Um copo quebrado, cacos jogados no lixo: cuidados paliativos domiciliares e a saúde mental de trabalhadores na perspectiva da equipe de enfermagem

Abstract

This study aimed to understand the meanings nursing professionals attribute to the process of death and dying within the context of home-based palliative care. A mixed-methods approach was employed, and the study was conducted at the Home Care Service of a municipality in the interior of Minas Gerais, linked to the *Melhor em Casa* (Better at Home) Program. Nineteen nursing team members (registered nurses and nursing technicians) participated in the quantitative phase; they completed a sociodemographic questionnaire and an instrument regarding experiences of professional grief, consisting of statements with a Likert-type response format concerning emotional preparedness and institutional support. In the qualitative phase, 12 participants took part in two focus groups, with the resulting data subjected to thematic content analysis. The results showed that home-based palliative care fosters the development of meaningful bonds among professionals, patients, and family members. While fundamental to care, these bonds also lead to emotional distress for the nursing team when facing the process of death and dying. The study identified an acknowledgment of the impact of grief on these workers' mental health, linked to a perceived lack of institutional support and inadequacies in training for dealing with end-of-life care. Family distress also affects the professionals, intensifying the emotional burden of caregiving. Triangulation of quantitative and qualitative data revealed that professional grief often remains invisible in the workplace, with management relying mostly on individual strategies and informal peer support. The study indicated that working in home-based palliative care requires both technical-scientific competencies and institutional recognition of the subjective dimensions involved in the work. Although grief is recognized as an inherent part of home-based palliative care practice, this recognition is not matched by institutional support. Recognizing the psychological distress resulting from professional grief as an occupational phenomenon—rather than an individual weakness—is a crucial step toward strengthening the *Melhor em Casa* Program and fostering work environments that are more humane, protective, and sustainable. Investing in empathetic leadership, mental health training within undergraduate and continuing education, and the creation of spaces for listening and support are fundamental steps toward promoting the health of the nursing team and ensuring the ethical and human sustainability of palliative care practices within the Unified Health System (SUS).