Internation and Stay in the Intensive Care Unit from the Perceptions of Adult Patients

— Practices in intensive care units (ICUs) are constantly developing in Brazil, knowing the repercussions of an inpatient process is essential for humanized care. This work aims to investigate the perceptions of adult patients regarding their hospitalization and stay in the Intensive Care Unit. This is a descriptive study with a qualitative approach containing a population composed of 20 adult patients aged 18 years or older, hospitalized for at least 24 hours, assisted by physiotherapy while being lucid and oriented. A questionnaire consisting of a closed question referring to sociodemographic data and another open question related to the patient's perception regarding his hospitalization and stay in the ICU was used. The data were analyzed using descriptive statistics, using the Statistical Package for Social Sciencespor (SPSS) software, version 22.0 for Windows. Most patients were female, with a mean age above 53 years, with a predominance of respiratory and cardiovascular diseases. It was found that the patients demonstrated a positive perception in relation to the ICU stay, mainly regarding the care provided by the team, however there are still gaps regarding the functioning of the environment.

Currently, discussions about Integrality and Humanization in health care practices have been growing (SALMÓRIA & CAMARGO, 2008). Patients submitted to ICU care need, in addition to pathophysiological care, more attention to the psychosocial factor closely related to physical disease (LOPES & BRITO, 2009). Thus, the perception of patients who had an experience in the ICU is an important parameter for a reliable assessment of how In this context, considering the countless repercussions of hospitalization in intensive care units and the need for advances for effective humanized health care, the purpose of this article is to investigate the perceptions of adult patients regarding their hospitalization and stay in the Therapy Unit Intensive, in order to awaken further discussions on the theme and thus contribute so that improvements can be implemented in the exercise of care, of the hospital services offered and thus minimize or even avoid possible trauma of an inpatient process. This is a descriptive study, with a qualitative approach, developed in Intensive Care Units (ICUs) 1, 2 and 3 at Hospital Geral Prado Valadares (HGPV), in the municipality of Jequié, in Bahia, from January to October 2019. Such health institution has numerous services, including intensive care units, which serve, in addition to the local population, about 26 neighboring municipalities.

This
Twenty adult patients participated in this research, hospitalized for at least 24 hours, aged 18 years or over, of both sexes, who had already undergone at least three physical therapy sessions, with preserved oral and / or written verbalization capacity and be lucid and oriented what was assessed using the Glasgow coma scale version updated in 2018 .
All subjects signed the Free and Informed Consent Term (ICF), were assured that their data and information would remain confidential and confidential, not allowing their identification, as well as having the right to interrupt their participation in any stage of the research. Patients with reduced level of consciousness and impaired understanding were excluded.
A questionnaire consisting of a closed question on sociodemographic data and an open question related to the patient's perception of his hospitalization and stay in the ICU was used for collection.
The questionnaire was applied through an interview with the patient's bed in the intensive care units, without the presence of any other health professional, in order to provide greater safety and comfort, thus preserving the confidentiality of responses and avoiding constraints or obligations.
The collected data were cataloged and the following categories were established: I) sociodemographic data; II) the patient's perception regarding his hospitalization and stay in the ICU.
About the sociodemographic data, questions were asked about name, age, sex, marital status, education, hospitalization diagnosis, length of stay and physiotherapy sessions. As for the patient's perception, it was argued about how it was going to be to experience hospitalization and stay in the sector.
The analysis of the first category was performed using descriptive statistics and presented as a form of absolute and percentage numbers, using the Statistical Package for Social Sciencespor (SPSS) software, version 22.0 for Windows and the second category was analyzed through descriptive analysis.

III. RESULTS AND DISCUSSION
The results are presented in 2 (two) categories: 3.1 sociodemographic data; 3.2 the patient's perception regarding his hospitalization and stay in the Intensive Care Unit (ICU).

Sociodemographic data
The research consisted of 20 adult patients, who were hospitalized in the ICU sector for at least 24 hours and who had already undergone at least three physiotherapy sessions. Table 1 describes the main characteristics of the patients being considered: age, sex, marital status, education, hospitalization diagnosis, length of hospital stay and physiotherapy sessions.

