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Capacitação do familiar cuidador para a gestão do regime medicamentoso complexo em cuidados paliativos - Projeto de desenvolvimento de competências clínicas especializadas na área de Enfermagem à Pessoa em Situação Paliativa
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Advisor(s)
Abstract(s)
Os Cuidados Paliativos (CP) procuram melhorar a qualidade de vida do doente que enfrenta uma
condição de saúde potencialmente ameaçadora de vida, bem como da sua família, através da
prevenção e alívio do sofrimento por meio da identificação do diagnóstico e tratamento
adequado de todos os problemas cuja doença possa acarretar, quer sejam eles físicos,
psicológicos, sociais ou espirituais. Considerando o progressivo envelhecimento demográfico da
população portuguesa e o consequente aumento de diagnósticos de condições ameaçadoras da
vida que, por sua vez, contribui para o crescimento do número de doentes que padecem de
grande sofrimento, para o qual o Enfermeiro deve estar especialmente desperto, evidencia-se a
importância e a necessidade premente que se impõe de formação de profissionais
especializados na área dos CP.
Dentro da intervenção especializada em CP, urge destacar aquela que prevê o controlo
sintomático e que representa uma parte crucial dos cuidados que são prestados. A adaptação
da Hierarquia das Necessidades de Maslow aos CP prevê que o alívio dos sintomas físicos ocupe
o primeiro nível da pirâmide, considerando que a satisfação das necessidades neste campo é
necessária para que os níveis mais elevados possam ser atingidos. Um bom controlo
sintomático na fase de final de vida é um fator extremamente valorizado, tanto pelos
profissionais de saúde, como pelo próprio doente e o seu familiar cuidador, que reconhecem a
valorização da sua qualidade de vida.
Assim, o objetivo do presente relatório visa apresentar o percurso de aquisição e
desenvolvimento de competências especializadas de enfermagem, na área dos cuidados à
pessoa em situação paliativa, sendo que, para isso, se optou pela realização de Estágio de
Natureza Profissional (ENP) em contexto de internamento em unidade de CP e em contexto de
Equipa Comunitária de Suporte em CP.
O desenvolvimento deste relatório teve como base uma metodologia descritiva e críticoreflexiva
acerca do processo de obtenção das competências comuns e específicas do Enfermeiro
Especialista, de acordo com o que é preconizado pelo Decreto-Lei 429/2018, com especial foco
na intervenção especializada do Enfermeiro no âmbito da Capacitação do Familiar Cuidador para
a Gestão do Regime Medicamentoso Complexo em CP. Com base nas aptidões enumeradas na
legislação portuguesa para obtenção do grau de mestre, foi ainda adotada uma metodologia de
investigação baseada no desenvolvimento de uma revisão rápida da literatura acerca do tema
escolhido, que permitiu fundamentar a praxis clínica ao longo do ENP.
Apesar de se considerar o desenvolvimento a um nível satisfatório no que se refere à generalidade das competências específicas do EE na área da pessoa em situação paliativa, a
opção pelo destaque do tema que visa a Capacitação do Familiar Cuidador para a Gestão do
Regime Medicamentoso Complexo em CP permitiu o desenvolvimento de habilidades específicas
nas quatro vertentes dos CP: o controlo sintomático; a comunicação eficaz; o apoio à família e o
trabalho em equipa, pelo que se considera que a escolha desta área se revelou como um fator
facilitador para o atingimento dos objetivos propostos.
Considera-se que as experiências vivenciadas ao longo do ENP, assim como as aprendizagens
decorrentes das mesmas, contribuíram de forma fundamental para o desenvolvimento das
competências comuns do Enfermeiro Especialista e, com especial destaque para aquelas que
são específicas da área na qual se pretende obter especialização. O desenvolvimento da revisão
rápida da literatura permitiu, ainda, confirmar a aplicação de boas práticas clínicas, baseadas na
mais recente evidência científica, em contexto de ENP.
