When the heart becomes ill, the fantasies surrounding that unique organ that centralizes functions do not diminish, even though the technical procedures for its diagnosis and treatment have been perfected.
“Being sick is something that people are not prepared for, much less when it comes to the heart.One is left as if lost, as if afraid, whoever is not afraid, manipulating people’s hearts is messing with everything, it’s not a joke, right…” (Pedro)
“When the The doctor told me it was a heart problem, I thought I was going to die and I said the end of my days had come, for God’s sake help me face this…” (María)
In this way the indication of cardiac catheterization, represents an unpleasant and worrying experience for those who are experiencing it and we show that the insecurity of what can happen in the procedure, together with the lack of knowledge of it and the strangeness of the place, are factors that trigger fears, fears, anguish and greater insecurity in patients.
“YOU DO NOT UNDERSTAND PEOPLE’S FEELINGS”
In this sense , we consider that contact with the health team, nurses and doctors, constitutes a decisive moment for the understanding and acceptance of the problem and the procedure, allowing patients to collaborate during it and be less tense and anxious.
However, most of the time, this meeting is depersonalized and confusing for the patient, since there is not a clear and simple enough exchange of knowledge to facilitate understanding of the disease and the need for the procedure.
We verified that there is a difference in the social codes of communication.The scientific knowledge of professionals is distant from the common sense of patients, since communication is based on technical and routine language, incomprehensible to popular knowledge, leaving patients more confused and with more fears about the procedure. and what may happen from then on.
“From what I understood, it is a surgery, because they have to cut and invade my body to manipulate my heart and solve the problem (…) I I already told my wife, I am feeling like a cow when it goes to the slaughterhouse, I am very afraid, I feel without the strength to endure this… (Isaias).
We perceive that When patients express these feelings, many times the health team, including the nursing professional, does not value them, demonstrating indifferent and incomprehensible attitudes, which generates feelings of dissatisfaction in the patient, as demonstrated by the following statements:
“I’m scared because of what people say, it’s nonsense, but why tell you, for you to tell me, no, everything is going to turn out very well, be calm, like You always talk to everyone, so I prefer to stay silent and think that people are stupid…” (Bertha)
“Sometimes you don’t understand our fear, but we are the ones who are feeling, those of us who are suffering because of that, so that’s why I’m sad, upset…” (Rebeca)
“It’s no use for people to tell me to control myself, to stay calm, I believe that it is a human thing and you must understand and respect…” (María)
These statements show us that there is a significant gap between the objective world of professionals and the subjective world of the patients.While for the patient performing catheterization is a difficult experience to face and live, for professionals it is a situation that is part of the routine of their work and that is why they are so familiar and prepared for what may happen, leaving perceive the patient’s needs, assuming indifferent attitudes and behaviors, such as: lack of support, attention to the patient’s feelings and concerns, which have a negative influence, increasing suffering and disfavoring the trust that the patient needs to place in the health team. .
We attribute this fact to the fact that professionals, because they live these procedures daily and are so familiar with them, to the overload and routine of work, do not recognize the need for that special attention and Sometimes they believe the manifestation of these feelings is exaggerated.
The manifestation of these feelings and others already mentioned made it possible to think about the role that the nursing professional plays at that moment.Caring covers a set of theoretical and practical knowledge, based on a scientific and humanistic basis.
We believe that in these moments, the nursing professional needs to develop care that transcends merely biological and technical aspects. of care.
This does not mean abandoning the techniques necessary for the care of human beings, since knowledge and mastery of them is extremely important, it is about integrating the dimension of the human relationship and the dimension of the technique, to make true nursing care possible.(6)
In this way, we understand that the nurse-patient relationship must allow a space where the The patient can express his or her feelings and feel heard, so that his or her thoughts and needs are taken into account during the diagnostic intervention process and trust is recovered, as well as negative reactions are diminished, in order to help the patient navigate through a more comfortable and safe trajectory.
“I thought I was going to die, that I was going to faint, I was very nervous, thank goodness I had talked to you and that you stayed by my side , because I didn’t look at the doctor, I just looked at you as if asking for help, asking for strength to endure, it’s not easy being there you know?…” (Martha)
“We need someone to help us.” Come with me, because you go in there, you don’t know anyone, much less what they are going to do, so that’s something that makes you worry a lot, because it’s with your own heart, it’s my life that they’re dealing with. …” (Juan)
These statements show how important it is for the patient to feel the presence and concern of the team during the procedure, including that of the nursing professional, so that they can be transmit trust and security.
