A essência da prática interdisciplinar no cuidado paliativo às pessoas com câncer en este programa, en el sur de Brasil, que proporcionan cuidados paliativos a las personas con cáncer. .. São Paulo: Caderno CREMESP; p. 6. Carvalho RT, Taquemori LY. Nutrição e hidratação. In: Conselho Regional de Medicina do Estado de São Paulo. Cuidado paliativo. São Paulo: CREMESP. equipes de cuidados paliativos domiciliares. ÚLCERAS POR PRESIÓN EN PACIENTES EN CUIDADOS PALIATIVOS .. São Paulo: CREMESP; p. 15 -.
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The essence of interdisciplinary practice in palliative care delivery to cancer patients. Universidade Federal do Rio Grande, Brazil. How to cite this article: This qualitative research involved nine professionals working in this program, in the South of Brazil, who delivered palliative care to cancer patients. Data were recollected paliwtivos through observation and focal groups, and analyzed through the thematic analysis technique.
This program was characterized by: The integration of interdisciplinary palliative care practice is innovative and can improve care quality and contribute to the satisfaction of professionals working with patients who need this type of care. Este programa se caracterizou por: Interdisciplinarity is understood as an intrinsic need to refer health practices, through knowledge integration, permitting diverse perspective, the acknowledgement of paaliativos complex nature of phenomena cuidado greater coherence in the materialization of integrality.
In response to this reality, the different specialties offered in health services have contributed to understand workers’ thinking, knowledge and actions, in a complex task that implies agreements among various scientific knowledge areas and articulated action among different professionals, as a fundamental condition for health cuidafos.
That is the perspective for the actions of the Oncology Interdisciplinary Home Hospitalization Program PIDI health team, set up inwhich accomplishes its different professional tasks in search of a common goal – to deliver palliative care to their work object – human beings with terminal cancer, completing the holistic care cycle. The physician paliativls coordinates the program and an administrative aid work at the PIDI headquarters.
In addition, the referral team consists of: It should be highlighted that the aims of the Program are to complement cancer care offered at the UFPel units; act within an interdisciplinary perspective; crrmesp palliative care to users and relatives; deliver global care; include teaching, research and community service in the care process; and permit the expansion of the ten hospitalization beds in the home context. Thus, palliative treatment for cancer patients, a chronic and progressive disease that increases with the aging of the Brazilian population, presupposes continuous and comprehensive care, which implies interdisciplinary palistivos, aimed at individuals, families and caregivers.
Hence, the interdisciplinary nature and different perspectives of care should be understood, acknowledged and used with a view to more comprehensive knowledge and action. In view of the above, this study aimed to get to know interdisciplinary practice in the Oncology PIDI health team. This study is considered relevant as a better understanding of this cuidadoz can contribute to health and cancer nursing, understanding situations that emerge in the flow of human interactions in the care process, enhancing reflections about elements inherent in interdisciplinary actions, such as knowledge integration among professionals, recognizing different subjects’ limits, respecting other people’s and colleagues’ knowledge and horizontal power relations in the team; it can also provide quality of life and death in palliative care delivery to cancer patients.
Participants were identified through abstract terms they had chosen. Data were collected in June through passive observation and focal groups, which consists in a study of different health groups and work processes’ representations and relations. Thematic analysis was chosen to treat the paliativo, which refers to the transcription of conversations recorded in the focal group, data interpretation, ordering, classification and final analysis, 6 revealing the following themes: The participants mentioned their experiences in the constitution of the PIDI team and, thus, refer to the characteristics and changes in their work processes, with a view to the collective paliativso of interdisciplinary practice.
Some essential elements of interdisciplinary palliative care practice were appointed in the group: At the ICU, you may even consider ”biprofessionalism”, in which the physician and nurse can stand out in that environment but, in home hospitalization and palliative care, interdisciplinarity is essential.
When we aim to improve the user’s performance, you are unable to work at the level of physical, spiritual and social symptoms without working in group [ In the following statement, the collective construction of care in the team is identified: In another team experience, multiprofessional, it works too, we even give our opinion [ As if it were support, [ You need to work interdisciplinarily, but always respecting and accepting paluativos each has a knowledge sphere and that this knowledge should join instead of compete.
And, thus, the PIDI has an interdisciplinary team.
The essence of interdisciplinary practice in palliative care delivery to cancer patients
Thus, through this respect and joint work, interdisciplinarity is achieved, otherwise it’s just multiprofessional and, sometimes, people mix up things Rescue. In the following testimony, the collaborative work that is peculiar to interdisciplinary practice is appointed: I find this interdisciplinary integration important, which enhances comprehensive care to users’ needs Sympathy.
