The difficult symbolic construction of physicians’ and nurses’ experiences working in COVID-19 intensive care units: A qualitative study on reports at a university public hospital in Southeastern Brazil

Introduction

Humanistic studies that explore symbolic aspects of the experience of working on the COVID-19 frontline are necessary. Do these professionals have psychic time to symbolize such acute experiences? We expect these preliminary findings of this research provide subsidies for discussing psychological management in groups with these professionals.

Objectives

To interpret emotional meanings reported by physicians and nurses on their experiences of working at COVID-19 intensive care units.

Methods

Clinical-qualitative design. Data collection with semi-directed interviews with open-ended questions in-depth applied to a sample of six professionals, closed by theoretical information saturation, in a Brazilian university general hospital. Trigger question: “Talk about psychological meanings of your experience in face of management of patients with COVID-19 at ICU”. Data treatment by the Seven Steps of the Clinical-Qualitative Content Analysis. Theoretical framework of Medical Psychology using Balintian concepts.

Results

We raised 3 categories. (1) Psychic time and absence of symbolization in face of the pandemic; (2) Denial as a defense or psychosocial adaptation mechanisms; (3) Tensions and family support: triggers of ambivalent emotional experiences.

Conclusions

Raw experience of COVID-19 pandemic did not allow for realization of symbolization. Psychological defenses are manifested, either to maintain balance or to deny the existence of dangers related to mental health. Presence of families and health team confirm that the feeling of loneliness is avoided. Anxieties related to the fear of contamination are recurrent. There is dual relationship regarding the emotional experiences of health professionals, but the data point to importance of looking at how these individuals perceive and experience the pandemic.

Disclosure

No significant relationships.

Explanations on school task procrastination reported by medical students: A qualitative study at a public university in South-eastern Brazil

Introduction

How do medical students, who have self-criticism of being procrastinators of their study obligations, deal psychologically with daily tasks? The experience of procrastination by those who are considered high-performance students involves resources of mental health to cope with guilt, exhaustion, or even self-sabotage. According to MeSH used by PubMed, procrastination is ‘the deferment of actions or tasks to a later time, or to infinity’.

Objectives

To explore the psychological meanings that medical students attribute to procrastination phenomena to better understand how they handle the usual curriculum overload.

Methods

Clinical-qualitative design. Sample of 13 participants closed by information saturation with 2nd, 3rd, 4th-year students. Semi-directed interviews with open-ended questions in-depth. Clinical-qualitative content analysis, free-floating readings with psychodynamic concepts. Results were validated by peers at the Laboratory of Clinical-Qualitative Research.

Results

Emergent categories: 1) between procrastination and despair: the process of stress in procrastination; 2) a proving mechanism: procrastination as an emotional defense; 3) a very delicate rumination: between procrastination and mere delay, an emotional dilemma; 4) this conflict is painful: the confrontation between the desire to comply with tasks with excellence and the enjoyment of life.

Conclusions

Procrastination is reported by students as a source of great tension generated by opposing forces and desires, in which exhaustion is eventually reached. There are emotional contradictions related to guilt for leaving tasks to the last moment and the need to live other things besides doing academic tasks. Procrastination is a message-metaphor. It is important that institutions listen to students to understand what procrastination is saying about them.

Disclosure

No significant relationships.

Emotional experiences of elderly patients with Chronic Obstructive Pulmonary Disease using extended home oxygen therapy: A qualitative study on reports at a university specialized outpatient clinic in Brazil

Introduction

What do patients talk during a clinic evaluation? What do they report besides referring physical complaints? It is crucial to value ’hidden’ symbolic issues under a conversation between patient and his/her doctors and nurses. Elderly people are at increased risk of developing Chronic Obstructive Pulmonary Disease (COPD) that requires the management of associated emotions. In advanced stages, they need to use Long-term Home Oxygen Therapy (LTOT) as part of treatment. Patients perceive difficulties with its use, generating anguish.

Objectives

To explore meanings of emotional experiences as reported by patients regarding LTOT, seen in a public university outpatient service.

Methods

Qualitative design. Semi-directed interviews with open-ended questions were carried out with seven elderly patients at Pulmonology Outpatient Clinic at General Hospital at University of Campinas, diagnosed with COPD and using LTOT in period 2019 to 2020. Data were analyzed using Content Analysis with the support of Webqda software. COREQ checklist was used.

