Health professionals’ subjectivation towards end of life and death in home care service

Perboni, Jéssica Siqueira; Oliveira, Stefanie Griebeler; Cordeiro, Franciele Roberta

doi:10.1590/0034-7167-2021-0684

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Brasil

Revista Brasileira de Enfermagem

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ORIGINAL ARTICLE • Rev. Bras. Enferm. 75 (02) • 2022 • https://doi.org/10.1590/0034-7167-2021-0684 copy

Health professionals’ subjectivation towards end of life and death in home care service

Subjetivação dos profissionais de saúde no fim da vida e morte no serviço domiciliar

Subjetivación de los profesionales de la salud al final de la vida y muerte en el servicio a domicilio

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objectives:

to analyze the modes of subjectification of health professionals towards end of life and death in a home care service.

Methods:

this is qualitative research carried out in a home care service at a teaching hospital in southern Brazil, with 12 health professionals. Participant observation and semi-structured interviews were used for data collection, from April to September 2018. Data were analyzed based on Foucault’s concept of power and subjectivation.

Results:

professionals are sensitized by moral, spiritual and palliative care discourses, as well as experiences that constitute them subjects who modify their ways of life and professional practice based on the relation with death.

Final Considerations:

the discursive network of palliative care is internalized by professionals, who carry out their practices with behaviors aimed at promoting “a good death”.

Descriptors:
Home Care Services; Health Personnel; Death; Palliative Care; Qualitative Research

Facts/observation focuses	Main questions
Relation of professionals with patients and their families as well as between team members (in visits and when the team goes to their homes).	Have you ever had any loss in your family, if so, how was it?
How orientations are carried out.	Tell me about your beliefs. Do you have a religion? Tell me about the first patient death you experienced? (If you don’t remember the first one, tell me about a one that you do remember).
Relation with their emotions and how they behave and approach patients and families.
How they relate to end-of-life experiences; questions about the end of life.	How do you approach end-of-life care for patients and families?
Observation of mention of moral, religious and spiritual discourses.	How do you feel about watching another person die? Tell me about some experience.
How team members’ decisions regarding therapeutic decisions are conducted.

Category	Themes/codes	Foucault’s concepts
Home space occupation	Space occupation Ways to enter the home Other’s death gestures Religiosity	Knowledge-power relation Subjectivation Speech
Ways of conducting communication in relation to worsening disease and death	Disease severity Life span Palliative care Relations (patients, health professionals and caregivers)	Knowledge-power relation Conduction of conduits Subjectivation Speech
Procedures for “good death”	Death Palliative care Other’s death End-of-life care Care practices	knowledge-power relation Conduction of conduits Subjectivation Speech
Health professionals’ perception of death	Death Palliative care Religiosity Other’s death Care practices	Knowledge-power relation Subjectivation Speech

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[1] Corresponding author: Jéssica Siqueira Perboni E-mail: jehperboni@yahoo.com.br