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O respeito pela autonomia da pessoa com tetraplegia completa em reabilitação pelos profissionais de saúde
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Resumo(s)
O princípio bioético do respeito pela autonomia prende-se com o direito de cada pessoa de escolher as suas normas e valores e tomar as suas decisões o que implica que os profissionais de saúde respeitam a sua vontade.
Um Traumatismo Vertebro Medular é uma experiência devastadora decorrente de um trauma muitas vezes irreversível e condiciona a pessoa a viver para sempre numa cadeira de rodas e dependente de terceiros para a realização das suas atividades diárias. A pessoa com tetraplegia completa fica limitada a nível físico mas está consciente da sua situação e verbaliza as suas vontades. O seu processo de Reabilitação é longo com internamentos prolongados em diferentes instituições.
O objetivos gerais do estudo visam identificar as intervenções que a pessoa com tetraplegia considera serem promotoras da sua autonomia e compreender a perceção da pessoa com tetraplegia completa quanto ao respeito pela sua autonomia pelos profissionais de saúde em reabilitação enquanto internada numa instituição.
A compreensão desta realidade implica definir o princípio bioético de autonomia, tetraplegia completa e reabilitação e identificar o tipo de intervenções promotoras da autonomia existentes na literatura e relacioná-las com as descritas pelas pessoas com tetraplegia completa que experienciaram um processo de reabilitação recentemente.
Para a concretização destes objetivos desenhou-se um estudo do tipo exploratório - descritivo com uma Metodologia Qualitativa de orientação Fenomenológica, com recurso à entrevista semi- estruturada como método de colheita de dados e à utilização da análise de conteúdo para analisar as questões.
De entre os resultados obtidos, revela-se que a maioria das pessoas com tetraplegia completa considera como principais intervenções promotoras da autonomia as relacionadas com a comunicação, promoção da mobilidade, e a realização de atividades básicas de vida diária. Relacionam autonomia com o conseguirem executar certas tarefas sem apoio de terceiros. Considerando também que o respeito pela sua autonomia está presente nas atividades em que está dependente de terceiros desde que o profissional de saúde respeite a sua vontade e os seus hábitos de vida diária anteriores à lesão.
A comunicação eficaz é uma intervenção promotora da autonomia em destaque para a pessoa com tetraplegia completa em reabilitação que deve ser aplicada através de reforços positivos, afeto, apoio, empatia, sendo a capacidade de dar apoio, afeto assim como o profissionalismo entre as qualidades que o utente procura no profissional de saúde para uma melhor adesão aos tratamentos em reabilitação. O utente também procura a socialização com outras pessoas presentes no serviço de reabilitação.
As intervenções que as pessoas com tetraplegia completa consideram que não respeitam a sua autonomia interligam se com as intervenções que a respeitam, estando o não respeitar relacionado com o não satisfazer as vontades do indivíduo, mas esta não satisfação pode estar relacionada com a promoção do bem-estar do utente.
Existe a necessidade de melhorar o acolhimento aos serviços e o processo de reinserção social iniciando logo que possível o contato com a realidade exterior ao Centro de Reabilitação assim como a inclusão da família.
De acordo com os resultados obtidos conseguimos evidenciar que ao explorar o princípio bioético da autonomia podemos inovar nas intervenções realizadas diariamente pelos profissionais de saúde em Reabilitação abandonando a ideia de que respeitar a autonomia da pessoa é apenas respeitar a sua tomada de decisão devendo também incidir sobre as intervenções em que a pessoa com tetraplegia completa necessita de apoio de terceiros respeitando a sua autonomia através da satisfação da sua vontade desde que beneficie o utente.
