Atuação da psicologia frente ao paciente submetido à ventilação mecânica invasiva

Abstract

This dissertation is divided into three studies, whose central axis is the role of psychology in Intensive Care Units with patients who made use of Invasive Mechanical Ventilation. This tool is used as the main support for the treatment of critically ill patients with acute or chronic respiratory failure, but it triggers stressors and adverse emotional reactions, both during its use and during the weaning phase. With the Covid-19 pandemic, there was an increased need for the use of mechanical ventilation and the more active participation of psychology in the care of these hospitalized patients and their families. Thus, this research had the following objectives: to analyze the hospital experience and the emotional aspects involved in the perspective of hospitalized patients who used mechanical ventilation; develop a psychological care protocol for patients undergoing mechanical ventilation; and prepare a proposal for a psychological care protocol for patients with Covid-19 in the process of weaning from ventilation. The qualitative approach, the action research method and content analysis were used. The data collection techniques used were semi-structured interviews with five hospital psychologists and eight hospitalized patients, as well as participant observation with six patients undergoing ventilatory weaning, in which the psychologist-researcher performed psychological interventions and recorded them in a field script. The researched place is a general public hospital located in a medium-sized city in the Northeast region, whose space has forty beds of adult ICU. The first study points out that the experience of patients undergoing mechanical ventilation is perceived as shocking, unpleasant, distressing and sad, but the physical therapist, the psychologist, the family and religiosity emerged as important devices in reducing anxiety. Significant alterations in memory, thinking, felt perception and disturbing dreams were also identified. The second study presents as a result a protocol aimed at patients undergoing mechanical ventilation and is structured in nine stages that cover therapeutic planning, evaluation and possible psychological interventions. The third study provided the improvement and adaptation of a psychology protocol aimed specifically at patients with Covid-19 undergoing ventilatory weaning, mainly supporting the management of anxiety, fear, loneliness and stigma. It is concluded that understanding the experience of hospitalized patients, analyzing the practices of intensive care psychologists and proposing intervention instruments can favor an improvement in the psychological assistance provided in the Unified Health System.