Processo de transição do hospital-domicílio de pacientes em cuidados paliativos com ordem de não reanimação: percepções de enfermeiros e médicos

Abstract

Chronic health conditions have amplified the need for continuous and integrated care, requiring the inclusion of Palliative Care at various points within the Health Care Network. In the context of end-of-life, the implementation of a Do Not Resuscitate (DNR) Order represents a significant ethical and care challenge, especially during the transition from hospital to home care. This study aimed to understand the perceptions of nurses and physicians, working in Primary Health Care, regarding the transition from hospital to home Palliative Care for patients with a DNR Order. This was an exploratory qualitative research, employing semi-structured interviews as the data collection technique. The sample consisted of 55 participants, with 27 nurses and 28 physicians. For data processing, the IRaMuTeQ software (Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires), version 0.7, alpha, was utilized. The analysis was conducted using Thematic Content Analysis, grounded in Afaf Meleis' Transitions Theory. The content analysis resulted in two thematic blocks: 1) Ethical Dimensions and Decisions in End-of-Life Care, and 2) Organizational and Collaborative Dimensions in the Hospital-to-Home Transition Process. The results indicate that professionals are re-signifying their perceptions of the dying process, recognizing decisions such as the DNR Order as an ethical measure centered on patient autonomy. However, this recognition still faces individual, institutional, and sociocultural resistance, in addition to being hampered by training gaps, failures in communication between levels of care, and the absence of formal documentation. The findings demonstrated that the quality of the hospital-to-home transition for patients in Palliative Care with a DNR Order is conditioned by both inhibiting and facilitating factors. Fragmentation of services and a shortage of training generate fragile response patterns and care discontinuities. Conversely, valuing continuing education, interprofessional articulation, strengthening networks, and the institutionalization of processes and documents constitute fundamental strategies to ensure a safe, dignified transition aligned with the wishes of patients and their families. This study contributes by exploring the challenges and providing evidence to inform discussions, thereby guiding the development of policies and guidelines that promote more ethical and coordinated transitions of care.