Palliative Care in Congenital Syndrome of the Zika Virus: A Series of Cases
Ednalva Alves Heliodoro1, Darci de Oliveira Santa Rosa2* and Tábata Cerqueira Nascimento Nobre3
1Nurse, student of the Graduate Program in Nursing and Health UFBA, Brazil
2Permanent Professor of the Post-Graduate Nursing and Health UFBA, Brazil
3Teacher, Student of the Post-Graduate Nursing and Health UFBA, Brazil
Submission: January 10, 2018; Published: January 25, 2019
*Corresponding author:Darci de Oliveira Santa Rosa, nurse, doctor, School of Nursing, Federal University of Bahia, Basilio da Gama Street, 241 - Canela, Salvador - BA, 40231-300, Brazil
How to cite this article: Ednalva A H, Darci d O S R, Tábata C N N. Understanding on Palliative Care: Vision of Nursing Students. Palliat Med Care Int J. 2019; 1(5): 555573.- 10.19080/PMCIJ.2019.01.555573
Abstract
Objective: Learn how nursing students understand the palliative care provided by health professionals to the person at the end of life. Methodology: Qualitative study conducted with 28 nursing students of the final year. Data were collected through interviews, organized and analyzed through Triadic Configuration Humanistic, Existential and Personalist. Results: understanding of nursing students on palliative care considers the criteria: no cure, therapeutic failure and promote a dignified death, taking into account the condition and terminally process of human life. Final Thoughts: The graduate student has the understanding that palliative care in theoretical perspective and practice are important during their training.
Keywords: Palliative care; Nursing students; Knowledge
Introduction
The patient in the process of death / dying requires special attention, a differentiated care that promotes comfort, enables the integral care, improve quality of life, minimize your fears and desires, regardless of the time you have left to live. Palliative Care is indicated for all patients with disease threatening the continuity of life for any diagnosis, prognosis or any age and at any time of the disease when they have no expectations or needs atendidas [1]. Palliative care is expressed in a set of multidisciplinary actions that aim to make the control of physical, mental, spiritual and social symptoms that affect a person terminally process of its existence. It is important to note that during the formation of the nursing student teaching-learning process should be directed so that it will act providing support to the patient, minimizing their fears, anxieties and at the same time providing care to ensure improved quality of life. For palliative care environment becomes necessary to establish interpersonal relationships and inter-professional, particularly the family, in order to decrease pain and strengthen the family bond.
Given the above and the need for subsidies of identification that can guide the formation and practice of nurses and other health professionals in palliative care was established following research question: how nursing students understand the palliative care provided by nurses the person at the end of life? We aimed at learning how nursing students of an educational public institution include palliative care provided by the person nursing professionals at the end of life.
Methodology
It is a subproject of the research approved by the Research Ethics Committee of the Federal University of Bahia School of Nursing with Protocol 18/2011, developed at the same institution in the period of August 01, 2011 the July 30, 2012 . The participants were 28 nursing students, with the inclusion criteria: be enrolled in half of 2012.1, attending the 8th and 9th semesters, being excluded those who were with locked registration in cancellation proceedings, or absent for any reason . Was assuring participants anonymity by letter “EE” followed by the number and the confidentiality of the information obtained they considered confidential, and agreed to participate after the information and explanations, completed the Consent and Informed.
The data collection technique, semi-structured interview was carried out obtaining the following characterization data: gender, age and current semester, presented in the form of simple frequency and qualitative data were obtained from the guiding question: “What does it mean for you palliative care? “ The data were presented in the form of empirical categories and the analysis process was developed according to Triadic Configuration Existential Humanistic Personalist proposed by Vietta [2]. From the meaning of units was possible to build a large category and two empirical subcategories that will be presented in the next section
Results
Category - understanding of nursing students about hospice care provided by professional person in life purpose
Subcategory 1 - Palliative care meet three criteria
Promote a dignified death: Care should make the end of life, lived in a dignified manner. Palliative care is given to those who do not have more perspective on life and within those we care seeks to humanize care, make the most dignified death [...] (EE.06). Are care when the patient no longer has a prognosis of life, then you have to do what? palliative care to be able to him to have a dignified death, a death that has a comfort at least. For example, cancer patients, patients have already metastasized, no other way [...] (EE.10). It’s that care [...] It’s how you ensure a good death for that person. (EE.05). palliative care is to promote [...] the last days of her life as pleasant as possible ... (EE.28).
Inability therapy: They are the care of the person medical evaluation after reaching the conclusion that it is not possible to treat. They are cared for that patient that we know that his illness will not solve more [...] (EE.08). When the person is already a disease she has few days of life, which has been given up by the doctors, it will only give those same palliative care, do not know if it’s put off a little more [...] (EE. 09). palliative care we have when a person [...] It does not have a good prognosis [...] (EE.27).