The bioethical principle of respect for autonomy relates to the right of each person to choose their standards and values and make their decisions, which implies that health professionals respect their will. A Spinal Cord Injury is a devastating experience due to an often irreversible trauma, conditioning the person to live forever in a wheelchair and limits the ability of the individual to carry out common selfcare activities. The person with complete quadriplegia is physically limited but is aware of their situation and verbalizes their wishes. Its Rehabilitation process is long with hospitalizations in different Health care facilities . The general objectives of the study are to identify the interventions that the person with quadriplegia considers to be promoters of their autonomy and to understand the perception of the person with complete quadriplegia as to the respect for their autonomy by the health professionals in rehabilitation while hospitalized. The understanding of this reality implies defining the bioethical principle of autonomy, complete quadriplegia and rehabilitation and to identify the type of interventions that promote autonomy in the literature and relate them to those described by people with complete quadriplegia who have recently undergone a rehabilitation process. In order to achieve these objectives, an exploratory-descriptive study was designed with a Qualitative Methodology of Phenomenological orientation, using a semi-structured interview as a method of data collection and the use of content analysis to analyze the issues. Among the results obtained, it is revealed that the majority of people with complete quadriplegia consider as main interventions promoting autonomy those related to communication, mobility, and common selfcare activities. They relate autonomy to being able to perform certain tasks by themselves. Considering also that the respect for its autonomy is present in the activities in which it is dependent on third parties since the health professional respects his will and his daily self-care habits before the injury. Effective communication is a promoting intervention of autonomy in highlighting that must be applied through positive reinforcement, affection, support, empathy, being the ability to give support, affection as well as professionalism among qualities that the person with complete quadriplegia seeks in the health professional for an adhesion to the treatments in rehabilitation. The user also seeks socialization with other people besides the health professional. Interventions that people with complete quadriplegia consider that do not respect their autonomy interconnect with the interventions that respect it, being not respected is related to not satisfying the individual's wishes, but this nonsatisfaction may be related to the promotion his well being. There is a need to improve the integration in the different rehabilitation units and the process of social reintegration, starting as soon as possible the contact with the reality outside the Rehabilitation Center as well as the inclusion of the family. According to the results obtained, we can show that by exploring the bioethical principle of autonomy we can innovate in the interventions performed daily by health professionals in Rehabilitation. Respecting the autonomy of the person is not only respecting their decision making, or the promotion of their physical autonomy but should also focus on interventions in which the person with complete quadriplegia needs support from third parties by respecting their autonomy through the satisfaction of their will as long as it benefits the individual.
The bioethical principle of respect for autonomy relates to the right of each person to choose their standards and values and make their decisions, which implies that health professionals respect their will. A Spinal Cord Injury is a devastating experience due to an often irreversible trauma, conditioning the person to live forever in a wheelchair and limits the ability of the individual to carry out common selfcare activities. The person with complete quadriplegia is physically limited but is aware of their situation and verbalizes their wishes. Its Rehabilitation process is long with hospitalizations in different Health care facilities . The general objectives of the study are to identify the interventions that the person with quadriplegia considers to be promoters of their autonomy and to understand the perception of the person with complete quadriplegia as to the respect for their autonomy by the health professionals in rehabilitation while hospitalized. The understanding of this reality implies defining the bioethical principle of autonomy, complete quadriplegia and rehabilitation and to identify the type of interventions that promote autonomy in the literature and relate them to those described by people with complete quadriplegia who have recently undergone a rehabilitation process. In order to achieve these objectives, an exploratory-descriptive study was designed with a Qualitative Methodology of Phenomenological orientation, using a semi-structured interview as a method of data collection and the use of content analysis to analyze the issues. Among the results obtained, it is revealed that the majority of people with complete quadriplegia consider as main interventions promoting autonomy those related to communication, mobility, and common selfcare activities. They relate autonomy to being able to perform certain tasks by themselves. Considering also that the respect for its autonomy is present in the activities in which it is dependent on third parties since the health professional respects his will and his daily self-care habits before the injury. Effective communication is a promoting intervention of autonomy in highlighting that must be applied through positive reinforcement, affection, support, empathy, being the ability to give support, affection as well as professionalism among qualities that the person with complete quadriplegia seeks in the health professional for an adhesion to the treatments in rehabilitation. The user also seeks socialization with other people besides the health professional. Interventions that people with complete quadriplegia consider that do not respect their autonomy interconnect with the interventions that respect it, being not respected is related to not satisfying the individual's wishes, but this nonsatisfaction may be related to the promotion his well being. There is a need to improve the integration in the different rehabilitation units and the process of social reintegration, starting as soon as possible the contact with the reality outside the Rehabilitation Center as well as the inclusion of the family. According to the results obtained, we can show that by exploring the bioethical principle of autonomy we can innovate in the interventions performed daily by health professionals in Rehabilitation. Respecting the autonomy of the person is not only respecting their decision making, or the promotion of their physical autonomy but should also focus on interventions in which the person with complete quadriplegia needs support from third parties by respecting their autonomy through the satisfaction of their will as long as it benefits the individual.
Descrição
Tese de mestrado, Bioética, Universidade de Lisboa, Faculdade de Medicina, 2017
Palavras-chave
Profissionais de saúde Bioética Autonomia Tetraplegia Reabilitação Teses de mestrado - 2017