Results

Three categories emerged from interviews: (1) Changes of self-image perception with great dissatisfaction in not recognizing their selves physically. (2) Sadness with social isolation and feelings of awkwardness regarding themselves. (3) Affective aspects bringing the need to re-mean old family supports.

Conclusions

Simply listening to reports of emotional complaints implies only a description of a clinical condition of the psychic sphere. Elderly patients with COPD bring psychological representations of their clinical condition that call for a symbolic interpretation. If such patients become aware of hidden meanings, they can better manage their fears and other uncomfortable feelings.

Disclosure

No significant relationships.

“Permissiveness, guiltiness, anxiety”: A qualitative study on emotional meanings of school task procrastination reported by occupational therapy students in South-eastern Brazil

Introduction

According to the Medical Subject Headings, the vocabulary used by PubMed, procrastination is ‘the deferment of actions or tasks to a later time, or to infinity’. Studies on procrastination are increasing, especially among university students, gaining prominence in academic literature. However, studies on the procrastination phenomenon have been mainly quantitative, correlating such experiences with clinical and behavioral manifestations. Specific research with occupational therapy students is lacking in the literature.

Objectives

To interpret symbolic meanings related to life experiences of the procrastination phenomenon of school tasks as reported by occupational therapy undergraduate students, self-referred as procrastinators.

Methods

Clinical-qualitative design. Data collected through semi-directed interviews with open-ended questions in-depth. Clinical-Qualitative Content Analysis generated categories discussed in the light of the psychodynamic theoretical framework. This study was carried out in a private Brazilian university. The sample was closed by the information saturation criterion.

Results

Seven students were interviewed. Procrastination comes associated with anxiety as productivity, but not reported as an “executive drive”, that would imprison the individual in a vicious cycle. There are defense mechanisms referred to as self-preservation for not assume responsibilities for tasks. Ineffective strategies seem to be experienced by the students to avoid procrastination, but without resolving possible psychodynamic conflicts related to the task.

Conclusions

Students’ procrastination ambivalently affects their daily lives, although they can report the phenomenon as negative. It is suggested further qualitative studies that explore specifically meanings of procrastinating personal activities, in general, considering these individuals will work precisely in a therapeutic approach in the field of occupations of the people.

Disclosure

No significant relationships.

“It’s not only the bad side” - Experiences reported by health professionals working with women victims of sexual violence in a Brazilian university specialized outpatient service: A qualitative study

Introduction

Health Psychology is a scientific branch that studies interpersonal relationships in the field of emotions and behavior in clinical settings. Violence against women is a gender-based action that alarmingly affects the population, with sexual violence (SV) being one of its main phenomena. The complexity of the care offered to SV patients by clinical professionals impacts themselves, affecting their personal lives and the quality of their work.

Objectives

To explore symbolic emotional meanings attributed by health professionals to care and follow-up of women victims of SV in state service of reference of the Unified Health System.

Methods

Clinical-Qualitative design was used to guide semi-directed interviews with open-ended questions in-depth. Clinical-Qualitative Content Analysis was employed to treat data. Five participants make up the multi-professional team at the Hospital of the Woman of the State University of Campinas. Theoretical framework chosen to interpret categories was Balintian Medical Psychology.

Results

Three categories were selected for this presentation: The human anguishes as the main challenge and handling of working with sexual violence; “To see things progressing”: to the patient and together with the team, a facilitator of the work; and “I try to leave it on the three’s leaves”: the difficult attempt to separate work from personal life.

Conclusions

Taking care of SV is a very emotionally demanding task. Working with the team and see expected outcomes help clinical professionals deal with negative feelings, avoiding, for example, compensatory traumas. New research about social-cultural impacts of working with SV is important to develop institutional approaches of coping for health teams.

Disclosure

No significant relationships.

Perceptions reported by residents in psychiatry on oral health problems in their patients with severe mental disorders: a qualitative study at a Brazilian university specialized psychiatric service

Introduction

There is a greater prevalence of oral problems in patients suffering from severe mental illness than in the general population. The psychiatrist use to be, naturally, a health professional with great clinical influence over these patients. Do young psychiatrists in training include oral evaluations on their patients? How does this doctor perceive oral health care in the context of follow-up of people with chronic mental disorders?

Objectives

To interpret the meanings of the practice or not, regarding oral health guidelines, as reported by residents in psychiatry working in care and follow-up services to patients with severe disorders at a public university.

