Nurses defending the autonomy of the elderly at the end of life

Abstract

Objective: to understand how nurses deal with the elderly’s autonomy at the end of life. Method: qualitative, exploratory study, guided by the Grounded Theory. Ten nurses, eight doctors and 15 nursing technicians were interviewed between November 2016 and May 2017 at a university hospital in Rio de Janeiro/Brazil. Results: nurses deal with the elderly’s autonomy in compliance with the code of ethics and exercise leadership in actions and interactions to defend this right, evaluating, guiding and listening to the preferences of the elderly; interacting with the family; and sharing information with the health team. Final considerations: the elderly’s autonomy must be ensured in care planning, based on patient-centered communication and developed in the interaction among agents involved in care. The discussion on “Living Wills” Health Care Directives and principles of palliative care must be encouraged.

Reflections on elderly autonomy and its meaning for the practice of nursing care

“…The consequences of CNCDs greatly affect the quality of life of the elderly, directly impacting their autonomy and independence, given that the developments are mostly associated with some form of physical limitation, which compromises the activities of daily living and interpersonal relationship (4,9) .…”

“…Furthermore, the difficult psycho-emotional confrontation in dealing with the aging process, along physiological changes during the illness, compound with other social challenges, such as the negative stigmatized image of the elderly in the collective ideal, which generates depersonification and whose influence interferes in the nurse-client relationship. The association between advancing age and disability compromises the development of a professional-patient shared care plan, which tends to become imposing and unilateral, with the possibility of depriving the elderly of the decision-making power over themselves, a fact that contributes to the perpetuation of a paternalistic care posture (3)(4) .…”

“…This whole context points to a complex situational dynamic that culminates in great damage to the elderly. The low integration and social receptivity, combined with the unpreparedness of health professionals in dealing with the issues of aging in a comprehensive manner, impose serious limitations to their wellbeing and satisfaction with life (3)(4)(5)(6) .…”

“…How can the nursing practice add quality of life and social transformation to them?" The reasons are innumerable and crucial for the improvement of the planning of care in which the interaction between the peers prevails, above all, the active participation of the patient, considering that the projection for this population gains prominence and the inability to meet global biopsychosocial demands still compromise the care provided to it (4)(5) .…”

“…564/2017, includes as a professional duty for nursing professionals, the respect towards the right of the person or his/her legal representative to exercise autonomy (8) . However, in the understanding of nursing, this issue is beyond compliance with the law, since the damage caused to patients in the absence of the promotion of autonomy affects physical, emotional, psychological, and social spheres (3)(4)(5)(6) . Thus, this reflection addresses current and unavoidable issues in the field of public health and the provision of qualified and unique assistance services.…”