Publicação
Futilidade terapêutica em enfermagem em cuidados intensivos de adultos
| Resumo: | This thesis is the result of an investigation carried out with the aim of obtaining a doctoral degree in the scientific area of nursing, awarded by the Universidade Católica Portu guesa. Due to the essence of the theme under investigation, with regard to the areas of specialization of this Doctorate in Nursing, this study falls within the area of “advanced nursing”. This framework is justified by the research carried out on a specific nursing phenomenon in a context of clinical care practice, specifically, the therapeutic futility of nursing in adult intensive care. Over time, therapeutic futility has been a matter of interest and special concern for health professionals. However, despite all the studies carried out, especially since the last two decades of the last century, countless doubts persist about this phenomenon, confirming that the lack of a universally accepted concept for this conception contributes to its ex istence lasts and continues to be recognized by nurses, especially in contexts dedicated to providing care to people in critical situations, such as intensive care for adults. In the phase that preceded this investigation, of preliminary research, it was confirmed that there were few studies carried out by nurses on this problem, especially in Portugal. The few studies that were identified show that therapeutic futility is a reality in intensive care for adults, recognize some dimensions associated with the phenomenon and iden tify negative effects directly related to its persistence. However, they do not conceptually delimit therapeutic futility in nursing and are non-specific in the real recognition of futile therapeutic interventions. Given this gap in knowledge, the research carried out took place in three distinct phases. The first phase, a literature review, in which the studies carried out on therapeutic futility were identified, enabled the identification and characterization of the phenomenon under study. The second phase, with a qualitative approach, enabled the response to two cen tral objectives identified for this study. On the one hand, to describe the perceptions that some expert nurses in adult intensive care in Portugal have about therapeutic futility in nursing, by carrying out a qualitative and descriptive study, on the other hand, to con struct the concept of therapeutic futility in nursing, using Ingetraut Dahlberg's concept theory. The third and final phase, with a quantitative approach, was aimed at identifying futile nursing therapeutic interventions that are implemented in adult intensive care, ac cording to nurses’ perception, by carrying out a cross-sectional and descriptive study, using a questionnaire for data collection. Regarding the perceptions that some expert nurses in adult intensive care in Portugal have about therapeutic futility in nursing, through a focus group it was proved that this phenomenon is a current reality. The content analysis carried out on their narratives made it possible to identify four central categories associated with this phenomenon and their correspondent subcategories, which will be presented and explored throughout this thesis, providing a detailed description of their perceptions. Regarding the conceptual delimitation of therapeutic futility in nursing that is presented in this study, which is be lieved to be the first proposed for this phenomenon that comes from a construction pro cess that fully respected a scientific method of concept construction, the expectation remains that this will offer an important contribution to a simplified and timely identifica tion of situations of therapeutic futility in nursing. Finally, with regard to the identification of futile nursing therapeutic interventions that are implemented in adult intensive care in the nurses' perception, it is worth highlighting the statistical analysis that was carried out and which provided important elements related to these professionals' perception of the futility of their interventions. The relevance is not only in descriptive terms, but also on some statistically significant associations between demographic and professional varia bles and the correspondent nursing interventions, as well as the statistical inference pro posals that are presented and analyzed, which, although these must be interpreted pru dently, they offer contributions to understanding nurses' perception of the futility of the interventions they implement. In addition, due to the exploratory factor analysis and con firmatory factor analysis that were operationalized, the proposal for a scientifically tested and validated assessment instrument stands out and can significantly contribute to new explorations on the issue of therapeutic futility in nursing. With this thesis and the research that supports it, it is preserved the expectation of con tributing to nursing knowledge and reinforcing, or reconfiguring, the scientific debate among nurses on the implementation of futile nursing interventions to people in critical condition admitted to adult intensive care. |
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| Autores principais: | Vieira, João Vítor da Silva |
| Assunto: | Critical care Cuidados intensivos Enfermagem Futilidade terapêutica Nursing Therapeutic futility |
| Ano: | 2025 |
