Objective: to identify the coping strategies of oncology services of nurses in highly complex hospital care before the person with cancer. Method: it is a qualitative research, with 18 nurses in inpatient oncology units and/or outpatient chemotherapy in two cities in southern Brazil, sampled by a snowball and carrying out semi-structured interviews. Data were submitted to thematic analysis. Results: three categories emerged that show strategies such as denial and resignation in care, for support in the health team and the plurality and multiplicity of perspectives on the care, including the patient and his family and the search for personal and professional improvement. Conclusion: coping strategies are expressed in the cultural understanding of what it means to have cancer or not and management of health institutions for nurses to work with satisfaction. The service in education is a major factor in the development of ethical competence.

The aim of this quantitative study was to identify the socio-demographic and academic profile of intensive care registered nurses and participants of the events organized by the Department of Nursing of the Brazilian Association of Intensive Care Medicine. Data were collected by means of 400 questionnaires applied between January and July of 2010, however only 324 questionnaires were returned and 295 questionnaires were considered for the analysis. Data were analyzed with descriptive statistics resources with absolute relative frequency and simple mean, presented in tables. Results show the predominance of women, with specific graduate degrees. The skills and values highlighted include technical and scientific knowledge, and leadership. These professionals seek work in intensive care because of the high technological complexity. The study emphasized the existence of the professional profile required to work in the intensive care unit. The qualification of these professionals must prioritize the mastering of the technological language and the comprehensive and safe care.

Objective: to know the ethical problems experienced by oncology nurses. Method: descriptive and exploratory study with a qualitative approach, performed in inpatient units and in chemotherapy out-patients units that provide assistance to oncological patients in two capitals in the South region of Brazil. Eighteen nurses participated in this study, selected by snowball sampling type. For data collection, semi-structured interviews were carried out, which were recorded and transcribed, and then analyzed by thematic analysis. Results: two categories were established: when informing or not becomes a dilemma - showing the main difficulties related to oncological treatment information regarding health staff, health system, and infrastructure; to invest or not - dilemmas related to finitude - showing situations of dilemmas related to pain and confrontation with finitude. Conclusion: for the effective confrontation of the ethical problems experienced by oncology nurses to occur, it is important to invest in the training of these professionals, preparing them in an ethical and human way to act as lawyers of the patient with cancer, in a context of dilemmas related mainly to the possibility of finitude.

Objective: to analyze how intensive care nurses practice patient advocacy in view of the need for hospitalization by court order to an intensive care due to bed unviability. Method: analytical exploratory qualitative research. Data were obtained through interviews with 42 nurses, selected via snowball sampling, between January and December 2016. The interviews were analyzed using elements of the Discursive Textual Analysis. Results: two categories emerged: 1) Between obedience to the law and the ethical-moral duty of the intensive care nurse; 2) The position of nurses in the practice of patient advocacy for patients requiring intensive care beds. Conclusions: intensive care nurses exercise sensitivity and moral duty of the care process when defending their patients by informing them of their rights, guiding, acting and talking to and on behalf of patients and their families, valuing care free of judgment and harm to the patient hospitalized by court order.

Objetivo: analisar os problemas éticos vivenciados por enfermeiros intensivistas em situações de internação por ordem judicial na perspectiva da deliberação moral. Método: pesquisa qualitativa entre janeiro e dezembro de 2016, mediante entrevistas semiestruturadas com 42 enfermeiros intensivistas das regiões Sul e Sudeste do Brasil. Apreciada por meio da Análise Textual Discursiva. Resultados: a análise resultou em três categorias que apresentam como conteúdo a prioridade da deliberação, o sofrimento moral dos enfermeiros e a advocacia do enfermeiro. Considerações finais: a judicialização da saúde traz alterações significativas nas relações sociais e institucionais. Os enfermeiros devem perceber que, frente às diferentes possibilidades de tomadas de decisão diante dos problemas éticos, valores morais importantes encontram-se em conflito.

