O processo de morrer e a morte no enfoque dos profissionais de enfermagem de UTIs

The experience of nursing students facing death and dying

OBJECTIVE

To understand the phenomenon experienced by nursing students in their academic practices in view of death and dying.

METHODOLOGY

This was a qualitative study, based on Martin Heidegger' existential phenomenology, undertaken at a public University in Alagoas, Brazil, between August and October 2013. Seven senior students of nursing were interviewed.

RESULTS

The phenomenological analysis yielded the following existential themes: Facing death and dying in academic practice; Acknowledging impotence in the face of death; Glimpsing the possibility of solicitude; Interacting with the family in view of the loss; Experiencing spirituality in the face of dying.

CONCLUSION

It is deduced that, during the academic education, the theme involving death and dying has been addressed insufficiently, without precisely attending to all the demands of the nursing students during care in the dying process.

[Representational structure of intensive care for professionals working in mobile intensive care units]

This qualitative study was performed based on the Social Representations Theory, using a structured approach. The objective was to analyze the social representations of intensive care for professionals who work in mobile intensive care units, given the determination of the central nucleus and the peripheral system. This study included the participation of 73 health care professionals from an Emergency Mobile Care Service. Data collection was performed through free association with the inducing term care for people in a life threatening situation, and analyzed using EVOC software. It is observed that a nucleus is structured in knowledge and responsibility, while contrasting elements present lexicons such as agility, care, stress, and humanization. The representational structure revealed by participants in this study refer particularly to the functionality of intensive care, distinguishing itself by the challenges and encouragements provided to anyone working in this area.

[Nurses' challenges in view of the pain and suffering of families of terminal patients]

This qualitative study was performed with the objective to identify the challenges faced by nurses who assist families of patients with no hope of cure, in view of their pain and suffering. Data collection was performed in 2008 using semi-structured interviews, including eighteen nurses who worked in the Intensive Care Units of a private hospital located in São Paulo, after receiving approval from the Research Ethics Committee. The content analysis of the data revealed three categories: facing the challenges of assisting the family, expected attitude, and guiding yourself by experience. It was revealed that, in order to assist the families, nurses must reflect on their personal and ethical values, as well as examine their feelings regarding the process of dying. It is expected that experienced nurses will exchange their knowledge with those beginning their practice in this health care setting.

Significado do processo morte/morrer para os acadêmicos ingressantes no curso de enfermagem

Trata-se de uma pesquisa qualitativa, embasada na fenomenologia existencial heideggeriana, com o objetivo de desvelar o significado do processo morte/morrer para acadêmicos ingressantes no curso de enfermagem, realizada numa universidade pública do Noroeste do Paraná, Brasil, entre os meses de agosto e outubro de 2010, quando se entrevistaram 33 graduandos do primeiro ano do curso de enfermagem. Da análise fenomenológica, emergiram as seguintes temáticas existenciais: "Entendendo a morte como um processo difícil de ser compreendido"; "Compreendendo a morte como um processo natural"; "Vislumbrando a morte como uma passagem para outra vida". Por este estudo, compreendeu-se que o saber e a morte estão enredados na temporalidade e historicidade de cada ser, sendo necessária uma compreensão científica, filosófica e ética do fenômeno morte/morrer para que o acadêmico possa se preparar para o cuidado humanizado ao doente e sua família.

Morte digna da criança: percepção de enfermeiros de uma unidade de oncologia

O objetivo deste estudo foi identificar o significado e as intervenções de enfermeiros que atuam em oncologia pediátrica na promoção de morte digna da criança. Utilizaram-se como referencial teórico e metodológico o interacionismo simbólico e a pesquisa de narrativa. Os dados foram coletados junto a oito enfermeiros de uma unidade de oncologia pediátrica de um hospital público de São Paulo, por meio de entrevistas semiestruturadas. A análise dos dados permitiu a identificação de cinco categorias: sentir-se sem autonomia para a tomada de decisão; cuidar da família; oferecer conforto físico; valorizar o cuidado humanizado e aprender a lidar com a morte e o morrer. Este estudo contribui para ampliar a compreensão do processo de cuidar e permite avançar na postulação de um quadro teórico que contemple a integração de saberes e ações que constituem uma assistência integral, transcendendo o atendimento de necessidades apenas clínicas e biológicas.

