Compreendendo os cuidados paliativos na Unidade de Terapia Intensiva Neonatal sob a perspectiva Heideggeriana

Abstract

The human being is a being thrown into the world, he did not choose to exist in the world, in the philosophical understanding, the newborn is thrown into the world without having had the possibility of choosing when, where and how this would happen, in what way and at what time. Furthermore, from his conception he is already configured as a being-towards-death. The objective of this study is to reveal the understanding of health professionals about palliative care in the Neonatal Intensive Care Unit. This is a qualitative, phenomenological research by Martin Heidegger. Approved by the Research Ethics Committee, under the Opinion number: 6.128.810. Conducted with professionals from the multidisciplinary team of a Neonatal Intensive Care Unit of a Teaching Hospital in the State of Rio Grande do Sul. To search for information, a phenomenological interview was conducted from June to September 2023. The information was transcribed in full with double checking and sent to the participants for validation, then inserted into the WebQDA - Qualitative Data Analysis program. Paul Ricoeur's philosophical hermeneutics was used to interpret the information. Three units of meaning emerged: Understanding palliative care; Understanding death in the Neonatal Intensive Care Unit; Professionals' care for terminally ill newborns and their families. It is revealed that professionals understand palliative care as a way of providing comfort and improving the quality of life at the end of life. In neonatology, it is clear that this is a delicate subject that requires discussion and in-depth study. Death is perceived by health professionals as the end of life, a terminal process that refers to pain, loss, suffering, passage, and farewell. Regarding neonatal death, participants question the facticity of why some live and others do not. Some have difficulty dealing with the death of someone who lived so little, and acceptance becomes easier when there is a scenario in which the prognosis is poor, such as when the baby will have sequelae. Care for terminally ill newborns consists of comfort, control and relief of pain, and reduced handling. It is also worth highlighting the creation of memories and the involvement of parents in care, to strengthen the bond. Regarding the use of a palliative care protocol, most professionals agree that its implementation is important. In view of this, palliative care in neonatology challenges health professionals, mainly to establish moments in which investments should stop, and to determine neonatal palliative care as a conduct, as they do not see the newborn as a being-to-die. In this context, knowledge, training and discussions about neonatal palliative care and the baby's dying process are necessary to implement palliative care management protocols that meet the baby's needs as a being-in-the-world with his/her family. In this way, the team feels empowered and confident that their actions will contribute to the quality of care for this being, who, although fragile, is a being-towards-death.