Translação do conhecimento baseado em evidências científicas para melhorar a prática clínica de obstetras

Abstract

The predominant model of childbirth assistance in Brazil is characterized by the abusive or inappropriate use of obstetric interventions in all clinical periods of childbirth. It is known that these interventions can be prevented or reduced with the adoption of practices advocated by the National Guidelines for Assistance to Childbirth of the Ministry of Health. This document is subsidized by the World Health Organization, however, in our reality, most obstetric practices do not follows these recommendations. The study aimed to evaluate the effectiveness of educational interventions based on scientific evidence to improve the clinical practice of obstetricians. This is a longitudinal, quasi-experimental study with nurses and doctors who work in childbirth care at the Hospital Estadual de Santana, Amapá, Brazil, where 21 structured interviews were carried out in the pre and post-audit, in addition to educational interventions with “audit and feedback” and “clinical practice guidelines” recommended by Cochrane collaboration to bring about changes in the behavior of healthcare professionals. In the interviews, a structured questionnaire with 29 questions and five answer options on a Likert scale was used, ranging from “never” to “always”, with a score from 1 to 5. In addition, 12 printed banners in the form of stickers, measuring 120 x 90 centimeters, were fixed at the maternity reception and in the two delivery rooms to reinforce the professionals to those recommendations of the clinical practice guidelines. The study was carried out in three phases: pre-audit and (phase 1); implementation of practices (phase 2, which corresponds to educational interventions); post-audit (phase 3). The data were described and analyzed in a descriptive and inferential way through the average ranking and total average ranking of the Likert scale (by comparing the results of steps 1 and 3), with a significance level of 5%. The study was approved by the Research Ethics Committee of the Federal University of Amapá under opinion No. 2,853,419. The findings show that in relation to obstetric practices, and according to the average ranking of the Likert scale, there was a significant increase in the proportion of professionals who recommend or perform the perineal suture with absorbable synthetic thread (p = 0.003) and the warm compress technique in the perineum (p = 0.031). Regarding obstetric interventions, proportionally, there was a reduction in the number of professionals who recommend or perform the Kristeller maneuver in childbirth, with a statistical difference (p = 0.023). In the analysis of the total average ranking, there was an increase in the proportion of professionals in favor of recommending or performing obstetric practices, after the exposure of the banners, in the comparison between phases 1 and 3, however, without significant statistical difference (p = 0.230) and reduction proportion of professionals recommending or performing unnecessary obstetric interventions, with statistical difference (p = 0.024), between phases 1 and 3. It is concluded that educational interventions provided improvements in the professionals' practice. We suggest new research with educational intervention strategies that include multifaceted approaches to improve the quality of evidence-based care in childbirth care.