Tereza Cristina Cavalcanti Ferreira de Araujo

Pessoas com deficiência e políticas de saúde no Brasil: reflexões bioéticas

The purpose of this article is to analyze the dilemma of allocation of public funds to the healthcare of people with disabilities in Brazil from a bioethical standpoint. The concept of disability and the legal framework are presented; the question of budgetary constraints and theoretical bioethics references about this issue are discussed; and the role of Bioethics of Protection and Bioethics of Intervention is stressed. It is concluded that, because of their vulnerability, people with disabilities should be protected by the state and funds must be allocated to guarantee their access to healthcare services. However, in spite of the existing legal basis, the actual destination of public funds to people with disabilities still depends on other factors, among others social and political participation of the disabled persons themselves in the negotiation of healthcare policies.

Termômetro de Distress: validação de um instrumento breve para avaliação diagnóstica de pacientes oncológicos

The specialized literature provides instruments measuring stress for general application. Those instruments have been employed in occupational and health contexts. But since 1997, the National Comprehensive Cancer Network (NCCN) recommends the adoption of a specific measuring instrument for the assessment of cancer patients. Considering the existence of clinical and scientific interest to develop future meta-analysis studies in the field of Oncology, which will include Brazilian samples, the adaptation and validation of the Distress Thermometer (TD) was undertaken. The effectiveness of the TD in assessing distress was verified by comparison with the Anxiety and Depression Scale (HAD), a clinically established tool for evaluating distress. In order to that, a sample of 83 patients answered the TD and the HAD. The data were analyzed using SPSS 15.0. Results of the analysis indicated 82% for sensitivity and 98% for specificity. Using the TD appeared feasible and effective for psychological distress screening.

A sobrevivência em oncologia: uma vivência paradoxal

Mestre em Psicologia pela Universidade de Brasília, Psicóloga responsável pelo Serviço de Oncologia Pediátrica do Hospital Sarah de Brasília. A partir de um levantamento da literatura especializada, os autores propõem uma revisão crítica da problemática da sobrevivência de pacientes neoplásicos, destacando o caráter paradoxal das vivências dos sujeitos implicados, fornecendo, desta maneira, subsídios para a atuação do psicólogo em serviços de Oncologia.

Distress levels in patients undergoing chemotherapy in Brazil

Objective: The objective of this study was to measure distress at three points during the course of chemotherapy: beginning, middle, and the last day of therapy in a private cancer center in Brazil.

Voluntariado hospitalar: um estudo sobre a percepção dos profissionais de saúde

Volunteer work in hospitals: a study about health professional’s perception. Strongly encouraged as a way to act on present-day social problems, volunteer services are usually reffered as enriching for the person involved. However, when related to health, volunteer’s technical and emotional support is questionable, for its absence or weakness may induce psychological suffering in the agent or jeopardize the interventions provided and the volunteer-professional relations. In order to better understand the nature of volunteer work and the way it is perceived by health team members, a two-part study was carried out. At the first part, 29 professionals answered a questionnaire about their perception concerning the volunteer work in the hospital; at the second, 14 of them were interviewed. Data were submitted to a thematic content analysis and to the software Alceste. Although the results indicated differences among professionals, the general evaluation of the volunteer services was positive, in spite of the limitations identified by some team members. The need for more qualification and supervision of the volunteers is discussed, and suggestions for future investigations are pointed.

Religiosidade e espiritualidade em oncologia: concepções de profissionais da saúde

La literatura especializada viene identificando influencias positivas y negativas de creencias religiosas y espirituales en el enfrentamiento de enfermedades, como el cancer. La presente investigacion objetivo conocer, analizar y comprender las concepciones de profesionales de salud respecto a la asociacion entre religiosidad, espiritualidad y salud en Oncologia. Primeramente, se utilizo un cuestionario electronico que fue contestado por 85 profesionales. Posteriormente, siete profesionales participaron de grupos focales online. Los resultados indicaron que aproximadamente la mitad de los participantes de la primera etapa no practican actividades religiosas. Todavia, 85% revelaron alto grado de espiritualidad. Temas religiosos/espirituales son frecuentes en los atendimientos. Los integrantes del los grupos relataron que no recibieron formacion academica para abordar la tematica. En suma, los participantes evidenciaron concepciones positivas sobre la influencia de la religiosidad/espiritualidad a la salud, con efectos negativos en menor proporcion. Futuras investigaciones pueden apoyar programas de capacitacion de futuros profesionales en la Oncologia.

Estresse Ocupacional e Resiliência Entre Profissionais de Saúde

Studies show that work-related experiences can lead to illness, and several adverse effects have been identified especially for health professionals. Considering this evidence, a research study on stress and resilience among professionals was conducted. This research was organized in two stages: a) 92 professionals from different categories, as determined through a sociodemographic information and occupational questionnaire online survey, completed the Job Stress Scale and Resilience Inventory, and b) twoface to face focal groups, totaling six nurses. The data were subjected to statistical analyses, and the thematic content analysis was conducted. Two main risk factors were found for adverse effects: work on duty scale and having more than one job. Social support was found to be the most significant protective factor. Practical nurses represented the most vulnerable category. More than half of the participants showed control over their labor activity and low occupational stress. Among the resilience indicators, job satisfaction, emotional competence, empathy and tenacity, and innovation were highlighted. It is recommended that future research should evaluate the effectiveness of interventions which are aimed at strengthening and developing associated factors with resilience as well as targeting stress reduction experienced in the acting of health.