Palliative Care (PC) seeks to improve the quality of life of patients who face a potentially lifethreatening health condition, as well of his family, through the prevention and relief of suffering through the identification of the diagnosis and adequate treatment of all problems whose disease may entail, whether physical, psychological, social or spiritual. Considering the progressive demographic aging of the Portuguese population and the consequent increase in diagnoses of life-threatening conditions, which contributes to the growth in the number of patients facing a great suffering, for which the nurse must be especially alert, it shows the importance and pressing need for training specialized professionals in the area of PC is highlighted. Within the specialized intervention in PC, it's urgent to highlight the one that provides for symptomatic control and that represents a crucial part of the care that is provided. An adaptation of Maslow's Hierarchy of Needs to PC predicts that the relief of physical symptoms occupies the first level of the pyramid, considering that the satisfaction of needs in this field is necessary so that the highest levels can be achived. Good symptoms control at the end of life is an extremely valued factor, both by health professionals and by the patient himself and his family caregiver, who recognize the value of their quality of life. Thus, the objective of this report is to present the path of acquisition and development of specialized nursing skills, in the area of care for people in a palliative situation, and, for this, it was decided to carry out a Professional Internship (PI) in context of a PC unit and in the context of a Community Support Team in PC. The development of this report was based on a descriptive and critical-reflexive methodology about the process of obtaining the common and specific competences of the specialist nurse, in accordance with what is recommended by Decree-Law 429/2018, with special focus on the specialized intervention of the nurse in the context of training family caregivers to the management of the complex medication regimen in PC. Based on the skills listed in the Portuguese legislation for obtaining a master's degree, a research methodology was also adopted based on the development of a rapid literature review on the chosen topic, which allowed to base the clinical praxis throughout the PI. Despite considering the development at a satisfactory level with regard to the generality of the specific competences of a specialist nurse in the area of the person in a palliative situation, the option to highlight the theme that aims at training the family caregiver to manage the complex medication regimen in PC allowed the development of specific skills in the four aspects of PC: symptomatic control; effective communication; family support and teamwork, which is why it is considered that the choice of this area proved to be a facilitating factor for achieving the proposed objectives. It should be considered that the experiences lived throughout the PI, as well as the learning resulting from them, develop in a fundamental way for the development of common competences of the specialist nurse and, in particular, for those that are specific to the area in which I am intended to get specialization. The development of the rapid literature review also allowed confirming the application of good clinical practices, based on the most recent scientific evidence, in the context of PI
Palliative Care (PC) seeks to improve the quality of life of patients who face a potentially lifethreatening health condition, as well of his family, through the prevention and relief of suffering through the identification of the diagnosis and adequate treatment of all problems whose disease may entail, whether physical, psychological, social or spiritual. Considering the progressive demographic aging of the Portuguese population and the consequent increase in diagnoses of life-threatening conditions, which contributes to the growth in the number of patients facing a great suffering, for which the nurse must be especially alert, it shows the importance and pressing need for training specialized professionals in the area of PC is highlighted. Within the specialized intervention in PC, it's urgent to highlight the one that provides for symptomatic control and that represents a crucial part of the care that is provided. An adaptation of Maslow's Hierarchy of Needs to PC predicts that the relief of physical symptoms occupies the first level of the pyramid, considering that the satisfaction of needs in this field is necessary so that the highest levels can be achived. Good symptoms control at the end of life is an extremely valued factor, both by health professionals and by the patient himself and his family caregiver, who recognize the value of their quality of life. Thus, the objective of this report is to present the path of acquisition and development of specialized nursing skills, in the area of care for people in a palliative situation, and, for this, it was decided to carry out a Professional Internship (PI) in context of a PC unit and in the context of a Community Support Team in PC. The development of this report was based on a descriptive and critical-reflexive methodology about the process of obtaining the common and specific competences of the specialist nurse, in accordance with what is recommended by Decree-Law 429/2018, with special focus on the specialized intervention of the nurse in the context of training family caregivers to the management of the complex medication regimen in PC. Based on the skills listed in the Portuguese legislation for obtaining a master's degree, a research methodology was also adopted based on the development of a rapid literature review on the chosen topic, which allowed to base the clinical praxis throughout the PI. Despite considering the development at a satisfactory level with regard to the generality of the specific competences of a specialist nurse in the area of the person in a palliative situation, the option to highlight the theme that aims at training the family caregiver to manage the complex medication regimen in PC allowed the development of specific skills in the four aspects of PC: symptomatic control; effective communication; family support and teamwork, which is why it is considered that the choice of this area proved to be a facilitating factor for achieving the proposed objectives. It should be considered that the experiences lived throughout the PI, as well as the learning resulting from them, develop in a fundamental way for the development of common competences of the specialist nurse and, in particular, for those that are specific to the area in which I am intended to get specialization. The development of the rapid literature review also allowed confirming the application of good clinical practices, based on the most recent scientific evidence, in the context of PI
Description
Keywords
cuidados paliativos Competências Enfermeiro especialista Gestão do regime medicamentoso Familiar cuidador Relatório de estágio