Background: Identify the main stressors of the nursing team in assisting patients in oncology palliative care with suspicions and confirmed for COVID-19.Methods: Qualitative, descriptive and exploratory study with theoretical framework in the psychodynamics of work, carried out in the emergency and hospitalization sector of a national reference center for cancer treatment in Rio de Janeiro/Brazil. The semi-structured interview was used to collect the data, from April to May 2020. The data were organized and analyzed using the Collective Subject Discourse (CSD) method with the aid of the Qualiquantisoft ® software.Results: Twenty members of the nursing team participated (10 nurses and 10 nursing technicians). After the analysis, three CSDs with their respective central ideas (CI) emerged. The CSD software, Qualiquantisoft ® , also provided a quantitative analysis of the responses, in which 12 (60%) of the respondents believe that the main stressors are associated with work organization, 6 (30%) of the respondents believe that the main stressors are associated to work relationships and 2 (10%) of respondents believe that the main stressors are associated with working conditions. Conclusions:The adaptations that took place in the management of care and in the organization of work, to better serve patients in oncology palliative care with suspicions and confirmed for COVID-19, brought greater impact and psychological stress on the nursing team. Considering all the difficulties and influences that the nursing team members are facing in this pandemic moment by COVID-19 associated with palliative oncology care, it is believed that identifying the source of the psychological stress presented by them may contribute to them have a more effective, humanized and holistic care, in addition to spreading knowledge to nursing and other segments of the health area and bringing subsidies to other scientific productions, as well as highlighting the importance of early detection of psychological stress as a way of preventing impacts physical and psychosocial problems caused by work.
Estresse da equipe de enfermagem em cuidados paliativos no enfrentamento da COVID-19Stress in palliative care nursing staff while coping with COVID-19 Estrés del equipo de enfermería de cuidados paliativos en el enfrentamiento a la COVID-19
Objective: to report a case of periductal mastitis, whose initial presentation has been necrosis of nipple in a client of the Public Unified Health System (SUS) in the city of Magé / Rio de Janeiro. The public healthcare system client had reported prolonged use of cheap cigarettes which she used to smoke and which she could afford. Method: case report qualitative study, anchored in anamnesis and physical examination with emphasis on patient social history and pathophisiology of benign breast mastitis related to tobacco use. Result: According to anamnesis and physical examination, it is suggested that a chronic inflammatory process in breast ducts had occurred. A chronic breast inflammatory process may be linked with toxins eliminated in cigarette combustion, nevertheless an overwhelming patient social vulnerability and issues concerning self-care must be regarded by primary health care nursery. Conclusion: Quitting smoking may imply multifactorial aspects, including willpower, psychiatric and somatic disorders, poverty and little access to healthcare system in Brazil. Body care should have been emphasized concerning medical and nursing management. In Magé, mastitis diagnosis associated with tobacco use has been somewhat frequent, and recurrent non-puerperal breast abscess complicates most cases. Often, poor female patients with low self steem have consumed cheaper cigarettes, perhaps less subject to appropriate quality control.
Objetivo: identificar as principais influências psíquicas na percepção da equipe de Enfermagem na atenção paliativa oncológica durante a pandemia da COVID-19. Método: estudo interpretativo de abordagem qualitativa com referencial teórico na psicodinâmica do trabalho de Christophe Dejours. Compuseram a amostra 20 membros da equipe de Enfermagem que atuam na assistência de pacientes em cuidados paliativos oncológicos suspeitos e confirmados para COVID-19. Desenvolvido em uma unidade hospitalar especializada em cuidados paliativos oncológicos na cidade do Rio de Janeiro/Brasil. Foram realizadas entrevistas semiestruturadas e analisadas com base no referencial metodológico do discurso do sujeito coletivo (DSC). Resultados: emergiram dois discursos do DSC com suas ideias centrais: DSC1 -"influências psíquicas negativas da assistência paliativa oncológica durante a pandemia pela COVID-19 na percepção da equipe de Enfermagem"; e DSC2 -"influências psíquicas positivas da assistência paliativa oncológica durante a pandemia pela COVID-19 na percepção da equipe de Enfermagem". Conclusão: pôde-se perceber que a carga emocional demandada por esses profissionais,bem como tudo que está envolvido no processo do enfrentamento dessa pandemia, apresenta importante relação com o aparecimento dos sintomas que podem desencadear a síndrome de burnout. Por outro lado, foi possível identificar fatores positivos relacionados ao bem-estar profissional nesse momento de pandemia e fatores protetivos à saúde do trabalhador, tal como se manter na mesma equipe de trabalho visando ao apoio mútuo.
Os desafios vivenciados pelos residentes multiprofissionais diante da sedação paliativa, e a necessidade de capacitação para a formação de profissionais éticos, humanos e reflexivos na assistência em cuidados paliativos, são impasses que refletem diretamente na assistência prestada ao paciente. O objetivo deste presente trabalho é discorrer acerca da percepção dos residentes multiprofissionais frente a sedação paliativa oncológica com base em uma análise de artigos científicos sobre o tema. Trata-se de uma revisão integrativa incluindo artigos primários indexados nas bases de dados LILACS, MEDLINE, BDENF, IBECS e COLECIONA SUS, conforme recomendações da ferramenta PRISMA, publicados a partir de 2017. Após análise foi observado que as publicações envolveram aspectos relacionados, categorizando 03 temas principais: Percepção bioética dos residentes sobre sedação paliativa; percepção de boas práticas da sedação paliativa e percepção da formação profissional dos residentes sobre sedação paliativa. Identificou-se uma grande lacuna do tema abordado. Todos estes aspectos impactam diretamente na atuação dos residentes no processo da abordagem da sedação paliativa oncológica devido a insegurança e despreparo, fazendo-se necessário a abordagem do tema na formação desses profissionais.
ObjectiveTo report the experience of offering the Quality End of Life Care for All (QELCA) Programme, highlighting the distinct methodology for the training of health professionals.DevelopmentThe QELCA Programme, intellectual property of St Christopher’s Hospice, was offered to seven health professionals working in the hospital palliative care unit at the National Cancer Institute, between June and December 2022, with the support of Premier Institute. The programme, which originates in the UK, has been evaluated there and is currently being evaluated in Hong Kong, and is delivered in two phases: (1) a 5-day immersion programme; (2) monthly sessions of Action Learning for 6 months. Participants realised that communication between members of the multidisciplinary team, as well as between health professionals and patients/loved ones, was one of the key challenges for achieving quality of death in the hospital palliative care unit. This insight empowered them to drive forward significant changes in practice that promise to improve quality of care.ConclusionThe QELCA Programme enabled participants to engage in active problem-solving to promote the relief of suffering of patients and their families in end-of-life care.
We developed a search strategy to retrieve relevant studies from electronic databases, including MEDLINE (OVID), EMBASE, CINAHL and Cochrane Central Register of Controlled Trials. Controlled vocabulary terms, text words and medical subject headers (MeSH) were searched. Recovery time was from the beginning of the databases up to May 24, 2022. Search strategy peer review was performed through PRESS Checklist.
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