O presente estudo teve como objetivos conhecer os conflitos éticos relativos a pacientes terminais identificados por enfermeiros das clinicas médica, cirúrgica e pronto socorro adulto de um hospital público e geral; compreender como os enfermeiros tomam as decisões frente a conflitos éticos referentes a esses pacientes e conhecer o que é levado em consideração, pelos enfermeiros, para a tomada de decisão frente a conflitos éticos relacionados a pacientes terminais. Foi feito um estudo exploratório, descritivo e de abordagem qualitativa. Para análise dos dados foi utilizada a análise de conteúdo proposta por Bardin. Foram entrevistados dez enfermeiros de um hospital público e geral do Município de São Paulo. Após a análise, emergiram três categorias e quinze sub-categorias: Categoria 1- A vivência dos enfermeiros em relação ao paciente terminal. Subcategorias: Cuidados como condição essencial para assistência aos pacientes terminais; Postura da família frente ao paciente terminal; Conseqüências da vivência profissional com pacientes terminais; e Postura profissional frente aos pacientes terminais. Categoria 2- Fatores geradores de conflitos éticos em relação ao paciente terminal. Subcategorias: Obstinação terapêutica; Situações administrativas; A quebra do sigilo e desrespeito à privacidade do paciente terminal; Despreparo profissional; e Falta de autonomia do enfermeiro. Categoria 3- Fatores considerados para a tomada de decisão em relação aos conflitos éticos frente ao paciente terminal. Subcategorias: Os aspectos ético-legais; O uso do conhecimento científico; A participação das equipes multiprofissional e de enfermagem; O respeito à autonomia do paciente e da família; A importância do esclarecimento de pacientes e familiares; e A multifatorialidade concorrendo para a tomada de decisão. O estudo evidenciou que os conflitos éticos relativos aos pacientes terminais, vivenciados pelos enfermeiros, emergem de seu cotidiano e são decorrentes de diversos fatores relacionados à assistência, ao gerenciamento e à capacitação dos profissionais. Foi evidenciado, ainda, que os enfermeiros apontam fatores que devem ser levados em consideração no processo de tomada de decisão, mas revelam sua pouca participação nesse processo frente aos conflitos éticos relativos a pacientes terminais. / The present study aims to identify and understand the ethical conflicts related to terminal patients experienced by nurses and are what considered for decision making to cope with these conflicts. The methodology adopted was the qualitative strand, using the content analysis proposed by Bardin. Ten nurses were interviewed in a general hospital in Sao Paulo. After the analysis emerged three categories and fifteen sub-categories: Category 1 - The experience of nurses in relation to the patient terminal. Subcategories: care as an essential condition for assistance to terminally ill patients; Posture family towards the patient terminal; Consequences of professional experience with terminal patients, and professional attitude to patients facing terminal. Category 2 - Factors generators to ethical conflicts in respect to the terminal patient. Subcategory: Therapeutic futility; Situations administrative on generating of conflict; The breaking secrecy and privacy disrespect of the patient terminal; A lack of professional preparation; and lack of autonomy of nurses. Category 3 - Factors considered in the decision-making in relation to the conflicts ethic facing the terminally ill patient. Subcategories: ethical and legal aspects; The use of scientific knowledge; The participation of multidisciplinary teams and nursing staff; The Respect for patient autonomy and family; The importance of clarifying patients and families, and, The multifactorial competing to decision-making. The study showed that ethical conflicts related to the patients, experienced by nurses, emerge from their everyday and are caused by several factors related to assistance, to management and capacitation professional. It was evidenced, also, that the nurses point to factors that must be taken account in decision-making process, but they reveal their little participation in this process front to the ethical conflicts related to terminally ill patients.

Thesis (Ph. D.)--University of Missouri-Columbia, 2000. / Typescript. Vita. Includes bibliographical references (leaves 194-200). Also available on the Internet.

Thesis (Ph. D.)--University of Texas at Austin, 1999. / Vita. Includes bibliographical references (leaves 256-280). Available also in a digital version from Dissertation Abstracts.

