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A transição do doente renal crónico para hemodiálise
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Advisor(s)
Abstract(s)
O aumento da esperança média de vida, o aumento da acessibilidade aos cuidados de saúde e o avanço tecnológico, segundo a Organização Mundial de Saúde (OMS) (2012) são precedentes para o aumento da incidência e prevalência das doenças crónicas e envelhecimento das sociedades, estando por sua vez relacionados com a existência simultânea de comorbilidades condicionantes da qualidade de vida de cada indíviduo.
A Doença Renal Crónica é afirmada pela OMS como um problema de saúde pública devido ao aumento da sua prevalência e associação com uma maior morbilidade e mortalidade (Glassock, Warnock, & Delanaye, 2017). Esta é classificada em 5 estádios de progressão da doença (KDIGO, 2013) e, de acordo com a Direção-Geral da Saúde (DGS, 2012), quando esta atinge o seu último estádio (considerado a fase terminal com a Taxa de Filtração Glomerular (TFG) inferior a 15 ml/min/1.75 m2) implica o início de uma modalidade terapêutica designada de técnica de substituição da função renal (TSFR).
Esta mudança leva a uma transição onde se pressupõe a sua ocorrência de forma saudável com a redefinição de significados, modificação de expectativas, reestruturação de rotinas da vida diária, desenvolvimento de conhecimento e competências, manutenção contínua, criação de novas escolhas e encontro de novas oportunidades. O sucesso desta transição é imperativo para a sobrevivência, adaptação e adesão do doente renal crónico a uma nova realidade que permita evitar sintomas de doença, sub-otimização do status funciona e sentimentos de desconexão, disempowerment e perda de integridade (Meleis, 2010).
O presente relatório tem como objetivo a descrição das atividades desenvolvidas em âmbito de estágio para alcance das competências de enfermeiro especialista em Enfermagem Médico-Cirúrgica, ao longo do 3º semestre curricular do 13º Curso de Pós-Licenciatura e Mestrado em Enfermagem na Área de Especialização em Enfermagem Médico-Cirúrgica, Área de Intervenção Nefrológica. O Enfermeiro Especialista é definido pelo Regulamento nº190/2015 como “(…) aquele a quem se reconhece competência científica, técnica e humana para prestar cuidados de enfermagem especializados nas áreas de especialidade em enfermagem.” (p.4744). Segundo o mesmo , a atribuição a um enfermeiro do título de especialista, pressupõe um leque de competências comuns passíveis de se aplicarem em qualquer contexto profissional designadas de Competências Comuns do Enfermeiro Especialista. Estas dividem-se em domínios da responsabilidade profissional, ética e legal; melhoria da qualidade dos cuidados; gestão dos cuidados e desenvolvimento das aprendizagens profissionais.
Contudo, a Ordem dos Enfermeiros não define competências específicas para a área de intervenção nefrológica, sendo por isso necessário recorrer às competências específicas do enfermeiro de nefrologia definidas pela EDTNA/ERCA, agrupadas para os diferentes contextos da área (Chamney, 2007). Desta forma, o Enfermeiro Especialista em Enfermagem Nefrológica atua de acordo com competência e conhecimentos perante a pessoa com DRC ao longos dos seus diferentes estádios, com inclusão das TSFR e tratamento conservador, respetiva gestão de sintomas, comorbilidades e ensinos, em contexto de internamento e ambulatório. Em suma, o enfermeiro presta cuidados ao longo das diversas transições do doente renal crónico.
Por fim, o presente relatório enuncia as aprendizagens desenvolvidas no decorrer de ensinos clínicos realizados, em contexto de cuidados de enfermagem em Nefrologia, assim como o estudo do tipo Scoping Review com o tema “A Transição do Doente Renal Crónico para Hemodiálise”, de acordo com as normas do Joanna Briggs Institute (JBI) e evidenciando de forma dedutiva e implícita o papel do enfermeiro no processo de transição para hemodiálise do doente renal crónico.
