Cultura de segurança da mulher no parto hospitalar: um estudo misto das percepções dos profissionais de enfermagem e médicos

Abstract

The dominant obstetric model in hospitals is characterized by medicalized care and excessive interventions, which conflict with the organizational safety culture for the woman and her child. The objectives of the study are: to describe the evaluation of the safety culture for the woman and her child in hospital birth assistance; to know the perceptions of the nursing and medical team about the safety of this assistance; to identify the factors involved in the safety culture according to this team of professionals. This is a mixed study, quan  QUAL, with an explanatory sequential design, carried out in a public maternity hospital in the city of Rio de Janeiro. Its quantitative phase was of the survey type, and for the data collection the questionnaire created by the Agency for Healthcare Research and Quality (AHRQ), entitled Hospital Survey on Patient Safety Culture (HSOPSC), was validated and transculturally adapted to Portuguese. The data received descriptive statistical treatment, by absolute and relative frequencies. In its qualitative phase, it was a descriptive study. Data were collected through semi-structured interviews; transcribed and analyzed through the thematic content analysis. A valid sample of 26 (100%) participants, randomly selected in the work environment, was obtained: 9 (34.6%) obstetrician nurses, 9 (34.6%) nursing technicians and 8 doctors. It was found that none of the dimensions assessed reached the level of strengthened safety culture. The mean frequencies of the positive responses in the 12 dimensions evaluated were 48.14%, which represents a fragile safety culture in the maternity hospital. The general perception of patient safety was 31.8%, with the personal dimension being one of the critical points of safety compromise, with only 31.5% of the positive responses, whereas the dimension with the highest percentage of positive responses was the organizational learning and continuous improvement, with 70.4%. At the qualitative phase, 12 professionals participated, including 4 obstetrician nurses, 4 nursing technicians, 2 obstetricians and 2 pediatricians. The interviews revealed that the team's perceptions about safe obstetric care refer to the prevention of incidents and appropriate technical care. In addition, the factors that interfere in the safety culture from the perspective of the team are: lack of knowledge of safety actions, deficiency in the uniformity of behaviors and limited staff quantitative in relation to the demand for care. Therefore, there are weaknesses in the safety culture for the woman and her child in hospital birth. The team’s professionals consider that following the national, institutional and municipal healthcare system protocols, as well as scientific evidence, is necessary for a safe care, which expresses a still incipient view regarding the issues, measures and tools that involve patient safety.