Intensiva; Enfermería; Adaptación Psicológica

Search strategies used according to the PCC (MEDLINE via Pubmed)	Description of descriptors and keywords included in each search strategy	Results in number of articles retrieved according to search key
Search Key #1	Search: "Patient Safety"[mh] OR "Patient Safety"[tiab]	52,471
Search Key #2	Search: "Adult"[mh] OR Adult*[tiab] OR "Aged"[mh] OR Elderly[tiab] OR "senior citizen"[tiab] OR "Middle Aged"[mh] OR "Middle Age"[tiab] OR Middle-Aged[tiab]	8,569,706
Search Key #3	Search:"Adaptation, Psychological"[mh] OR "Psychologic Adaptation"[tiab] OR "Psychological Adaptation"[tiab] OR Adjustment[tiab] OR "Coping Skills"[tiab] OR "Coping Skill"[tiab] OR "Adaptive Behavior"[tiab] OR "Adaptive Behaviors"[tiab] OR "Coping Behavior"[tiab] OR "Coping Behaviors"[tiab] OR Meaning[tiab] OR experience[tiab] OR Behavior[tiab] OR Coping[tiab] OR Adaptation[tiab] OR Perception[mh] OR Perception[tiab] OR "Sensory Processing"[tiab] OR "Surveys and Questionnaires"[mh] Survey[tiab] OR Questionnaire[tiab] OR Respondent[tiab] OR Questionnaire[tiab] OR Nonrespondent[tiab] OR Emotions[mh] OR Emotion[tiab] OR Feeling[tiab] OR Regret[tiab] OR "Patient Satisfaction"[mh] OR "Patient Satisfaction"[tiab] OR Respect[tiab] OR Dignity[tiab]	1,797,855
Search Key #4	Search:"Intensive Care Units"[mh] OR "Intensive Care Units"[tiab] OR "Intensive Care Unit"[tiab] OR ICU[tiab] OR "Critical Care"[mh] OR "Critical Care"[tiab] OR "Intensive Care"[tiab] OR "critical care unit"[tiab] OR "intensive therapy unit"[tiab] OR "intensive treatment unit"[tiab] OR "respiratory care unit"[tiab] OR "respiratory care units"[tiab] OR "intensive therapy"[tiab] OR acute-care[tiab] OR "Critical Care Nursing"[mh] OR "Critical Care Nursing"[tiab] OR "Intensive Care Nursing"[tiab]	303,777
Search Key #5	Search: Search key #1 AND Search key #2 AND Search key #3 AND Search key #4	332

