Cuidado paliativo à pessoa no percurso cirúrgico oncológico: a enfermeira transcendendo impossibilidades terapêuticas

Abstract

The longevity increases the prevalence of chronic and degenerative conditions, such as câncer. Sometimes, itevolve into serious manifestations beyond therapeutic possibility of cure. When assisting cancer patients, the nursing is not only based on curative care, but also on those related to well-being and health promotion, paying attention to the context and circumstances of people's lives. In this sense, this study emerged from the following guiding question: What is the meaning, for the nurse, of caring for a person with an oncological disease who has received an intraoperative medical indication for palliative care? To answer this question, the following objective was developed: Understanding the meaning, for the nurse, of the act of caring for a person with an oncological disease whose indication for palliative care was defined in the surgical course. This is a descriptive, exploratory, qualitative and phenomenological study. In this sense, the phenomenon studied is “the act of caring for a person in the postoperative period of an oncological surgery, in which the patient has received the indication of palliative care”. The study was carried out in a surgical ward of a public hospital in the State of Rio de Janeiro. The data collection was carried out in July 2023, with 12 clinical nurses. Through analysis, the meaning of the phenomenon was understood as follows: Nurses establish emotional bonds with patients and their families, go through ethical conflicts, which are permeated by moral and psychological suffering. However, providing comfort to the patient and their family members is seen as a priority given the prognosis of impossibility of cure, shifting the focus from the disease to the person. It was concluded that the period of coexistence and care of nurses with patients and family members during hospitalization has contributed to strengthening the emotional bond. Nevertheless, the bond created is one of the determining factors for psychological suffering due to the feeling of sadness, pain, anguish and impotence in the face of the impossibility of healing. These nurses are faced with ethical conflicts during care, such as: lack of explanation to the patient about their prognosis by the professional responsible for this communication; lack of alignment between teams, lack of structure for adequate assistance to patients and their families. Furthermore, the deficiency in training and the lack of continuing education makes the nursing to shorten their presence in care amidst issues that permeate their ability/autonomy in the act of caring. It is important to look at the health of these workers, who, in the midst of so many conflicts, have shown themselves to be suffering due to the recognition of the inadequacy of care in some situations. It is noted that the palliative care process in the studied ward needs to be reviewed. However, despite all the limitations, nurses prioritize caring actions to provide comfort.