Bakgrund: Svåra besked lämnas dagligen inom vården och definieras som svår eller ledsam information som drastiskt förändrar en persons uppfattning om livet och framtiden negativt. Sjuksköterskans yrkesroll i överlämnandet av ett svårt besked är att vara närvarande för läkare, patient och anhöriga. Majoriteten av den forskning som är gjord riktar sig till läkare och mindre till sjuksköterskor. Syfte: Syftet var att belysa sjuksköterskans erfarenheter i samband med att svåra besked delges till patienten. Metod: Studien genomfördes som en allmän litteraturstudie. Resultat: I litteraturstudiens resultat framkom fem kategorier: Vikten av att anpassa information, Vikten av att använda sin professionalitet, Vikten av att bibehålla en god relation, Meningsskiljaktighet i teamet och Kunskapsbrist. Sjuksköterskan gav information och stöd samt skapade en relation med patient och anhöriga. Meningsskiljaktighet mellan läkare och sjuksköterska angående undvikande av svåra besked identifierades samtidigt som det i motsats identifierades att läkare och sjuksköterska delade samma värderingar angående hög sanningsenlighet till patient. Det framkom även att utbildning och övning saknades och efterlyses. Konklusion: Forskning och utbildning kring sjuksköterskans involvering i svåra besked anses bristfällig och litteraturstudiens resultat visar att fortsatt forskning behövs för att kunna ge evidensbaserad omvårdnad. / Background: In healthcare difficult news are given on a daily basis and is defined as any difficult or sad information that drastically changes a persons perceptions about his or her life and future in a negative way. The nurses role in delivering difficult news is to be present for physicians, patients and relatives. The majority of the previous research focuses more on physicians than nurses. Aim: The aim was to illuminate the nurses experience when difficult news is delivered to the patient. Method: The study was conducted as a literature study. Results: In the literature study´s result five categories emerged: The importance of adjusting information, The importance of using one’s professionalism, The importance of maintaining a good relationship, Disagreement in the team and Lack of knowledge. The nurse gave information and support and established a relationship with the patient and relatives. Disagreement between physicians and nurses regarding evasion of difficult news was identified while in the contrary physicians and nurses shared the same values regarding truthfulness to the patient. It also emerged that education and practise was missing and requested. Conclusion: Research and education about the nurses involvement in delivering bad news is considered being inadequate and the results of the literature study shows that continued research is required in order to give care based on scientific evidence.

Submitted by Rosivalda Pereira (mrs.pereira@ufma.br) on 2017-05-18T17:50:01Z No. of bitstreams: 1 LucianaPalacioCabeca.pdf: 2342971 bytes, checksum: e2373d00bc8296307898091b1041db60 (MD5) / Made available in DSpace on 2017-05-18T17:50:01Z (GMT). No. of bitstreams: 1 LucianaPalacioCabeca.pdf: 2342971 bytes, checksum: e2373d00bc8296307898091b1041db60 (MD5) Previous issue date: 2014-06-15 / 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. / O ambiente da Unidade de Terapia Intensiva Neonatal caracteriza-se por constantes expectativas de situações de emergência, onde o recém-nascido será constantemente submetido a procedimentos invasivos e sujeito a riscos de complicações e mudanças súbitas no estado geral. Diante disto, é frequente os familiares serem abordados pelos profissionais com informações que poderão ser traduzidas como notícias difíceis. O ponto de partida desta investigação associa-se à racionalidade dos atores, aos contextos, situações e acontecimentos que emergem do processo de adoecimento do recém-nascido gravemente enfermo, delimitado pelo problema de pesquisa: Que experiências e habilidades emergem do processo de comunicação de notícias difíceis entre profissionais e familiares na Unidade de Terapia Intensiva Neonatal? A pesquisa teve como objetivo compreender habilidades, experiências e implicações no processo de comunicação de notícias difíceis no contexto da UTI Neonatal a partir das concepções de