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Crenças e atitudes dos enfermeiros dos cuidados de saúde primários sobre os cuidados centrados na família
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Enquadramento: Desde a década de 1970 que se tem observado a evolução e a mudança de paradigmas dos
cuidados de saúde primários (CSP), inicialmente focados no modelo biomédico e atualmente no foco da família
como unidade de cuidados (Melo, 2021). Esta evolução foi acompanhada pelo desenvolvimento da área de
enfermagem de saúde familiar (ESF), que atualmente é uma área conceituada para a promoção de saúde e
acompanhamento dos sistemas familiares ao longo de todo o seu ciclo vital (Figueiredo, 2012). Torna-se, por
conseguinte, importante adotar uma prática de enfermagem centrada na família, com base em modelos que
considerem o indivíduo no contexto familiar e social, promovendo a participação ativa de todos os
intervenientes (Oliveira et al., 2011). Vários estudos demonstram que a qualidade dos cuidados depende das
atitudes dos enfermeiros face à inclusão da família. Contudo, esta não é a única variável que influencia a sua
inclusão (Fernandes et al., 2015; Oliveira et al., 2011). Outros estudos apontam para a influência das crenças
dos enfermeiros no seu comportamento e nas suas práticas diárias, sugerindo que estas podem afetar de
forma inconsciente a integração da família nos seus cuidados (Hraunfjörd et al., 2024; Nobokuni et al., 2021).
No presente relatório, será efetuada uma breve contextualização da prática clínica de ESF, do local onde
decorreu o estágio, dos modelos teóricos que serviram de suporte ao estágio e ao projeto de investigação,
bem como do trabalho resultante da aplicação da prática baseada em evidência durante o estágio.
Objetivos: Contextualizar os CSP, focando na Unidade de Saúde Familiar (USF) onde decorreu o estágio entre
28 de abril de 2025 e 29 de janeiro de 2026. Refletir sobre a aquisição das competências gerais e específicas
do Enfermeiro Especialista em Enfermagem Comunitária na área de ESF desenvolvidas a partir da análise
críticas das atividades desenvolvidas. Evidenciar, por meio de um projeto de investigação, quais as crenças e
atitudes dos enfermeiros face aos cuidados centrados na família, analisar a sua relação, bem como a se existe
ligação com variáveis sociodemográficas e profissionais, e identificar crenças que funcionem como obstáculos
ou facilitadores dessa abordagem.
Metodologia: A análise de indicadores e dados estatísticos configura-se como um instrumento central para a
caracterização e contextualização da população abrangida pela USF. Posteriormente, procede-se ao
desenvolvimento das competências comuns e específicas do Enfermeiro Especialista em Enfermagem
Comunitária, na área de ESF, sustentado numa análise crítico-reflexiva das práticas desenvolvidas ao longo do
estágio. O projeto de investigação assenta num estudo de abordagem mista, de natureza descritiva, relacional
e transversal, no qual foi aplicada a escala “Importância das Famílias nos Cuidados de Enfermagem – Atitudes
dos Enfermeiros”, originalmente criada por Benzein et al. (2008) e posteriormente traduzida e adaptada para
versão portuguesa por Oliveira et al. (2011), complementada por três questões abertas, a uma amostra de 49
enfermeiros dos contextos de USF e Unidade de Cuidados de Saúde Personalizados da Unidade Local de Saúde
onde decorreu o estágio. Este teve como objetivo geral analisar a relação entre as crenças e as atitudes dos
enfermeiros face aos cuidados centrados na família em contexto de CSP e como objetivos específicos avaliar
as atitudes dos enfermeiros dos CSP face aos cuidados centrados na família, analisar a relação entre as atitudes
e as variáveis sociodemográficas e profissionais dos enfermeiros de CSP, explorar as crenças dos enfermeiros
dos CSP relativamente à família enquanto foco de cuidados e identificar quais crenças são percecionadas como
obstáculos e como facilitadores dos cuidados centrados à família, por parte dos enfermeiros de CSP.