Impact of the clinical management of pain: evaluation of stress and coping among health professionals

A literatura especializada destaca que o manejo clinico da dor comporta dificuldades psicologicas, associadas a busca de alivio do sofrimento dos pacientes. Sendo assim, investigaram-se a percepcao de estresse e as estrategias de enfrentamento de 31 profissionais de diferentes categorias, em um centro de atendimento a grandes queimados (dor aguda) e uma unidade de controle de dor e cuidados paliativos (dor cronica). Para tanto, aplicaram-se um questionario sociodemografico, a Job Stress Scale (versao resumida) e o Inventario de Estrategias de Coping. Comparativamente as demais categorias, os tecnicos de enfermagem indicaram mais fatores de estresse. Em compensacao, informaram maior diversidade de estrategias de enfrentamento com diferencas significativas entre os servicos. Esses resultados corroboram estudos anteriores, os quais alertam sobre as condicoes adversas que interferem na atuacao em enfermagem. Porem, tambem revelam disponibilidade de fatores de protecao, apontando perspectivas de intervencao preventiva, destinada a equipe de enfermagem.La literatura especializada destaca que el manejo clínico del dolor produce dificultades psicológicas asociadas a las actividades realizadas para aliviar el sufrimiento de los pacientes. Siendo así, se investigaron la percepción del estrés y las estrategias para enfrentarlo en 31 profesionales de diferentes categorías en un centro de atención a quemaduras de gran tamaño (dolor agudo) y una unidad de control del dolor y cuidados paliativos (dolor crónico). Para esto, se aplicó un cuestionario sociodemográfico, la Job Stress Scale (versión resumida) y el Inventario de Estrategias de Coping. Comparado con las demás categorías, los técnicos de enfermería indicaron más factores de estrés. En compensación, informaron mayor diversidad de estrategias de enfrentamiento con diferencias significativas entre los servicios. Estos resultados corroboran estudios anteriores, los cuales alertan sobre las condiciones adversas que interfieren en la actuación en enfermería. Sin embargo, también revelan la disponibilidad de factores de protección, apuntando perspectivas de intervención preventiva destinadas al equipo de enfermería.The specialist literature highlights that the clinical management of pain involves psychological difficulties associated with the pursuit of the alleviation of the suffering of patients. Therefore, an investigation was conducted into the perception of stress and coping strategies of 31 professionals of different categories from a severe burns care center (acute pain) and a pain control and palliative care unit (chronic pain). For this, a sociodemographic questionnaire, the Job Stress Scale (short version) and the Coping Strategies Inventory were applied. Compared to other categories, the nursing technicians indicated more stress factors. In compensation, they reported a greater diversity of coping strategies with significant differences between the services. These results corroborate previous studies, which warn of the adverse conditions that interfere in nursing practice. However, they also reveal the availability of protective factors, indicating perspectives of preventive intervention for the nursing team.

Eficácia terapêutica de intervenção em grupo psicoeducacional: um estudo exploratório em oncologia

The following study evaluated the effectiveness of a psychoeducational group intervention designed to promote adaptive coping abilities, minimize distress and improve quality of life in oncology patients during the initial phase of chemotherapy. Three women made up the intervention group, organized into six weekly meetings and they were evaluated before, immediately following and three months after the intervention. The Ways of Coping Scale; WHOQOL-BREF and the Psychological Screening Tool for Cancer Patients were used as evaluation instruments. Another patient, who did not attend the group, had her results compared to the others. Immediately after the intervention, a significant improvement was observed in the group members: increase in problem-focused coping strategies, search for social support and quality of life, as well as a reduction in symptoms of anxiety and depression. The patient who did not participate in the intervention group obtained less favorable results. In the reevaluations, these results were maintained, indicating that the psychoeducational group intervention achieved its therapeutic goals.

Trabalho de equipe em reabilitação: um estudo sobre a percepção individual e grupal dos profissionais de saúde

A multi-professional team intervention model has been advocated in order to achieve the goal of integral assistance. To better understand this intervention model, this study aimed to identify and compare individual and group perceptions of professionals of two rehabilitation services about teamwork. Individual and group interviews were carried out with professionals from the Spinal Cord Injury and Brain Injury specialized services at the same hospital. The main results comprised: team conceptualization; identification of positive and negative mediating factors in teamwork; assessment of the decision making process; professional autonomy; and similarities and differences between the two teams. We suggest that future studies focusing on the functioning of health teams adopt the group interview procedure.A fim de atingir as metas da atencao integral a saude, argumenta-se a favor da atuacao em equipe multiprofissional. Visando ampliar a compreensao sobre essa modalidade assistencial, este artigo tem como objetivo identificar e comparar a percepcao individual e grupal dos profissionais de dois servicos de reabilitacao de um mesmo hospital sobre o trabalho em equipe. Para tanto, foram feitas entrevistas individuais e grupais com profissionais de um servico especializado no atendimento ao lesado medular e de outro servico especializado no atendimento ao lesado cerebral. Os principais resultados obtidos abrangeram: concepcao de equipe; identificacao de fatores facilitadores e perturbadores do trabalho grupal; avaliacao do processo de tomada de decisao; autonomia profissional; semelhancas e diferencas entre as equipes. Sugere-se que futuras investigacoes adotem o procedimento de entrevista grupal em estudos relativos ao funcionamento de equipes de saude.