Pesquisa-ação de abordagem exploratória aplicada em cinco Grupos Focais com doze enfermeiros intensivistas de São Paulo. Objetivou desvelar competências necessárias ao enfermeiro atuante em terapia intensiva segundo os profissionais, possibilitando a construção do perfil de competências de atuação do enfermeiro intensivista, desencadeando estratégias para capacitação deste e criação de uma proposta para desenvolvimento das competências. Apontou-se como competências do enfermeiro intensivista: conhecimento e desempenho técnico/tecnológico; conhecimento científico; tomada de decisões; liderança; trabalho em equipe; relacionamento interpessoal; comunicação; planejamento; organização; equilíbrio emocional.Dentre estas, como competências essenciais: conhecimento técnico e científico, liderança, equilíbrio emocional e tomada de decisão.Descritores: Competência profissional; Unidades de terapia intensiva; Enfermagem. UNVEILING SKILLS INTENSIVE IN CARE NURSEAction-research of exploratory approach applied in five focus group with twelve intensivist nurses of São Paulo. Aimed to identify the necessary skills for a nurse to work in intensive care second professionals, enabling the construction of the skills profile of the intensive care nurse action, triggering strategies for this training and creating a proposal to develop these skills. It was pointed as skills of intensive nursing: knowledge and technical/technological performance; scientific knowledge; decision making; leadership; teamwork; interpersonal relationships; communication; planning; organization; and emotional balance.Among these, evidenced as core competencies: technical and scientific knowledge, leadership, emotional balance and decisionmaking.Descriptors: Professional competence; Intensive care units; Nursing. DESCUBRIENDO COMPETENCIAS DEL ENFERMERO EN CUIDADOS INTENSIVOSInvestigación-acción, enfoque exploratorio aplicada en cinco grupos focales con doce enfermeras intensivistas, de São Paulo.Pretendía conocer las habilidades necesarias según los profesionales, permitiendo construcción del perfil de competencias de desempeño de la enfermera intensivista, con lo cual se puso en marcha estrategias para formación y creación de una propuesta para desarrollo destos. Hay que señalar como enfermera intensivista competencias: conocimientos y desempeño técnico/tecnológico; conocimiento científico; toma de decisiones; liderazgo; trabajo en equipo; relaciones interpersonales; comunicación; planificación; organización; equilibrio emocional. Entre estos, se evidencia en las competencias clave: conocimientos y desempeño técnico/tecnológico, liderazgo, equilibrio emocional y toma de decisiones.

Objective: to identify, from the nurse perspective, situations that interfere with the availability of beds in the intensive care unit in the context of hospitalization by court order. Method: qualitative exploratory, analytical research carried out with 42 nurses working in adult intensive care. The selection took place by non-probabilistic snowball sampling. Data collected by interview and analyzed using the Discursive Textual Analysis technique. Results: three categories were analyzed, entitled deficiency of physical structure and human resources; Lack of clear policies and criteria for patient admission and inadequate discharge from the intensive care unit. In situations of hospitalization by court order, there is a change in the criteria for the allocation of intensive care beds, due to the credibility of professionals, threats of medico-legal processes by family members and judicial imposition on institutions and health professionals. Conclusion: nurses defend the needs of the patients, too, with actions that can positively impact the availability of intensive care beds and adequate care infrastructure.

Advanced heart failure (HF) is associated with reduced quality of life and high hospitalization and mortality rates. Ventricular assist devices (VADs) promote an increase in cardiac output, and consequently improvements in body functions, functional capacity and patient survival. However, the use of VAD may be associated with complications and require systematic and specialized care. Ischemic and hemorrhagic stroke is among the most feared complications and its occurrence is related to thrombus formation in the pump. The connection between the driveline and the external power source is a potential source of infection that may extend to the mediastinum. Management of bleeding caused by anticoagulation therapy may be challenging, since discontinuation of the treatment may lead to thrombus formation. Aortic insufficiency and right ventricular dysfunction may occur, particularly in prolonged periods of support, requiring optimization of VAD parameters and clinical management. Although uncommon, mechanical failure of the VAD may occur and require replacement of the pump or even heart transplant. Thus, identification and management of the main complications of VAD in patients with advanced HF is needed, so that strategies for prevention and rigorous clinical follow-up can be implemented. This review aims to summarize the main adverse events in patients with long-term VAD.