	Characteristics						Experiences
Author/journal/year	Title	Qualis Capes	Impact Factor	Origin	Methodological Design	Sample Subtype	Aspects
Author/journal/year	Title	Qualis Capes	Impact Factor	Origin	Methodological Design	Sample Subtype	Relational	Functional
Dodek,P M et al/ Critical Care Medicine/ 2012	The relationship between organizational culture and family satisfaction in critical care/2012	A1	9.2	Canada	Quantitative	Family Members	Openness in communication between healthcare professionals and family members	Teamwork
Lasiter, Sue/ Clinical Nursing Research / 2014	“The Button”: initiating the Patient-Nurse Interaction	A1	1.7	USA	Qualitative	Patients		Physical structure (e.g., visual call devices) that facilitates quick visibility and response from the nursing team.
Galvis López CR, Salamanca Ramos E/ Investigación en Enfermería: Imagen Desarrolo/ 2014	Percepción de necesidades en cuidadores familiares de adultos internados en una unidad de cuidados intensivos de una institución prestadora de salud (IPS) privada en Villavicencio, Colombia	B1	Without impact factor	Colombia	Quantitative	Family Members of ICU Patients	Clear communication about prognosis. Being informed about changes in the patient’s condition. Honest responses to questions	Receiving information once a day.
Wassenaar, Annelies et al / International Journal of Nursing Studies/ 2014	Factors promoting intensive care patients’ perception of feeling safe: A systematic review	A1	8,1	United Kingdom	Systematic review	Studies with ICU Patients	Communication and information. Nursing care was mainly referenced in terms of how the professional interacts with the patient; respectful interaction	Patients noted that technological support provided a sense of security and that being able to visualize or "feel" the presence of the team due to the structural organization in the ICU was reassuring.
Rainey, H et al/ Health Expectations/ 2015	The role of patients and their relatives in ‘speaking up’ about their own safety - a qualitative study of acute illness	Without Qualis	3.2	London	Qualitative	Patient	Adequate communication and information	Appropriate care for medical needs regarding both the team's technical skills and the hospital system; workload overload for the team reduced the likelihood of the patient expressing their needs
Wong, et al/ Intensive and Critical Care Nursing/ 2015	Families’ experiences of their interactionswith staff in an Australian intensive careunit (ICU): A qualitative study	Without Qualis	5.3	Australia	Qualitative	Families of Patients	Communication was identified as a relevant theme; the nurse was seen as an accessible professional with simplified language; some identified inconsistent communication; family exclusion.
Alasad, et al/ Journal of Critical Care/ 2015	Patients' experience of being in intensive care units	A3	3.7	Jordan	Quantitative	Surgical and Medical ICU Patients	Adequate information	Noisy ward; inability to distinguish between day and night; poor pain management. Reported that technological support provided a sense of security and that being able to visualize the team or know they were nearby.
Lupieri, Giulia et al. / Intensive and Critical Care Nursing/ 2015	Cardio-thoracic surgical patients’ experience on bedside nursing handovers: Findings from a qualitative study	A1	5.3	Italy	Qualitative	Cardiac ICU Patients		Bedside shift change
Jensen, et al/ Critical Care / 2017	Satisfaction with quality of ICU care for patients and families: the euroQ2 project	A1	15.1	Denmark	Quantitative	Patients and Family Members	Consistency of information; need for improvement in emotional support; including the patient in decision-making	Management of dyspnea and agitation;
Jerng, Jih-Shuin et al/ Critical Care/ 2018	Comparison of complaints to the intensive care units and those to the general wards: an analysis using the Healthcare Complaint Analysis Tool in an academic medical center in Taiwan	A1	15.1	Taiwan	Mixed Methods	ICU Patients and Family Members	Decisions or planning not communicated; recognized problems not addressed, not followed up, or not resolved; staff with poor behaviors	Issues with visits or scheduling; delays in medical procedures; insufficient equipment; uncomfortable physical environments; interaction problems between patients and visitors.
Bell SK, Roche SD, Mueller A, et al/ BMJ Quality & Safety/ 2018	Speaking up about care concerns in the ICU: patient and family experiences, attitudes, and perceived barriers	A1	5.7	USA	Mixed Methods	Patients and Family Members	Patients and family members perceive barriers to communicating their safety concerns, fearing they might harm the relationship with the medical team, being labeled as troublemakers, or finding the team too busy or not knowing whom to speak with
Schenk, Elizabeth C et al/ Journal of Nursing Care Quality / 2019	Perspectives on Patient and Family Engagement with Reduction in Harm: The Forgotten Voice	Without Qualis	1.2	USA	Qualitative	Patients, Family Members, and Healthcare Professionals	Patient/family involvement and communication.
Collins, Sarah A et al/ Journal of Patient Safety/ 2020	Mixed-Methods Evaluation of Real-time Safety Reporting by Hospitalized Patients and their care partners: The MySafeCare Application	A2	2.2	USA	Mixed Methods	Patients and Family Members or Caregivers	Inadequate communication related to treatment; shift changes; performance of procedures; professionals not introducing themselves upon entering the ward	Lack of adherence to institutional protocols; inadequate physical structure that does not support hand hygiene; lack of identification of visitors.
Pérez E & Dzubay DP/ Health Care Management Science/ 2021	A scheduling-based methodology for improving patient perceptions of quality of care in intensive care units	Without Qualis	3.6	USA	Mixed Methods	Patients	Communication from the physician and information regarding discharge

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[TFN1] Source: The Authors, 2021/2022.