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Vivências dos enfermeiros relativamente a cuidados post mortem em unidades de medicina
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A morte continua a ser um grande mistério, e por vezes está associada ao horror, absurdo e sofrimento. Por isso, reflectir sobre a morte e o morrer, numa perspectiva de enfermagem, significa dedicar algum tempo a pensar como os enfermeiros vivenciam a morte de um doente, a quem prestam os cuidados post mortem.
O tema a que nos propusemos estudar foi as vivências dos enfermeiros relativamente aos cuidados post mortem em unidades de medicina; Este estudo foi inspirado nos trabalhos intitulados “Cuidar em Fim de Vida” (Magalhães, 2009) e “A aprendizagem do cuidar e a morte: um desígnio do enfermeiro em formação” (Frias, 2003), já que do trabalho destes dois autores se concluiu acerca da necessidade de aprofundar este assunto. Enquanto enfermeira que desenvolveu a sua actividade em serviço de medicina, inserida numa equipa de cuidados continuados, e actualmente desenvolve actividade em hospital de dia médico, em oncologia, o confronto com o doente em fase terminal e a morte é muito comum. Após a observação de colegas, apercebi-me que a morte e a prestação dos cuidados post mortem podem influenciar a vida profissional e pessoal, e por isso existe a necessidade de reflectir sobre a morte, sobre a nossa conduta e sobre as estratégias de coping utilizadas para conseguir ultrapassar estas situações, as quais levaram à pergunta de partida: quais as vivências dos enfermeiros ao cuidar o corpo post mortem numa unidade de medicina?
Para dar resposta a esta questão realizámos um estudo de carácter qualitativo, de natureza exploratório descritivo. Deste modo, o presente trabalho teve como objectivo geral: compreender as vivências dos enfermeiros, relativamente aos cuidados prestados ao corpo post mortem, em unidades de medicina. Elegemos como instrumento de colheita de dados a entrevista semi-estruturada, tendo-se realizado doze entrevistas, o que correspondeu ao total de doze participantes do estudo, os quais cumpriram os critérios de elegibilidade definidos.
Como procedimento de tratamento e análise dos dados obtidos foi adoptada a metodologia proposta por Miles e Huberman (1984). Dos mesmos dados emergiram cinco temas centrais, que correspondem a: “alterações causadas no enfermeiro pela prática dos cuidados post mortem”, “cuidar do corpo post mortem”, “influência da morte na esfera pessoal e profissional do enfermeiro”, “estratégias de adaptação utilizadas pelo enfermeiro para lidar com a morte” e “o valor do cuidar em fim de vida”.
A cada tema encontram-se associados as respectivas categorias e subcategorias, perfazendo um total de doze para as primeiras e de setenta e três em relação às segundas.
Salientam-se como principais conclusões o facto da vivência da prestação dos cuidados post mortem assumir repercussões intensas no domínio biopsico-emocional dos enfermeiros; esta experiência leva os enfermeiros a desenvolver um conjunto de percepções em relação à morte, em que a mesma constitui-se como um elemento integrante do percurso de vida, sendo que o enfermeiro encontra estratégias de coping para ultrapassar esta problemática; a prestação dos cuidados em fim de vida coloca os enfermeiros em diversos dilemas ético-deontológicos que só a formação e a reflexão podem ajudar a ultrapassar.
