TESE DE DOUTORADO - PROGRAMA DE PÓS-GRADUAÇÃO EM SAÚDE COLETIVA

URI Permanente para esta coleçãohttps://tedebc-teste.ufma.br/handle/tede/1009

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    Cuidados oferecidos a crianças elegiveis para cuidados paliativos em ambiente hospitalar
    (Universidade Federal do Maranhão, 2018-12-19) LIMA, Sara Fiterman; SOUZA, Tadeu de Paula; 055221367-00; http://lattes.cnpq.br/9097512115715636; LAMY, Zeni Carvalho; 128326933-34; http://lattes.cnpq.br/9896819318523369; LAMY, Zeni Carvalho; 128326933-34; http://lattes.cnpq.br/9896819318523369; ALVES, Rosana; http://lattes.cnpq.br/5958737240424992; GARCIA, João Batista; http://lattes.cnpq.br/0424234103760462; ALVES, Maria Teresa Seabra Soares de Britto e; http://lattes.cnpq.br/3910533965773430; SIMÕES, Vanda Maria Ferreira; http://lattes.cnpq.br/4024829764707677
    The study sought to analyze the care offered to eligible children for palliative care in a hospital environment. This is an exploratory study, with a quantitative and qualitative approach, carried out in 04 hospitals of the network of public institutions with hospitalization care for children in the municipality of São Luís - Maranhão. The universe of the study was composed of children hospitalized in the hospitals during the period of data collection. Using the inclusion criteria to be between 0 and 9 years old, potential indication for palliative care according to service professionals and to fall into one of the 04 groups of conditions eligible for pediatric palliatives of the Association for Children Palliative Care, emerged 133 children, that went through an expert evaluation for the application of non-inclusion criteria - not being eligible and being in final moments of life - according to the opinion of this professional. Thus, study participants were 131 children eligible for palliative care, their primary caregivers, and the professionals who provided care. The techniques for collection were interviews, participant observation and documentary analysis. From this sample, the case study of 09 children was carried out. The results are as follows: The profile of the public network for pediatric palliative care in the municipality; The socio-demographic profile of children and caregivers; The characterization of the clinical conditions of these children; The evaluation of the dynamics that involves the provision of palliative care in one of the hospitals. The process of indicating palliative care in pediatrics allows different understandings. Eligible children also had other diagnoses that helped the palliative indication. Social issues were present and fragmented care. Spirituality can help or serve as a barrier to care. Mourning care still comes down to the moment of death, with guidelines for funeral procedures. Several misunderstandings interfere in practice. We conclude that findings point to the need for investments in the training and preparation of professionals, for the sharing of decisions among the members of the team, for the rapprochement with the relatives and the reception of their symptoms of suffering, for the inclusion of this family and child in the decision-making, and to broaden the focus of care, understanding family and death as an integral part of the care process.
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    A morte na Unidade de Terapia Intensiva: o agir e o sentir do profissional de saúde
    (Universidade Federal do Maranhão, 2013-06-22) NINA, Rachel Vilela de Abreu Haickel; GARCIA, João Batista Santos; 135570488-02; http://lattes.cnpq.br/0424234103760462; LAMY, Zeni Carvalho; 128326933-34; http://lattes.cnpq.br/9896819318523369; LAMY, Zeni Carvalho; http://lattes.cnpq.br/9896819318523369; GARCIA, João Batista Santos; http://lattes.cnpq.br/0424234103760462; MARINHO, Suely Oliveira; http://lattes.cnpq.br/9819749776052051; SIMÕES, Vanda Maria Ferreira; http://lattes.cnpq.br/4024829764707677; THOMAZ, Érika Bárbara Abreu Fonseca; http://lattes.cnpq.br/3644251156905353
    Death is a natural process intrinsically linked to life that brings different emotions and meanings, and in recent decades has moved from the familiar environment for the hospital environment, adding a burden of loneliness and negativity that caused her to be transformed into a subject rarely discussed among health professionals. In the training of nurses and doctors death and dying has been shalowed treated and the students have contact with them at specific times and increasingly rare during their training. At the end of their graduation, when faced with the finitude of their patients feelings of failure, anxiety and helplessness may arise, and even cause illness in these professionals. In ICU death is part of their daily lives, it is the place of occurrence of the majority of hospital deaths. The ICU is the space for specialized treatment where technology and training unite to address clinical situations where the threat to life is always present, and thus prolong the dying indefinitely many times. The treatment of these conditions requires the professional to a need to focus on the disease, making him forget and even deny that the human body threatened by the imminence of death. Transformed into an enemy, death is fought at all costs, and during this battle the relationship between professional and patient/family is lost. Aiming to analyze factors associated with the perception of the meaning and attitudes toward death held a study with quantitative and qualitative methods of research. With the quantitative methodology performed a crosssectional study, analytical professional with the four ICUs of a university hospital between August 2010 and August 2012 in which we considered five different outcomes: meaning of death ";" meaning of the patient's death terminal ";" attitude at the news of the death "; "resuscitation of the patient without therapeutic possibility "," discussion of non-resuscitation order ", we used Poisson regression and multinomial logistic (alpha = 5%) to estimate associations. Through questionnaires and semi-structured interviews with professionals from pediatric intensive care, we used qualitative methodology with analysis of the thematic content. Results: there were 118 professionals working in the ICU during the study, 97 were included in this research , and of these 14 were the sample of qualitative methodology. had 52 doctors and 45 nurses whose age ranged from 24 to 62 years (M = 38 ± 7.6), 77.32% were female, aged 27-53 years, the time in the ICU ranged from 1 to 32 years and who worked on average 43 hours weekly. meaning of death varied according to the professional category, type of ICU and weekly workload. Regarding attitude to death news and nurses and those who had weekly workload greater than 60 h share the communication, who said to have their behavior at the news of death to be influenced by education and nurses agreed with the resuscitation of the patient terminal; professionals with over 38 years working in ICU children agreed that the DNR should be discussed. Among those who worked with children a sense of ambivalence about the situation of death was related to the clinical condition and the context in which it took that child. Anxiety, emotion very present among these professionals can arouse guilt and helplessness demonstrating the complexity involved in the perception of death. They use religion as a coping mechanism and recognize the lack of preparation during undergraduate and postgraduate. In conclusion we sought that the feeling was associated with workload weekly professional category and type of ICU in which they work, while the act was associated with vocational training and category, in relation to the death of children, this arouses mixed feelings in health professionals, who use the religion and involvement Family to face it and resent the lack of contact with the subject during their training.