Percepção de enfermeiros sobre dilemas éticos relacionados a pacientes terminais em unidades de terapia intensiva.

Abstract

Percepção de enfermeiros sobre dilemas éticos relacionados a pacientes terminais em Unidades de Terapia ABSTRACTThe aims of the present study are twofold: to know the nurses perception about the existing ethical dilemmas during nursing assistance to terminal patients in the intensive care unit (ICU) context of a general hospital in São Paulo city, and what is considered in the decision-making when facing those dilemmas. The study was carried out with a qualitative approach, utilizing the content analysis proposed by Bardin. Interviews were made with ten practicing nurses in the ICU. After analysis, there emerged the following categories and subcategories: Category 1-Dilemma-generating factors.Subcategories -values and beliefs, professional responsibility, and the relation with terminal patient's family; Category 2-Factors that influence the decision-making. Subcategories -the explanations to the family and to the terminal patient, the professional posture of nurses and doctors, the difficulties referred to by nurses, and the values and principles of these professionals; Category 3-Participation on process of decision-making. Subcategories -the terminal patient, the family of the terminal patient, the medical team, and the nurses; Category 4-Interferences in nursing support to the terminal patient; Subcategories -care organization and personal values; Category 5-Considerations on the terminality and feelings related to the terminal patient, and category 6 -therapeutic obstinacy verification. The study showed that the nurses face ethical dilemmas resulting from the terminal patient's admission in the ICU generated by several factors: diversity of values; presence of terminal patients in the ICU; religious principles; personal values; uncertainties regarding the terminality of the patient and the limits of intervention to prolong life; the professional responsibility related to the overload of tasks; decision-taking discord; the necessity to prioritize care between terminal patient and others with therapeutical possibilities; nonacceptance of the death process by the patient's family, and the absence of explanations about their clinical status. It was verified that the nurses do not participate actively in the decisions for dealing with the terminal patient, but they consider important the family participation, the respect for the patient's wishes and the participation of other professionals in the process. In addition to that, they take into account their values, professional ethics, the empathy, and the dialogue with colleagues when taking decisions in the face of ethical dilemmas. Key words:Terminal disease, Intensive care unit, Nursing, Ethical dilemmas.Chaves AAB Percepción de enfermeros sobre dilemas éticos relacionados a pacientes terminales en unidades de terapia intensiva [Disertación]. San Pablo (SP): Escuela de Enfermería de la Universidad de São Paulo; 2006. RESUMEN El presente estudio tuvo como objetivos conocer la percepción de enfermeros sobre dilemas éticos existentes en la asistencia de enfermería ...