Methods

Clinical-qualitative design. Semi-directed interviews with open-ended questions in-depth carried out with six participants. Sample closed by saturation information criterion. Residents see their patients at the General Hospital of the State University of Campinas. Interview material, audio-recorded and transcribed in full, was treated by Clinical-Qualitative Content Analysis, using concepts of theoretical framework from Medical Psychology. Interviewer was a female professor of dentistry.

Results

From the discussion, two categories of analysis were selected for this presentation. (1) medical practice obeys the natural logic of construction of paradigmatic areas: historically, dentistry has created a care model with independence from medicine; (2) dentist is not called to participate in “collusion of anonymity”. This is an expression construct by the psychoanalyst Balint to describe the taking of relevant clinical decisions, without no professional assume the responsibility for these.

Conclusions

These meanings may guide changes in professional conduct as well as in the curriculum of medical training programs.

Disclosure

No significant relationships.

Is the Living Will an interesting way to determine themselves? Qualitative research about considerations said by oncologists in a university service care in Southeast Brazil

Introduction

What does the physician think in his/her intimacy about clinical care for when his/her death would be near? Living Will is a type of advance directive with the aim to guarantee the testator’s autonomy when faced with death. Particularly oncologists are often faced with human finitude. Their delicate work does not protect them from the possible anguish of thinking and preparing for their own death. It is pertinent to know the psychic mechanisms normally present in the management of this expectation.

Objectives

To explore symbolic representations of oncologists such as referred to the possible elaboration of their own Living Will.

Methods

Qualitative design. Eight participants, clinicians, sample closed by theoretical saturation of information. Semidirected interviews in-depth were conducted online during the pandemic, fully transcribed. Technique of Clinical-Qualitative Content Analysis used for data treatment to generate categories of discussion. The authors search for core meanings in the corpus of interviews, after free-floating readings.

Results

Three categories emerged from the material: Living Will: postponing the decision in order to not anticipate death; From Rationalization Mechanism to Intellectualization: a more sophisticated defensive strategy; Loss of Autonomy: the doctor’s belief while to feel him/herself patient.

Conclusions

(1) Even with all scientific knowledge, respondents have archaic thoughts on defining advance directives as healthy individuals would mean rushing time of their death. (2) Resistance of these professionals to an imagined scenario of end reveals underlying anguish in writing of living will. (3) There is fear of losing autonomy when they do not know how their Living Will can be seen.

Disclosure

No significant relationships.

Head and neck cancer treatment and its sexual impact on quality of life: An integrative literature review

Objective: To identify the impacts of head and neck cancer treatment on the sexual health of patients. Methods: An integrative literature review was carried out from May to October 2020 using PubMed, CINAHL, Web of Science, LILACS, and the SciELO portal. A total of 287 primary articles were identified. After assessing them, 6 articles met the eligibility criteria, which were: all articles published in the last ten years that addressed the sexual impact of HNC treatment on people's lives, without any language or age. Results: Patients with Head and Neck Cancer have to face aesthetic disfigurement challenges in post-treatment. This leads to a greater degree of suffering and social and sexual problems than is observed in other cancer patients. Health professionals do not feel safe to access the intimate and sexual demands of patients during the clinical treatment. Conclusions: Most of the studies included in this review focused on measuring the quality of life using only one or two variables related to sexuality. There is the need other research to explore how multiple factors, such as social, psychological, cultural, religious, ethnic, and ethical factors, affect sexuality. This promotes the creation of the paths for comprehensive care and management of patients.

Psychocultural experiences of medical students in simulated care in cases of type 2 diabetes mellitus at a public university in southeastern brazil: A qualitative study

Introduction

The generalist assistance at the Primary Attention is fundamental to face the increase of type 2 diabetes mellitus cases through the relationship physician-patient. This sets the therapeutic plan and its continuous review. Therapeutic Plan could be affected by the same psychocultural phenomena related to the increasing cases numbers of DM2. Therefore, new trends in Medical Psychology have been promoted during medical undergraduate course. These incorporate methods and concepts of Liberal Arts to develop specific psychosocial management skills to DM2 clinic.

Objectives

AIM: To understand the experience of medical students in the simulated care of DM2 cases in two different moments: 1) to diagnose and start treatment; 2) start insulinization.

Methods

METHOD: Clinical-Qualitative design; data collected through an semidirected interview of open-end questions in depth; thematic analysis generated categories discussed in light of Medical Psychology of psychodynamic framework.