According to the World Health Organization (2012) the increase in the average life expectancy, the increased accessibility to health care and the technological advances are precedents for the increase in the incidence and prevalence of chronic diseases and the aging of societies, which are in turn related to the simultaneous existence of comorbidities that affect the quality of life of each individual. Chronic kidney disease is considered a public health problem by the WHO due to its increased prevalence and association with increased morbidity and mortality (Glassock, Warnock, & Delanaye, 2017). This disease is classified into 5 stages of disease progression (KDIGO, 2013) and, according to the Directorate-General for Health (DGS, 2012), when it reaches its last stage (considered the terminal stage with a Glomerular Filtration Rate (GFR) below 15 ml/min/1.75 m2), a therapeutic modality called renal function replacement technique (RRT) must be initiated. This change then leads to a transition where it is assumed to occur in a healthy way with the redefinition of meanings, modification of expectations, restructuring of daily life routines, development of knowledge and skills, continuous maintenance, creation of new choices, and finding new opportunities. The success of this transition is imperative for the survival, adaptation and adherence of the chronic kidney patient to a new reality that allows avoiding symptoms of disease, suboptimization of the status of function and feelings of disconnection, disempowerment and loss of integrity (Meleis, 2010). This report aims to describe the activities developed in clinical teaching to achieve the competencies of a nurse specialist in Medical-Surgical Nursing, throughout the 3rd curricular semester of the 13th Postgraduate Course and Master's Degree in Nursing in the Specialization in Medical-Surgical Nursing, Nephrology Intervention Area. The Specialist Nurse is defined by Regulation No. 190/2015 as "(...) one who is recognized as having scientific, technical and human competence to provide specialized nursing care in nursing specialty areas." (p.4744).According to the same author, the attribution of the title of specialist to a nurse presupposes a range of common competencies that can be applied in any professional context, namely the Common Competencies of Nurse Specialists, which are divided into the domains of professional, ethical and legal responsibility; improvement of the quality of care; care management and development of professional learning. However, the OE does not define specific competencies for the nephrological intervention area, thus it is necessary to use the specific competencies of the nephrology nurse defined by EDTNA/ERCA, grouped for the different contexts of the area (Chamney, 2007). In this way, the Nurse Specialist in Nephrological Nursing acts according to his/her competence and knowledge towards the person with CKD throughout its different stages, including RRT and conservative treatment, respective symptom management, comorbidities and teaching, in inpatient and outpatient settings. Finally, this report describes the learning experiences during the clinical teaching sessions held in the context of nursing care in Nephrology, as well as the Scoping Review with the theme "The Transition of the Chronic Renal Patient to Hemodialysis", according to the standards of the Joanna Briggs Institute (JBI) and demonstrating deductive and implicitly the nurse's role in the process of transition to hemodialysis of the chronic renal patient.
According to the World Health Organization (2012) the increase in the average life expectancy, the increased accessibility to health care and the technological advances are precedents for the increase in the incidence and prevalence of chronic diseases and the aging of societies, which are in turn related to the simultaneous existence of comorbidities that affect the quality of life of each individual. Chronic kidney disease is considered a public health problem by the WHO due to its increased prevalence and association with increased morbidity and mortality (Glassock, Warnock, & Delanaye, 2017). This disease is classified into 5 stages of disease progression (KDIGO, 2013) and, according to the Directorate-General for Health (DGS, 2012), when it reaches its last stage (considered the terminal stage with a Glomerular Filtration Rate (GFR) below 15 ml/min/1.75 m2), a therapeutic modality called renal function replacement technique (RRT) must be initiated. This change then leads to a transition where it is assumed to occur in a healthy way with the redefinition of meanings, modification of expectations, restructuring of daily life routines, development of knowledge and skills, continuous maintenance, creation of new choices, and finding new opportunities. The success of this transition is imperative for the survival, adaptation and adherence of the chronic kidney patient to a new reality that allows avoiding symptoms of disease, suboptimization of the status of function and feelings of disconnection, disempowerment and loss of integrity (Meleis, 2010). This report aims to describe the activities developed in clinical teaching to achieve the competencies of a nurse specialist in Medical-Surgical Nursing, throughout the 3rd curricular semester of the 13th Postgraduate Course and Master's Degree in Nursing in the Specialization in Medical-Surgical Nursing, Nephrology Intervention Area. The Specialist Nurse is defined by Regulation No. 190/2015 as "(...) one who is recognized as having scientific, technical and human competence to provide specialized nursing care in nursing specialty areas." (p.4744).According to the same author, the attribution of the title of specialist to a nurse presupposes a range of common competencies that can be applied in any professional context, namely the Common Competencies of Nurse Specialists, which are divided into the domains of professional, ethical and legal responsibility; improvement of the quality of care; care management and development of professional learning. However, the OE does not define specific competencies for the nephrological intervention area, thus it is necessary to use the specific competencies of the nephrology nurse defined by EDTNA/ERCA, grouped for the different contexts of the area (Chamney, 2007). In this way, the Nurse Specialist in Nephrological Nursing acts according to his/her competence and knowledge towards the person with CKD throughout its different stages, including RRT and conservative treatment, respective symptom management, comorbidities and teaching, in inpatient and outpatient settings. Finally, this report describes the learning experiences during the clinical teaching sessions held in the context of nursing care in Nephrology, as well as the Scoping Review with the theme "The Transition of the Chronic Renal Patient to Hemodialysis", according to the standards of the Joanna Briggs Institute (JBI) and demonstrating deductive and implicitly the nurse's role in the process of transition to hemodialysis of the chronic renal patient.
Description
Keywords
Enfermagem em nefrologia Insuficiência renal crónica Terapia de substituição renal Cuidados de enfermagem Hemodiálise Cuidados continuados