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Desenvolvimento de Competências Especializadas em Enfermagem à Pessoa em Situação Crítica - Capacitação do cuidador informal da pessoa dependente: um projeto de melhoria contínua da qualidade dos cuidados de Enfermagem
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O presente relatório reflete o percurso académico, para obtenção do grau de Mestre em Enfermagem Médico-Cirúrgica na área de especialização à Pessoa em Situação Crítica, ministrado na Escola Superior de Saúde do Instituto Politécnico de Leiria. Pretende realçar a aquisição de competências no âmbito da Unidade Curricular Estágio de Enfermagem à Pessoa em Situação Crítica (PSC) com Relatório e o desenvolvimento da prática especializada baseada na evidência, em contexto de exercício profissional num Serviço de Medicina de um hospital da região centro de Portugal, encontrando-se organizado em duas partes.
A Parte I foi elaborada tendo por base a reflexão na ação e para a ação e as oportunidades de aprendizagem, com recurso à evidência científica para desenvolver e consolidar competências gerais e específicas. A Parte II refere-se à prática especializada baseada na evidência. A investigação realizada, abordou a temática “Capacitação do Cuidador Informal (CI) da Pessoa Dependente (PD): um projeto de melhoria contínua da qualidade dos cuidados de Enfermagem”. A escolha deste tema prende-se com o facto de diariamente prestar cuidados de Enfermagem, a doentes que maioritariamente apresentam dependência nos autocuidados em grau elevado. A dificuldade manifestada por toda a equipa de Enfermagem em momentos informais, na implementação de estratégias de capacitação do CI da PD que reside no domicílio revelou-se uma necessidade crescente de melhoria nas intervenções de Enfermagem dirigidas ao CI.
A investigação, teve como objetivos avaliar as necessidades da PD no autocuidado, as capacidades do CI para cuidar da PD no domicílio e a perceção dos enfermeiros sobre a capacitação do CI, tendo sido conduzida em duas etapas principais. A primeira etapa, consistiu num estudo de diagnóstico de situação, em que foram identificadas as necessidades de autocuidado da PD, as capacidades do CI para cuidar da PD e a perceção dos enfermeiros sobre a capacitação do CI. A segunda etapa, consistiu na análise dos dados e na revisão da literatura, com vista a propor uma estratégia de melhoria da capacitação do CI. Posteriormente, fora do âmbito académico, será concretizada a validação da estratégia de melhoria com a equipa de Enfermagem e sua implementação.
Os resultados demonstraram que a PD, apresentou média de idade de 81,69 anos (DP=11,35) e dependência prévia de outra pessoa 77,28% em pelo menos um autocuidado há cerca de 4,79 anos (DP=4,08). Os autocuidados com maior grau de dependência foram as “atividades da vida diária" (média 2,05, DP=0,97) e “tomar a medicação” (média 2,18, DP=1,13), numa escala em que pontuações mais baixas indicam maior dependência. Na amostra, os cuidadores informais eram maioritariamente mulheres (77,14%); a relação predominante com a PD foi filho/a (57,14%); 28,57% apresentavam baixa escolaridade e 51,43% coabitavam com a PD. Para cuidar da PD, o CI apresentou média de pontuação global nas dimensões: “alimentação” (M=3,84; DP=0,29), “higiene sanitária” (M=3,89; DP=0,46), “cuidados de higiene e conforto” (M=3,94; DP=0,34), “mobilidade” (M=3,70; DP=0,57), “transferências” (M=3,83; DP=0,53), “vestir e despir-se” (M=3,98; DP=0,41), “tomar medicação” (M=3,65; DP=0,48) e “gestão de sintomas” (M=3,61; DP=0,49), muito próxima de 4, o que poderá sugerir que os CI "Concordam totalmente" que se sentem capazes de satisfazer estes autocuidados. Na dimensão “comunicação” a média de pontuação global é 4,17 (DP=0,38). Estando este valor acima de 4, os CI "Concordam totalmente" que se sentem capazes de satisfazer o autocuidado comunicação. No entanto, os resultados demonstram que na dimensão “gestão de sintomas” no item “atuar perante a falta de ar” apresenta pontuação mais baixa 3,14 (DP=0,91), seguindo-se com média mais baixa a dimensão “tomar a medicação” de 3,65 (DP=0,48) no item “perceber se a medicação está a produzir os efeitos desejados” com média de 3,00 (DP=0,80). Os enfermeiros eram maioritariamente do sexo feminino (80%). Apenas 30% reportaram experiência na capacitação formal do CI. Estes achados reforçam a necessidade de capacitação estruturada do CI, com percursos educativos padronizados, tempo dedicado ao ensino e materiais multimodais (digital/papel), apoiados por dotação adequada e suporte à decisão. Estes salientaram a centralidade do seu papel na capacitação do CI (13 menções). Identificaram como recursos necessários: estratégias pedagógicas centradas no ensino ao CI (20), dotações adequadas de enfermeiros (14), acesso a materiais didáticos em suporte digital (16) e em suporte papel (14), bem como recursos clínicos (11) e não clínicos (11).
