Objective: to understand how nurses deal with the elderly’s autonomy at the end of life. Method: qualitative, exploratory study, guided by the Grounded Theory. Ten nurses, eight doctors and 15 nursing technicians were interviewed between November 2016 and May 2017 at a university hospital in Rio de Janeiro/Brazil. Results: nurses deal with the elderly’s autonomy in compliance with the code of ethics and exercise leadership in actions and interactions to defend this right, evaluating, guiding and listening to the preferences of the elderly; interacting with the family; and sharing information with the health team. Final considerations: the elderly’s autonomy must be ensured in care planning, based on patient-centered communication and developed in the interaction among agents involved in care. The discussion on “Living Wills” Health Care Directives and principles of palliative care must be encouraged.
Objective: To study the understanding of health professionals in relation to end-of-life patient care in an oncology intensive care unit, and discuss the objectives they seek to achieve when planning care from a palliative point of view. Methods: Descriptive study, with a qualitative approach, conducted in the adult ICU of a cancer hospital. Twenty-five professionals participated in the study: 12 nurses, eight physicians, two nutritionists and three physiotherapists. The inclusion criterion was: working in the sector for one year or more. Professionals on vacation or medical leave during the data collection, which took place between December 2015 and May 2016, were excluded. The data collection technique used was the semi-structured interview. Thematic content analysis was employed to analyze the data, in the following stages: preanalysis; exploration of the material or codification; treatment of the results, inference and interpretation. Results: The three categories encompass contextual particularities according to the severity of the cases, disease stages and treatments, end-of-life condition, medication and management difficulties. However, a need was noted to promote comfort, attend to families and invest in the integration of palliative and critical care. Conclusion: Care planning from a palliative perspective in this context is in the initial stages; challenges for putting it into practice are listed, with a concern to humanize care. It is suggested to use an interconsultive model for integration of specialties, through institutional characteristics. ResumoObjetivo: Analisar o entendimento dos profissionais de saúde acerca da assistência ao paciente em cuidados ao fim da vida na unidade de terapia intensiva (UTI) oncológica, e discutir os objetivos que buscam alcançar ao planejar a assistência na perspectiva dos cuidados paliativos. Métodos: Estudo descritivo, com abordagem qualitativa, realizado na UTI adulto de um Hospital do Câncer. Participaram do estudo 25 profissionais: 12 enfermeiros, oito médicos, dois nutricionistas e três fisioterapeutas. Respeitou-se o critério de inclusão: estar atuando no setor por tempo maior ou igual a um ano. Foram excluídos profissionais de férias e de licença médica durante o período de coleta de dados, que transcorreu entre dezembro de 2015 a maio de 2016. A técnica de coleta de dados foi a entrevista semiestruturada. Para análise dos dados utilizou-se a análise de conteúdo temática, seguindo as etapas: pré-análise; exploração do material ou codificação; tratamento dos resultados, inferência e interpretação. Resultados: As três categorias abrangem particularidades contextuais pela gravidade dos casos, fases da doença e tratamentos, terminalidade da vida, medicalização e dificuldades gerenciais. Entretanto, evidenciou-se a necessidade de promover conforto, atender a família, e investir na integração dos cuidados paliativos e críticos. Conclusão: O planejamento assistencial na perspectiva dos cuidados paliativos no contexto é incipiente; elencam-se desafios para a...
Objectives: To understand the meaning attributed by the nurse to the management of nursing care to the person hospitalized due to clinical complications caused by AIDS; to analyze actions related to palliative care; and to construct a theoretical matrix regarding the management of nursing care. Method: Qualitative, exploratory research, guided by the Grounded Theory. Seven nurses and ten nursing technicians were interviewed between May and September 2015, in a university hospital, located in Rio de Janeiro State, Brazil. Results: Five categories that covered the profile of the hospitalized person, palliative care, intervening conditions for care management, the need for professional qualification, and other aspects to better organize and manage care, including conflict management arose. Final considerations: The theoretical matrix values the quality of life, the need to understand the flow of care to avoid readmissions and not adherence to medications, requiring new research in the area, such as implementation.
Objetivo: Refletir sobre a saúde da pessoa idosa na pandemia pelo COVID - 19, para a elaboração de orientações de enfermagem, dirigidas a Atenção Primária à Saúde e à Assistência Hospitalar Especializada. Método: Análise e discussão à luz da produção científica sobre a COVID 19, pautando-se em indicadores epidemiológicos, clínicos, políticos, sociais e espirituais, considerados estruturantes do cuidado de enfermagem. Resultados: Identificou-se que a prática de enfermagem deve ser direcionada à pessoa idosa em três situações específicas e a seus desdobramentos: o idoso frágil e acamado na comunidade; o idoso autônomo e independente em isolamento social; o idoso em potencial risco de hospitalização. Conclusão: O estudo identificou que idosos acamados, residentes em comunidades, compõem o grupo de alto risco dessa pandemia. Entende-se que os esforços para que a situação seja contida, requer empenho coletivo e conscientização da população e do cuidador do idoso. Sendo então, a articulação, os esforços e apelos realizados pelos profissionais de saúde, parte fundamental, para que ocorra a promoção da saúde e não só auxílio para resolutividade de comorbidades e recuperação dele. Ademais, também é dever do Estado acolher a população vulnerável, considerando os determinantes sociais implicados no processo de adoecimento a fim de minimizar os danos.
Objective: to understand the meanings attributed by nurses about conditions that interfere in defending of the elderly’s autonomy on the terminality of life in the context of hospitalization. Method: qualitative and exploratory study, which applied the Grounded Theory. Data were collected between November 2016 and May 2017, in the internal medicine wards of a hospital in Rio de Janeiro, Brazil, through non-participant observation and semi-structured interviews. Three sample groups composed of ten nurses, eight doctors, and 15 nursing technicians were investigated. Results: the conditions are related to the medical power, subordination of nurses, family influences; the functional decline of the elderly; and biomedical model. Final considerations: the elderly’s autonomy is veiled and violated since their abilities are subjugated, and the family’s will and professional paternalism may prevail. However, this right must guide contemporary care models and integrate palliative care.
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