Enfrentamento da pandemia: reestruturação para unidades de terapia intensiva COVID-19

Abstract

Restructuring is a form of organizational change that made it possible for intensive care units to face the COVID-19 pandemic. The general objective of this study was to analyze the restructuring for ICU COVID-19 in the face of the pandemic and the specific objectives: To identify the elements of restructuring of the ICU in the face of the COVID-19 pandemic; Describe how the changes were implemented in the ICU in the context of the COVID-19 pandemic. This is a study with a qualitative and exploratory approach developed in 05 COVID 19 ICUs of public hospitals in the city of Salvador-Bahia. The study participants were 17 nurses who performed care and management positions. Data collection took place after the opinion of the Ethics Committee in the period from December 2021 to June 2022 through a semi-structured interview whose instrument consisted of two parts, the first with initial information on the characterization of the participants, which contained the gender, age, training time, employment relationship, position, double occupation, weekly workload, time of experience in the ICU, existence of postgraduate studies. The second part is a script with semi-structured questions based on the recommendations of the World Health Organization, which links the strengthening of the health system in response to COVID-19 to “4 S” (S for Space or space/structure; S for Staff, or team; S for Supplies, or supplies; S for Systems, or systems). Bardin's content analysis (2016) was used. As a result of the analysis of the corpus of the interviews, four categories and 05 subcategories were built for analysis: Category I - Modifications of the physical space - Subcategory I - adaptation of the physical space to care for COVID-19 patients and subcategory II - expansion of the number of ICU beds for the care of patients with COVID-19; Category II - management of the nursing team - subcategory I Training of the team to meet the new patient profile; subcategory II - (re)sizing of staff in the COVID-19 ICU and subcategory III - Increase in mental disorders in health professionals at the COVID-19 ICU; Category III- Availability of hospital supplies - supply and demand of hospital supplies in the COVID -19 ICU; Category IV - Changes in processes - Modifications management systems in response to the COVID - 19 pandemic. We conclude that the intensive care units were restructured to meet the demand of patients generated by an unprecedented health crisis with a profile of patients with a high degree of severity imposed by COVID-19. In this sense, there were many difficulties and problems in the implementation of the restructuring so that the care and management process took place in a fair and safe way, since it involved issues of staff dimensioning, supplies, insecurity and illness of the team that caused a high rate of leave and turnover. of staff.