A singularidade do pós-operatório mediato e tardio de pessoas em situação de rua, seus desafios e barreiras

Abstract

Introduction: Perioperative care encompasses the period from pre-surgical assessment to hospital discharge, including the preoperative, intraoperative, and postoperative phases. Within this context, homeless individuals constitute a vulnerable group, facing social inequalities and deprivation of basic rights, such as access to healthcare. In Brazil, public policies such as the National Policy for the Homeless Population (PNPSR, 2009) and the “Street Clinic” teams (Consultório na Rua, 2011) seek to ensure healthcare assistance for this population. Despite these regulatory advances, significant difficulties in access to healthcare services persist among homeless individuals. Lack of support, inadequate professional training, prejudice, communication failures, and insufficient investment and public participation negatively impact treatment adherence. This study aims to investigate the factors influencing postoperative recovery in homeless individuals, considering the complexity of their living conditions and the barriers faced within the healthcare system. Objective: To identify factors involved in intermediate and late postoperative recovery that may significantly contribute to satisfactory or unsatisfactory outcomes in homeless individuals. Method: This qualitative, descriptive-exploratory study was conducted at the Sobradinho Regional Hospital (HRS) and the Street Clinic (UBS No. 1), Federal District, Brazil. Participants included healthcare professionals (physicians, nurses, nursing technicians, social workers, and psychologists) from both institutions, as well as homeless individuals aged 18 years or older, literate or illiterate, in intermediate or late postoperative stages, assisted by the units. Professionals from other institutions and ineligible patients were excluded. All participants signed an Informed Consent Form. Data collection occurred in November 2021 and was approved by the FEPECS Ethics Committee (Opinion No. 5,049,390; CAAE: 51713221.6.0000.5553). Professionals answered a semi-structured questionnaire regarding recovery and postoperative guidance, while patients were questioned about surgery, postoperative care, and difficulties after discharge. Ten professionals and three homeless individuals participated. Interviews were recorded, transcribed, and analyzed using content analysis. Alphanumeric coding ensured confidentiality. Results: Ten healthcare professionals (2 physicians, 3 nurses, 1 nursing technician, 3 social workers, and 1 psychologist) from HRS (7) and the Street Clinic (3), as well as three homeless individuals in postoperative recovery (1 intermediate and 2 late), were interviewed. Both professionals and patients identified several factors hindering postoperative recovery, with street living conditions representing the main barriers. Chronic stress, inadequate sleep, poor nutrition, and poor hygiene conditions were highlighted. Difficulties in following medical guidance, such as rest and specific dietary recommendations, along with the absence of an appropriate recovery environment, increased the risk of infections and other complications. Lack of access to medications and malnutrition were also mentioned. Patients confirmed these challenges, reporting infections, substance use, and poor treatment adherence. The absence of a support network was identified as a crucial factor. One participant reported: “I had a lot of difficulty when I left the hospital [...] after I left the hospital, I did not take any more medication.” Failure to attend follow-up appointments was also a recurring issue. Professionals unanimously emphasized the need for postoperative shelters for this population. They suggested the creation of specific support houses and family reintegration, when possible and desired by the patient, as important recovery strategies. Discussion and Conclusion: The findings of this study corroborate the literature, such as the 2008 report from the Ministry of Social Development, which identifies homelessness as a factor contributing to vulnerability. Postoperative difficulties among homeless individuals are associated with unsanitary environments and lack of resources, compromising recovery. A broader understanding of the health-disease process, considering social aspects and the patient’s life history, is essential. Strategies such as qualified listening and welcoming approaches, central to the “Street Clinic” model, strengthen patient-professional bonds and encourage self-care. Recovery outcomes are often unsatisfactory due to factors such as poor treatment adherence and the absence of adequate recovery spaces. The study highlights the urgent need to revise public policies and develop projects aimed at reducing inequalities. The lack of specific facilities to accommodate postoperative patients was particularly emphasized. Limitations of the study include the COVID-19 pandemic and the scarcity of literature on the topic.