Conditioning factors for nurses to defend the autonomy of the elderly on the terminality of life

Abstract

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.

Association between common mental disorders and quality of life in older adults

“…Autonomy concerns the ability or freedom of older adults to make decisions and experience their old age autonomously and independently (18) , deciding aspects that they believe are best for them and that are in accordance with their social, cultural and religious values (19)(20) . Therefore It is an essential concept because it involves issues related to human dignity, regardless of health conditions (17) , that is, the exercise of autonomy is a right guaranteed, even to older adults in conditions of dependence (20) and in palliative care (19) . Our results show that, regardless of the suspicion of CMD, older adults had better QoL in the sensory skills facets, corroborating a study (21) and diverging from another (22) , in which a better perception of QoL in the intimacy facet was identified (22) .…”

Autonomia de pacientes em quimioterapia no Instituto Nacional de Câncer

“…"Foi um tratamento que não se sabe se era muito eficaz, pelo que foi passado aqui. Aqui eu faço terça, quarta, quinta, sexta, sábado e domingo seguindo, descanso 16 Esse sentimento de abandono relatado pelo participante resulta da clara deficiência de comunicação entre os diferentes pontos da rede de atenção à saúde responsáveis pelos pacientes com câncer. Conforme descreve Mendes 22 , a construção de uma rede de atenção à saúde está muito além da existência dos pontos de assistência aos enfermos.…”

“…Apesar da importância do tema, há carência de estudos que abordam a visão do paciente sobre o respeito a sua autonomia em cenários de tratamento quimioterápico. Além disso, as pesquisas que abordam a temática da autonomia de pacientes com câncer estão focadas, principalmente, nas decisões de fim de vida, e menos nas decisões durante o tratamento oncológico 6,15,16 .…”

Personal autonomy of patients undergoing chemotherapy at the Instituto Nacional de Câncer

“…Despite the importance of the topic, there is a lack of studies addressing the patient's view of respect for their autonomy in chemotherapy treatment scenarios. Studies addressing the autonomy of patients with cancer are also mostly focused on end-of-life decisions, and not on decisions during cancer treatment 6,15,16 .…”

“…what was explained here. Here I do it on Tuesday, Wednesday, Thursday, Friday, Saturday, and Sunday, then I rest for16 [days] and do it for five more[days]. Soon after that, I had a problem.…”