RESUMO

Las tasa de trasplantes en Chile es baja en comparación con otros países. Si bien se han hecho importantes avances para aumentar este número, existe poca claridad en cuanto a protocolos de seguridad de los equipos de procuramiento de órganos. A nivel internacional existen diferentes tragedias que han marcado este trabajo, la más conocida es la ocurrida en Michigan, donde un equipo médico perdió la vida al caer sobre el lago en un transporte por un trasplante de pulmón. Años después de la tragedia se conocieron los reiterados reclamos por parte del personal médico en relación a la falta de seguridad durante los traslados. Si bien el procuramiento de órganos tiene un riesgo asociado inherente, este se debe mantener al mínimo. Para avanzar en esto se confeccionó una guía de seguridad donde participaron las organizaciones de trasplante más importantes de Estados Unidos. Se emitieron recomendaciones, donde se regula el transporte aéreo, terrestre, seguros y el futuro de esta actividad. En Chile la orientación técnica que regula el procuramiento, no especifica ninguno de estos puntos y no existe información pública disponible, dejando la seguridad a disposición de las instituciones locales. Si bien es importante reconocer el esfuerzo nacional por mejorar el número de trasplantes año a año, es necesario avanzar en mejorar la seguridad de los equipos de procuramiento, y no esperar que ocurra una tragedia, para generar cambios necesarios, particularmente en un país con una geografía desafiante como Chile.

The transplant rate in Chile is low compared to other countries. Although significant advances have been made to increase this number, there is little clarity regarding safety protocols for organ procurement teams. Internationally, various tragedies have marked this work, the most famous being the one that occurred in Michigan, where a medical team lost their lives when they crashed into a lake during transport for a lung transplant. Years after the tragedy, repeated complaints by medical personnel came to light concerning the lack of safety during transfers. Although organ procurement inherently carries associated risks, these should be kept to a minimum. In 2020, a safety guide was created to make progress with participation from the most crucial transplant organizations in the United States. Recommendations were issued regulating air and ground transportation, insurance, and the future of transplant activity. In Chile, technical guidelines that regulate procurement need to specify crucial safety metrics, and there is no publicly available information or recommendations, leaving safety to the discretion of local institutions. While it is essential to recognize the national effort to improve the number of transplants year after year, it is necessary to advance in improving the safety of procurement teams and not wait for a tragedy to occur to generate the required changes, particularly in a country with challenging geography like Chile.

RESUMO

The objective of this research is to investigate family members' perceptions as to the end-of-life decision-making process in an ICU. The authors conducted a qualitative descriptive study in which they interviewed six family members of critically ill patients admitted to the ICU of a private hospital. Five categories of analysis emerged from the examination of the material. This study will discuss two of those categories: the decision-making process and the relationship with the medical staff. The results indicate that family members were satisfied with communication with the medical staff, an important aspect for the decision-making process. Within this context, the shared model, prioritization of palliative care and identification of futile treatments prevailed, aimed at ensuring the patient's comfort and dignity at the end of life. The results also reveal the need for integration of palliative care in ICUs, particularly in end-of-life situations. (AU)

O presente estudo tem como objetivo investigar a percepção dos familiares acerca do processo de tomada de decisão na terminalidade em UTI. Realizou-se uma pesquisa descritiva de cunho qualitativo, na qual foram entrevistados seis familiares de pacientes gravemente enfermos, internados na UTI de um hospital privado. Do estudo do material emergiram cinco categorias de análise. Neste trabalho serão discutidas duas categorias: processo de tomada de decisão e relação com a equipe médica. Os resultados indicam que os familiares se mostraram satisfeitos com a comunicação com os membros da equipe de saúde, aspecto importante para o processo de tomada de decisão. Neste contexto prevaleceram o modelo compartilhado, a priorização de medidas paliativas e a identificação de medidas fúteis, a fim de garantir o conforto e a dignidade no processo de morrer do paciente. Evidenciou-se a busca de integração dos cuidados paliativos em UTI, principalmente em situações finais de vida. (AU)

El presente estudio tiene como objetivo investigar la percepción de los familiares sobre el proceso de toma de decisiones en el estado terminal de vida en la UCI. Se realizó una investigación descriptiva de carácter cualitativo, en la cual fueron entrevistados seis familiares de pacientes gravemente enfermos, internados en la UCI de un hospital privado. Del estudio del material surgieron cinco categorías de análisis. En este trabajo serán discutidas dos categorías: proceso de toma de decisiones y relación con el equipo médico. Los resultados indican que los familiares se mostraron satisfechos con la comunicación con los miembros del equipo de salud, aspecto importante para el proceso de toma de decisiones. En este contexto prevalecieron el modelo compartido, la priorización de medidas paliativas y la identificación de medidas inútiles, con el fin de garantizar comodidad y dignidad en el proceso de muerte del paciente. Se evidenció la búsqueda de integración de los cuidados paliativos en la UCI, principalmente en situaciones finales de vida. (AU)

Assuntos

RESUMO

This study sought to investigate the significance of death for doctors who work with terminally ill patients in the Bone Marrow Transplant (BMT) context. The research was based on a qualitative, methodological and collective case study approach, and used Dejours' psychodynamics of work as a theoretical framework. Five practitioners linked to a Bone Marrow Transplant Unit in a university hospital in São Paulo, Brazil, participated in the research. A semi-structured script was applied which addressed the personal, academic and professional experiences elicited by a terminal situation. Data were organized into two categories: "Work and professional identity: the doctor's battle against death" and "Vocation and medical training: it all beggins at home." The results show that, in the medical and hospital context, death is almost always reduced to technical rationality and this must be avoided at all costs. The significances attributed to death are rooted in the values of contemporary society and subjectively perceived through the physician's life trajectory and academic training, which influence how these professionals experience the dying process of the patients.