| País: | Portugal |
| Tipo de documento: | tese de doutoramento |
| Tipo de acesso: | acesso embargado |
| Instituição associada: | Universidade Católica Portuguesa |
| Idioma: | português |
| Origem: | Veritati - Repositório Institucional da Universidade Católica Portuguesa |
| Resumo: | This thesis is the result of an investigation carried out with the aim of obtaining a doctoral degree in the scientific area of nursing, awarded by the Universidade Católica Portu guesa. Due to the essence of the theme under investigation, with regard to the areas of specialization of this Doctorate in Nursing, this study falls within the area of “advanced nursing”. This framework is justified by the research carried out on a specific nursing phenomenon in a context of clinical care practice, specifically, the therapeutic futility of nursing in adult intensive care. Over time, therapeutic futility has been a matter of interest and special concern for health professionals. However, despite all the studies carried out, especially since the last two decades of the last century, countless doubts persist about this phenomenon, confirming that the lack of a universally accepted concept for this conception contributes to its ex istence lasts and continues to be recognized by nurses, especially in contexts dedicated to providing care to people in critical situations, such as intensive care for adults. In the phase that preceded this investigation, of preliminary research, it was confirmed that there were few studies carried out by nurses on this problem, especially in Portugal. The few studies that were identified show that therapeutic futility is a reality in intensive care for adults, recognize some dimensions associated with the phenomenon and iden tify negative effects directly related to its persistence. However, they do not conceptually delimit therapeutic futility in nursing and are non-specific in the real recognition of futile therapeutic interventions. Given this gap in knowledge, the research carried out took place in three distinct phases. The first phase, a literature review, in which the studies carried out on therapeutic futility were identified, enabled the identification and characterization of the phenomenon under study. The second phase, with a qualitative approach, enabled the response to two cen tral objectives identified for this study. On the one hand, to describe the perceptions that some expert nurses in adult intensive care in Portugal have about therapeutic futility in nursing, by carrying out a qualitative and descriptive study, on the other hand, to con struct the concept of therapeutic futility in nursing, using Ingetraut Dahlberg's concept theory. The third and final phase, with a quantitative approach, was aimed at identifying futile nursing therapeutic interventions that are implemented in adult intensive care, ac cording to nurses’ perception, by carrying out a cross-sectional and descriptive study, using a questionnaire for data collection. Regarding the perceptions that some expert nurses in adult intensive care in Portugal have about therapeutic futility in nursing, through a focus group it was proved that this phenomenon is a current reality. The content analysis carried out on their narratives made it possible to identify four central categories associated with this phenomenon and their correspondent subcategories, which will be presented and explored throughout this thesis, providing a detailed description of their perceptions. Regarding the conceptual delimitation of therapeutic futility in nursing that is presented in this study, which is be lieved to be the first proposed for this phenomenon that comes from a construction pro cess that fully respected a scientific method of concept construction, the expectation remains that this will offer an important contribution to a simplified and timely identifica tion of situations of therapeutic futility in nursing. Finally, with regard to the identification of futile nursing therapeutic interventions that are implemented in adult intensive care in the nurses' perception, it is worth highlighting the statistical analysis that was carried out and which provided important elements related to these professionals' perception of the futility of their interventions. The relevance is not only in descriptive terms, but also on some statistically significant associations between demographic and professional varia bles and the correspondent nursing interventions, as well as the statistical inference pro posals that are presented and analyzed, which, although these must be interpreted pru dently, they offer contributions to understanding nurses' perception of the futility of the interventions they implement. In addition, due to the exploratory factor analysis and con firmatory factor analysis that were operationalized, the proposal for a scientifically tested and validated assessment instrument stands out and can significantly contribute to new explorations on the issue of therapeutic futility in nursing. With this thesis and the research that supports it, it is preserved the expectation of con tributing to nursing knowledge and reinforcing, or reconfiguring, the scientific debate among nurses on the implementation of futile nursing interventions to people in critical condition admitted to adult intensive care. |
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