Results

RESULTS: Ten clinical clerkship students attended as clinicians two cases of Standard Patients of DM2. They reported their reflections toward the role they should sustain: being doctor in front of the patient and their colleagues; difficulty to play the leading and show skills and knowledge in a scenario full of surprises and fantasies; an existential and professional gains in simulation activity; and considerations about responsible in conduct so impacting situations to patients.

Conclusions

FINAL CONSIDERATONS: The themes translate moments during their simulated attending experience in which they have not sustained their semblance – the intended rule. These could be enriched though group reflecting, supervisor discussion, and patient dialog in the process of developing Medical Psychology skills.

Disclosure

No significant relationships.

The practice of sedation in palliative care for oncologic patients: Fantasies reported by a nursing team in a specialized hospital in Brazil: A qualitative study

Introduction

CONTEXTUALIZATION: Palliative sedation is a resource used to control symptoms of terminal patients in general. It is considered that it should be discussed by the professionals involved in the process, based on the competence of each one, as well as with family members and patients when possible.

Objectives

AIM: To understand symbolic meanings attributed by nursing professionals who provide assistance to the terminal patient regarding to the act of the palliative sedation.

Methods

Strategies: Clinical-qualitative design, semi-directed interview of open questions in depth. Nine oncologist nurses participated in the study; sample closed by the criterion of theoretical information saturation. Interviews were audio recorded, transcribed fully, categorized by qualitative content analysis. The results were discussed by colleagues of the Laboratory of Clinical Qualitative Research at the University of Campinas.

Results

FINDINGS: The treatment of the data led to 6 emerging categories: (1) death maintains its ambivalent values in our culture; (2) serving the death symbolically on a tray; (3) the act of sedation and its “unfortunate coincidences”; (4) palliative sedation: agent of a pious death; (5) late sedation: cause for distress to the professional; (6) the professional’s self-comfort considering certain psychological strength from the patient and family.

Conclusions

Final considerations: palliative sedation takes a general and individual meanings for the professional and even in case of experienced professionals regard to palliative sedation, the death phenomenon conduct them to expresses multiple and peculiar emotional issues, not ever perceveid.

Disclosure

No significant relationships.

Emotional experiences reported by psychologists attending patients with suicidal crises in a service in northeastern Brazil: A qualitative study

Introduction

Contextualization: Emotional experiences of psychologists related to the care of suicide crises are important since the health professional has been trained to save lives. It makes him apprehend the aggressive side of suicide and symbolize it as an attack. When the patient’s desire to liveceases, the professional may feel confused, since his/her profession/vocation was confronted.

Objectives

AIM: To explore and interpret the meanings of emotional experiences reported by psychologists who care for patients in suicide crises.

Methods

Strategies: clinical-qualitative design, semi-directed interviews with open-ended questions in-depth. Six clinical psychologists from a Brazilian city participated, with a sample closed by information saturation. Interviews audio recorded, full transcribed and categorized by Qualitative Content Analysis. Results were peer-reviewed in meetings in a Qualitative Research Study Group.

Results

Findings: Three emerging categories - (1) Ambivalent emotions as challenges for clinical management, (2) The non-paralyzing experience of emotions, (3) The management that is learned in practice.

Conclusions

Considerations: assistance to patients with a suicidal crisis can generate ambivalent emotions, not always paralyzing. When recognized and elaborated can assist in clinical practice. It can be tools that will support qualified approaches, especially in relation to suicide. As a public health problem, it demands a combination collective actions with effective individual clinical approaches.

Distresses reported by physicians and nurses toward peculiarities of patients with head and neck cancer at a university general hospital in Brazil: A qualitative study

Introduction

Contextualization: health professionals’ anguish towards the patient with head and neck cancer (HNC) permeates clinical issues: the location of the tumour, if advanced diagnosis, the psychosocial features of the patient. The perception, coming from patients as undesirable, refers to the conflict of how to deal with one’s own anguishes.

Objectives

AIM: To explore and interpret how anguish experienced by physicians and nurses are mobilized regarding to the clinical and psychosocial peculiarities of patients with HNC.

Methods

Strategies: Clinical-qualitative design; semi-directed interview with open-ended questions in depth. Trigger question: “Tell me about the management of the patient with …”. Ten interviewees (06 nurses and 04 resident doctors) from a university oncology outpatient. Intentional sample. Clinical-Qualitative Content Analysis with psychodynamic concepts. Findings validated by peers at the Laboratory of Clinical-Qualitative Research at the University of Campinas, Brazil.