Death remains a great mystery, and is often associated with horror, absurdity and suffering. So, thinking about death and dying, in a nursing perspective, means dedicating some time to try to understand how nurses experience the death of a patient, to whom they provide post mortem care. The theme we set ourselves to study was experiences of nurses relatively to post mortem care in medical units; This study was inspired in the readings of the works entitled “Cuidar em Fim de Vida” (Magalhães, 2009) and “A aprendizagem do cuidar e a morte: um desígnio do enfermeiro em formação” (Frias, 2003), whereas of the work of these two authors it was concluded about the need to deepen this subject. As a nurse who has developed her activity in medicine service, in a continuous care team, and currently develops activity in Day Care Hospital, in Oncology Service, the confrontation with the terminally ill patient and death is very common. After the observation of colleagues, I realized that death and post mortem care delivery may influence the professional and personal life, and therefore there is the need to think about death, about our conduct, and on coping strategies used for overcoming these situations, which led to the starting question: “what are the nurses experiences to care a post mortem body in a medical unit?”. To answer this question we organized a study of qualitative character, of descriptive exploratory nature. Thus, the present work had, as general objective: to understand the experiences of nurses relatively to the provided care to the post mortem body, in Medical Units. Elected as a tool for collecting data was the semi-structured interview, with twelve interviews realized, which corresponded to the total of twelve participants in the study, who fulfilled the eligibility criteria set. As a treatment procedure and analysis of the data obtained, the methodology proposed by Miles and Huberman (1984) was adopted. Of the same data, five main themes emerged, which correspond to: “alterations caused in the nurse by the post mortem care practice”, “caring for the post mortem body”, “influence of death to the nurse on a personal and professional level”, “adaptation strategies used by the nurse to cope with death”, and “ the value of end-of-life care”. To each theme are associated the respective categories and subcategories, making a total of twelve for the first and of seventy three in relation to the latter. The main conclusions to underline are the fact of the experience of post mortem care delivery assumes intense repercussions in the biopsico-emotional domain of nurses; these experiences lead nurses to develop a set of perceptions about death, in which the same constitutes as an integral element of the life path, being that nurses find coping strategies to overcome this matter; the end-of-life care delivery put nurses in several ethical and deontological dilemmas that only training and reflection can help to overcome.
Death remains a great mystery, and is often associated with horror, absurdity and suffering. So, thinking about death and dying, in a nursing perspective, means dedicating some time to try to understand how nurses experience the death of a patient, to whom they provide post mortem care. The theme we set ourselves to study was experiences of nurses relatively to post mortem care in medical units; This study was inspired in the readings of the works entitled “Cuidar em Fim de Vida” (Magalhães, 2009) and “A aprendizagem do cuidar e a morte: um desígnio do enfermeiro em formação” (Frias, 2003), whereas of the work of these two authors it was concluded about the need to deepen this subject. As a nurse who has developed her activity in medicine service, in a continuous care team, and currently develops activity in Day Care Hospital, in Oncology Service, the confrontation with the terminally ill patient and death is very common. After the observation of colleagues, I realized that death and post mortem care delivery may influence the professional and personal life, and therefore there is the need to think about death, about our conduct, and on coping strategies used for overcoming these situations, which led to the starting question: “what are the nurses experiences to care a post mortem body in a medical unit?”. To answer this question we organized a study of qualitative character, of descriptive exploratory nature. Thus, the present work had, as general objective: to understand the experiences of nurses relatively to the provided care to the post mortem body, in Medical Units. Elected as a tool for collecting data was the semi-structured interview, with twelve interviews realized, which corresponded to the total of twelve participants in the study, who fulfilled the eligibility criteria set. As a treatment procedure and analysis of the data obtained, the methodology proposed by Miles and Huberman (1984) was adopted. Of the same data, five main themes emerged, which correspond to: “alterations caused in the nurse by the post mortem care practice”, “caring for the post mortem body”, “influence of death to the nurse on a personal and professional level”, “adaptation strategies used by the nurse to cope with death”, and “ the value of end-of-life care”. To each theme are associated the respective categories and subcategories, making a total of twelve for the first and of seventy three in relation to the latter. The main conclusions to underline are the fact of the experience of post mortem care delivery assumes intense repercussions in the biopsico-emotional domain of nurses; these experiences lead nurses to develop a set of perceptions about death, in which the same constitutes as an integral element of the life path, being that nurses find coping strategies to overcome this matter; the end-of-life care delivery put nurses in several ethical and deontological dilemmas that only training and reflection can help to overcome.
Descrição
Tese de mestrado, Cuidados Paliativos, Faculdade de Medicina, Universidade de Lisboa, 2010
Palavras-chave
Cuidados paliativos Enfermagem Papel do profissional de enfermagem Cuidados de enfermagem Atitude face à morte Luto Adaptação psicológica Esgotamento profissional Teses de mestrado - 2010