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Abstract
OBJECTIVE: to understand the meaning of the Adult Intensive Care Unit environment of care, experienced by professionals working in this unit, managers, patients, families and professional support services, as well as build a theoretical model about the Adult Intensive Care Unit environment of care. METHOD: Grounded Theory, both for the collection and for data analysis. Based on theoretical sampling, we carried out 39 in-depth interviews semi-structured from three different Adult Intensive Care Units. RESULTS: built up the so-called substantive theory "Sustaining life in the complex environment of care in the Intensive Care Unit". It was bounded by eight categories: "caring and continuously monitoring the patient" and "using appropriate and differentiated technology" (causal conditions); "Providing a suitable environment" and "having relatives with concern" (context); "Mediating facilities and difficulties" (intervenienting conditions); "Organizing the environment and managing the dynamics of the unit" (strategy) and "finding it difficult to accept and deal with death" (consequences). CONCLUSION: confirmed the thesis that "the care environment in the Intensive Care Unit is a living environment, dynamic and complex that sustains the life of her hospitalized patients".
Highlights
The care environment involves multiple dimensions of care, and comprises a set of elements that integrate it, and it is necessary to take into account the whole that involves the parts, in the same way as the parts that involve the whole, as is well argued by the idealizer of complex thinking[1]
It is believed that the Grounded Theory was the most adequate method for this study, due to the relevance to the subjective indicators, and because it enable one to understand the collective significance of the care environment in the Adult Intensive Care Unit (ICU), resulting from the process of the research in question, which involved the participant observation and holding in-depth interviews, with the participation of 47 subjects, among them health professionals, managers, intra-hospital support service professionals, family members and patients hospitalized in the ICU, or those who had been discharged from the ICU
The present study, allied to Edgar Morin’s theoretical reference of complexity, from a systemic point of view, provided a view of the set and new understanding with regard to the care environment in an ICU, and the construction of the substantive theory “Sustaining life in the complex care environment of the Intensive Care Unit”, which is a useful theory, based on research data, which culminated in the development and integration of eight categories
Summary
The care environment involves multiple dimensions of care, and comprises a set of elements that integrate it, and it is necessary to take into account the whole that involves the parts, in the same way as the parts that involve the whole, as is well argued by the idealizer of complex thinking[1]. These aspects, are not always considered in the biomedical health care model, whose focus is centered on disease, fragmentation of knowledge, doing and being professional, in which sometimes, not even the being that is cared for is seen as an integrated whole, a being with multiple social relationships, potentiated by the natural and social environment In this sense, the care environment requires the creation of conditions favorable to health, promoting a healthy and constructive environment, with harmonious, vitalizing interpersonal relationships that potentiate positive energies for better living[2]. Where aggressive and invasive procedures are performed, the pace is accelerated and the duel between life and death is ever present; and death is frequently imminent[3,4,5]
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