O conhecimento de estratégias de comunicação no atendimento à dimensão emocional em cuidados paliativos

End-of-life communication strategies for healthcare professionals: A scoping review

BACKGROUND

Timely and effective communication about end-of-life issues, including conversations about prognosis and goals of care, are extremely beneficial to terminally ill patients and their families. However, given the context, healthcare professionals may find it challenging to initiate and facilitate such conversations. Hence, it is critical to improving the available communication strategies to enhance end-of-life communication practices.

AIM

To summarise the end-of-life communication strategies recommended for healthcare professionals, identify research gaps and inform future research.

DESIGN

A scoping review performed in accordance with the Arksey and O'Malley framework.

DATA SOURCES

A literature search was conducted between January 1990 and January 2022 using PubMed, CINAHL, Embase, PsycINFO, Web of Science, Scopus, Cochrane Library and China National Knowledge Infrastructure databases and Google, Google Scholar and ProQuest Dissertations & Theses Global. Studies that described recommended end-of-life communication strategies for healthcare professionals were included.

RESULTS

Fifty-nine documents were included. Seven themes of communication strategies were found: (a) preparation; (b) exploration and assessment; (c) family involvement; (d) provision and tailoring of information; (e) empathic emotional responses; (f) reframing and revisiting the goals of care; and (g) conversation closure.

CONCLUSIONS

The themes of communication strategies found in this review provide a framework to integrally promote end-of-life communication. Our results will help inform healthcare professionals, thereby promoting the development of specialised training and education on end-of-life communication.

Therapeutic lying: Brazilian speech and language therapists' point of view about a controversial communication strategy employed in the care for people with dementia

PURPOSE

The objective of this research was to obtain the speech and language therapists' point of view about the use of therapeutic lying as a communication strategy in dementia care.

METHODS

The present research was a quantitative, qualitative, and descriptive cross-sectional study. Data was collected through an online survey with multiple choices and open answer questions.

RESULTS

The quantitative results indicated that the majority of the speech and language therapists have already used therapeutic lying as a communicative strategy and wish to learn more about it, considering the technique as relatively valid, ethical and adequate. The qualitative results indicated the reasons for the usage of the technique: to reassure the patient in case of agitation; to encourage engagement in therapy; to avoid stress-related to memory loss; to manage difficulty or refusal to eat; to manage difficulty or refusal for drug treatment; to prevent patients from leaving the building; to manage delirium, confusion and/or paranoia; to ensure safety; and for use when other strategies do not work.

CONCLUSION

The majority of speech and language therapists use therapeutic lying in their clinical practice, taking into consideration the best interest of the person with dementia, although professionals recognize their lack of knowledge on the subject. They have considered the communication strategy as relatively ethical, valid and adequate. The article calls attention to the necessity of education and guidelines for speech and language therapists in the use of therapeutic lying among people with dementia.

O Acolhimento como Postura na Percepção de Psicólogos Hospitalares

Resumo Atualmente, é possível encontrar múltiplas vertentes no significado atribuído à prática do Acolhimento, em especial aquelas descritas nas diretrizes da Política Nacional de Humanização (PNH). No contexto das práticas psicológicas, no entanto, os significados e as características do Acolhimento não são suficientemente explorados pela literatura. Considerando essa lacuna teórica, este estudo teve por objetivo investigar, por meio de entrevistas semiestruturadas realizadas com psicólogos que atuam em hospitais de um município do interior paulista, os significados atribuídos ao Acolhimento em sua rotina profissional. A análise de conteúdo das entrevistas resultou em seis categorias temáticas, agrupadas no eixo central “Acolhimento como postura” e assim nomeadas: conduta , vínculo , resgate da subjetividade , escuta , atributos pessoais e empatia . Os resultados indicaram que os entrevistados enfatizam o Acolhimento como uma prática que existe primordialmente em uma vertente relacional, na qual se valoriza a relação psicólogo-usuário e se privilegia a escuta da subjetividade. Eles também consideraram que a efetividade do Acolhimento requer o desenvolvimento de habilidades especiais de escuta do psicólogo. Chama a atenção que não foram abordadas outras vertentes do Acolhimento, previstas na PNH como tarefas que cabem também ao psicólogo executar, como as que estão voltadas para aspectos de gestão do trabalho e responsabilização pelo acompanhamento do fluxo dos usuários no sistema de saúde.

Intensive care unit team perception of palliative care: the discourse of the collective subject

OBJECTIVE

To learn the perception of health professionals in an intensive care unit towards palliative care.

METHOD

This was a descriptive and qualitative study based on the converging care approach conducted at an intensive care unit in the South of Brazil. Semi-structured interviews were used to investigate the understanding of the professionals about palliative care in this unit. The data were organized and analyzed using the discourse of the collective subject method with the help of Qualiquantisoft® software.

RESULTS

Participants included 37 professionals (12 nurses, 11nursing technicians, 5 physical therapists and 9 doctors). The key ideas extracted from the interviews were: care in the end stage of life that avoids futile measures; comfort care; lack of standardized care and lack of team training.

CONCLUSION

The professionals perceived palliative care as appropriate in the last stages of life, with no need for futile treatment or as comfort measures. However, they are aware of the lack of standardization and lack of capacity building in this area, which leads them to conceive palliative care as terminal care, and measures are recommended to break with this stigma.

OBJETIVO

Conhecer a percepção dos profissionais de saúde de uma Unidade de Terapia Intensiva acerca do cuidado paliativo.