No cure: They are the care of the person who received the news incurable disease and the possibility of death. Is palliative care that has no curative intent [...] (EE. 16). It is when the patient no longer has the healing chances [...] (EE.22). Going forward the people have nothing to do, no more therapeutic possibility [...] (EE.23).
Subcategory 2 - Palliative care is provided the person considering the condition and the process of terminal illness
Condition of terminally: Palliative care is provided to the person from the moment that there is confirmation of end-of human life. Well, palliative care I imagine it would care to leave, more comfortable in recent times, is [...] (EE.19). Are those care those people terminally ill to ensure a better quality of life at least in the terminal phase of his life. (EE.26). Are those care as well [...] to patients who are already terminally ill, right? (EE.01). It is the patient care that is at risk of imminent death. (EE.24). Palliative care is the care involving patients with cancer [...] (EE.20).
Condition of terminally: Palliative care is provided to the person from the moment that there is confirmation of end-of human life. Well, palliative care I imagine it would care to leave, more comfortable in recent times, is [...] (EE.19). Are those care those people terminally ill to ensure a better quality of life at least in the terminal phase of his life. (EE.26). Are those care as well [...] to patients who are already terminally ill, right? (EE.01). It is the patient care that is at risk of imminent death. (EE.24). Palliative care is the care involving patients with cancer [...] (EE.20).
Discussion
Nursing students reveal their understanding of palliative care as that care provided before the therapeutic failure to the person who, due to illness, received the news no cure, and that being aware of death, care needs that make it a moment worthy. To EE.06, EE.10, EE.05, EE.28 palliative care is provided to the person who has no more prospect of life, to promote comfort and ensure a dignified death. For them the dignified death is understood throughout the professional development and maturity the meaning given that they attribute to death has relationship with principles of autonomy and values such as comfort, pain relief and care família [3]. EE.08, EE.09, EE.27 consider palliative care that is delivered to the patient that has no chance to heal his sickness, to be affected by diseases that threaten the continuity of life. For them the patient considered out of curability is in terminal, suffers from an incurable disease, treatments or surgeries when indicated not restore health and require palliative care as a way to alleviate suffering and anguish of terminally process of life
In this context the care of patients with end stage, to be considered effective, before the patient with or without possibility of cure require the nurse knowledge of the condition, the ability to deal with the feelings of the other and with their own emotions [4]. EE.16, EE.22, EE.23 include palliative care as that provided to the person with a disease that does not reach a diagnosis and there is no kind of therapy that can be provided to be healed. Over the course of the disease that has no therapeutic possibilities of cure, the intensity of palliative care is variable, with disease-modifying treatments to approaches for the control of physical and psychological symptoms, behaviors exclusively paliativas [1]. The nursing student should develop special attention to this patient, provide sensitive care, give psychological support, provide a harmonious environment, favor the presence of family and friends to follow in order to provide better quality of this life.
EE.19, EE.26, EE.01, EE.24, EE.20 agree also in the understanding of palliative care to express that they are provided to patients who are terminally ill in order to produce quality to life. In this context, the final stage is the final stage of life, which is indefinitely. In this phase the patient has progressive evolution of the signs and symptoms that require changes in the care plan, to promote comfort, and at the same time should include the following aspects: physical, emotional, spiritual and social, as well, where every individual and family is assisted to fully and individual [5]. EE.21, EE.14, EE.25, EE.04, EE.15 state that palliative care is provided the person who is experiencing the death process. This process is considered as one in which “the person faces in its last phase of transition between life and death.” It is understood death as a process, a progressive phenomenon and not as a moment. And the care for the patient in this process is considered by students as difficult and associated with feelings of sadness, frustration, helplessness and even guilt for failure occurrences in the assistance provided. They have the feeling that everything that was done was not enough, that could have been done more and more and melhor [6]. Thus, the student needs a magnified look on death as a dynamic and complex process involving different meanings and actions that may impact a person’s quality of life that is in care paliativos [7].
Final Considerations
The undergraduate nursing students have the understanding that palliative care have two perspectives theoretical and practical and are important for their training. For them the concept of palliative care, also meets the following criteria: no cure, therapeutic failure and promote a dignified death. They understand that the provision of palliative care should consider the patient’s condition and the terminally process of human life. In conclusion, this study allowed the comprehension of concepts attributed by nursing students on palliative care, the implications of technical knowledge acquired and that the creation of an environment conducive to reflection can create a unique setting of nursing education. The implications for the practice of palliative care are related to educational activities be developed in scenarios such as laboratories, hospitals and clinics.
This study recommends: i. Include in nursing program grid more content about death in general and specific subjects; ii. Cross and interdisciplinary Making palliative care content to prepare the nursing student to act, to face death as a natural process in this condition; iii. Expand the concepts of palliative care and quality of life and the principles recommended for people in this condition; iv. To encourage the publication of nurses experience reports working in terminally conditions to broaden the quantitative and the qualitative publications on the subject
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