Este estudo teve como objetivo investigar o significado da morte para médicos que atuam com pacientes em condição crítica no contexto do Transplante de Medula Óssea (TMO). A pesquisa foi fundamentada no enfoque metodológico qualitativo e no estudo de caso coletivo, e utilizou o referencial teórico da psicodinâmica do trabalho. Participaram os cinco médicos vinculados a uma Unidade de TMO de um hospital universitário do interior paulista. Aplicou-se um roteiro semiestruturado, que abordava as vivências pessoais, acadêmicas e profissionais suscitadas pela situação de terminalidade. Os dados foram sistematizados nas categorias: "Trabalho e identidade profissional: a peleja do médico contra a morte" e "Vocação e formação médica: tudo começa em casa". Os resultados mostram que, no âmbito médico-hospitalar, a morte é quase sempre reduzida à racionalidade tecnicista e por isso deve ser combatida a qualquer custo. As significações atribuídas à morte são ancoradas nos valores da sociedade contemporânea e subjetivadas nos percursos e percalços enfrentados pelo médico ao longo de sua história de vida e na formação acadêmica, que influenciam o modo como os profissionais vivenciam o processo do morrer dos pacientes.

Assuntos

RESUMO

Se destaca la notable significación de los principios de la concepción sistémica, de la objetividad, la multifactorialidad, el historicismo y de la práctica social transformadora, en su aplicación a la gestión asistencial y se argumenta que en las condiciones mundiales actuales del ejercicio de la medicina, la clásica relación médico-paciente se ha expandido a la relación equipo de salud-paciente-familiar. Se comentan brevemente algunos factores determinantes de las modificaciones de la relación médico-paciente originalmente limitada al facultativo y el enfermo. Se discuten los resultados de un estudio preliminar donde se exploraron en un centro asistencial, las apreciaciones de pacientes y estudiantes sobre el significado del desempeño interpersonal y cumplimiento idóneo de las funciones de los miembros del equipo de salud en sus niveles, profesional, técnico, administrativo y auxiliar. Se invita a la reflexión sobre los efectos nocivos que pueden derivarse del trato inadecuado de los diferentes integrantes del equipo y se propone que el médico, como su responsable básico, se preocupe por sensibilizar a sus compañeros en relación con el significado de sus actitudes y comportamientos ante los enfermos y sus familiares.

The remarkable significance of the principles of systemic conception, objectivity, multifactorial nature, historicism and transforming social practice in their application to medical care management was underlined in this paper. It is also stated that under the present world conditions of medical practice, the classical relationship between the physician and the patient has been extended to the relationship among the health care team, the patient and the family. Some determining factors of the changes occurred in the physician-patient relationship (PPR), originally limited to the physician and the sick person, are briefly commented on. The results of a preliminary study, which explored the criteria of patients and students in a health care center about the significance of inter-personal performance and the optimum fulfillment of the functions of the health care team at professional, technical, administrative and auxiliary levels were discussed. Readers are encouraged to make reflections on the harmful effects that may stem from improper treatment provided by the team members; it is also suggested that the physician should, as the ultimate responsible of the team, sensitize his/her colleagues in relation to the significance of their attitudes and behaviors in dealing with sick persons and their relatives.

RESUMO

El objetivo de este estudio fue describir la percepción del paciente infértil acerca del equipo médico tratante y conocer sus expectativas de recibir apoyo emocional. Se evaluaron 106 pacientes infértiles, 72 mujeres y 34 varones, en tratamiento en Unidades de Medicina Reproductiva de la ciudad de Santiago. Los pacientes evaluaron como buena la información entregada por el médico. No obstante, la mayoría (89%) declaró desear recibir más información sobre infertilidad. La acogida por parte del equipo médico tratante fue evaluada como regular (promedio 3,9 en escala 1 a 5), influyendo negativamente en la percepción de los pacientes la dificultad en el contacto telefónico y la falta de continuidad del equipo tratante. En otros aspectos la percepción de acogida fue positiva, tanto en el contexto del hospital universitario como en el de las clínicas privadas. Para las mujeres, haber sido citadas con su pareja se correlacionó positivamente con la percepción de ser escuchadas por su médico.

The aim of this study was to describe the perception of the infertile patient about the medical team and to determine his (her) expectations about receiving emotional support. One hundred and six infertile patients (72 women, 34 men) undergoing treatment in Reproductive Medicine Units of the city of Santiago were assessed. Patients reported that information given by their physicians was good. Nevertheless, most of them said they would like to receive more information on infertility. Receptivity of the medical team was rated as moderate. Difficulties in contacting the medical team by phone and lack of continuity of the medical staff negatively influenced patient's perception about the receptivity of the medical team. Regarding to other aspects, patients tended to view favourably the receptivity of the medical team, both in university hospitals and private clinics. For Women, having been asked to attend appointments with their partners positively correlated with the perception of being heard by their physicians.