MÉTODO

Pesquisa descritiva, qualitativa do tipo Convergente Assistencial realizada em uma Unidade de Terapia Intensiva da região sul do Brasil. Utilizou-se de entrevista semiestruturada que investigou o entendimento e a compreensão sobre cuidado paliativo nesta unidade. Os dados foram organizados e analisados pela técnica do discurso do sujeito coletivo com auxílio do software Qualiquantisoft®.

RESULTADOS

Participaram do estudo 37 profissionais (12 enfermeiros, 11 técnicos de enfermagem, cinco fisioterapeutas e nove médicos). As ideias centrais extraídas dos relatos: cuidado na fase terminal da vida sem medidas fúteis; cuidados de conforto; falta uniformizar a assistência e falta capacitação para a equipe.

CONCLUSÃO

Os profissionais percebem o cuidado paliativo apropriado na fase terminal da vida, sem necessidade de medidas fúteis de tratamento e promotoras de conforto. No entanto, estão conscientes da falta de uniformização e da sua capacitação nesta matéria, o que os leva a conceber o paliativismo como cuidado de terminalidade, pelo que se recomendam medidas para romper com este estigma.

A comunicação de Más Notícias na UTI: Perspectiva dos Médicos

RESUMO Este estudo objetivou compreender o processo de comunicação de más notícias no contexto da uma Unidade de Tratamento Intensivo para adultos, na perspectiva dos médicos. Configurou-se como uma pesquisa qualitativa, de caráter exploratório e descritivo. Os dados foram coletados a partir de entrevistas semiestruturadas e observação registrada em diário de campo. Participaram 12 médicos de um hospital-escola do interior do Rio Grande do Sul. A análise foi realizada por meio da análise de conteúdo. Destacam-se dificuldades dos médicos em comunicar más notícias, bem como o uso de mecanismos de defesa para realizar essa tarefa. Considera-se necessário resgatar a importância da reflexão sobre a relação médico-familiar como prática diária tão importante para a medicina.

Care protocol for fine-needle aspiration biopsy of breast and thyroid

This study had the aim of building a care protocol for fine-needle aspiration biopsy of breast and thyroid. Using a convergent-care type qualitative approach, it was developed in a teaching hospital in southern Brazil, between September 2010 and April 2011. The study participants were 88 patients and 20 professionals who work in the Radiology Service. The protocol was built in three stages: development of educational activities in the waiting room with the patients for the identification of doubts and anxieties in relation to the examination; meetings held with the professionals for the evaluation and validation of the protocol; and search for scientific evidence in data sources. The organization of data allowed to elaborate the flowchart of patient care and the care protocol, which was organized in sequential activities and included the executor, the activity and the scientific justification. The professionals expressed the importance of the protocol, which brings advantages for patient care, such as agility, organization and the humanization of the service.

Interpersonal relationships among hospital nurses and the use of communication skills

A qualitative exploratory and descriptive study investigating how the work relationships of nursing professionals are affected by the organizational problems experienced in hospital units and their management. Participants consisted of 21 nurses who worked in a general hospital in the north of Spain, during the period between 2010 and 2012. The study was approved by an ethics research committee and participants signed an informed consent form. Data were collected through in-depth interviews and field records. Using thematic analysis, the results displayed that work disorganization affects interpersonal relationships, generating feelings of impotence and demotivation among participants. Thus, they considered it necessary for a work plan to be established, clearly defining the activities of each professional role and developing the necessary communication skills for expressing problems to managers and coworkers. We believe it would be of great benefit for managers to take into consideration the suggestions for improvement presented in this study.

Ressignificando o cuidado em uma unidade especializada em cuidados paliativos: uma realidade possível?

Pesquisa qualitativa, tipo estudo de caso, realizada no Núcleo de Cuidados Paliativos do Hospital de Clínicas de Porto Alegre, Brasil, com os objetivos de conhecer como é prestado o cuidado paliativo ao paciente em uma unidade especializada e como a equipe de enfermagem atua junto ao cuidador(a)/familiar para a continuação das medidas de conforto e alívio da dor. Projeto aprovado pelo Comitê Ética em Pesquisa. Procedeu-se a coleta dos dados por observação do funcionamento da unidade e entrevista semiestruturada com enfermeiras e técnicas de enfermagem. Os resultados são apresentados por meio das temáticas: características do Núcleo de Cuidados Paliativos, sua equipe e a interação inicial desta com o paciente e familiares; e os modos de cuidar, a importância da abordagem da dor e da comunicação. Conclui-se que neste tipo de serviço é ressignificado o papel da tecnologia e dos atributos das relações de cuidado, enfatizando valores éticos, como a confiança e a autonomia.

The importance of communication in pediatric oncology palliative care: focus on Humanistic Nursing Theory

OBJECTIVE: to investigate and analyze communication in palliative care contexts from the perspective of nurses, based on Humanistic Nursing Theory. METHOD: this is a field study with a qualitative approach, in which ten nurses working in the pediatric oncology unit of a Brazilian public hospital participated. Semi-structured interviews were used to collect data. The testimonies were qualitatively analyzed using Humanistic Nursing Theory and based on the five phases of Nursing Phenomenology. RESULTS: two thematic categories emerged from the analysis of the study's empirical material: "strategy to humanize nursing care, with an emphasis on relieving the child's suffering" and "strategy to strengthen ties of trust established between nurse and child." CONCLUSION: communication is an efficacious element in the care provided to the child with cancer and is extremely important to promoting palliative care when it is based on Humanistic Nursing Theory.