Perspectivas de enfermeiras haitianas sobre cuidados em fim de vida aos idosos hospitalizados: análise a partir da teoria da enfermagem transcultural

Abstract

The aging of the population is a global issue that requires attention from health service managers, especially in developing countries with limited resources, such as Haiti. The elderly often suffer from chronic diseases that, at some point, no longer respond to treatments aimed at modifying them, ultimately leading to the end of life. In this phase, nursing becomes essential, and when providing care, it must consider the cultural aspects that involve the life history of the elderly, respecting their beliefs, values, and desires— a challenge in the context of hospitalization. Therefore, this research aimed to understand the perspectives of Haitian nurses on end-of-life care for hospitalized elderly individuals based on the concepts of transcultural nursing. To answer this, a qualitative study was conducted based on the Theory of Transcultural Nursing. Between July and September 2024, semi-structured interviews were conducted online or completed via Google Forms with 11 nurses working at the Centre Médico-Social de Ouanaminthe (CMSO), Haiti. The data were managed using the Atlas.ti program, in its demo and cloud versions, and we used thematic content analysis. We obtained the consent to conduct the research at CMSO. We structured the results into two categories: 'Training of Haitian nurses for the care of hospitalized elderly at the end of life' and 'The interface of culture in the dimensions of care for hospitalized elderly at the end of life.' In the first category, I presented an overview of the main elements of the training of Haitian nurses for the care of elderly individuals at the end of life, focusing on the areas of gerontology and palliative care. It was found that, although they mention specific training, it is focused on physical aspects and seems to lack sufficient time to directly impact the care provided. This was evident when identifying the challenges and difficulties faced by hospitalized elderly individuals at the end of life. In the second category, I discuss the main elements of the cultural interface in the dimensions of care for elderly individuals hospitalized at the end of life. It was notable, on the one hand, that nurses attempted to incorporate cultural aspects into the care provided, despite the precarious economic structure of the service. On the other hand, limitations and cultural clashes were evident, arising from the difference between nurses' worldviews regarding elderly people’s behavior and their preferences for generic care, which sometimes took precedence over more personalized care from health professionals. I conclude that there is a need for political, economic, and structural investment to establish a palliative culture within the service, as well as to train nurses for comprehensive and culturally congruent care—something fundamental, considering the specificities of Haitian elderly individuals and their ways of life.