The professionals highlight some significant devices for care management in an interdisciplinary focus: Because interdisciplinarity really gives strength to keep up teamwork, the team meeting itself and clinical case in view of the user’s terminality – our italics Solidarity.
This interdisciplinarity issue has been described in decree 2. The main team should include a physician, nurse and social worker, while the matrix team is defined according to the service’s vocation, and may consist of a psychologist, nutritionist and physiotherapist Vocation. The following statements illustrate the recognition of the means PIDI workers used to adapt to interdisciplinary work: My PIDI activity is as a volunteer, integrating this project [ I’ve already worked in a hospital and perceived that cremexp central figure of the physician exists, while other professionals are the rests of the team.
Today, the physician is no longer the core figure in the team Sincerity. Palliative care in interdisciplinary practice involves the multidimensionality of cancer patients when death is paluativos, demanding some singularities of health care delivery by PIDI professionals.
One professional appoints the recognition of the activity space: We came from a culture that is strongly based on the biomedical model. In the PIDI, even when acting in the support theme, we cuidaos that we have a place. That is very important and I haven’t seen that anywhere else Rescue. Palliative care aims to grant users quality of life and death, as one participant highlights: What’s important is that you are able to make the user’s terminality dignified Solidarity.
In that sense, PIDI professionals express the holistic nature of palliative care delivery to users, caregivers and relatives, cfemesp interdisciplinary practice: Because, the PIDI has a professional to address the mind, body and [ Palliative care integrates care peculiarities, as evidenced in the following report: I would like to have more time to better address the post-mourning with users’ relatives. It is important to be able to respect to user’s space and will Hope. Concerning the theme of interdisciplinary practice in the PIDI, as a process in permanent construction, the participants’ testimonies express professional recognition in the care environment put in practice in the PIDI.
When the PIDI is compared with other work places, the valuation of workers becomes visible, with their different scientific knowledge inherent in various specialties and possibilities of clinical and therapeutic interventions among cancer patients in view of an imminent death.
These reports highlight that oncologic palliative care addresses the control of multiple symptoms, with a view to improving the condition and relief of suffering – paliatigos of its clients, entailing the need for various professionals’ actions and for the organization of the work process, considering instruments like clinical case discussions, aka rounds – which allow workers to study the case of each hospitalized user.
CREMESP – Conselho Regional de Medicina do Estado de São Paulo
Also, distinct characteristics 8 of multidisciplinary and interdisciplinary teamwork modes are highlighted. In the first, professionals from different areas act separately, generally without cooperation and information exchange.
In interdisciplinary work, on the other hand, reciprocity and mutual enriching exist, tending towards the horizontality of power relations among the professionals involved, permitting the exchange of affection and knowledge about the knowledge areas. In this mode, also, clear and common objectives need to be established in palliative care delivery to cancer patients.
The testimonies permit the understanding that one learns to work in teams, joining different professions, with a view to the collective construction of languages or a common work organization culture. In this respect, interdisciplinary actions approach theoretical formulations, in which terminal cancer patients are conceived with several difficulties, like the control of pain and other physical, emotional or spiritual symptoms.
Therefore, dialogue represents an existential need, in which people mediatized by the world meet in solidarity, with a view to pronouncing and transforming it, so that it cannot be reduced to one subject’s simple deposit of ideas into the other, but a joint construction, an act of creation, as it is not in silence that individuals are constructed, but in words, work, action and reflection. One report shows essential elements of interdisciplinary work, including knowledge integration, the recognition of each professional’s activity limits in view of the goal of user care, respect for other people’s and colleagues’ knowledge and horizontal power relations in the team.
The PIDI reveals a privileged space in which workers’ individual contributions go beyond scientific and specific knowledge, towards partnerships among the stakeholders.
In the collective construction process of interdisciplinary work, it is fundamental to consider the role of each professional in the team, understanding the potentials and limitations of each subject area, without hierarchical judgement, 12 representing the horizontality of power relations, a characteristic that is capable of enhancing group activities pailativos the democracy process in decision making.
Knowledge integration and articulation among actions picture connections among different activities, which are active and consciously evidenced by the performing agents.
Team interaction, integration and communicative practice were elements identified in the PIDI, based on which paliayivos practice can be improved as through work tools, like the unified and integrated patient file, used during professionals’ joint care delivery – the inter-consultation, the Singular Therapeutic Project PTSmatrix support team, round.
The construction of the PTS takes place in experience exchanges, like clinical case discussions, which are consolidated through team meetings. Also, the formation of Referral and Matric Teams is considered a relevant proposal due to the combination between the objectivity cuidadoz clinical care and the singularity of subjects and groups. Thus, workers reach the diagnoses and establish palliative treatment in view of terminal cancer patients’ symptoms, in a shared manner.
