Molduras da Comunicação de Notícias Difíceis em UTI Neonatal: sentidos do presente, reflexos para o futuro

Abstract

The environment of the Neonatal Intensive Care Unit is characterized by constant expectations of emergency situations, where the newborn will be constantly submitted to invasive procedures and subject to risks of complications and sudden changes in the general state. Thus, it is frequent that family members are approached by health professionals with information that can be translated as difficult news. The starting point of this research is associated with the rationality of the actors as well as the contexts, situations and events that emerge from the process of illness of seriously ill newborn, delimited by the following research problem: What experiences and skills emerge from announcement process of difficult news between professionals and family members in the Neonatal Intensive Care Unit? The research intended to understand skills, experiences and implications in the announcement process of difficult news in the context of the Neonatal Intensive Care Unit (NICU) from the conceptions of health professionals and families. For this it was realized descriptive exploratory study with qualitative approach. To find out information was used open interview with data analysis from the Thematic Analysis. The study was consisted in a corpus defined by 24 interviews in which involving 10 mothers of high-risk newborns hospitalized in the NICU and 14 health professionals specialized in this service and contemplated the inclusion criteria defined in the survey. From the analysis process were extracted 1.359 units of sense that after organized and grouped, built eight themes: Characterizing difficult news in the context of the Neonatal Intensive Care Unit; Dimensions Qualifying for communication of difficult news in Neonatal Intensive Care Unit; Process noise communication of difficult news in the Neonatal Intensive Care Unit; Feelings and maternal reactions and professionals front communication of difficult news in Neonatal Intensive Care Unit; Experiencing the process of communication of difficult news in Neonatal Intensive Care Unit; Maternal strategies to access information about their child in the Neonatal Intensive Care Unit; The Announcement of Difficult News in Neonatal Intensive Care Unit: Who and Where?; The Dynamics of Negotiations in the context of the Neonatal Intensive Care Unit. The theme Dimensions Qualifying for communication of difficult news in Neonatal Intensive Care Unit two sub-themes emerged: Helpers Strategies in/ for communication of difficult news in the Neonatal Intensive Care Unit; Structural Elements for Communication of difficult news in the Neonatal Intensive Care Unit. The themes and subthemes, as a result of this investigation, it is configured as elements that frame the process of communication of difficult news in context studied, sometimes facilitating others, limiting the care to the newborn and family. This dynamic movement that is health communication, the participants showed skills, knowledge, fears, insecurities and needs for the announcement of difficult news in neonatal intensive care. The themes, while groups of concepts, bring some clinical implications for the care in the neonatal intensive care which include: interventions that promote trust; recognize patterns of behavior revealed in the mother-infant relationship; opt for family-centered care; maintain, support and encourage the maternal participation in child care when appropriate; help to promote and strengthen the network of family support; increase the probability of behavior patterns for the development of relationship/attachment; care sensitive to the environment and the special needs of mothers. These are some of the statements that make it necessary to value the theme and, especially, require relational, interpersonal and communication skills among professionals, from an expanded perspective of care and caring that goes beyond the technical and technological dimension so prevalent in intensive care.