Em conclusão, o relatório evidencia o alcance das competências comuns e específicas do Enfermeiro Especialista (EE) no cuidado à PSC e reforça a importância da prática baseada na evidência em contexto profissional, assim como, o seu contributo para a implementação de estratégias de melhoria para a segurança e qualidade dos cuidados de enfermagem à PD e CI.
This report reflects the academic path taken to obtain a Master's degree in Medical-Surgical Nursing in the area of specialisation in Critical Care, taught at the School of Health Sciences of the Polytechnic Institute of Leiria. It aims to highlight the acquisition of skills within the scope of the Nursing Internship for Person in Critical Condition (PCC) Course Unit with Report and the development of evidence-based specialised practice in the context of professional practice in a Medical Service at a hospital in central Portugal, it is organised into two parts. Part I was developed based on reflection in action and for action and learning opportunities, using scientific evidence to develop and consolidate general and specific skills. Part II refers to evidence-based specialised practice. The research conducted addressed the theme ‘Training of Informal Caregivers (IC) of Dependent Persons (DP): a project for the continuous improvement of the quality of nursing care.’ This topic was chosen because nursing care is provided on a daily basis to patients who are mostly highly dependent on self-care. The difficulty expressed by the entire nursing team in informal moments in implementing training strategies for ICs of DP who live at home revealed a growing need for improvement in nursing interventions aimed at ICs. The research aimed to assess the DP's self-care needs, the IC's ability to care for the DP at home, and the nurses' perception of the IC's training. It was conducted in two main stages. The first stage consisted of a diagnostic study of the situation, in which the self-care needs of DP, the capabilities of IC to care for DP, and nurses' perceptions of IC training were identified. The second stage consisted of analysing the data and reviewing the literature with a view to proposing a strategy for improving IC training. Subsequently, outside the academic sphere, the improvement strategy will be validated with the nursing team and implemented. The results showed that DP had a mean age of 81.69 years (SD=11.35) and previous dependence on another person in at least one self-care activity for approximately 4.79 years (SD=4.08) in 77.28% of cases. The self-care activities with the highest degree of dependence were ‘activities of daily living’ (mean 2.05, SD=0.97) and ‘taking medication’ (mean 2.18, SD=1.13), on a scale where lower scores indicate greater dependence. In the sample, informal carers were mostly women (77.14%); the predominant relationship with the DP was son/daughter (57.14%); 28.57% had low educational attainment and 51.43% lived with the DP. To care for DP, the IC presented an average overall score in the following dimensions: feeding (M=3.84; SD=0.29), sanitary hygiene (M=3.89; SD=0.46), hygiene and comfort care (M=3.94; SD=0.34), mobility (M=3.70; SD=0.57), transfers (M=3.83; SD=0.53), dressing and undressing (M=3.98; SD=0.41), taking medication (M=3.65; SD=0.48) and symptom management (M=3.61; SD=0.49), very close to 4, which may suggest that the ICs ‘totally agree’ that they feel capable of satisfying these self-care needs. In the communication dimension, the overall average score is 4.17 (SD=0.38). With this value above 4, the ICs ‘strongly agree’ that they feel capable of satisfying self-care communication. However, the results show that in the ‘Symptom management’ dimension, the item ‘acting on shortness of breath’ has the lowest score of 3.14 (SD=0.91), followed by the dimension ‘Taking medication’ with a lower average of 3.65 (SD=0.48) in the item ‘understanding whether the medication is producing the desired effects’ with an average of 3.00 (SD=0.80). The nurses were mostly female (80%). Only 30% reported experience in formal IC training. These findings reinforce the need for structured IC training, with standardised educational pathways, dedicated teaching time and multimodal materials (digital/paper), supported by adequate funding and decision support. They emphasised the centrality of their role in training IC (13 mentions). They identified the following as necessary resources: teaching strategies focused on teaching to the IC (20), adequate staffing levels for nurses (14), access to teaching materials in digital format (16) and in paper format (14), as well as clinical (11) and non-clinical (11) resources. In conclusion, the report highlights the scope of the common and specific competencies of Specialist Nurses (SN) in PCC care and reinforces the importance of evidence-based practice in a professional context, as well as its contribution to the implementation of strategies to improve the safety and quality of nursing care for DP and IC.