[Death and dying process: evidences from the literature of nursing]

The objective was to identify the profile of production and analyze perceptions, feelings and confrontations on the process of death and dying in the practice evidenced in nursing scientific production in the period 1994 to 2009. There was a qualitative, descriptive research, developed through a systematic literature review with metasynthesis from the meta-ethnographic method. Ten studies met the inclusion criteria, this set was subjected to quality assessment checklist with Critical Appraisal Skills Programme. Subjects perceive this process as a transition, separation and finitude. This is permeated with feelings of frustration and powerlessness and the most effective interventions to this issue is the development of coping strategies that vary with the reality of each individual.

[Experiences and feelings of nursing professionals in caring of the dead patient]

This study aimed to understand the experiences and feelings of ten professional nurses related to the dead patient, in a private hospital of the metropolitan area of Porto Alegre-RS, Brazil. We used a qualitative approach, descriptive, exploratory, with data collected in July 2009, through interviews with semi-structured questionnaire. The results were grouped into the categories: feelings about the patient's death, reactions to the death and preparing the patient's body. It was concluded that the most remarkable experiences were related to the first contact with the death, the presence of emotional bonding with patients and families and the patients' age at death. The latter two are considered hindering elements of care offered to patients without life.

[Caring for the patient in the process of dying at the Intensive Care Unit]

The objective of this study is to characterize how nursing care is performed at the ICU to patients with no possibility of cure. Ten nurses were interviewed. The field study was performed at the Intensive Care Unit of a public teaching hospital. For the nurses, there is no uniform pattern of care. Furthermore, according to their reports, it was observed that there is an overestimation of the technical care over the emotional, social and spiritual aspects. It was, however, observed that nurses are strongly with the suffering of the family in view of their loss. Results show that nurses must understand death as a part of the life cycle and review care as the essence of nursing, thus increasing the discussions on the issue in both the academic and daily practice environments.

Nursing Administration: Aspects that Can Facilitate and Hinder Care in a Coronary Unit

La asistencia de enfermería en la Unidad Coranariana requiere un equipo de cuidados de salud especializado, equipamientos de alta tecnología y un liderazgo atento a las facilidades y dificultades diarias del cuidado de enfermería. Objetivo: discutir los aspectos que facilitan y dificultan la administración de enfermería en la unidad coronariana. Métodos: se realizó una investigación bibliográfica en la base de datos SciELO y recolección de datos, utilizando un plan de entrevista semiestructurada con 6 enfermeras líderes del sector de la unidad coronaria del Hospital Universitario de la Universidad Federal de Río de Janeiro. Resultados: acerca de los aspectos que facilitan la administración de enfermería, los estudios seleccionados y las enfermeras apuntaron factores objetivos y subjetivos, respectivamente, como el uso de instrumentos de la distribución del equipo y la buena comunicación y relación interpersonal. Sobre los aspectos que la dificultan, han señalado la mecanización de la enfermera, la complejidad de una unidad de cuidados críticos y la escasez de recursos materiales. Conclusiones: es deber de la administración de enfermería identificar estos factores, para permitir mejor desempeño de los profesionales y, en consecuencia, asistencia más eficaz y segura para los pacientes y sus familias.

Stressors in the nursing care delivered to potential organ donors

This study examines those situations that are typical to the work of the nursing team in the intensive care unit, especially those that nursing teams consider stressful and are common in intensive care units in the treatment of patients being considered as potential organ or tissue donors. It is an exploratory-descriptive study, established with a qualitative approach, conducted at an Adult Intensive Care Unit. The reports revealed the fact that organ donation leads to different situations and emotions. Regarding the perception of nursing care to the potential organ donor patient, the subjects reported they did not discriminate patients when delivering care, but recognize a certain lack of self-confidence and preparation dealing with brain death. They try to minimize the effects of stressors with physical activities, social support, spirituality, or attempt to separate work from personal life.

Absenteísmo - doença na equipe de enfermagem: relação com a taxa de ocupação

Estudo de natureza quantitativa, descritiva, transversal, elaborado com o objetivo de analisar a quantidade e as causas de afastamentos por doença dos profissionais de enfermagem e sua relação com taxa de ocupação das unidades de internação de um hospital de ensino. A metodologia foi desenvolvida em duas etapas: caracterização demográfica dos profissionais e identificação e análise das ausências quanto à quantidade e tipos de afastamento por doença, aos diagnósticos médicos e à relação com a taxa de ocupação do Hospital. Os técnicos de enfermagem apresentaram a maior quantidade de licenças por doença. As doenças do sistema osteomuscular e do tecido conjuntivo representaram 4.957 dias (41,5%) de ausências e os transtornos mentais e comportamentais 3.393 dias (28,4%). O percentual mensal de licenças por doença foi inversamente proporcional à taxa de ocupação, sugerindo que os profissionais ausentaram-se por doença após terem sido submetidos a ritmos maiores de trabalho.