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Avaliação e intervenção familiar, em famílias com elemento idoso portador de DPOC (Doença Pulmonar Obstrutiva Crónica): Relatório de desenvolvimento de competências clínicas especializadas na área de Enfermagem de Saúde Familiar
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Abstract(s)
O presente relatório reporta o desenvolvimento de competências em Enfermagem Comunitária na
área de Enfermagem de Saúde Familiar (ECESF) e a sua elaboração promoveu a reflexão crítica sobre
o percurso realizado, no âmbito da componente clínica da realização do Mestrado em Enfermagem
Comunitária na área de Enfermagem de Saúde Familiar, da Escola Superior de Enfermagem do Porto.
A elaboração deste relatório teve como objetivo apresentar e descrever as atividades desenvolvidas,
apoiadas em modelos teóricos de enfermagem, evidenciando o processo de desenvolvimento de
competências comuns do enfermeiro especialista e específicas do enfermeiro especialista em ECESF.
Para a concretização do desenvolvimento de competências foram definidos os seguintes objetivos:
prestar cuidados a famílias com membro idoso portador de DPOC, enquanto unidade de cuidados bem
como dos seus membros, ao longo do ciclo vital e nos diferentes níveis de prevenção e, promover a
liderança e a colaboração em processos de intervenção de saúde familiar.
O recurso à evidência científica, ao Modelo Dinâmico de Avaliação e Intervenção Familiar (MDAIF)
como referencial teórico e operativo, e à Teoria das Transições, permitiu identificar as forças, os
recursos e as necessidades das famílias sensíveis ao exercício do Enfermeiro Especialista em ECESF,
bem como compreender as propriedades da experiência de transição individual em situação de saúde
ou de doença. Foram utilizados instrumentos para a avaliação familiar e dos seus membros,
permitindo elaborar um processo de cuidados individualizado com o objetivo de modificação positiva
dos diagnósticos de enfermagem. Considerando o processo de Enfermagem, foram desenvolvidas
consultas neste âmbito a seis famílias com membro idoso portador de DPOC que permitiram a
avaliação e a intervenção familiar e individual. As intervenções realizadas originaram ganhos em saúde
nestas famílias a partir da capacitação para a mobilização dos seus recursos e forças. No âmbito dos
processos de intervenção que visaram a gestão, articulação e mobilização de recursos para a prestação
de cuidados, evidencia-se o contributo para a promoção de uma cultura organizacional, sustentada na
formação, prática e investigação. Outros contributos significativos surgiram por meio do processo
formativo facultado aos enfermeiros relativo à ESF, bem como, o trabalho desenvolvido com a equipa
multiprofissional na reestruturação do PAI, no âmbito da DPOC. A reflexão sobre as atividades
desenvolvidas permitiu o desenvolvimento das competências, comuns e específicas, e a atual
evidência científica, auxiliaram na prestação de cuidados à família.
This report reports on the development of skills in Community Nursing in the area of Family Health Nursing (ECESF) and its preparation promoted critical reflection on the path taken, within the scope of the clinical component of the Master's Degree in Community Nursing in the area of Nursing of Family Health, from the Porto Superior School of Nursing. The objective of preparing this report was to present and describe the activities developed, supported by theoretical nursing models, highlighting the process of developing common skills of specialist nurses and specific skills of specialist nurses in ECESF. To achieve the development of skills, the following objectives were defined: providing care to families with an elderly member with COPD, as a care unit as well as its members, throughout the life cycle and at different levels of prevention and, promoting leadership and collaboration in family health intervention processes. The use of scientific evidence, the Dynamic Model of Family Assessment and Intervention (MDAIF) (Figueiredo, 2012) as a theoretical and operational framework, and the Theory of Transitions, allowed us to identify the strengths, resources and needs of families sensitive to the exercise of the ECESF Specialist Nurse, as well as to understand the properties of the individual transition experience in a health or disease situation. Instruments were used for the evaluation of the family and its members, allowing the elaboration of an individualized care process with the objective of positive modification of nursing diagnoses. Considering the nursing process, consultations were developed in this context with six families with elderly members with COPD, which allowed for family and individual assessment and intervention. The interventions carried out resulted in health gains in these families from the training for the mobilization of their resources and forces. Within the scope of the intervention processes aimed at the management, articulation and mobilization of resources for the provision of care, the contribution to the promotion of an organizational culture, based on training, practice and research, is evidenced. Other significant contributions emerged through the training process provided to nurses related to the FHS, as well as the work developed with the multidisciplinary team in the restructuring of the IAP in the context of COPD. The reflection on the activities developed allowed the development of common and specific skills, and the current scientific evidence, helped in the provision of care to the family.
This report reports on the development of skills in Community Nursing in the area of Family Health Nursing (ECESF) and its preparation promoted critical reflection on the path taken, within the scope of the clinical component of the Master's Degree in Community Nursing in the area of Nursing of Family Health, from the Porto Superior School of Nursing. The objective of preparing this report was to present and describe the activities developed, supported by theoretical nursing models, highlighting the process of developing common skills of specialist nurses and specific skills of specialist nurses in ECESF. To achieve the development of skills, the following objectives were defined: providing care to families with an elderly member with COPD, as a care unit as well as its members, throughout the life cycle and at different levels of prevention and, promoting leadership and collaboration in family health intervention processes. The use of scientific evidence, the Dynamic Model of Family Assessment and Intervention (MDAIF) (Figueiredo, 2012) as a theoretical and operational framework, and the Theory of Transitions, allowed us to identify the strengths, resources and needs of families sensitive to the exercise of the ECESF Specialist Nurse, as well as to understand the properties of the individual transition experience in a health or disease situation. Instruments were used for the evaluation of the family and its members, allowing the elaboration of an individualized care process with the objective of positive modification of nursing diagnoses. Considering the nursing process, consultations were developed in this context with six families with elderly members with COPD, which allowed for family and individual assessment and intervention. The interventions carried out resulted in health gains in these families from the training for the mobilization of their resources and forces. Within the scope of the intervention processes aimed at the management, articulation and mobilization of resources for the provision of care, the contribution to the promotion of an organizational culture, based on training, practice and research, is evidenced. Other significant contributions emerged through the training process provided to nurses related to the FHS, as well as the work developed with the multidisciplinary team in the restructuring of the IAP in the context of COPD. The reflection on the activities developed allowed the development of common and specific skills, and the current scientific evidence, helped in the provision of care to the family.
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Keywords
Enfermagem de Saúde Familiar Pessoa Idosa DPOC Relatório de estágio