DIRETIVAS ANTECIPADAS DE VONTADE DO PACIENTE TERMINAL: Percepção de enfermeiros de cuidados paliativos.

Abstract

Advance directives (AD) are conceived as desires previously expressed by the patient about the care and treatments that he or she desires to receive when he/she is unable to consciously express his/her will. Objective: To unveil the perception by nurses that works in the palliative care. Methodology: A descriptive exploratory study with a qualitative approach supported by Content Analysis was carried out in two reference hospitals in Oncology in the city of São Luís-Maranhão. The survey included nurses who are members of the palliative care department of the respective hospitals. The data were obtained through individual, open, unstructured interviews with guiding questions after the opinion of the HUUFMA Ethics Committee with protocol number 2,891,954. The study consisted of a corpus defined by 10 interviews from which 120 registration units were extracted and three themes: Knowledge of the nurses about advance directives, Meanings for nurses about the implementation of the anticipated will directives and Challenges brought by the advance directives. From the process it was revealed that the nurses have little knowledge about the advance directives, but after explaining the document, they affirmed that the tool will make it possible to guarantee the autonomy of the patient in the terminal phase, but it was reinforced the need for legal support to support professionals, patients and families. For nurses it is important to understand the opinions of family members, since they used to participate actively in the decision of the therapeutic plan of the terminal patient. It seems that the implementation of the advance directives could reduce cases of therapeutic obstinacy by ensuring the wishes of the sick person. Regarding the challenges revealed, the instability of patient's decision-making process can cause restlessness and psychological shock. A good relationship and communication between professionals, family and patient is seen as a strategy to avoid conflicts in the therapeutic decision process. For nurses, palliative care education is essential to expand the discussion about the issue, as well as to stimulate dialogue about termination, the process of death and dying. Conclusion: It will be necessary to create educational projects, especially for professionals who work directly with palliation, so that there is a spread on this possibility of care for patients and their families, making these subjects active and knowledgeable about their fundamental rights and guarantees.