The true presence of the nurse contributes to the transmission of support to the person, so that they feel valued and respected and not like another object that is part of the job.( 7)
In general, professionals in the health area and within them, nursing, often use phrases such as: “stay calm”, “don’t worry”, “it’s a quick thing.”As strategies to try to minimize the patients’ reactions and which, in turn, are part of the routine work discourse, forgetting and not taking into account that for patients, these phrases are sometimes not only difficult to understand but are also interpreted as deceptive, losing trust and security in the team that cares for them, as demonstrated by the following statement:
“It was horrible, everyone told me that it was a simple thing, even in the nurse told me that it was simple and fast and none of that happened, it’s not like that…” (Raquel)
“You know, I had a very bad time, that’s why I wonder, could it be that All those who say that it is simple, that it is nothing to worry about, have they already gone through this?…” (Bertha)
“I am going to tell you, it is not as easy as you say, because everything What interferes with one’s heart is very scary, it is oneself who is feeling, so, sometimes, it makes me angry because, is it really to be calm?, to not worry when it is my heart that has problems? …” (Jacobo)
Many times, neither scientific knowledge nor words of reassurance are enough to calm patients; on the contrary, they are often interpreted as false support that generates more distress and why not to say anger in the face of helplessness.
We show the need for professionals to go back to understand a little more those feelings and emotions so emphasized in patients.Who knows if more precise information and words, without subterfuges, will help the patient better cope with the situation and with this, make the experience of the procedure as enjoyable as possible.
Vital(8) highlights that supposedly reassuring expressions such as: “this is nothing”, there is no risk”, “you are not going to feel anything”, among others, are frequently used by the team and instead of encouraging the patient, they can produce feelings even more contradictory, such as anger and distrust in the health team.
We believe that the nursing team should have a more active role in preparing the patient for carrying out this procedure, offering information that is closer to the reality that they are going to face, that is, telling the patient about the existence of possible physiological discomforts, as well as the discomfort of the exam, so that the patient has a more real image of what they are going to experience and of that way, reduce insecurity, fear and anguish, making the experience more pleasant and less stressful.
Final Considerations
We consider that nursing care must be comprehensive, because it is not enough to just have a team trained and trained in technological management, since care as a whole also needs to have knowledge of the patients’ experiences during this process, and above all, develop skills to enable patients to travel this path in a calmer and safer manner.
In this sense, nursing care during the cardiac catheterization experience should be a little more concerned with creating spaces for dialogue with the patient, resolve doubts, offer support, as well as give information that is as real as possible and make them feel that they have their presence, to better face the reality of the procedure.Lotufo P. Epidemiology of ischemic heart disease in Brazil.In: Lessa I. The Brazilian adult and the diseases of modernity.São Paulo, Hucitec Abrasco, 1998.
2. Dantas RAS.Rehabilitation of patients after myocardial revascularization surgery.Doctoral thesis.Ribeirão Preto Nursing School, University of São Paulo, 1999.
3. Silva A. Nurses’ perception regarding the emotional support offered to surgical patients.In: Nursing Journey in a surgical center in the State of São Paulo, 3. Anais.Ribeirão Preto, 1998.
4. Minayo MCS.The challenge of knowledge: qualitative research in health.3. Ed. São Paulo Hucitec – Abrasco, 1994.
5. Boehs AE, Patricio AMO.What is this caring/caring – an initial approach.Rev. Esc. Enferm.USP.São Paulo, 24 (1), 1990
6. Armelin MV.Emotional support for hospitalized people.Masters dissertation.Ribeirão Preto School of Nursing.University of Sao Paulo.Ribeirão Preto, 2000.
7. Waldow VR.Way of caring, way of teaching: nursing between school and professional practice.Porto Alegre, Artes Médicas, 1995.
8. Vital ML.Study on guidance for a group of patients preparing for hemodynamic examination.Masters dissertation.Ribeirão Preto School of Nursing, University of São Paulo.São Paulo, 1984.
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