Results

Topics: the treatment of the speeches resulted in three emerging categories: (1) Cancer is literally on the face: self-perception of peculiarities; (2) An appalling illness: dealing with the ‘deteriorated’; (3) To naturalize without trivializing: handling with their own anguish.

Conclusions

Final considerations: The anguish of health professionals who deals with the HNC patient consists of the feelings, which are not exposed, because they are not organized and neither understood as natural feelings. It is up to them to seek neutrality to minimize the anguish present in the conflict of not manifesting thoughts considered inadequate by the patient, avoiding moral judgments and conflicts. Balint groups are recommended to attend emotional demands of health professionals.

Implementation of balint group for a team who care patients with head and neck cancer in a service in Brazil: A proposal post qualitative research

Introduction

The Balint group emerged at the Tavistock Clinic in London in the early 1950s. Its creator was a doctor and psychoanalyst Michael Balint. It consisted of a group process, with meetings among general practitioners, in which non-conscious aspects of the professional-patient relationship were approached. We present how a proposal for implementation of a Balint Group has emerged, specifically for physicians and nurses who care for cancer patients. Is is a consequence of results obtained from a qualitative study conducted by a student of the professional master’s degree linked to a Clinical Oncology.

Objectives

To present a technical product, as required in a Brazilian professional master’s degree, as a result of research that studied reports of doctors and nurses who deal with usual difficulties of handling patients with HNC.

Methods

The group work is triggered by the report of a case brought by a participant, presenting a problem-situation in the management of his patient. The meeting leader seeks to understand the reactions reported by the presenter in the light of a psychodynamic approach.

Results

Expected results: the holding of a Balint group, perhaps monthly, in charge of a colleague who has knowledge in applied psychoanalysis, will allow insights to the participants who will bring them conditions to perceive “neurotic elements” in the relationship with their patient.

Conclusions

Final consideration: having accumulated decades of positive experience, Balint Groups must remain as an updated proposal for the work on emotional issues of professional teams, with emphasis on clinical services with the management of so-called “difficult patients”.

Disclosure

No significant relationships.

Spirituality meanings reported by Southeast Brazilian nursing staff at the psychiatric ward of a university general hospital: A clinical-qualitative study

Introduction

Despites nursing holistic trends for caring, in psychiatric wards of general hospitals the spiritual dimension remains controversy. Evidence shows spirituality rule in recovering and also alerts about complications associated to mental disorders and spirituality.

Aim

To describe spirituality meanings attributed by a psychiatric nursing team and discuss how they apply them on professional cares.

Method

Clinical-qualitative design is a particularization of generic qualitative strategies brought from humanities to approach symbolic research questions in clinical settings. A semi-directed interview with open-ended question, in-depth, was carried out with a team of 22 nursing professionals in the psychiatric ward of a general hospital in Southeast Brazil. Data analysis was driven under the Ricoeur understanding of Freudian symbolic meaning, which affirm that a statement revels multiple meanings overwritten.

Results

Spirituality is developed from several sources of restlessness and living together. The function of spirituality is to help fulfill social roles, keep internal balance and to maintain sacred practice attitudes towards life that brings symbolic salvation: help or redemption to hard life times. Nature of mental illness remains as spiritual stigma and a suspicion contradictorily to spiritual approach caring to patients in inpatients services, which is described, as inappropriate or confusable.

Conclusions

Even spirituality meanings are covered by symbolism, which expresses human attitudes to help in life crises they are surrounded by contradictions that situate this dimension in the limit of reason, which approximates carriers and patients causing weirdness. Nursing staff still needs training to deliver holistic care, and spiritual counseling to gain clarity in this issue.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

[The prelude to psychiatric reform in Brazil: the contradictions of the 1970s]

The article provides a historical reconstruction of the period leading up to what has become known as Brazil's Movement for Psychiatric Reform, which runs from the 1967 creation of the national social welfare system (INPS) to 1978, when the Mental Health Workers Movement gained prominence. Focusing on technical criteria influenced by the U.S. prevention model, our discussion examines the contradictions in Brazil's official mental health policy and also looks at the practice of financing and strengthening private psychiatric institutions, to the detriment of community action. Although most official documents from the 1970s contain proposals clearly aimed at community actions, what we observe is the crystallization of a model under which the government purchases psychiatric beds in private hospitals.