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Valoração da vontade anteriormente manifestada : da perspetiva dos enfermeiros na tomada de decisão sobre o cuidar em fim de vida
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Orientador(es)
Resumo(s)
No estudo aqui apresentado objetivou-se genericamente uma descrição da
perspetiva dos enfermeiros sobre a valoração da vontade anteriormente manifestada na tomada de decisão sobre o cuidar em fim de vida, procurando-se especificamente conhecer a sua experiência, os contextos e os princípios implicados neste domínio.
Efetuou-se um estudo de nível I, sob o paradigma participativo e com
abordagem qualitativa. Para a constituição do corpus a analisar selecionou-se o Parecer n.º 245/2010 do Conselho Jurisdicional da Ordem dos Enfermeiros e realizaram-se seis entrevistas semiestruturadas a enfermeiros peritos, seguindo um método de amostragem intencional com recurso à técnica de «bola de neve» até se alcançar a saturação da amostra e do campo. Procedeu-se à análise dos dados seguindo as cinco etapas propostas por Fairclough para a análise crítica do discurso.
Concluiu-se que a valoração da vontade anteriormente manifestada é uma
preocupação tida pelos enfermeiros no seu (inter)agir profissional. Apesar da
comprovada existência atual de um enquadramento ético, deontológico e jurídico para essa mesma valoração, já os contextos social, cultural, histórico e político não estão em harmonia com tal. Foram identificados obstáculos e subsequentes possíveis formas de resolução para essa harmonização, os quais se fundam, não só, numa necessária complementaridade funcional entre os mais diversos elementos individuais/coletivos implicados na tomada de decisão sobre o cuidar em fim de vida, bem como numa sua devida e respetiva informação, formação e regulamentação. As declarações antecipadas de vontade emergem enquanto possível instrumento necessariamente complementar neste contexto para (a)firmar o Bem do/tido pelo Outro num tom de partilha de autonomia e responsabilidade, contrariando a testemunhada prevalência de um modelo de atuação/relação biomédico/paternalista.
The general purpose of this study was to describe the nurses’ perspective on the valuing of the previously expressed wishes in decision making about end of life care, looking specifically to know their experience, the contexts and the principles involved in this domain. It was developed an exploratory-descriptive study, under the participatory paradigm and with a qualitative approach. To form the corpus of data to analyse, was selected the Parecer n.º 245/2010 do Conselho Jurisdicional da Ordem dos Enfermeiros and was realized six semi-structured interviews to expert nurses, following an intentional sampling method using the «snowball» technique till obtain sample and field saturations. The data analysis was conducted by the five stages of Fairclough’s analytical framework to the critical discourse analysis. It was concluded that the valuing of the previously expressed wishes is a concern taken by nurses in their professional (inter)act. Although the actual proved existence of an ethical, deontological and legal framework for that valuation, the social, cultural, historical and political contexts are not in harmony with that. Obstacles have been identified and subsequent possible ways to past them, trying to obtain an harmonization not only based on a functional complementarity among the different individual/collectives elements involved in decision making about end of life care as well as in their appropriate information, training and regulamentation. The advance healthcare declarations appear as a possible and necessarily complementary instrument in this context to (af)firm the Good of the Other, not only sharing autonomy and responsibility as well as counteracting the prevalence of a biomedical/paternalistic model witnessed by nurses in decision making about end of life care.
The general purpose of this study was to describe the nurses’ perspective on the valuing of the previously expressed wishes in decision making about end of life care, looking specifically to know their experience, the contexts and the principles involved in this domain. It was developed an exploratory-descriptive study, under the participatory paradigm and with a qualitative approach. To form the corpus of data to analyse, was selected the Parecer n.º 245/2010 do Conselho Jurisdicional da Ordem dos Enfermeiros and was realized six semi-structured interviews to expert nurses, following an intentional sampling method using the «snowball» technique till obtain sample and field saturations. The data analysis was conducted by the five stages of Fairclough’s analytical framework to the critical discourse analysis. It was concluded that the valuing of the previously expressed wishes is a concern taken by nurses in their professional (inter)act. Although the actual proved existence of an ethical, deontological and legal framework for that valuation, the social, cultural, historical and political contexts are not in harmony with that. Obstacles have been identified and subsequent possible ways to past them, trying to obtain an harmonization not only based on a functional complementarity among the different individual/collectives elements involved in decision making about end of life care as well as in their appropriate information, training and regulamentation. The advance healthcare declarations appear as a possible and necessarily complementary instrument in this context to (af)firm the Good of the Other, not only sharing autonomy and responsibility as well as counteracting the prevalence of a biomedical/paternalistic model witnessed by nurses in decision making about end of life care.
Descrição
Tese de mestrado, Bioética, Faculdade de Medicina, Universidade de Lisboa, 2013
Palavras-chave
Análise crítica do discurso Bioética Declarações antecipadas de vontade Enfermagem Fim de vida Tomada de decisão Vontade anteriormente manifestada Teses de mestrado - 2013