Resultados: Sobre o relatório, emergem as atividades desenvolvidas para a concretização das competências
gerais e específicas do Enfermeiro Especialista em Enfermagem Comunitária na área de ESF, que advêm do
percurso desenvolvido ao longo do estágio. Relativamente ao projeto de investigação, a maioria dos
participantes é do género feminino, com uma média de idades compreendia em 50,306 anos e tempo de
experiência profissional média de 27,796 anos, são licenciados e trabalham em contexto de USF. Não se verificaram associações estatisticamente significativas entre as variáveis sociodemográficas e profissionais e as
atitudes observadas na amostra em relação à família enquanto foco de cuidados. Relativamente às crenças
dos participantes, foram identificados obstáculos de natureza cultural, familiar, comunicacional e ética, e como
estratégias para a sua superação a adoção da prática baseada na evidência e a implementação de uma
abordagem holística aos cuidados. Como consequências positivas do uso das crenças na prática clínica,
destacam-se: Promoção de boas práticas em saúde; fortalecimento da comunicação e o maior envolvimento
da família nos cuidados. Por fim, a conceptualização de família enquanto foco de cuidados foi categorizada em
três dimensões: Família como unidade de cuidados, família como recurso e parceira no processo de cuidar e
família como fonte de empoderamento.
Conclusão: O presente relatório sistematiza o percurso formativo realizado na USF onde decorreu o estágio,
sustentado nos objetivos gerais e específicos preconizados, evidenciando o processo de aquisição e
consolidação de competências no âmbito da Enfermagem Comunitária na área da ESF. Relativamente ao
projeto de investigação, os resultados indicam não existir associação entre as características sociodemográficas
e profissionais dos enfermeiros e as atitudes face à família enquanto foco de cuidados. Simultaneamente,
demonstram que a presença de crenças e atitudes favoráveis à centralidade da família favorece a adoção de
práticas clínicas concordantes com as orientações normativas nacionais e internacionais, promovendo a sua
integração efetiva no processo de cuidar.
Implicações para a prática clínica: Face às condicionantes identificadas, os achados reforçam a necessidade
de investir em estratégias formativas e de suporte à prática que facilitem a integração sistemática da família
nos cuidados de enfermagem, bem como na conceção e implementação de instrumentos e indicadores
específicos que permitam monitorizar e evidenciar o impacto das crenças e atitudes dos profissionais na
qualidade dos cuidados, particularmente no contexto da ESF.
Background: Since the 1970s, there has been a shift and a change in paradigms in primary health care (PHC), initially centered on the biomedical model and now focused on the family as the unit of care (Melo, 2021). This evolution has been accompanied by the development of the field of Family Health Nursing (FHN), which is now a well-established discipline for health promotion and the support of family systems throughout their entire life cycle (Figueiredo, 2012). Thus, it is essential to adopt a family-centered nursing practice, based on models that consider the individual within the family and social context, promoting the active participation of all stakeholders (Oliveira et al., 2011). Several studies demonstrate that the quality of care depends on nurses’ attitudes toward family inclusion, however, this is not the only factor influencing such inclusion (Fernandes et al., 2015; Oliveira et al., 2011). Other studies indicate that nurses’ beliefs are factors that influence their behaviours and daily practices, potentially affecting, even unconsciously, how they integrate the family into their care (Hraunfjörd et al., 2024; Nobokuni et al., 2021). Throughout this report, a brief overview is provided of the clinical practice of the FHN, the location where the internship took place, the theoretical models that underpinned the internship and the research project, and the work that resulted from the application of evidence-based practice during the internship. Objective: Provide context for the Family Health Unit (FHU) where the internship took place between April 28, 2025, and January 29, 2026. Reflect on the acquisition of the general and specific competencies of the Specialist Nurse in Community Nursing within the FHN, as