Cuidados da enfermagem na transição do paciente para o domicílio após transplante de células-tronco hematopoiéticas

Abstract

Hematopoietic stem cell transplantation has evolved as a therapy for people suffering from previously incurable hematological diseases, restoring their quality of life. The post-transplant period requires changes in the patients' routine life and nurses provide care to help with the transition home. The aim of this study was to categorize how nurses provide care in preparation for the discharge of patients who experience the transition between hospital and home after HSCT. A qualitative, comprehensive and explanatory study was carried out using Robert Yin's case study method, based on Afaf Meleis' Transitions Theory. Data was collected from the population served in documents and records; in open interviews with seven nurses from a reference service for Hematopoietic Stem Cell Transplantation and in direct observation of nine discharges, after obtaining a favorable opinion from the Research Ethics Committee (CAAE: 54297521.2.0000.5133). The analysis used a logical analytical model in a deductive and inductive interpretative process and coding. The construction of the categories was supported by OpenLogos 2.0 software. The case was understood and can be explained by the following categories: From admission to post-discharge: essential conditions for the transition process; Patient response to discharge preparation; Nurses' role in helping with the transition. The findings were summarized in tables, one of which contains nursing care, taken from the nurses' experience, and in diagrams explaining this case study from Meleis' theoretical perspective. A key finding is that nurses use their personal skills, as well as their technical and scientific skills, to act on the conditioning factors of the transition, stimulate the facilitators and intervene in the inhibitors that arise, obtaining the response patterns on the expectations experienced during the transition. It is recommended that nursing preparation for discharge takes place systematically from admission (critical event) through hospitalization and post-discharge follow-up, in dialogue with the Primary Care service, if applicable, until the patient is mastered or empowered to continue treatment at home, with a view to ensuring safety in achieving health goals.