The diploma is focused on Ethical aspects of nursing care from the perspective of staff providing nursing care in the intensive care units and long-term intensive care units. We were also interested in respondent?s knowledge in the field of ethical principles in biomedicine and their legislation. The thesis is divided into two parts - theoretical and empirical. The theoretical part describes nursing care of the mechanically ventilated patients, short history of medical ethics and current status of the ethics in biomedicine. The investigative part was implemented by combination of a quantitative and a qualitative research. For the quantitative part of the investigation we used the method of questioning by a questionnaire. The questionnaire consisted of 20 questions, 10 closed questions, 8 half-opened questions and 2 open questions which offered to show a personal opinion. Questionnaires were anonymous. Respondents that were asked were workers providing nursing care in the intensive care units and long-term intensive care units. The first goal of the diploma was to find out respondents point of view on nursing care in patients on long term mechanical ventilation. The second goal was to find out the most important ethical problems in providing nursing care in this category of patients. The last goal of the diploma was to find out respondents knowledge of codes of ethics and legislation. For the quantitative research we had two hypotheses: 1. There are ethical problems related to providing nursing care in patients on long term mechanical ventilation. This hypothesis was verified, because statistically significant majority of respondents said, that there are ethical problems related to providing nursing care in this category of patients. 2. The nurses´ approach to patients on long term mechanical ventilation is different in the intensive care units and long term intensive care units. This hypothesis was verified, because there were statistically significant differences between answers of respondents providing nursing care in intensive care units and long term intensive care units. For the qualitative research we used the technique of half-structured interview offering open questions. Into the research file was involved 10 nurses, 5 from intensive care units and 5 from long term intensive care units. There were set three investigatory questions. 1. What opinion has respondents about nursing care in patients on long term mechanical ventilation? The investigation showed that nurses have the same attitude to long term ventilated paitents as in the case of patients on acute short term mechanical ventilation. 2. What are the most serious ethical problems related to nursing long term mechanical ventilated patients? The research found out the most serious ethical problems related to long term mechanical ventilation from the point view of a nursing staff. These are preservation of human dignity and prolonging medically futile treatment. 3. What awareness of basic ethical principles and their legislation the respondents have? The investigation showed that nurses have poor knowledge of the issue. The results confirm the current situation of this issue. Based on the results of our research, we prepared educational brochure draft, which could help to facilitate orientation in this field.

Submitted by Luis Guilherme Macena (guilhermelg2004@gmail.com) on 2013-07-05T17:39:56Z No. of bitstreams: 1 Maria Tereza Fonseca da Costa.pdf: 3605712 bytes, checksum: d115f31efe017f3b85af7f13d23776d3 (MD5) / Made available in DSpace on 2013-07-05T17:39:56Z (GMT). No. of bitstreams: 1 Maria Tereza Fonseca da Costa.pdf: 3605712 bytes, checksum: d115f31efe017f3b85af7f13d23776d3 (MD5) Previous issue date: 2011 / Fundação Oswaldo Cruz. Instituto Fernandes Figueira. Departamento de Ensino. Programa de Pós-Graduação em Saúde da Criança e da Mulher. Rio de Janeiro, RJ, Brasil / Internações hospitalares de crianças e adolescentesportadores de alguma condição crônica de saúde têm evoluído de modo crescente em diferentes países e também apresentam-se como uma situação de saúde que deve ser considerada no planejamento de ações e organização de serviços de saúde, no Brasil. O exemplo das internações por dependência crônica de ventilação pulmonar mecânica é apresentado no presente estudo,a partir da observação inicial de que constituem-se situações que determinam longa permanência hospitalar em leitos de alta complexidade, como nosde terapia intensiva pediátrica, sendo também alvo de solicitações através de sentenças judiciais para cobertura de assistência domiciliar ainda precariamente estabelecida no âmbito do sistema de saúde brasileiro. Há mais de três décadas que têm sido realizados estudos em outros países, na tentativa de ampliar-se o conhecimento sobre este problema de saúde, sendo analisados diferentes aspectos relacionados ao mesmo, como alternativas de locais seguros para cuidados em saúde oferecidos a estes pacientes crônicos e as diferenças de resultados médicos e sociais entre as alternativas possíveis. Com o objetivo de conhecer e analisar a ocupação de leitos de terapiaintensiva pediátrica por pacientes com dependência crônica de ventilação pulmonar mecânica, foi realizado um estudo seccional do tipo levantamento censitário de casos, de janeiro a março de 2011, em 29 hospitais públicos localizados na Cidade do Rio de Janeiro. O estudo permitiu identificar 31 pacientes de 0 a 18 anos, internados e em ventilação mecânica invasiva há 3 meses ou mais, em 10 dos 29 hospitais consultados. Nas unidades de terapia intensiva havia 14 internações justificadas por esse tipo de dependência tecnológica, caracterizando uma ocupação de 21% do total de leitos disponíveis de terapia intensiva, no período de estudo. O conhecimento desse quantitativo permite aprofundamento da discussão sobre aspectos éticos, técnicos e normativos que devem ser considerados no desenvolvimento de propostas à assistência de pacientes crônicos, visando a melhor relação entre investimentos e resultados, para os pacientes, seus familiares e a sociedade. / Children and adolescents with chronic health conditions hospitalizations are increasingly evolved in different countries and presented as a health situation that must be considered in planning and organizing action of health services in Brazil. The hospital chronic dependency on mechanical ventilation is an example presented in this study, from the initial observation situation which determining long stay high complexity hospital beds, as in the pediatric intensive care, is also the subject of requests through sentences legal coverage for home care, still precariously established within Brazilian health system. Studies in others countries to expand knowledge about this health problem had been for over three last decades, analyzing different aspects related as alternative safe places for health care offered tothese chronic patients and differences between medical and social results from possible alternatives. With the aim to understand and analyze the occupation ofpediatric intensive care beds with ventilator-dependent patients, a survey was realized from January to March, 2011, in 29 public hospitals located in the city of Rio de Janeiro. The study identified 31 patients from zero to 18 years,hospitalized and on invasive mechanical ventilation for 3 months or more, in 10 of the 29 investigated hospitals. In 14 stays in intensive care units werejustified for this type of technological dependency, characterizing a 21% rateoccupancy of total intensive care beds available, along the research period. Knowledge that quantitative conduct to in-depth discussion on ethical, technical and legal standards should be considered when developing proposals aimed assistance for chronic patients, seeking the best value between investments and outcomes for patients, their family and society.