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Avaliação e Intervenção Familiar em Cuidados de Saúde Primários para Famílias de Crianças com Necessidades de Saúde Especiais
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Enquadramento: O presente relatório insere-se no âmbito do Estágio de natureza profissional em
Enfermagem de Cuidados à Família, integrado no VIII Mestrado em Enfermagem Comunitária na área de
Enfermagem de Saúde Familiar, da Escola Superior de Saúde do Instituto Politécnico de Leiria. O percurso
formativo decorreu em contexto de Unidade Saúde Familiar (USF) da Unidade Local de Saúde da Região de
Leiria, permitindo o desenvolvimento progressivo de competências especializadas na prestação de cuidados
centrados na família enquanto unidade de cuidados. A prática clínica foi sustentada por referenciais teóricos
da Enfermagem de Saúde Familiar e por uma abordagem sistémica, sendo complementada por uma
componente de prática baseada na evidência centrada nas necessidades de saúde especiais (NSE) em crianças,
com particular enfoque no Transtorno do Défice de Atenção e Hiperatividade (TDAH). As NSE em crianças
correspondem a condições que afetam a funcionalidade e requerem cuidados diferenciados, com impacto no
desenvolvimento e bem-estar (OE, 2022). Estas crianças apresentam maior risco de problemas de saúde
mental, exclusão social e dificuldades no acesso aos cuidados (OMS, 2023; Stevens et al., 2024). A presença
de NSE implica desafios significativos para a família, nomeadamente stress, sobrecarga e impacto na saúde
dos cuidadores (Stevens et al., 2024). A identificação precoce e a intervenção centrada na família são
fundamentais para promover a adaptação e prevenir complicações (Okido et al., 2018). No caso do TDAH,
enquanto perturbação frequente do neuro desenvolvimento, destaca-se a necessidade de reorganização
familiar e de intervenções ajustadas às necessidades específicas (WHO, 2019; American Psychiatric
Association, 2023; Wright & Leahey, 2011; Meleis, 2010).
Objetivos: Desenvolver competências comuns e específicas do Enfermeiro Especialista em Enfermagem de
Saúde Familiar em contexto de cuidados de saúde primários; Caracterizar o contexto da prática clínica; e, no
âmbito da prática baseada na evidência, identificar crianças com NSE numa USF e avaliar o funcionamento de
uma família com uma criança com diagnóstico de TDAH.
Metodologia: O relatório baseia-se numa abordagem descritiva e reflexiva do percurso de estágio, articulando
uma análise crítica da prática clínica com uma componente de investigação. Esta integrou dois estudos, um
quantitativo, com aplicação do Children with Special Health Care Needs Screener © (CSHCN Screener ©), e um
estudo qualitativo, através de um estudo de caso de uma família com uma criança com TDAH. A avaliação
familiar foi realizada com recurso ao Modelo de Calgary de Avaliação e Intervenção Familiar, complementado
por instrumentos validados, nomeadamente a escala APGAR Familiar, Escala de Risco Familiar de Segovia-
Dreyer, Escala de García-González, Escala de Readaptação Social de Holmes e Rahe e FACES II.
Resultados: A prática clínica permitiu o desenvolvimento de competências ao nível da avaliação e intervenção
familiar, da tomada de decisão clínica e da articulação com a equipa multidisciplinar, evidenciando a
importância da continuidade de cuidados nos CSP. No âmbito do estudo, verificou-se que as NSE nem sempre
estão associadas a diagnósticos médicos, manifestando-se sobretudo ao nível da funcionalidade e necessidade
de vigilância contínua. Observou-se que as famílias podem apresentar níveis adequados de adaptação e
funcionalidade, mesmo na presença de uma criança com NSE, coexistindo, contudo, fatores de risco como o
aumento do stress parental e a sobrecarga do cuidador principal.
Conclusão: O relatório evidencia que a Enfermagem de Saúde Familiar assume um papel central na resposta
às necessidades das famílias em contexto de CSP, exigindo uma prática baseada na evidência, centrada na
família e sustentada em modelos teóricos. A componente de investigação reforça a importância de uma
abordagem multidimensional das NSE, centrada na funcionalidade e no impacto familiar. O desenvolvimento
de competências ao longo do estágio permitiu consolidar uma prática autónoma, crítica e reflexiva, orientada para a promoção da adaptação familiar, da resiliência e da qualidade dos cuidados. Apesar das limitações
associadas à dimensão da amostra, os resultados obtidos contribuem para a valorização da intervenção do
Enfermeiro Especialista em Enfermagem de Saúde Familiar.
