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Advisor(s)
Abstract(s)
O Serviço de Urgência (SU) é direcionado para o doente crítico, com
necessidade de estabilização emergente, estando subjacente o cuidado emergente. Mas não são
só estes doentes que procuram este serviço, também os doentes em fim de vida com
necessidades de cuidados paliativos (CP) entram na porta do SU, sendo necessário que os
enfermeiros(as) que lá exercem possam dar uma resposta efetiva neste âmbito. Daí ser fulcral
colocar ênfase à investigação de forma a refletir nas estratégias de intervenção mais
adequadas a estas pessoas.
Objetivo: Analisar as vivências dos enfermeiros no cuidado à pessoa em fim de vida (PFV),
no SU.
Metodologia: Estudo qualitativo. A recolha de dados foi realizada com recurso a uma
entrevista semiestruturada a um grupo focal de sete enfermeiros participantes no estudo, de
uma Unidade Local de Saúde (ULS) do Norte de Portugal, durante a primeira semana do mês
de abril de 2023.
Resultados: Os enfermeiros (as) atribuem o conceito de PFV a uma doença incurável com
pouco tempo de vida. Ao conceito de CP associam a promoção de conforto e bem-estar ao
doente, a promoção do bem-estar da família, os cuidados promotores de dignidade. Os
sentimentos negativos vivenciados pelos enfermeiros expressam sentimentos negativos
(frustração) e emoções negativas, como a tristeza, raiva e revolta. As principais intervenções
destes enfermeiros dirigidas à PFV enquadram-se no paradigma paliativo como alívio dos
sintomas, apoio ao doente e à sua família e proporcionar medidas de conforto. Consideram
intervenções fundamentais dirigidas à PFV, o conforto físico e psicológico, dando-se ainda
enfâse ao toque. Apontam para a adoção de medidas terapêuticas centradas na abordagem
curativa com a formatação e formação recebida e a pressão da família. Foi possível distinguir
nas dificuldades a “Sobrecarga de trabalho”, “Dificuldades de apoio ao nível da instituição”,
“Dificuldades ao nível dos recursos”. Por sua vez, de entre as necessidades sentidas
emergiram a “Necessidade de uma estrutura física adequada”, “Necessidade de melhoria ao
nível organizacional”. Todos foram unânimes em salientar a falta da dignidade para a PFV no
SU, por razões físicas/estruturais e por défice de formação. Como estratégias de melhoria, os
enfermeiros propõem: o investimento nas equipas multidisciplinares, a melhoria da estrutura
física e a uniformização de procedimentos na abordagem da PFV.
Conclusão: Os resultados apontam para um leque de dificuldades associadas às vivências dos
enfermeiros no cuidado à PFV, contudo também emergem estratégias de melhoria. Devem ser
promovidas estratégias organizacionais e individuais. Um exemplo seria a formação/
promoção de atividades de melhoria das estratégias de coping, visando facilitar a gestão dos
sentimentos e emoções por parte dos enfermeiros. Das várias medidas propostas destaca-se a
criação de uma rede de urgência de CP.
The Emergency Service (ES) is geared towards critically ill patients in need of emergent stabilization, with emergent care as its underlying principle. But it's not only these patients who come to this service. End-of-life patients in need of palliative care (PC) also enter the ES, and nurses working in these services need to provide an effective response in this area. That's why it's crucial to put the emphasis on research in order to reflect on the most appropriate intervention strategies for these people. Objective: To analyze the experiences of nurses in caring for people at the end of life (PEL) in the ES. Methodology: A qualitative study. Data was collected using a semi-structured interview with a focus group of seven nurses participating in the study, from a Local Health Unit in Northern Portugal, during the first week of April 2023. Results: Nurses attribute the concept of PEL to an incurable disease with a short time to live. To the concept of PC they associate the promotion of comfort and well-being for the patient, the promotion of the family's well-being and care that promotes dignity. The negative feelings experienced by the nurses express negative feelings (frustration) and negative emotions, such as sadness, anger, and revolt. These nurses' main interventions aimed at the PEL fall within the palliative paradigm, such as relieving symptoms, supporting the patient and their family and providing comfort measures. They consider physical and psychological comfort to be fundamental interventions aimed at the PEL, with an emphasis on touch. They point to the adoption of therapeutic measures centered on the curative approach with the formatting and training received and pressure from the family. Difficulties included "Work overload", "Difficulties with support from the institution" and "Difficulties with resources". Among the needs felt, the following emerged: "Need for an adequate physical structure", "Need for organizational improvement". All were unanimous in highlighting the lack of dignity for PEL in the ES, due to physical/structural reasons and a lack of training. As strategies for improvement, the nurses propose: investing in multidisciplinary teams, improving the physical structure, and standardizing procedures for dealing with PEL. Conclusion: The results point to a range of difficulties associated with nurses' experiences in caring for people at the end of life, but strategies for improvement also emerge. Organizational and individual strategies should be promoted. One example would be training / promoting activities to improve coping strategies, with the aim of making it easier for nurses to manage their feelings and emotions. Of the various measures proposed, the creation of an emergency PC network stands out.
The Emergency Service (ES) is geared towards critically ill patients in need of emergent stabilization, with emergent care as its underlying principle. But it's not only these patients who come to this service. End-of-life patients in need of palliative care (PC) also enter the ES, and nurses working in these services need to provide an effective response in this area. That's why it's crucial to put the emphasis on research in order to reflect on the most appropriate intervention strategies for these people. Objective: To analyze the experiences of nurses in caring for people at the end of life (PEL) in the ES. Methodology: A qualitative study. Data was collected using a semi-structured interview with a focus group of seven nurses participating in the study, from a Local Health Unit in Northern Portugal, during the first week of April 2023. Results: Nurses attribute the concept of PEL to an incurable disease with a short time to live. To the concept of PC they associate the promotion of comfort and well-being for the patient, the promotion of the family's well-being and care that promotes dignity. The negative feelings experienced by the nurses express negative feelings (frustration) and negative emotions, such as sadness, anger, and revolt. These nurses' main interventions aimed at the PEL fall within the palliative paradigm, such as relieving symptoms, supporting the patient and their family and providing comfort measures. They consider physical and psychological comfort to be fundamental interventions aimed at the PEL, with an emphasis on touch. They point to the adoption of therapeutic measures centered on the curative approach with the formatting and training received and pressure from the family. Difficulties included "Work overload", "Difficulties with support from the institution" and "Difficulties with resources". Among the needs felt, the following emerged: "Need for an adequate physical structure", "Need for organizational improvement". All were unanimous in highlighting the lack of dignity for PEL in the ES, due to physical/structural reasons and a lack of training. As strategies for improvement, the nurses propose: investing in multidisciplinary teams, improving the physical structure, and standardizing procedures for dealing with PEL. Conclusion: The results point to a range of difficulties associated with nurses' experiences in caring for people at the end of life, but strategies for improvement also emerge. Organizational and individual strategies should be promoted. One example would be training / promoting activities to improve coping strategies, with the aim of making it easier for nurses to manage their feelings and emotions. Of the various measures proposed, the creation of an emergency PC network stands out.
Description
Keywords
Serviço hospitalar de emergência Fim de vida Atitude frente à morte Assistência terminal Enfermagem médico-cirúrgica