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Conhecimentos, crenças e atitudes dos enfermeiros acerca dos cuidados paliativos
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Advisor(s)
Abstract(s)
Os cuidados paliativos são prestados com base nas necessidades e não apenas no
diagnóstico ou no prognóstico, devendo ser introduzidos de forma estruturada em fases
mais precoces da doença. Conforme as necessidades dos doentes o justifiquem, estes
assumirão importância cada vez maior na prestação de cuidados. Todas as pessoas com
doenças crónicas sem resposta à terapêutica de intuito curativo e com prognóstico de vida
limitado, são candidatas a cuidados paliativos. A família deve ser incorporada nos cuidados
prestados aos doentes e ser ela própria objeto de cuidados, durante a doença e durante o
luto (DGS, 2010).
O estigma associado aos cuidados paliativos está relacionado com a morte, ou a
proximidade desta (Hui et al.,2015; Zimmerman et al.,2016). Mas também com a ideia de
que já não há nada a fazer, que não há esperança, uma ideia de dependência e
incapacidade (Bruera & Hui,2010; Zimmerman et al.,2016).
Este estudo insere-se no âmbito do Mestrado em Enfermagem Médico Cirúrgica e é parte
integrante do projeto “Representações, Famílias e Modelos de Intervenção em Saúde:
REFAMIS” que é um dos projetos da unidade pedagógica Enfermagem, Disciplina e
Profissão da ESEP. Com a elaboração deste estudo pretendemos contribuir para a melhoria
da intervenção de enfermagem no âmbito dos cuidados paliativos diminuindo atitudes
negativas e estigmatizantes.
O objetivo geral surge da necessidade de compreender se existem comportamentos
estigmatizantes por parte dos enfermeiros em relação ao doente paliativo através da
realização um estudo quantitativo, descritivo, transversal e correlacional, no qual a
amostra são os enfermeiros dos Serviços de Medicina Interna e de Cuidados Paliativos do
Centro Hospitalar e Universitário de São João, EPE. Tendo como método de recolha de
dados a aplicação de um questionário ADOC.
Apesar de ser difícil objetivar a presença de estigma por parte dos enfermeiros em relação
ao doente paliativo, percebe-se que mais do que atitudes estigmatizantes são as
dificuldades que os profissionais demonstram no que diz respeito a questões sobre o fim de
vida, realização ou suspensão de intervençoes, ou a relação com a família. Estas são
questões que inquietam os profissionais de forma transversal, profissionais que são desde
cedo incitados e ensinados na doutrina do curar em vez de paliar. Deste modo, “cuidar da
pessoa em fim de vida é complexo e difícil para os profissionais de saúde, nomeadamente
para os enfermeiros que se deparam com a incurabilidade da doença e com prescrições
que visam combater a morte, mesmo que seja reconhecida a irreversibilidade da situação
clínica” (Pimenta, 2015, p.14).
Palliative care is provided based on needs and not only on diagnosis or prognosis and should be introduced in a structured manner at earlier stages of the disease. As patients' needs warrant, they will become increasingly important in care delivery. Everyone with chronic diseases unresponsive to curative therapy and with a limited life prognosis are candidates for palliative care. The family should be incorporated into the care provided to patients and be itself the object of care during illness and bereavement (DGS, 2010). The stigma associated with palliative care is related to death or near death experiences (Hui et al., 2015; Zimmerman et al., 2016). But also with an idea that there is nothing left to do, that there is no hope, an idea of dependence and disability (Bruera & Hui, 2010; Zimmerman et al., 2016). This study is part of the Master in Surgical Medical Nursing and is an integral part of the project “Representações, Famílias e Modelos de Intervenção em Saúde: REFAMIS” which is one of the projects of the ESEP Nursing, Discipline and Profession pedagogical unit. With the development of this study we intend to contribute to the improvement of nursing intervention in the context of palliative care by reducing negative and stigmatizing attitudes. The general objective comes from the increased need to understand if there are requirements for nurses in relation to sick patients, by conducting a quantitative, descriptive, cross-sectional and correlational study, without qualification for nurses of Internal Medicine and Palliative Care Services from the Centro Hospitalar e Universitário de São João, EPE, having as data capture method the application of an ADOC questionnaire. Although it is difficult to objectify the presence of stigma by nurses in relation to the palliative patient, it is clear that more than stigmatizing attitudes there are the difficulties that professionals show regarding end-of-life, executing or suspending interventions, or the relationship with the family. These are issues that worry professionals across the board, professionals who are early on incited and taught in the doctrine to heal rather than mitigate. Thus, “caring for the end-of-life person is complex and difficult for health professionals, particularly nurses facing the incurability of the disease and prescriptions aimed at combating death, even if the irreversibility of the situation is recognized clinically ” (Pimenta, 2015, p.14).
Palliative care is provided based on needs and not only on diagnosis or prognosis and should be introduced in a structured manner at earlier stages of the disease. As patients' needs warrant, they will become increasingly important in care delivery. Everyone with chronic diseases unresponsive to curative therapy and with a limited life prognosis are candidates for palliative care. The family should be incorporated into the care provided to patients and be itself the object of care during illness and bereavement (DGS, 2010). The stigma associated with palliative care is related to death or near death experiences (Hui et al., 2015; Zimmerman et al., 2016). But also with an idea that there is nothing left to do, that there is no hope, an idea of dependence and disability (Bruera & Hui, 2010; Zimmerman et al., 2016). This study is part of the Master in Surgical Medical Nursing and is an integral part of the project “Representações, Famílias e Modelos de Intervenção em Saúde: REFAMIS” which is one of the projects of the ESEP Nursing, Discipline and Profession pedagogical unit. With the development of this study we intend to contribute to the improvement of nursing intervention in the context of palliative care by reducing negative and stigmatizing attitudes. The general objective comes from the increased need to understand if there are requirements for nurses in relation to sick patients, by conducting a quantitative, descriptive, cross-sectional and correlational study, without qualification for nurses of Internal Medicine and Palliative Care Services from the Centro Hospitalar e Universitário de São João, EPE, having as data capture method the application of an ADOC questionnaire. Although it is difficult to objectify the presence of stigma by nurses in relation to the palliative patient, it is clear that more than stigmatizing attitudes there are the difficulties that professionals show regarding end-of-life, executing or suspending interventions, or the relationship with the family. These are issues that worry professionals across the board, professionals who are early on incited and taught in the doctrine to heal rather than mitigate. Thus, “caring for the end-of-life person is complex and difficult for health professionals, particularly nurses facing the incurability of the disease and prescriptions aimed at combating death, even if the irreversibility of the situation is recognized clinically ” (Pimenta, 2015, p.14).
Description
Keywords
Cuidados paliativos Estigma Enfermeiros