Background: This report is developed within the scope of the professional internship in Family Nursing, integrated in the 8th Master’s Degree in Community Nursing, specializing in Family Health Nursing, at the School of Health Sciences of the Polytechnic Institute of Leiria. The training pathway took place in a Family Health Unit (FHU) of the Local Health Unit of the Leiria Region, enabling the progressive development of specialized competencies in the provision of family-centered care. Clinical practice was grounded in theoretical frameworks of Family Health Nursing and a systemic approach, complemented by an evidencebased practice component focused on children with special health care needs (CSHCN), with particular emphasis on Attention Deficit Hyperactivity Disorder (ADHD). CSHCN correspond to conditions that affect functionality and require differentiated care, impacting development and well-being (OE, 2022). These children are at increased risk of mental health problems, social exclusion, and difficulties in accessing healthcare (WHO, 2023; Stevens et al., 2024). The presence of CSHCN poses significant challenges for families, including stress, burden, and negative impacts on caregivers’ health (Stevens et al., 2024). Early identification and family-centered intervention are essential to promote adaptation and prevent complications (Okido et al., 2018). In the case of ADHD, as a frequent neurodevelopmental disorder, there is a clear need for family reorganization and tailored interventions (WHO, 2019; American Psychiatric Association, 2023; Wright & Leahey, 2011; Meleis, 2010). Objectives: To develop common and specific competencies of the Specialist Nurse in Family Health Nursing within the context of primary health care; to characterize the clinical practice setting; and, within the scope of evidence-based practice, to identify children with CSHCN in a Family Health Unit and to assess the functioning of a family with a child diagnosed with ADHD. Methods: This report is based on a descriptive and reflective approach to the internship pathway, combining critical analysis of clinical practice with a research component. This included two studies: a quantitative study using the Children with Special Health Care Needs Screener © (CSHCN Screener ©) and a qualitative study through a case study of a family with a child diagnosed with ADHD. Family assessment was conducted using the Calgary Family Assessment and Intervention Model, complemented by validated instruments, namely the Family APGAR, the Segovia-Dreyer Family Risk Scale, the García-González Family Risk Scale, the Holmes and Rahe Social Readjustment Rating Scale, and FACES II. Results: Clinical practice enabled the development of competencies in family assessment and intervention, clinical decision-making, and interdisciplinary collaboration, highlighting the importance of continuity of care in primary health care. Within the research component, it was found that CSHCN are not always associated with formal medical diagnoses, being mainly expressed through functional limitations and the need for continuous monitoring. Families were found to present adequate levels of functioning and adaptation, even in the presence of a child with CSHCN, although risk factors such as increased parental stress and caregiver burden were also identified. Conclusion: This report highlights that Family Health Nursing plays a central role in addressing family needs within primary health care, requiring an evidence-based, family-centered approach supported by theoretical models. The research component reinforces the importance of a multidimensional understanding of CSHCN, focused on functionality and family impact. The development of competencies throughout the internship allowed the consolidation of an autonomous, critical, and reflective practice, aimed at promoting family adaptation, resilience, and quality of care. Despite limitations related to sample size, the findings contributeto valuing the role of the Specialist Nurse in Family Health Nursing.
Background: This report is developed within the scope of the professional internship in Family Nursing, integrated in the 8th Master’s Degree in Community Nursing, specializing in Family Health Nursing, at the School of Health Sciences of the Polytechnic Institute of Leiria. The training pathway took place in a Family Health Unit (FHU) of the Local Health Unit of the Leiria Region, enabling the progressive development of specialized competencies in the provision of family-centered care. Clinical practice was grounded in theoretical frameworks of Family Health Nursing and a systemic approach, complemented by an evidencebased practice component focused on children with special health care needs (CSHCN), with particular emphasis on Attention Deficit Hyperactivity Disorder (ADHD). CSHCN correspond to conditions that affect functionality and require differentiated care, impacting development and well-being (OE, 2022). These children are at increased risk of mental health problems, social exclusion, and difficulties in accessing healthcare (WHO, 2023; Stevens et al., 2024). The presence of CSHCN poses significant challenges for families, including stress, burden, and negative impacts on caregivers’ health (Stevens et al., 2024). Early identification and family-centered intervention are essential to promote adaptation and prevent complications (Okido et al., 2018). In the case of ADHD, as a frequent neurodevelopmental disorder, there is a clear need for family reorganization and tailored interventions (WHO, 2019; American Psychiatric Association, 2023; Wright & Leahey, 2011; Meleis, 2010). Objectives: To develop common and specific competencies of the Specialist Nurse in Family Health Nursing within the context of primary health care; to characterize the clinical practice setting; and, within the scope of evidence-based practice, to identify children with CSHCN in a Family Health Unit and to assess the functioning of a family with a child diagnosed with ADHD. Methods: This report is based on a descriptive and reflective approach to the internship pathway, combining critical analysis of clinical practice with a research component. This included two studies: a quantitative study using the Children with Special Health Care Needs Screener © (CSHCN Screener ©) and a qualitative study through a case study of a family with a child diagnosed with ADHD. Family assessment was conducted using the Calgary Family Assessment and Intervention Model, complemented by validated instruments, namely the Family APGAR, the Segovia-Dreyer Family Risk Scale, the García-González Family Risk Scale, the Holmes and Rahe Social Readjustment Rating Scale, and FACES II. Results: Clinical practice enabled the development of competencies in family assessment and intervention, clinical decision-making, and interdisciplinary collaboration, highlighting the importance of continuity of care in primary health care. Within the research component, it was found that CSHCN are not always associated with formal medical diagnoses, being mainly expressed through functional limitations and the need for continuous monitoring. Families were found to present adequate levels of functioning and adaptation, even in the presence of a child with CSHCN, although risk factors such as increased parental stress and caregiver burden were also identified. Conclusion: This report highlights that Family Health Nursing plays a central role in addressing family needs within primary health care, requiring an evidence-based, family-centered approach supported by theoretical models. The research component reinforces the importance of a multidimensional understanding of CSHCN, focused on functionality and family impact. The development of competencies throughout the internship allowed the consolidation of an autonomous, critical, and reflective practice, aimed at promoting family adaptation, resilience, and quality of care. Despite limitations related to sample size, the findings contributeto valuing the role of the Specialist Nurse in Family Health Nursing.
Descrição
Palavras-chave
Enfermagem de saúde familiar Enfermeiro especialista Necessidades de Saúde Especiais TDAH Criança Família Cuidados de Saúde Primários
Contexto Educativo
Citação
Editora
Licença CC
Sem licença CC