Social representations of Family Health Strategy professionals regarding palliative care for older adults

Queiroz, Luciana Meneguim Pereira de; Lazarini, Carlos Alberto; Higa, Elza de Fátima Ribeiro; Pinto, Adriana Avanzi Marques

doi:10.1590/1981-22562024027.230170.en

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Original Articles • Rev. bras. geriatr. gerontol. 27 • 2024 • https://doi.org/10.1590/1981-22562024027.230170.en copy

Social representations of Family Health Strategy professionals regarding palliative care for older adults

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To comprehend the Social Representations of nurses, physicians, and dentists working in Primary Health Care (PHC) regarding Palliative Care (PC) for older adults.

Method

This research was grounded in the Theory of Social Representations. Data were obtained through semi-structured interviews comprising closed-ended questions (socio-demographic and professional data) and open-ended questions (Describe your understanding of Palliative Care for older adults and Explain how you provide palliative care for the older adults under your care at this unit). For data analysis and organization, the Collective Subject Discourse technique was employed.

Results

Regarding the question about what professionals understood about Palliative Care for older adults, four Central Ideas emerged: incurable diagnosis; biopsychosocial and humanized care for the older adult and family; quality of life; and health education. The five central ideas concerning how this care was conducted at the unit were: home visits; biopsychosocial and spiritual care for the older adult and family; activity groups; promotion of quality of life; and assistance at the moment of death.

Conclusion

The data obtained allowed for the identification of the social representations of PHC professionals regarding PC for older adults, as well as its implementation. The understandings of PC are closely related to those advocated by the World Health Organization, with the exception of health education, which is a principle rather than a concept. These understandings also allowed for the identification of actions by nurses, physicians, and dentists that demonstrate how they provide palliative care for older adults.

Keywords
Palliative Care; Older Adults; Social Representation; Primary Health Care; National Health Strategies

Identification of central ideas	Collective Subject Discourse
Incurable diagnosis	I believe it's not about giving the cure to the patient. In palliative care, we acknowledge that perhaps they do not have those conditions, that there is no cure. It's a patient who is in the final stages of life, who no longer has any options left, but there's a possibility of providing comfort. Sometimes it's cancer, I don't know, AIDS. In these cases, the medical aspect has already been addressed. So, palliative care is when the patient already has a terminal diagnosis and it's not always about curing a particular condition. (E2, E3, E6, E8, E10, M6, M7, M9, O1, O5, O6, O8)
Biopsychosocial and humanized care for older adults and family	I believe it involves providing the greatest possible support, both for the patient and for the family, who accompany them through their final moments. It's about facilitating autonomy, humanizing care, listening, and creating a Singular Therapeutic Project for both the patient and their family. Because the family also becomes ill and suffers alongside the patient who is receiving palliative care. It involves offering both professional and psychological support to everyone involved. In most cases, this individual remains under the care of the family, where they receive attention, affection, and better care. This type of care should be integrated with the multiprofessional team. So, I understand this as palliative care, not only for the patient but also for their support network. (E1,2,4,9, M2,9, O2,4,6,8)
Quality of life	For me, it's about providing the older adult with a better quality of life related to aging. Dispensing comfort to those older adults, alleviating the suffering of pain, providing leisure, good nutrition, and attention, things they sometimes lack. It involves the presence of family members, the attention of others, and ensuring quality of life both inside and outside the home. So, for me, it aims to relieve pain while also taking a comprehensive look not only at their illness but at the human being, ensuring they have a voice in their treatment and autonomy in decision-making regarding their illness, between life and death. It involves keeping them nourished, maintaining good hygiene, being close to family and pets, maintaining that contact, ensuring quality of life in their final period of life, and providing a dignified death. (E2-10, M1,2, M4-10, O1,3,5,7,10)
Health education	I believe it's when we provide information, both to the patient and to the family, about the advantages and disadvantages of a procedure. For those who are dependent or have other limitations, we empower the caregiver, the family member. Sometimes the family tells the older adult that they have to take this or that medication, and they don't comply. When we explain, they can understand. There's also guidance on hygiene, which is always important for maintaining health. Often, people have the misconception that if they don't have teeth, they don't need to clean their mouth, and soft tissues end up developing a variety of lesions and diseases. These are the types of guidance we can provide in primary care. (E1,5, M1, O6,10)

Identification of central ideas	Collective Subject Discourse
Home visits	Here in the unit where I work, we conduct routine visits. Community health workers perform these visits regularly for preventive and palliative care. For bedridden patients, we have periodic visits for catheter changes, exchanging information, because they usually also consult specialists, which goes beyond primary care. Visits are always scheduled, although lately we haven't been able to do as many due to Covid, although we always keep an open channel of communication with the family of these patients, especially those in palliative care. So, what we can do for them is to monitor, conduct home visits when necessary. In dental practice, the majority are edentulous and use dentures. I check for ill-fitting dentures, provide wound care, extract any mobile teeth. I also provide guidance on oral cancer, oral hygiene. (E1,3-6,8-10, M1,2,5,7,8, O2,5-8)
Biopsychosocial-spiritual care for older adult and family	I make it a point to listen when they come in for a consultation. If they report any episodes of falls, any discomfort in any limb, or any complaints, I pay attention because that's what they appreciate. And when there's a problem, I try to resolve it with the team in the best way possible. I initially talk to the older adult. If I notice a loss of function, I talk to the family with the aim of restoring their daily activities, such as caring for plants, attending a mass, or listening to country music. And I always try to listen to the caregiver, if there are any health issues, if they are experiencing any muscle pain, how they are doing emotionally, if they can go out, if they work outside the home or not. The family feels very comfortable coming to the unit whenever they need to clarify any doubts. (E2,4,10, M2,9,10, O5)
Activity groups	I have a walking group here at the unit, not only for older adults, although they make up the majority. And it's not just about walking. There's stretching with the physical educator, physiotherapist, and there's a conversation, an exchange of ideas, both during stretching and during the walk. There's a community health worker who participates in this group, she spends some time with each group of older adults talking about various topics. We also have an occupational therapy group for crafts; we are mainly resuming activities with those older adults who can move around and come to the unit. (E5,8,9, M8)
Promotion of quality of life	I strive to provide comfort to the extent of my capabilities, so that they can feel better. There was a case of an older woman who developed a pressure ulcer; she was well cared for, we treated the ulcer, obtained the necessary materials, prescribed antibiotics, and the daughter began to come to terms with the fact that there wasn't much more to be done... except to provide comfort and dignity to her mother. That's what we emphasized a lot in this past month, providing comfort. Older adults may lose some motor function for oral hygiene, so we provide guidance on hygiene, both for them and for their caregivers. Therefore, we prioritize care, we apply dressings, at least to ensure they don't feel pain and to prevent infection. (E3,5, M1,2,8, O1,4,6,7)
Assistance at the moment of death	The community health worker and I often assist during the time of death. We provide all the support to the family at that moment. On Tuesday, we had a death here of a patient who was already 100 years old, bedridden due to Alzheimer's, and highly demented. She had been bedridden for three years, completely dependent. She took her last breath in our arms, and the daughter was grateful. We helped with tasks such as closing the mouth, changing clothes, praying with the family holding hands, looking for documents, calling the funeral home... the family is often very lost during such moments. (E1,2, M1)

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[1] Correspondence Luciana Meneguim Pereira de Queiroz lumeneguimpq@gmail.com

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Social representations of Family Health Strategy professionals regarding palliative care for older adults

Abstract

﻿Objective

Method

Results

Conclusion

Objective