The humanization process in the Emergency Department of the Botucatu Medical School Clinical Hospital according to the health professionals' perspective



Patricia Shirakawa Nakamoto

Dissertação (Mestrado), 2006 Programa de Pós-Graduação em Saúde Coletiva, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu.



Key words: Humanization. Communication. Physician-patient relations. Emergency medical services.

Palabras clave: Humanización. Comunicación. Relaciones medico-paciente. Servicios medicos de urgencia.



The teaching hospitals have been stimulated to become a service that recovers the essential part of care: the relationship among human beings mentioned in the National Humanization Policy. The humanization study in the development process of Sistema Único de Saúde (SUS) (Brazilian public health system) is relevant and the observation of the system in a university teaching hospital pertinent, because it functions as a health care center, attracting to itself great demand, which often overloads its services. The Clinical Hospital from Botucatu Medical School (CH from BMS) receives patients of all levels of complexity, and its emergency department is a reference to the DRS-VI for high complex procedures in emergency/urgency and a place of tension and overload of care. The purpose of this paper is to analyze the humanization of the emergency department of the CH from BMS through the eyes of the health professionals. This is a quantitative research into which eight doctors, a nurse and a psychologist were interviewed and as a result is shows the reflection of their position towards the reality, moments of development and the social dynamics, concerns and personal interests, typical of a social research from which emanates contradictions and conflicts of the daily work. The analyses of the interviews allowed the elaboration of theme centers through which the results are presented: a) Emergency Department and environment: inappropriate physical space which compromises the care and opposes the environment concept proposed by the Ministry of Health; b) Emergency Department and its users: even though there has been a reorganization of the department, which is no longer a free access entrance, the emergency department still cares for cases of low complexity and patients of all social levels, due to the lack of other emergency services in the area; c) Emergency Department, care space: the unit overload is justified by the low resoluctivity of the primary care services and by the different perceptions of the users and professionals about the concept of emergency and urgency; about the doctor-patient relationship, there is a concern about listening to the patient and pay attention to the non-verbal language, but the relationship is still very unbalanced with a concentration of power and decision in the doctors' hands; d) Emergency Department, work and teaching place: the constant pressure and stress, the work overload, the difficulty in dealing with death, the feeling of lack of recognition from the CH from BMS could be enough to drag the professionals from work, however, despite all the problems, there is a great identification with the work in the emergency department and a great satisfaction in teaching and following up the medical students and residents. Therefore, the Emergency Department from the CH from BMS can be characterized as a place of health care which receives all kinds of problems, without apparent organization or conformity to the regionalization and hierarquization proposed by SUS, which also causes relationship difficulties with the patients. It was possible to identify that in the daily work the interviewees, even though recognizing the need and the importance of the humanization in care felt, quite often, "dehumanized". At last, it was detected among the professionals the perception of a depreciation of the work in the emergency department if compared to other areas in the hospital.



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UNESP Botucatu - SP - Brazil