This report reflects the academic path taken to obtain a Master's degree in Medical-Surgical Nursing in the area of specialisation in Critical Care, taught at the School of Health Sciences of the Polytechnic Institute of Leiria. It aims to highlight the acquisition of skills within the scope of the Nursing Internship for Person in Critical Condition (PCC) Course Unit with Report and the development of evidence-based specialised practice in the context of professional practice in a Medical Service at a hospital in central Portugal, it is organised into two parts. Part I was developed based on reflection in action and for action and learning opportunities, using scientific evidence to develop and consolidate general and specific skills. Part II refers to evidence-based specialised practice. The research conducted addressed the theme ‘Training of Informal Caregivers (IC) of Dependent Persons (DP): a project for the continuous improvement of the quality of nursing care.’ This topic was chosen because nursing care is provided on a daily basis to patients who are mostly highly dependent on self-care. The difficulty expressed by the entire nursing team in informal moments in implementing training strategies for ICs of DP who live at home revealed a growing need for improvement in nursing interventions aimed at ICs. The research aimed to assess the DP's self-care needs, the IC's ability to care for the DP at home, and the nurses' perception of the IC's training. It was conducted in two main stages. The first stage consisted of a diagnostic study of the situation, in which the self-care needs of DP, the capabilities of IC to care for DP, and nurses' perceptions of IC training were identified. The second stage consisted of analysing the data and reviewing the literature with a view to proposing a strategy for improving IC training. Subsequently, outside the academic sphere, the improvement strategy will be validated with the nursing team and implemented. The results showed that DP had a mean age of 81.69 years (SD=11.35) and previous dependence on another person in at least one self-care activity for approximately 4.79 years (SD=4.08) in 77.28% of cases. The self-care activities with the highest degree of dependence were ‘activities of daily living’ (mean 2.05, SD=0.97) and ‘taking medication’ (mean 2.18, SD=1.13), on a scale where lower scores indicate greater dependence. In the sample, informal carers were mostly women (77.14%); the predominant relationship with the DP was son/daughter (57.14%); 28.57% had low educational attainment and 51.43% lived with the DP. To care for DP, the IC presented an average overall score in the following dimensions: feeding (M=3.84; SD=0.29), sanitary hygiene (M=3.89; SD=0.46), hygiene and comfort care (M=3.94; SD=0.34), mobility (M=3.70; SD=0.57), transfers (M=3.83; SD=0.53), dressing and undressing (M=3.98; SD=0.41), taking medication (M=3.65; SD=0.48) and symptom management (M=3.61; SD=0.49), very close to 4, which may suggest that the ICs ‘totally agree’ that they feel capable of satisfying these self-care needs. In the communication dimension, the overall average score is 4.17 (SD=0.38). With this value above 4, the ICs ‘strongly agree’ that they feel capable of satisfying self-care communication. However, the results show that in the ‘Symptom management’ dimension, the item ‘acting on shortness of breath’ has the lowest score of 3.14 (SD=0.91), followed by the dimension ‘Taking medication’ with a lower average of 3.65 (SD=0.48) in the item ‘understanding whether the medication is producing the desired effects’ with an average of 3.00 (SD=0.80). The nurses were mostly female (80%). Only 30% reported experience in formal IC training. These findings reinforce the need for structured IC training, with standardised educational pathways, dedicated teaching time and multimodal materials (digital/paper), supported by adequate funding and decision support. They emphasised the centrality of their role in training IC (13 mentions). They identified the following as necessary resources: teaching strategies focused on teaching to the IC (20), adequate staffing levels for nurses (14), access to teaching materials in digital format (16) and in paper format (14), as well as clinical (11) and non-clinical (11) resources. In conclusion, the report highlights the scope of the common and specific competencies of Specialist Nurses (SN) in PCC care and reinforces the importance of evidence-based practice in a professional context, as well as its contribution to the implementation of strategies to improve the safety and quality of nursing care for DP and IC.
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Keywords
Enfermagem Enfermeiros especialistas Cuidados críticos Cuidadores Capacitação Paciente