profissionais de saúde e mães de recém-nascidos de alto risco. Foi realizado estudo exploratório descritivo com abordagem qualitativa. Para apreensão dos dados foi utilizada entrevista aberta com análise dos dados por meio da Análise Temática. Participaram da pesquisa 10 mães de recém-nascidos de alto risco internados na UTI Neonatal e 14 profissionais de saúde com exercício nesse serviço e que contemplaram os critérios de inclusão definidos na pesquisa. Do processo de análise emergiram oito temas: Caracterizando notícias difíceis no contexto da Unidade de Terapia Intensiva Neonatal; Dimensões Qualificadoras para a comunicação de notícias difíceis em Unidade de Terapia Intensiva Neonatal; Ruídos do processo da comunicação de notícias difíceis na Unidade de Terapia Intensiva Neonatal; Sentimentos e reações maternas e profissionais frente à comunicação de notícias difíceis em Unidade de Terapia Intensiva Neonatal; Vivenciando o processo de comunicação de notícias difíceis em Unidade de Terapia Intensiva Neonatal; Estratégias maternas para acessar informações sobre o filho na Unidade de Terapia Intensiva Neonatal; A comunicação de Notícias Difíceis em Unidade de Terapia Intensiva Neonatal: Quem e Onde?; A Dinâmica das Negociações no contexto da Unidade de Terapia Intensiva Neonatal. No tema Dimensões Qualificadoras para a Comunicação de Notícias Difíceis em Unidade de Terapia Intensiva Neonatal emergiram dois subtemas: Estratégias Auxiliadoras no/para a Comunicação de Notícias Difíceis na Unidade de Terapia Intensiva Neonatal; Elementos Estruturais para a Comunicação de Notícias Difíceis na Unidade de Terapia Intensiva Neonatal. Os temas e subtemas configuraram-se como elementos que emolduram o processo de comunicação de notícias difíceis no contexto estudado, às vezes facilitando outras, limitando o cuidado ao recémnascido e à família. Os participantes revelaram habilidades, saberes, medos, inseguranças e necessidades para a comunicação de notícias difíceis em terapia intensiva neonatal e trouxeram algumas implicações para o cuidado em terapia intensiva neonatal das quais destaca-se: Intervenções que promovam confiança; reconhecer padrões de comportamento revelados nas relações mãe-bebê; optar pelo cuidado centrado na família; manter, apoiar e incentivar a participação materna no cuidado a criança quando apropriado; ajudar a promover e fortalecer a rede de suporte familiar; aumentar a probabilidade de padrões de comportamento para o desenvolvimento de vínculo/apego; cuidado sensível ao ambiente e às necessidades especiais das mães. Estas são algumas das assertivas que tornam necessário valorizar a temática e, sobretudo, a exigência de competências relacionais, interpessoais e comunicacionais nos profissionais, a partir de uma perspectiva ampliada do cuidado e do cuidar que ultrapassa a dimensão técnica e tecnológica tão prevalentes em terapia intensiva.

Background: Health care is a strange place for the patient. To make this enviroment as good as possible, would the patient be well informed. The patient has right to know if it is a bad mews and often he/she needs caring after the information. Nurse´s basic responsibility is caring, for her/him it´s important to prevent the shock for the patient that can appear.  Aim: Describe the nursing staff responses to the patient, using the patient´s perspective in relation to bad news.  Method: A litterture review has been made with nine articles. Current research materials that meet the study´s purpose has been applied in databases and analyzed. Four themes and nine subthemes was emerged.  Results: Nurse should allow patient to talk, when bad news had been given. Conversation is important for the patient, because they want information to be able to participate in care. Good communication skills are important for the nurse in connection with bad news. Patient wants information in an honest, peaceful and transparent manner. Time is often in short supply in this conversation. To have the family in care is a good support for the patient, but not all patients want the family to participate.  Conclusion: Patients desire individually aids at handover of bad news. It gives them a safety. The most common mould of aids according to patients where that the nurse shows that she/he has time for them.