International Journal of Advanced Engineering Research and Science (IJAERS)
[  Brazilian researchers show in their study that 60% of consumption and expenses in UTIS are used by elderly people between 50 and 75 years old (RODRIGUEZ, 2016), and that by 2050 these results may intensify proportionally to the elderly population (VIANA & WHITAKER, 2011).
As for the main reasons for hospitalizations, respiratory disorders stood out, which corresponded to 25% of the cases and cardiovascular 25%. Regarding the prevalent causes of acceptance in the ICU, the data of this research are similar to other findings, in which the complications of the respiratory, cardiovascular system and surgical situations were among the main reasons with 28.6%, 15.6% and 27.5% respectively (GUIA et al.,2015).
Regarding the length of stay in the ICU, 50% of the interviewed patients had already completed about 3 to 6 days of hospitalization. Checking these data with that of the literature, it is ensured that the majority of patients remained hospitalized for a period of time equal to or less than 6 days (TURGEON et al.,2011).
In addition, about 40% of patients had already undergone at least 3 to 5 physiotherapy sessions. Considering its importance in this environment, studies indicate that patients undergoing early motor physiotherapy show improved functionality, such as bed rest and early walking, consequently reducing the length of hospital stay (PINHEIRO & CHRISTOFOLETTI, 2012). In view of this, it is also important to know the patients' perceptions about the ICU admission process. As noted, questions about food were emphasized, which suggests a possible relationship with the fact that these patients are idle in a bed and this generates anxiety or even the feeling that time is passing slowly and as soon as the food is slow to arrive, or even because it has to adapt to a more regulated and balanced diet. However, no other studies that could confirm or refute such findings were found in the literature.

Perception of the patient regarding his hospitalization and stay in the ICU
Despite this, considering the importance of food, a study shows that the number of malnourished patients tends to increase according to the length of hospital stay, despite the existence of physical and psychological particularities, as well as other factors inherent to this process (RIBEIRO, 2010). It is valid to rethink about the nutrition dynamics of these patients and their repercussions in the recovery process, since adequate nutrition is an essential part of improving health. Furthermore, the fact of being fasted due to a procedure that sometimes cannot be performed on the day, was one of the factors that caused discomfort to patients, as reported.

"[It was okay, it bothers me not to eat because of surgery and the procedure is not performed on the day]" (p16)
One of the positive factors analyzed is that many of the patients reported feeling well treated during hospitalization, which is consistent with the findings of another study, which showed positive perceptions such as the feeling of well-being, satisfaction and confidence regarding the treatment to which they were treated. was submitted to and taken care of by professionals MOREIRA & CASTRO, 2006 Corroborating the scenario found, another study carried out with patients in the intensive care unit, points out the humanized care of the team as one of the main factors for the positive perception that patients had of the work performed in the ICUs, which referred that the service had a differentiated character when compared to other hospital sectors (PROENÇA & AGNOLO, 2011).
The feeling of isolation and loneliness that is often faced during hospitalization, ends up generating more suffering for patients, since they lose contact with their living environment and consequently feel helpless In addition, studies also ensure that the family is part of the healing process. Therefore, this care also reaches family members, who feel fragile and suffered by the situation experienced, however, it is sometimes seen as an obstacle to the routine assistance of ICUs ( The repercussions of an internment affect not only the patient, but also family members who are faced with situations of impotence in the face of the problem, so much so, that this perspective has already been discussed by other studies (TOMÁS, 2018;MONTEIRO et al,.2017;REIS et al.,2016).
In addition, despite the difficulties faced during hospitalization, there was recognition on the part of patients about the benefits acquired after admission to the intensive care unit, which revealed an improvement in health and recognized the need to be in this environment. The Proença e Agnolo 2011 study, also reveals this perspective, in which patients highlight the team's continued, comprehensive and humanized care. Another aspect observed refers to the fact that, while there is a view that the ICU is related to serious illnesses and death, patients recognize the environment as a place that sends hope for their recovery, since they have resources and qualified professionals to revert situations considered serious (SEVERO & GIRAR-PERLINI, 2005). Associated with this scenario, the desire to change habits is already manifested after the experience, as stated by one interviewee. This awakening is extremely important, considering that maintaining health and improving quality of life depends to a large extent on patients. Such awareness is essential if lifestyle changes are to be adopted.
The experiences in this hospital suggest that the service provided has a qualified assistance, but they also have some gaps, given the complexity of the environment of the Intensive Care Units. However, it is possible to observe that patients feel well supported and assisted in terms of their needs, which is extremely important considering the growing reflection on humanized health care, highlighted in some studies (MONDADORI Among the possible limitations of this study, the fact that the interviews were conducted within the intensive care units, may have led to the probability of omitting information, either due to embarrassment or even inhibition, since these patients were still under treatment. unity.
However, the present study brings significant contributions in terms of giving voice to those who have been and are going through the hospitalization process and thus experienced the difficulties and challenges faced by patients in their entirety.
Understanding the hospitalization process from the perspective of patients will provide subsidies for a more humanized environment and care, which encompasses all professionals who are inserted in these units. In addition, the physical therapists that play an important role in the recovery and reintegration of these patients in society stand out in this study, since the main objective of treatment aims at the individual's functionality.

IV. CONCLUSION
In view of the results presented, there was a positive perception of hospitalization in the three intensive care units addressed, mainly to the care provided by the team. However, there are still gaps related to some characteristics inherent to the environment, such as cold, noise, regulated food, the distance from family members and home.
In this sense, it is necessary that more studies be carried out in the context of care in Intensive Care Units and their repercussions, with larger populations and in different regions of the country, since their results will contribute to the development of programs and measures of coping, considering the individuality and need of each patient and thus promoting the improvement of the quality of care in these places.