Thesis (Ph. D.)--University of Missouri-Columbia, 2000. / Typescript. Vita. Includes bibliographical references (leaves 194-200). Also available on the Internet.

Thesis (J.C.L.)--Catholic University of America, 2000. / Includes bibliographical references (leaves [54]-59).

Thesis (D. Min.)--Concordia Seminary, 2000. / Abstract. Includes bibliographical references (leaves 131-132).

Att vårda en patient i livets slutskede innebär att bekanta sig med känslomässiga situationer som ofta påverkar sjuksköterskans omvårdnadshandling exempelvis effektiv symtomlindring. Syfte: Syftet med denna studie var att beskriva sjuksköterskans upplevelse av det vårdande mötet med patienten i samband med palliativ vård. Metod: Metoden var en litteraturstudie med kvalitativa ansatser. Sex vetenskapliga artiklar samlade in och användes som analysmaterial av denna studie. Innehållanalysen inspirerad av Graneheim och Ludman (2003) användes för att analysera insamlade data. Resultat: Resultatet visade att sjuksköterskan upplever tillfredställelse och välbefinnande om hon lyckas med att tillgodose patientens behov exempelvis smärta. Effektiv smärtlindring upplevdes som meningsfull och det innebar att hon hade betytt något för patienten och dess närstående. Däremot upplevdes hon stress, frustration, maktlöshet och konflikt när hennes omvårdnadshandling inte mött patientens behov. Samverkan mellan arbetsteamen och stöd från kollegor upplevdes som viktigt i den palliativa vården. Sjuksköterskan höll distans för att kunna hjälpa patienten. Slutsatsen: Sjuksköterskan behöver kunskap om smärtlindring samt kunskap om palliativ vård för att effektivt lindra patientens smärta. För att tillgodose patientens behov i sin helhet behöver hon tillräcklig med tid och frihet att själv planerar sitt arbete. Samarbetet med andra vårdteam och kollegornas stöd måste stärkas och ha ett gemensamt mål: patientens välbefinnande då kan sjuksköterskan uppleva välbefinnande.

The purpose of this study was to explore spiritual and psychological issues as experienced by persons who know they have a terminal illness. An existentialphenomenological method was chosen to understand and articulate the structure and meaning underlying the experience of living with the knowledge that one has a terminal illness. The study had its genesis at the bedside(s) of people who were dying, yet living or living, yet dying. The experience of knowing one has a terminal illness serves to bring life and consciousness to those who may have otherwise continued to live unconsciously, to exist in a potentially weary and dormant state, oblivious to the fact that life was passing them by. The evidence of experience of knowing what it means to have a terminal illness exists in the words and expressions of the twenty-one people who graciously participated in this study as co-researchers. They have given testimony of their own experience to those of us who seek to understand that experience, to understand what it means to have a terminal illness, to confront one's end to life as it is known, to embrace life or to prepare to die. For some it was a single in-depth interview, for others there were numerous indepth interviews over the course of two to eleven months. Eight of the twenty-one coresearcher narratives were presented in this study. Each interview was recorded by audio and video tape, the former being used for transcription. Subsequently, transcriptions were reviewed for accuracy. As a measure of trustworthiness, themes were identified by the principal investigator and presented in the context of the narrative to the coresearchers who confirmed the data and validated the themes. Implications based on the themes identified in this study are presented under theory development, professional practice and future research. One of the strongest implications pertains to clinical practice in that the results could serve as the framework for a palliative care program which models palliative care as defined by the World Health Organization. The co-researchers were eager to tell their stories and to speak their truth with the hope that the care of persons with terminal illness would some day include care of people as whole persons—physical, psychological and spiritual.

Thesis (Ph.D.)--Tufts University 1999. / Submitted to the Interdisciplinary Program. Adviser: Howard M. Solomon. "Doctor of Philosophy in the Interdisciplinary Program." Includes bibliographical references (leaves 454-497). Access restricted to members of the Tufts University community. Also available via the World Wide Web;

Dissertation (Ph.D.)--Auburn University, 2006. / Abstract. Includes bibliographic references.