The research team, led by Roseane Christhina da Nova Sá-Serafim, Gabriella Tambara Nunes de Souza, and Emerson Do Bú, designed the study around a deceptively simple question: if national and state-level documents recommend specific practices for hospital psychologists, are those recommendations actually being followed? The answer, in many cases, is no. Using an online questionnaire that presented 30 statements derived from the main guideline documents governing Brazilian hospital psychology, participants rated how closely each statement reflected their daily practice and how strongly they believed it should be implemented as a guideline. The statements spanned two domains distilled from existing professional references: the management of hospital psychology services, covering team organization, supervision, protocol development, and working conditions, and the professional performance of hospital psychologists, covering direct patient and caregiver care, interprofessional collaboration, documentation, emergency response, and bereavement support.

The technical core of the analysis was a comparison between current practice and intention to implement. For each statement, the researchers used one-sample t-tests to determine whether a practice was performed systematically, benchmarking mean ratings against the scale midpoint of 3.5 on a six-point agreement scale. Paired-sample t-tests then compared each current-practice rating with its corresponding intention-to-implement rating, revealing where professionals see room for standardization. The results showed that several recommended practices are not consistently institutionalized. In the management domain, only the systematization of psychological assessment and performance protocols failed to differ significantly from the midpoint, suggesting these activities lack routinized, standardized execution. In the performance domain, two gaps stood out: psychologists do not uniformly cap their caseloads at 12 patients per 12-hour shift, and 24-hour availability of psychological services is not systematically guaranteed across hospitals.

These two practical gaps carry significant clinical weight. The absence of round-the-clock psychological support is especially consequential in emergency departments, intensive care units, and palliative care settings, where emotional crises do not respect office hours. Meanwhile, the inconsistency around patient-per-shift limits points to a workload problem that extends beyond convenience. Unregulated caseloads can produce work overload, elevating the risk of burnout syndrome among psychologists and, by extension, threatening the quality and equity of care delivered to patients and families. The study’s authors note that clear workload standards, combined with adequate staffing, leadership support, and documentation infrastructure, are precisely the organizational conditions that implementation science identifies as decisive for translating professional consensus into routine practice.

Not everything, however, needs fixing. Several practices scored as well-established, with no meaningful difference between current performance and intention to implement. These include organizing the work process, attending to psychological complications, providing care to caregivers when needed, intervening with grieving family members, and refraining from communicating test results, a task typically reserved for physicians. This pattern suggests that while the structural and managerial scaffolding of hospital psychology remains uneven, the core relational and clinical work, listening to patients, supporting families, facilitating communication within the multidisciplinary team, is already deeply embedded in daily routines across the country.

To test whether the intention to adopt guidelines varied systematically across professional and institutional characteristics, the researchers turned to confirmatory factor analysis and analysis of variance. The two-factor structure of the intention measure fit the data well, with excellent fit indices including a comparative fit index of 0.984 and strong internal consistency for both dimensions. The subsequent ANOVAs, however, told a subtler story. Intentions to implement guideline-based practices were uniformly high across the sample, so high that the researchers describe a ceiling effect: with almost everyone expressing strong endorsement, restricted variance limits the ability to detect reliable differences between subgroups. Within that constraint, two institutional variables emerged with marginal, preliminary associations. Psychologists in public hospitals showed greater intention than those in private hospitals to implement management guidelines, and professionals in medium-sized hospitals expressed stronger intentions regarding practice guidelines than those in small hospitals.

Neither finding should be read as definitive. The authors are explicit that marginal effects falling between conventional significance thresholds of 0.05 and 0.10 should be treated as preliminary signals rather than confirmatory evidence, particularly given uneven subgroup sizes in this exploratory sample. More importantly, individual characteristics such as gender, academic degree, type of contract, hospital region, city type, and theoretical orientation showed no reliable association with intentions. The interpretive takeaway is not that these variables are irrelevant, but that universal endorsement of standardization flattens the differences the researchers hoped to detect. Hospital management model and size may still matter as proxies for governance arrangements, administrative oversight, documentation infrastructure, and service complexity, all of which shape how feasible and legitimate standardization feels within a given institution.

The study frames its central concept, intention to implement, through the lens of implementation science rather than assuming that agreement automatically produces action. Drawing on classic behavioral research, including the theory of planned behavior and meta-analytic evidence of a persistent intention-behavior gap, the authors distinguish endorsement from implementation. A professional can strongly agree that guidelines are valuable and appropriate while facing structural barriers, limited staffing coverage, inadequate documentation systems, or uneven institutional support, that prevent routine adoption. This distinction tempers causal interpretation of the results and clarifies what regulatory bodies can realistically do: leverage the observed professional consensus to advance guideline development, while investing in the organizational supports, training, supervision, and monitoring mechanisms that make fidelity achievable in real hospital conditions.

The urgency of standardization is underscored by recent crises. During the COVID-19 pandemic and the devastating floods that struck Rio Grande do Sul in 2024, hospital psychologists were called upon to deliver coordinated psychological support under extreme conditions, often without clear reference parameters. Well-defined guidelines, the authors argue, can reduce stress and trauma for both patients and healthcare teams during emergencies, promote evidence-based intervention, and facilitate collaboration among health professionals. Yet most Brazilian states lack the specific, objective guidelines that a handful of pioneering regional councils have already produced, such as the Siga Psi document in Paraíba and the technical note from Minas Gerais, which addresses professional qualification, team sizing, occupational health and safety, and medical record registration.

Looking forward, the researchers propose a pragmatic research agenda: translate the most strongly endorsed recommendations into a structured guideline package with clear operational definitions, examine feasibility and fidelity across public, private, and differently sized hospital contexts, and evaluate downstream outcomes ranging from service coverage and documentation quality to team communication, staff wellbeing, and patient- and caregiver-reported results. The study’s own limitations, including non-representative regional sampling and a lengthy questionnaire that may have induced cognitive fatigue, point toward larger and more balanced replications. What the current findings establish is a baseline: Brazilian hospital psychologists overwhelmingly want standardization, many recommended practices already function well, but the managerial and organizational conditions needed to institutionalize guidelines consistently remain a work in progress across the country’s hospitals.

Subject of Research: Current clinical practices of hospital psychologists in Brazil and their intentions to implement standardized guidelines in psychological care.

Article Title: Hospital Psychology in Brazil: Current Practices and Intentions to Implement Guidelines in Psychological Care

Article References: da Nova Sá-Serafim, R. C., de Souza, G. T. N., & Do Bú, E. (2026). Hospital Psychology in Brazil: Current Practices and Intentions to Implement Guidelines in Psychological Care. Trends in Psychology. https://doi.org/10.1007/s43076-026-00525-8

Image Credits: AI Generated

DOI: 10.1007/s43076-026-00525-8

Keywords: hospital psychology, Brazil, clinical guidelines, implementation science, psychological care, burnout, public hospitals, standardization, multidisciplinary teams, workload, evidence-based practice, Trends in Psychology