developed through a critical analysis of the activities carried out. Demonstrate, through a research project, the beliefs and attitudes of nurses regarding family centered care, analyse their relationship, as well as whether there is a connection with sociodemographic and professional variables, and identify beliefs that act as obstacles or facilitators of this approach. Methodology: The analysis of indicators and statistical data serves as a key tool for characterizing and contextualizing the population served by the FHU. Subsequently, the common and specific competencies of the Specialist Nurse in Community Nursing within the FHS are developed, based on a critical-reflective analysis of the practices carried out during the internship. The research project is based on a mixed-methods study of a descriptive, relational, and cross-sectional nature, in which the “Importance of Families in Nursing Care – Nurses’ Attitudes” scale was applied. This scale was originally created by Benzein et al. (2008) and subsequently translated and adapted into Portuguese by Oliveira et al. (2011), and it is supplemented by three open-ended questions, to a sample of 49 nurses from the FHU and the Personalized Health Care Unit of the Local Health Unit where the internship took place. The overall objective of this study was to analyse the relationship between nurses’ beliefs and attitudes toward family-centered care in the context of PHC, and its specific objectives were to assess the attitudes of nurses toward family-centered care, to analyse the relationship between these attitudes and the sociodemographic and professional variables of CSP nurses, to explore the beliefs of CSP nurses regarding the family as the focus of care, and to identify which beliefs are perceived as obstacles and which as facilitators of family-centered care by CSP nurses. Results: The report highlights the activities carried out to develop the general and specific competencies of the Specialist Nurse in Community Nursing within the FHS, which stem from the learning process undertaken during the internship. Regarding the research project, most participants are female, with a mean age of 50,306 years and an average professional experience of 27,796 years; they hold bachelor’s degrees and work in FHU. No statistically significant associations were found between sociodemographic and professional variables and the attitudes observed in the sample regarding the family as the focus of care. Regarding the participants’ beliefs, obstacles of a cultural, familial, communicational, and ethical nature were identified, and as strategies for overcoming them, the adoption of evidence-based practice and the implementation of a holistic approach to care were highlighted. Positive consequences of applying these beliefs in clinical practice include promotion of good health practices; strengthened communication; and greater family involvement in care. Finally, the conceptualization of the family as the focus of care was categorized into three dimensions: family as a care unit; family as a resource and partner in the caregiving process; and family as a source of empowerment Conclusion: This report summarizes the training program carried out at the FHU where the internship took place, based on the recommended general and specific objectives, highlighting the process of acquiring and consolidating competencies in the field of Community Nursing within the FHS. Regarding the research project, the results indicate that there is no association between the sociodemographic and professional characteristics of nurses and their attitudes toward the family as the focus of care. At the same time, they demonstrate that the presence of beliefs and attitudes favourable to the centrality of the family promotes the adoption of clinical practices consistent with national and international regulatory guidelines, fostering their effective integration into the care process. Relevance to clinical practice: Given the constraints identified, the findings underscore the need to invest in training and practice-support strategies that facilitate the systematic integration of families into nursing care, as well as in the design and implementation of specific tools and indicators to monitor and demonstrate the impact of professionals’ beliefs and attitudes on the quality of care, particularly within the context of the FHS.
