Identificación de los conflictos éticos en la atención sociosanitaria. Un estudio exploratorio

Atención de la salud en domicilio

“…Las consideraciones realizadas a continuación apoyan la función ética de mejorar la calidad de la atención y el cuidado de la salud, así como de fortalecer la agencia moral de pacientes en situación de atención y cuidado domiciliario. Hay cuestiones éticas que son comunes a la atención domiciliaria y hospitalaria, mientras que también se reconocen ciertas diferencias según el ámbito de asistencia del que se trate (38,39,40). Una de las principales diferencias que se puede establecer es en torno a la intimidad personal y del hogar.…”

Cuidados paliativos e a atenção primária à saúde: scoping review

“…The lack of truthfulness whilst talking to patients and their families about their actual health situation is another ethical problem identified in the relationship and communication of primary health care professionals working in palliative care 15 . Besides the lack of information, professionals report breach of confidentiality in the treatment and prognosis of patients 16 …”

“…Doctors and nurses have proposed some strategies for improvement of work in home-based palliative care: regular multidisciplinary meetings; easiness of referral to specialised services of palliative care; more nurses for home visits; nursing training in telephone service after the opening hours of the primary health care and, especially, the development and adoption of standardised protocols for the plan of treatment concerning each patient 18 . Professionals in the primary health care involved in palliative care wish to continue in the program, but the scarcity of resources, lack of organisation and management of services cause overload 10,16 . The lack of resources and referral services, the work overload and lack of space to discuss the experiences in the care of dying patients are factors that make nurses more prone to psychological illnesses, besides creating frustration among them, because they can not provide care of good quality 23 .…”

“…They also mention suspicion of physical, psychological and economical abuse practiced by the patient's family towards the patient. 16 . When faced with abuse, carelessness and neglect by family members, nurses change their behaviour in the attention to the patient , restricting their care to an exclusively technical scope.…”

“…Doctors report that informal caregivers are the main collaborators in the provision of palliative care at home 19 . The relationship between professionals of the PHC and the family and informal caregivers is of poor quality, according to those professionals 16 . The nurses claim lack of conditions, time and preparation to accompany the mourning family and informal caregivers 15 , while recognising their emotional suffering…”