Estratégias coletivas de defesa da equipe de enfermagem no contexto do cuidado oncopaliativo

Abstract

The object of this study dealt with the collective defense strategies adopted by the nursing team in the process of care/caring for patients with oncological disease under palliative treatment. Objectives: a) to identify the configuration of the work organization for the care of patients with oncological disease under palliative care; b) to analyze the feelings that emerge from the nursing team about the process of work directed to the patient with oncological disease under palliative care; and; c) to discuss the collective defense strategies adopted by the nursing professionals when in front of an oncological patient under palliative care. The study was approved by the Research Ethics Committee under protocol number 2,601,416 and Certificate of Presentation for Ethical Appreciation: 81886917.7.0000.5282. Methodology: Qualitative descriptive study whose participants were 18 nursing professionals 18: three nurses, 11 nursing technicians and four resident nurses of a university hospital in the State of Rio de Janeiro. The data were collected in July 2018 through focal group and participant observation. The data treatment occurred by means of the thematic content analysis technique. Results: The adopted analysis procedure brought out three categories as described hereinafter: 1) Work organization configurations and the problem of assistance to the patient with oncopalliative disease, which discussed the structural aspects, patient’s comfort conditions, team communication processes, the problem of professional training and its reflexes in the assistance to oncopalliative patients. 2) Feelings arising from the process of care/caring for the patient with oncopalliative disease, which analyzed the feelings that emerge during assistance to the patient with oncopalliative disease; and the perceptions from experiencing and accompanying the process of death and dying. 3) Defensive strategies adopted for the care of patients with oncopalliative disease, which discussed the collective and individual defense strategies used to cope with situations related to the care of patients with oncopalliative disease. Conclusion: The results showed that the investigated scenarios have inadequate physical structure for the provision of palliative care, an ineffective communication process among the multidisciplinary team members, as well as deficient training regarding the care of patients with oncopalliative disease. The professionals experience feelings of sadness, anguish, pain, fear and impotence when they fail to maintain the patient’s life, showing little comprehension about the process of death/dying. Such context favors the emergence of collective and individual defense strategies in order to neutralize and/or minimize the suffering. Knowing these strategies contribute to the development of actions and measures to safeguard the health of these workers.