ABSTRACT
RESUMO A proposta deste texto tem a função de trazer contribuições da ética do cuidado para práticas da Atenção Básica em Saúde a partir do legado de Maria de Lourdes Pintasilgo (1930- 2004), Primeira Ministra de Portugal, de julho de 1979 a janeiro de 1980. Por meio do registro narrativo, trazem-se aspectos da trajetória de vida dessa política por meio do testemunho de uma importante parceira de luta, acrescido de aportes teórico-documentais, os quais fazem parte do acervo da Fundação Cuidar o Futuro, a qual buscava a melhoria sustentada da qualidade de vida e defesa de direitos básicos. A parlamentar teve expressiva participação política em Fóruns Europeus e das Organizações das Nações Unidas propondo ações que combatessem a desigualdade social e a opressão das mulheres. Inspirada na ética feminista, compreendia o cuidado como a pedra de toque de suas ações. Valorizava as experiências singulares das pessoas e comunidades como principal parâmetro de fortalecimento da participação social e efetividade dos direitos humanos. Por fim, expressava uma forma de fazer política em que o compromisso ético e o respeito consigo mesma, com o outro e com o meio ambiente balizavam seu modo de estar no mundo.
ABSTRACT The purpose of this text is to bring contributions from the ethics of care to the practices of Primary Health Care based on the legacy of Maria de Lourdes Pintasilgo (1930-2004), Prime Minister of Portugal, from July 1979 to January 1980. Through the use of narrative record, aspects of the life trajectory of the politician are brought through the testimony of an important partner in fights, as well as theoretical and documentary contributions, which are part of the Caring for the Future Foundation's collection, which sought sustained improvement of quality of life and the defense of basic rights. The parliamentarian had significant political participation in European and the United Nations Organizations Forums proposing actions that would combat social inequality and the oppression of women. Inspired by feminist ethics, she understood care as the cornerstone of her actions. She valued the unique experiences of people and communities as the main parameter for strengthening social participation and the effectiveness of human rights. Finally, she expressed a way of doing politics in which ethical commitment and respect for oneself, others, and the environment marked her way of being in the world.
Subject(s)
Primary Health Care/ethics , Psychology, Social , Public Health/history , Ethics, Medical/history , Patient-Centered Care/ethicsABSTRACT
BACKGROUND: One of the biggest challenges of practicing medicine in the age of informational technology is how to conciliate the overwhelming amount of medical-scientific information with the multiple patients' values of modern pluralistic societies. To organize and optimize the the Decision-Making Process (DMP) of seriously ill patient care, we present a framework to be used by Healthcare Providers. The objective is to align Bioethics, Evidence-based Practice and Person-centered Care. MAIN BODY: The framework divides the DMP into four steps, each with a different but complementary focus, goal and ethical principle. Step 1 focuses exclusively on the disease, having accuracy is its ethical principle. It aims at an accurate and probabilistic estimation of prognosis, absolute risk reduction, relative risk reduction and treatments' burdens. Step 2 focuses on the person, using empathic communication to learn about patient values and what suffering means for the patient. Emphasis is given to learning and active listening, not taking action. Thus, instead beneficence, we trust comprehension and understanding with the suffering of others and respect for others as autonomous moral agents as the ethical principles of Step 2. Step 3 focuses on the healthcare team, having the ethics of situational awareness guiding this step. The goal is, through effective teamwork, to contextualize and link rates and probabilities related to the disease to the learned patient's values, presenting a summary of which treatments the team considers as acceptable, recommended, potentially inappropriate and futile. Finally, Step 4 focuses on provider-patient relationship, seeking shared Goals of Care (GOC), for the best and worst scenario. Through an ethics of deliberation, it aims for a consensus that could ensure that the patient's values will be respected as well as a scientifically acceptable medical practice will be provided. In summary: accuracy, comprehension, understanding, situational awareness and deliberation would be the ethical principles guiding each step. CONCLUSION: Hopefully, by highlighting and naming the different perspectives of knowledge needed in clinical practice, this framework will be valuable as a practical and educational tool, guiding modern medical professionals through the many challenges of providing high quality person-centered care that is both ethical and evidence based.
