Original Works
Clara Inés Durán Rojas, * Daniel Gonzalo Eslava. **
* Nurse Specialist of the Emergency Department. Santa Fe de Bogotá Foundation.
Master in Clinical Nursing, University of Sâo Paulo – Brazil.
** Nurse. Assistant Professor, Faculty of Nursing, Javeriana University.
Doctor in Public Health, University of Sâo Paulo – Brazil.
Summary
The objective of this study was to describe and analyze nursing practices during cardiac catheterization, based on the experience and statements of patients who undergo this procedure, in order to find important elements for better guide our practice in the care of coronary patients. The study was carried out in 2001 in a university hospital in the State of São Paulo – Brazil. 18 patients of both sexes, between the ages of 30 and 80 years, were interviewed. For data collection, semi-structured interviews were carried out pre- and post-catheterization and participant observation during the trans procedure. The results show us that there is a significant gap between the objective world of professionals and the subjective world of patients. While for the patient performing catheterization is a difficult experience to face and live, for professionals it is a situation that is part of the routine of their work and that is why they are so familiar and prepared for what may happen, leaving perceive the patient’s needs, assuming indifferent attitudes and behaviors. In this way, we believe that the nurse-patient interpersonal relationship is a true instrument of care and attention, since it helps the patient to go through the diagnostic process with greater confidence and security, because in addition to social coexistence and experiences, the here and now is a new experience.
Keywords: cardiac catheterization, nursing care.
Summary
The purpose of the present study is to describe and analyze the nursing intervention during the cardiac catheterization starting from the experience and patient’s statements with the goal of finding elements that improve nursing care in coronary patients. The study was carried out in the university hospital of Sao Paulo’s state-Brazil. Eighteen patients of both genders between 30 and 80 years old were interviewed before and after the procedure and during it, active observation was done.
The results showed that there is a significant gap between the objective world of the professionals and the subjective world of the patients. While for the patient the cardiac catheterization is a difficult experience to face and go through, for the professionals it is a situation that makes part of the daily routine; they are so used to it and prepared for possible complications, that they assume indifferent attitudes and behaviors without perceiving the patients needs.
This way we believe that the nurse-patient interpersonal relationship is a true tool of health care since it helps the patients go through the diagnostic process with trust and security, because besides the social coexistence and experience, it ends to be a new experience.
Key words: cardiac catheterization, nursing care.
Introduction
Through the literature, we were able to confirm that ischemic heart disease is responsible for the largest number of deaths worldwide, representing half of the deaths in developed countries, while in third world countries, they account for a quarter of the deaths. deaths.(1)
We have observed this reality in the daily routine of our emergency services, where a large percentage of young, adult and elderly people with clinical symptoms suspicious of coronary heart disease or with the disease already diagnosed with active symptoms consult.
This situation became a cause of concern for health professionals and as time went by, we verified that greater investments were being made in scientific and technological areas for the diagnostic accuracy and therapeutic efficacy of cardiovascular diseases.
In this way, hemodynamic services have been improving and perfecting their equipment and techniques in performing invasive procedures, such as cardiac catheterization, coronary angioplasty, valvuloplasty, among others, making survival and a better quality of life possible for many heart patients.
This significant increase, both in the number of sick people and in the indication for these procedures, showed us the need to deepen the scientific and technological knowledge of the professionals who work in this area, to assist the patient and satisfy their needs, to the detriment of knowledge of the sociocultural aspects of the patient, which can also influence the situation.
Particularly, we observe that nurses, in areas that require working and providing care with high technology, such as hemodynamic services, have been concerned about deepening their knowledge in the management and use of new equipment and in the development of skills. techniques that provide answers to the procedures, taking into account the professional practice that requires providing specialized care with scientific quality.
According to Dantas,(2) for each procedure performed there is an undifferentiated care routine, where the biological aspects are prioritized in the diagnostic determination, treatment and prognosis, while the cultural, social and psychological aspects do not have space to be attended to, much less considered part of the process.
This means that we are concentrating our care priorities on the manipulation of equipment and the valorization of the technical aspects for the maintenance of life, leaving aside the care of the person as a whole who needs the use of these resources and of our nursing care.
Although the biological aspect has great relevance in the health-disease process, we consider that the alterations and changes in the lives of people with heart problems are not restricted to this sphere, on the contrary, the psychological aspects , social and cultural, inherent to each of them, are always present, directly or indirectly influencing their illness and their life.
In this sense, we agree with Silva(3) when he states that it is difficult to conceive the attention to biological needs without considering the psychosocial aspects, since the human being is unique and indivisible, constantly interacting with the environment, reacting in different ways. ways to lived experiences.
Considering that care is the essence of nursing work, we believe that this process should be developed from the interactions established with the use of technical procedures for physical/biological care and interpersonal relationships, in order to offer comprehensive care.
When a person gets sick, their life can change for a temporary or indeterminate period, because they are suddenly faced with a series of situations that interrupt their rhythm of life and generate fear, anguish, fear, anxiety, etc. And this becomes even more acute when you start living in a hospital environment full of routines, with unknown people in whom you need to place all your trust, diagnostic tests and therapeutic procedures in some cases invasive that involve a certain risk, and as if that were not enough almost always imposed by the health team.
For this reason, we consider that people with coronary heart disease should not be seen only from the perspective of the organ in dysfunction, since in the face of an illness, there are innumerable psychosocial factors that determine the behavior and life of sick people.
In this way, we consider that coronary patients are important people for our nursing care, deserving greater attention, since coronary disease is a life event that generates a diversity of emotions and contradictory feelings, which make this situation a unique, difficult and incomparable experience. For this reason, we try to go beyond scientific knowledge, in search of common sense knowledge and the experience of patients.
In this way, the present study aimed to describe and analyze the nursing work during cardiac catheterization, based on the experience and statements of patients who perform this procedure, in order to find important elements to guide improve our practice in the care of coronary patients who need to undergo cardiac catheterization.
Cardiac catheterization consists of a set of techniques capable of offering anatomical and physiological data that allow an in vivo diagnosis of the blood vessels and chambers of the heart, after the infusion of a contrast medium. This procedure is performed in a surgical environment, with local anesthesia in the inguinal region. The study can be done via venous or arterial route, depending on the diagnostic need and the clinical symptoms of the person.
Historically, the 1980s were considered the era of cardiac catheterization. This procedure evolved with the purpose of diagnosing which people would be potential candidates for cardiac surgery, as well as to provide physiological data to better guide the treatment of coronary heart disease (acute myocardial infarction, unstable angina, coronary insufficiency).
Although the technique used to perform cardiac catheterization is constantly being perfected and is a relatively quick and routine procedure, the possibility of complications is not ruled out. Among the most frequent: arrhythmias, anginal pain, allergic reactions, heart attacks, bleeding at the puncture site and even death.
From the above, we observe the complexity that surrounds the performance of the procedure and therefore we deduce that its performance can cause negative feelings and contrary reactions in the patient, in the face of the doubts and concerns that arise in this situation.
In this way, we must consider that the diagnosis of coronary heart disease, regardless of the invasive method in which the heart and its main vessels are manipulated, requires the person to mobilize their feelings to face and accept the uncertainty of that moment.
It should be noted that although technological advance in this area has been a great achievement, we need to integrate human affectivity and the individuality of patients into this technology to provide quality and effective nursing care.
Methodology
This is a qualitative descriptive study, which aims to delve into the world of meanings, human actions and relationships, that is, the side that is not perceptible and cannot be captured in equations, measurements and statistics.(4) This same author comments that qualitative methodology allows us to understand the world of meanings, motivations, aspirations, beliefs, values, attitudes and phenomena, which can be learned through everyday life, experience and the explanation of the common sense of the people who live certain situation.
The study was carried out in a University Hospital in the interior of the State of São Paulo (BRAZIL), in the cardiology section, in the hemodynamics laboratory, where cardiac catheterization is performed.
18 patients of both sexes were interviewed, with a predominance of females (10), who underwent catheterization. The ages of the patients ranged between 30 and 80 years, with ages between 40 and 60 years prevailing (14).
The semi-structured interview was used, pre- and post-catheterization, in order to obtain information and perceive attitudes and behaviors of the nursing professional during this procedure, through the patients’ statements. The interview consisted of the following questions:
1. Do you know what they are going to do to you now?
2. Has anyone explained to you what catheterization is and what it is for?
3. How are you feeling right now?
4. How did you feel during the exam?
5. What were you thinking during the exam?
