O olhar dos sujeitos do ambulatório do Hospital do Câncer IV, do Instituto Nacional de Câncer, sobre as práticas integrativas aplicadas ao cuidado paliativo em Oncologia: uma "avaliação" do cuidado

Abstract

The present study is about ambulatory attention in palliative care, particularly user s perceptions over this care given in the Oncologic Ambulatory for Palliative Care of the Brazilian National Cancer Institute-RJ. From this perspective we brought the user s speech, as well as their difficulty, felt and experienced during the assistance, and its relation with the integrality. This one understood as a technology that is all through the actions facilitating and improving health care. When relating some of its pillars as, access, boundary, linkage, self-government and responsiveness, we can better understand the limits of this concepts and its applicability in the INCA system. We delimitate as theoretic path of this study, integrality issues and technologies to orient the work process in health services. The decisive element was the concept of soft technologies formulated by Merhy; within its definition there is a bridge to integrality basic concepts to the investigation proposed. This ambulatory underwent a transformation on its physical structure and on the assistance model offered to its users. The difference between this and the conventional ambulatory model of assistance that takes place on the other INCA ambulatory hospitals, for this one from HC IV, rely on the fact that this one is specific for patients undergoing oncological palliative care, in which the patients has walking difficulties. Because of those, a different model was build. In this new mode, patients are called to a room and wait for the assistance, the professionals alternates themselves between this and the other rooms, where there are other patients. This attitude prevents patients from walking from room to room to be assisted. As a reminder, this new assistance manner began on march 2009, with one year experience. The statement of the interviewed patients and their caretakers revealed, with not even one exception, that they prefer this new way of integrative care instead of the traditional experienced in other INCA hospital units. Patients appreciate the quietness of this process and the certainty of the scheduled appointment. Its impossible to deny that in this manner of assistance, not only the patients but also their caretakers have more privacy. One of its improvements for patients is the end of the walking from room to room to get assisted by all professionals. This new physical structure prevents undesirable walking and stress for patients under oncologic palliative care. And it s also clear that users express, as positive aspect, the reduction of time waiting for the appointment in the ambulatory. Taking into consideration the particularity of these users revealed, was the quality of the assistance they acquire: faster, human and multidisciplinary, since their necessities are more urgent because of their bio-psycho-social-spiritual fragility state. Finally, was possible to observe that the main Integrality pillars are expressed in their perceptions, although they don´t state this concepts specifically. About responsiveness, we found little evidence, as the user s don´t have their rights notion and there for they don´t criticize the system. Only one of them marked his position, asking about a patient s bath adapted for colostomy user`s