Subject(s)
Critical Care/ethics , Critical Illness/therapy , Decision Making/ethics , Evidence-Based Practice/ethics , Humans , Patient-Centered Care/ethicsABSTRACT
El pase de guardia se puede definir como la transmisión de la información referida a un paciente, su diagnóstico y tratamiento, cada vez que la responsabilidad de su atención se delega a otro/a enfermero/a. Es uno de los medios de coordinación intraservicio que utiliza enfermería con el objetivo de programar, administrar y evaluar el cuidado de los pacientes. Es importante tener claridad en el mensaje que se quiere transmitir, qué es relevante, para evitar la dispersión en información accesoria que sólo brindará confusión a quien escucha. Es una forma de transmisión oral que permite a los profesionales garantizar la continuidad y homogeneidad del cuidado
Subject(s)
Humans , Patient-Centered Care/ethics , Continuity of Patient Care/ethicsABSTRACT
É alta a prevalência de dor crônica em pacientes com câncer, que é comprovadamente associada ao sofrimento psicológico acentuado e muitas vezes não é adequadamente diagnosticada e tratada. Estudo que realizamos com 120 pacientes adultos em atendimento ambulatorial na Clínica de Dor do Instituto Nacional de Câncer, no Rio de Janeiro que demonstrou que os pacientes mesmo conhecendo o seu diagnóstico de câncer, não se sentiam informados sobre a doença e a dor oncológica a contento, o que trazia insatisfação com o tratamento recebido e maior exigência com os resultados do mesmo. Nosso estudo revelou, ainda, que o comportamento do profissional durante o atendimento pode ser percebido pelos pacientes como fator tanto de melhora como de piora da dor, sendo o comportamento atencioso do profissional muitas vezes mais valorizado pelos pacientes que a supressão da dor. Estes resultados suscitaram questões relativas à qualidade da interação entre médicos e pacientes, desenvolvidas nesta dissertação. Embora não sejam suficientemente investidas nem na relação médico-paciente, nem na educação e no treinamento profissional, as habilidades de comunicação do médico afetam diretamente o nível de informação e de satisfação do paciente, suas crenças e os resultados do tratamento. Ao longo do tempo a relação médico paciente vem mudando, deixando de ser tão centrada na doença e no médico, para centrar-se mais no doente como um ser integral, o que implica no reconhecimento, pelo médico, de saberes diferentes dos seus e de que o seu saber não constitui uma verdade absoluta a ser acatada pelos demais. Apesar de bem-vindas, estas mudanças trazem uma certa confusão nos papéis a serem desempenhados por médicos e pacientes e dificuldades aos médicos de lidarem com as diferenças, com as queixas subjetivas dos pacientes, com as emoções destes e as suas próprias...
Subject(s)
Humans , Male , Female , Pain Clinics/ethics , Pain Clinics , Patient Rights/ethics , Patient Rights/trends , Pain/psychology , Pain/therapy , Neoplasms/diagnosis , Neoplasms/psychology , Physician's Role/psychology , Physician-Patient Relations/ethics , Patient-Centered Care/ethics , Patient-Centered Care/methods , Patient Care/ethics , Patient Care/psychology , Interpersonal Relations , Sick Role , Oncology Service, Hospital/ethics , Oncology Service, HospitalABSTRACT
PURPOSE OF REVIEW: Medical literature has increasingly emphasized the need to observe patients' autonomy; however, not all experts agree with this principle. This discord is based on varying credence between the concepts of autonomy and beneficence. In critically ill patients, this conflict involves the patient's family and creates a particular family-physician relationship. The purpose of this review is to assess the evidence on medical decision making and the family-physician relationship. RECENT FINDINGS: The many studies published on this topic reveal that people's preferences around the medical decision-making process vary substantially. Although it is clear that a shared decision approach is popular and desirable to some, it is not universally favored; some patients prefer to leave final treatment decisions up to the doctor. This finding shows a robust moral pluralism, which requires special attention in multicultural societies. For critically ill patients, the diversity of opinion extends to the family, which creates a complex family-physician dynamic and necessitates utilization of particular interaction strategies. SUMMARY: Clinicians must understand the range of preferences in a society and should offer the opportunity to participate in treatment by sharing decision-making responsibility. This would involve assessing the preferences of patients and their families in order to provide care accordingly. Clinicians should then ensure proper information is provided for informed decision making and minimize factors that could have potential adverse effect.