Representações sociais entre profissionais de saúde em UTI sobre cuidados paliativos: revisão de escopo

Abstract

Objective: To map and analyze the social representations (SR) of healthcare professionals in Intensive Care Units (ICU) regarding palliative care (PC) in recent scientific literature. Methods: A scoping review based on PRISMA-ScR guidelines, conducted across the VHL/BVS, PubMed, Scopus, and SciELO databases (2020–2024). The 113 included studies underwent thematic analysis and were interpreted in light of Social Representations Theory. Results: A structural fragility was identified in the Information Field, where gaps in technical knowledge are filled by personal beliefs and legal fears. The social representation of PC proved to be paradoxical: anchored in the ethical ideal of the "good death," but objectified in institutional practice as "therapeutic failure" or "crisis management." This conflict manifests through defensive language (use of technical euphemisms) and is sustained by an interprofessional rift, where the medical representation (focused on decision-making) silences the nursing representation (focused on invisible care). Moral distress emerges not as an isolated event, but as a symptom of a collapsing symbolic system. Conclusion: Isolated formal education proves insufficient to transform practice, as new knowledge is consistently neutralized by the hegemonic curative cultural anchoring of the ICU. To mitigate moral distress and improve care quality, interventions must go beyond technical training and focus on reshaping organizational culture, horizontalizing decision-making processes, and reframing the language used to address death.