Background: Since the 1970s, there has been a shift and a change in paradigms in primary health care (PHC), initially centered on the biomedical model and now focused on the family as the unit of care (Melo, 2021). This evolution has been accompanied by the development of the field of Family Health Nursing (FHN), which is now a well-established discipline for health promotion and the support of family systems throughout their entire life cycle (Figueiredo, 2012). Thus, it is essential to adopt a family-centered nursing practice, based on models that consider the individual within the family and social context, promoting the active participation of all stakeholders (Oliveira et al., 2011). Several studies demonstrate that the quality of care depends on nurses’ attitudes toward family inclusion, however, this is not the only factor influencing such inclusion (Fernandes et al., 2015; Oliveira et al., 2011). Other studies indicate that nurses’ beliefs are factors that influence their behaviours and daily practices, potentially affecting, even unconsciously, how they integrate the family into their care (Hraunfjörd et al., 2024; Nobokuni et al., 2021). Throughout this report, a brief overview is provided of the clinical practice of the FHN, the location where the internship took place, the theoretical models that underpinned the internship and the research project, and the work that resulted from the application of evidence-based practice during the internship. Objective: Provide context for the Family Health Unit (FHU) where the internship took place between April 28, 2025, and January 29, 2026. Reflect on the acquisition of the general and specific competencies of the Specialist Nurse in Community Nursing within the FHN, as developed through a critical analysis of the activities carried out. Demonstrate, through a research project, the beliefs and attitudes of nurses regarding family centered care, analyse their relationship, as well as whether there is a connection with sociodemographic and professional variables, and identify beliefs that act as obstacles or facilitators of this approach. Methodology: The analysis of indicators and statistical data serves as a key tool for characterizing and contextualizing the population served by the FHU. Subsequently, the common and specific competencies of the Specialist Nurse in Community Nursing within the FHS are developed, based on a critical-reflective analysis of the practices carried out during the internship. The research project is based on a mixed-methods study of a descriptive, relational, and cross-sectional nature, in which the “Importance of Families in Nursing Care – Nurses’ Attitudes” scale was applied. This scale was originally created by Benzein et al. (2008) and subsequently translated and adapted into Portuguese by Oliveira et al. (2011), and it is supplemented by three open-ended questions, to a sample of 49 nurses from the FHU and the Personalized Health Care Unit of the Local Health Unit where the internship took place. The overall objective of this study was to analyse the relationship between nurses’ beliefs and attitudes toward family-centered care in the context of PHC, and its specific objectives were to assess the attitudes of nurses toward family-centered care, to analyse the relationship between these attitudes and the sociodemographic and professional variables of CSP nurses, to explore the beliefs of CSP nurses regarding the family as the focus of care, and to identify which beliefs are perceived as obstacles and which as facilitators of family-centered care by CSP nurses. Results: The report highlights the activities carried out to develop the general and specific competencies of the Specialist Nurse in Community Nursing within the FHS, which stem from the learning process undertaken during the internship. Regarding the research project, most participants are female, with a mean age of 50,306 years and an average professional experience of 27,796 years; they hold bachelor’s degrees and work in FHU. No statistically significant associations were found between sociodemographic and professional variables and the attitudes observed in the sample regarding the family as the focus of care. Regarding the participants’ beliefs, obstacles of a cultural, familial, communicational, and ethical nature were identified, and as strategies for overcoming them, the adoption of evidence-based practice and the implementation of a holistic approach to care were highlighted. Positive consequences of applying these beliefs in clinical practice include promotion of good health practices; strengthened communication; and greater family involvement in care. Finally, the conceptualization of the family as the focus of care was categorized into three dimensions: family as a care unit; family as a resource and partner in the caregiving process; and family as a source of empowerment Conclusion: This report summarizes the training program carried out at the FHU where the internship took place, based on the recommended general and specific objectives, highlighting the process of acquiring and consolidating competencies in the field of Community Nursing within the FHS. Regarding the research project, the results indicate that there is no association between the sociodemographic and professional characteristics of nurses and their attitudes toward the family as the focus of care. At the same time, they demonstrate that the presence of beliefs and attitudes favourable to the centrality of the family promotes the adoption of clinical practices consistent with national and international regulatory guidelines, fostering their effective integration into the care process. Relevance to clinical practice: Given the constraints identified, the findings underscore the need to invest in training and practice-support strategies that facilitate the systematic integration of families into nursing care, as well as in the design and implementation of specific tools and indicators to monitor and demonstrate the impact of professionals’ beliefs and attitudes on the quality of care, particularly within the context of the FHS.
Descrição
Palavras-chave
Enfermagem Familiar Atitude Crença
Contexto Educativo
Citação
Editora
Licença CC
Sem licença CC