Gestão do Processo de Cuidar de Pessoas em Morte Encefálica

Abstract

Care management considered the ability to know the best way to do, care and manage so that all these components interact mutually in a rational manner. Taking care of people diagnosed as brain dead (BD) is involved, involving the health professionals’ ability to cope with family members and confront organizationally and care weaknesses that can influence the promotion of welcoming, problem-solving and individualized care for each patient. The objective in this qualitative case study was to explore the experience of (intensive care) health professional in the management process of individuals after BD and understand the meaning they attach to the care process of these patients. Twenty-two professionals (physicians, nurses and nursing technicians) participated in the study at a referral hospital for emergency care in the city of Goiânia-GO. The data were collected through semistructured interviews, and interpretive thematic analysis included the following stages: immersion in the data; identification of codes; clustering of codes into thematic cores; review of cores; definition and final designation of codes; elaboration of description and interpretation of the meanings the health professional expressed. The following thematic cores identified: The technical dimension of care for individuals after BD: advances and difficulties; the challenge to cope with death and dying: The family approach in the context of BD. The results evidenced that the establishment of the BD protocol considered a landmark and that, after the implementation of the Intra-hospital Organ and Tissue Donation and Transplantation Committee in 2014, new operating procedures were put in practice that contributed to overcome the gaps and develop skills to cope with the technical dimension. When considered as a mere body, however, care for this patient prioritizes technical aspects related to hygiene, aspiration, position change and its primary objective is to improve the quality and safety in the organ procurement process for transplantation. For the professionals, coping with death and dying in situations of BD is an emotionally wearisome and anguishing process to all, which requires psychological support. The family, which is often neither included in the therapeutic plan nor correctly welcomed, experiences difficulty at this challenging moment. The need is highlighted to adopt care models that embrace the family of the patient after BD as the central focus, being engaged in this process and supported for mourning. Therefore, the team needs to make shared decisions for the care process to take place effective and safe