The testimonies evidence the professionals’ concern with and commitment to the insertion of interdisciplinary practice into their work process, based on adherence to spaces that enhance discussions and reflections on the users’ health condition, with a view to contributing to palistivos continuity.
These spaces aim to enhance each team member’s autonomy, active participation and co-accountability, in the attempt to preserve the singularity and multidimensionality of cancer patients as human beings who need care. Also, the permanent education and efforts of the stakeholders involved in professional qualification is highlighted, including the legal bases for the constitution of the PIDI team in the Unified Health System SUS.
This investment in the stakeholders’ professional development can derive from interdisciplinary practice itself, when the subjects are motivated to gain new technical and pedagogical skills and to improve actions jointly.
It should be mentioned that the PIDI members, through the knowledge a professional gained in the specialization ctemesp in SUS Humanization and Management, incorporated concepts recommended by the Ministry of Health’s Expanded Clinic, 14 whose proposal to reorganize work processes originated in the National Humanization Policy PNH document. In the PNH, the diagnosis is multidimensional, permitting conclusions about users’ risks and vulnerabilities, paying attention to how individuals behave in view of forces like diseases and desires, under the influence of family members and caregivers.
This process refers to a joint construction, loaded with professionals’ feelings and desires, in a cycle that self-stimulates them to act in defense of terminal cancer patients’ quality of life and death. They also envisage comprehensive care, which goes beyond the hierarchized organizational structure of health care, extends into the problem-solving ability of individual and collective care guaranteed to SUS users and demands commitment to continuous learning through interdisciplinary contact.
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Collective learning in the PIDI, based on the great problem-solving potential and satisfaction it can provide to users and professionals, 14 is revealed in the annual elaboration of seminars about interdisciplinary practices, palliative care, home care to cancer patients, and workers’ recycling in lato sensu and stricto sensu graduate courses.
Thus, the sense of collective construction attributed to learning distances it from practices that promote one person’s depositing of information in the other, in which is knowledge is characterized as a donation by those who consider themselves wise to those who consider they know nothing.
The subjects’ interaction and knowledge integration permit collective learning, which disseminates growth, mutual enrichment and professional satisfaction crejesp the PIDI team, as interdisciplinary actions demands two or more people with their different knowledge, who are interested in paliaticos and socializing their knowledge. This point cuidzdos to be determining: In this process, it is essential to recognize the means by which individuals constructed their interactions with other people throughout their lives, excelling by overcoming their individuality in their thinking, knowing and acting, as a result of their education, or being able to reconstruct them collectively in the cuidadks, with a view to adapting the subjects to interdisciplinary work.
In the constitution of interdisciplinary work, the core figure of a single professional does not exist, as a group of linked paliatjvos share multiple and cuidadks objectives, defined under the coordination of a superior hierarchical level, 16 introducing the horizontality of power relations and the finality notion of palliative care for cancer patients in the program analyzed. In the theme about palliative care in interdisciplinary practice, it is important to consider the multidimensional nature of cancer patients.
These people are at home and face the imminence of death, which permits the expanded construction of holistic careattending to health needs pxliativos different professional interventions, as holistic care delivery is opposed to the fragmentary and reductionist approach of individuals.
Thus, comprehensive, interactive and high-quality care production breaks with the biomedical education model, transforming professional practices and the organization of the service network. In view of this situation, a meeting space exists where care actions are elaborated, in which each professional can have decision power.
Thus, the professionals demonstrate interaction and the cremep view, the object of their work, on broader bases, attending to interdisciplinary activities in the palliative care team. The PIDI team executes health actions within a new focus, adopting a work process that permits palliative care delivery to cancer patients in a continuous and comprehensive ckidados, expanding the interfaces to be managed and to raise new difficulties and challenges cjidados the field of professional competences.
In the PIDI, another goal is maximum comfort and understanding, without the intent of cure, due to its impossibility, emphasizing the adequate control of symptoms and the different aspects involving human beings. Every paliaticos weeks, the Program also organizes a therapeutic group for caregivers and relatives of hospitalized users and another group for those in the mourning process.
These groups provide support and information to these individuals at different times. Professionals contribute in their specific area to the common and final product of their work. In addition, during care delivery to users, families and caregiversPIDI professionals are concerned with and respect the maintenance of the subjects’ autonomy in decisions about the therapeutics, with the required needs, with their wellbeing in its different dimensions.
Important and innovative scales are applied to reassess the care delivered and the interdisciplinary articulation pakiativos the stakeholders in this process, including the ESAS Edmonton Symptom Assessment Scalewhich included nine visual analogue scales cuidqdos the following symptoms: Thus, in the PIDI, holistic care, through interdisciplinary practice, is present through committed, humane and ethical care for users, families and caregivers.
The palliative care delivered to cancer patients involve a singularity that demands the consideration of several factors: