Perceção da morte e do morrer por parte dos Enfermeiros do Mestrado de Enfermagem da Pessoa em Situação Crítica
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2019-11-27
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Introdução: A morte faz parte do quotidiano da vida dos enfermeiros, principalmente daqueles que lidam com os doentes em situação crítica, cuja vida está ameaçada por falência ou eminência de falência de uma ou mais funções vitais e cuja sobrevivência depende de meios avançados de vigilância, monitorização e terapêutica. Apesar da sua presença constante, a morte não é um tema fácil de abordar, pois trata-se de um processo multifatorial que abrange diversas ciências sociais cujo ónus é o ser humano, designadamente filosofia, psicologia, antropologia, sociologia, teologia e fisiologia, entre outras. Não é fácil definir nem vivenciar a morte pela sua complexidade, não obstante tratar-se de um tema complexo, é fundamental que os enfermeiros consigam lidar com a morte de forma a prestar cuidados holísticos de enfermagem, para além da mera manutenção da vida a todo o custo. Objetivos: Identificar qual a perceção da morte e do morrer por parte dos enfermeiros do Mestrado em Enfermagem da Pessoa em Situação Crítica; compreender como os enfermeiros lidam com a morte dos doentes; indagar sobre a influência que a perceção da morte traz nos cuidados ao doente em fim de vida; perceber de que forma os enfermeiros encaram os cuidados à pessoa em fim de vida e, por último, perceber se os enfermeiros consideram a formação e a preparação adquiridas sobre a temática da morte suficientes para lidarem com o doente em fim de vida. Método: Trata-se de um estudo qualitativo de abordagem fenomenológica, constituído por uma amostra intencional de 11 alunos do Mestrado em Enfermagem da Pessoa em Situação Crítica, sendo a maioria do sexo feminino (n=7), com uma média de idades de 35,2 anos. A média de tempo de serviço dos participantes é de 11,6 anos. As entrevistas foram realizadas entre maio de 2018 e fevereiro de 2019, com uma duração média de 20 minutos. Procedeu-se à sua gravação e transcrição, sendo que esta foi processada através do método de Análise de Conteúdo de Bardin. Resultados: A análise das respostas permitiu apurar que os principais sentimentos associados à morte relatados pelos participantes foram: impotência, frustração/revolta, tristeza/angústia, aceitação e alívio. Quando questionados sobre os sentimentos associados à morte dos doentes, os participantes relatam discursos dos quais emergem categorias semelhantes aos sentimentos associados à morte em geral: impotência, frustração/revolta, aceitação/sensação de dever cumprido e alívio, sendo que a impotência e frustração/revolta têm menos representatividade. Surge, contudo, uma nova categoria: distanciamento. Todos os participantes referiram que aceitavam a morte como uma fase natural do ciclo de vida, apesar de a maioria a aceitar de forma restrita, como em situações terminais ou em idades avançadas. A maioria dos enfermeiros refere que não consegue desligar-se das situações de morte/morrer vivenciadas no local de trabalho, quando se encontra fora do contexto profissional. As opiniões dos participantes dividem-se em relação aos cuidados prestados aos doentes em fim de vida; mencionam bons cuidados; cuidados a melhorar e obstinação terapêutica. Consequentemente, a maioria dos participantes considera que não há uma especial atenção dedicada aos cuidados holísticos ao doente em fim de vida, nos seus locais de trabalho. Como aspetos a melhorar nos cuidados prestados ao doente em fim de vida, os participantes referiram um maior acompanhamento familiar; a necessidade de se privilegiar conforto; cuidados ao doente e à família e a necessidade de mais tempo para cuidar do doente em fim de vida. Os participantes consideraram que estavam pouco preparados para lidar com a morte/morrer, quando iniciaram a atividade profissional. A perceção deles sobre a abordagem da morte e do morrer na formação de base é que a temática foi abordada de forma subliminar e/ou insuficientemente para responder às necessidades verificadas no apoio aos doentes em fim de vida e às respetivas famílias. Considerações finais: Consideramos fundamental a criação de espaços para discussão nas instituições hospitalares, para que os profissionais possam partilhar experiências e, desta forma, atenuar situações de extrema exigência emocional e potenciadoras de sofrimento psíquico. Evidenciamos a necessidade de serem implementadas políticas de saúde, nas instituições hospitalares, que levem ao cumprimento das dotações seguras; este princípio permitirá uma prestação de cuidados holísticos, atendendo a uma maior disponibilidade dos enfermeiros, com destaque para a vertente do suporte ao doente e à família. Acreditamos que devem ser abordados os temas da morte e do morrer, não só na formação de base mas também na sociedade em geral, numa vertente científica e holística, que sirva o propósito de preparar os futuros enfermeiros e profissionais para uma melhor gestão do processo de morte/morrer.
Introduction: Death is part of daily life for nurses, especially for those who deal with the critically ill patients whose life is threatened by failure or by the eminence of failure of one or more vital functions and whose survival depends on advanced means of surveillance, monitoring and therapy. Despite its constant presence, death is not an easy subject to deal with, since it is a multifactorial process that involves several social sciences centred in the human being, namely philosophy, psychology, anthropology, sociology, theology and physiology, among others. It is not easy to define or experience death because of its complexity, although it is a complex issue, it is fundamental that nurses manage to deal with death in order to provide holistic nursing care, beyond the mere maintenance of life at all costs. Objectives: Identify the perception of death and dying of the MEPSC nurses; understand how nurses deal with the death of the patients; inquire about the influence that the perception of death brings in the care of the patients in the process of death and dying; understand how nurses view the care of the patients in the process of death and dying and, finally, see if nurses consider the training and preparation acquired on the subject of death to be sufficient to deal with the process of death and dying of their patients. Methods: This was a qualitative study of phenomenological approach, consisting of an intentional sample of 11 MEPSC students, most of them female (n=7), with an average age of 35.2 years. The average service time of the participants is 11.6 years. The interviews were conducted between May 2018 and February 2019, with an average duration of 20 minutes. The interviews were recorded and transcribed, and they were processed through the Bardin Content Analysis method. Results: The analysis of the answers allowed us to conclude that the main feelings associated with death reported by the participants were: impotence, frustration/revolt, sadness/distress, acceptance and relief. When asked about the feelings associated with the death of patients, participants reported answers from which emerged categories similar to feelings associated with death in general: impotence, frustration/rebellion, acceptance/sense of duty and relief, impotence and frustration/revolt are less representative. However, a new category emerges: detachment. All participants reported that they accepted death as a natural phase of the life cycle, although most accepted it in a restricted way, as in terminal situations or in advanced ages. Most nurses reported that they cannot get out of the death/dying situations experienced in the workplace when they are out of the professional context. The views of the participants were divided on the care of patients in the process of death and dying. They referred to good care, care that required improvement and therapeutic obstinacy. Consequently, most participants considered that there is no particular focus on holistic care of patients in the process of death and dying, in their workplaces. With regard to care that requires improvement, the participants reported a greater family follow-up; the need to privilege comfort; care for the patient and the family, and the need for more time to care for the patient in the process of death and dying. The participants considered that they were little prepared to deal with death and dying when they started the professional activity. Their understanding of the approach to death and dying in professional training is that the issue has been subliminally and/or insufficiently addressed to meet the needs of patients in the process of death and dying and their families. Final considerations: We consider it fundamental to create spaces for discussion in hospital institutions, so that professionals can share experiences and, in this way, attenuate situations of extreme emotional exigency and potentiators of psychic suffering. We demonstrate the need to implement health policies in hospital institutions that lead to the fulfilment of safe allocations; this principle will allow the provision of holistic care, considering the greater availability of nurses, with emphasis on the support of the patient and the family. We believe that the themes of death and dying should be addressed not only in professional training but also in society in general, in a scientific and holistic ways, to serve the purpose of preparing future nurses and professionals for a better management of the death and dying process
Introduction: Death is part of daily life for nurses, especially for those who deal with the critically ill patients whose life is threatened by failure or by the eminence of failure of one or more vital functions and whose survival depends on advanced means of surveillance, monitoring and therapy. Despite its constant presence, death is not an easy subject to deal with, since it is a multifactorial process that involves several social sciences centred in the human being, namely philosophy, psychology, anthropology, sociology, theology and physiology, among others. It is not easy to define or experience death because of its complexity, although it is a complex issue, it is fundamental that nurses manage to deal with death in order to provide holistic nursing care, beyond the mere maintenance of life at all costs. Objectives: Identify the perception of death and dying of the MEPSC nurses; understand how nurses deal with the death of the patients; inquire about the influence that the perception of death brings in the care of the patients in the process of death and dying; understand how nurses view the care of the patients in the process of death and dying and, finally, see if nurses consider the training and preparation acquired on the subject of death to be sufficient to deal with the process of death and dying of their patients. Methods: This was a qualitative study of phenomenological approach, consisting of an intentional sample of 11 MEPSC students, most of them female (n=7), with an average age of 35.2 years. The average service time of the participants is 11.6 years. The interviews were conducted between May 2018 and February 2019, with an average duration of 20 minutes. The interviews were recorded and transcribed, and they were processed through the Bardin Content Analysis method. Results: The analysis of the answers allowed us to conclude that the main feelings associated with death reported by the participants were: impotence, frustration/revolt, sadness/distress, acceptance and relief. When asked about the feelings associated with the death of patients, participants reported answers from which emerged categories similar to feelings associated with death in general: impotence, frustration/rebellion, acceptance/sense of duty and relief, impotence and frustration/revolt are less representative. However, a new category emerges: detachment. All participants reported that they accepted death as a natural phase of the life cycle, although most accepted it in a restricted way, as in terminal situations or in advanced ages. Most nurses reported that they cannot get out of the death/dying situations experienced in the workplace when they are out of the professional context. The views of the participants were divided on the care of patients in the process of death and dying. They referred to good care, care that required improvement and therapeutic obstinacy. Consequently, most participants considered that there is no particular focus on holistic care of patients in the process of death and dying, in their workplaces. With regard to care that requires improvement, the participants reported a greater family follow-up; the need to privilege comfort; care for the patient and the family, and the need for more time to care for the patient in the process of death and dying. The participants considered that they were little prepared to deal with death and dying when they started the professional activity. Their understanding of the approach to death and dying in professional training is that the issue has been subliminally and/or insufficiently addressed to meet the needs of patients in the process of death and dying and their families. Final considerations: We consider it fundamental to create spaces for discussion in hospital institutions, so that professionals can share experiences and, in this way, attenuate situations of extreme emotional exigency and potentiators of psychic suffering. We demonstrate the need to implement health policies in hospital institutions that lead to the fulfilment of safe allocations; this principle will allow the provision of holistic care, considering the greater availability of nurses, with emphasis on the support of the patient and the family. We believe that the themes of death and dying should be addressed not only in professional training but also in society in general, in a scientific and holistic ways, to serve the purpose of preparing future nurses and professionals for a better management of the death and dying process
Descrição
Dissertação de Mestrado em Enfermagem da Pessoa em Situação Crítica sendo apresentada
na Universidade de Trás-os-Montes e Alto Douro para a obtenção do grau de Mestre em
Enfermagem da Pessoa em Situação Crítica,
Palavras-chave
Perceção , Morte