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Cuidado à pessoa em fim de vida em unidade de cuidados intensivos :
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O aumento da espectativa de vida, a evolução social e científica, tem
colocado a morte como algo a “combater”. No entanto, cada vez mais, os
profissionais de saúde se deparam com a necessidade de cuidar de pessoas em
situação crítica em processo de fim de vida, com a com o qual se sentem pouco
preparados, pela dificuldade na limitação de intervenções do foro curativo e a
sua substituição por cuidados em fim de vida que preservem a dignidade e
promovam o conforto.
Surge assim um apelo à enfermagem, na medida em que, como
ciência, se tem vindo a assumir com um cariz diferenciado e complexo, exigindo
aos enfermeiros que estejam dotados de competências mais específicas e
complexas de forma a dar resposta à multidimensionalidade da pessoa crítica e
em fim de vida.
O papel competente e especializado do enfermeiro, na abordagem à
pessoa em situação crítica (PSC) em fim de vida, é um ponto fulcral para o
reconhecimento de que intervenções paliativas podem e devem existir em
cenários de cuidados intensivos, necessitando de um exercício de julgamento
clínico, em situações que são ambíguas e frequentemente repletas de conflitos
de valor.
O presente relatório teve como objetivo geral desenvolver
competências especializadas de enfermagem na prestação de cuidados à PSC
em fim de vida, tendo por base as atividades elaboradas em contexto hospitalar,
desenvolvidas numa Unidade de Cuidados Paliativos (UCP), Unidade de
Cuidados Intensivos (UCI) e Serviço de Urgência (SU). Toda a prática produzida
em contexto de estágio foi sustentada e analisada com base na evidência
científica assim como através dos referenciais teóricos Technological
Competency as Caring in Nursing, de Rozzano Locsin e da Teoria do Conforto
de Kolcaba, e do modelo de Dreyfus aplicado à enfermagem por Benner para o
desenvolvimento de competências profissionais.
A experiência resultante deste processo possibilitou mobilizar e
adquirir novos conhecimentos teóricos, consolidar competências
comunicacionais e relacionais e reforçar o raciocínio crítico-reflexivo dos
10
cuidados prestados, desenvolvendo competências de mestre especializadas no
cuidar à PSC.
O percurso formativo permitiu a mobilização do conhecimento
adquirido com base na constante problematização, observando a PSC como um
todo, proporcionando o meu crescimento profissional e traduzindo-se na
melhoria da qualidade dos cuidados prestados.
The increase in life expectancy, social and scientific evolution, has placed death as something to “fight”. However, more and more, health professionals are faced with the need to care for people in a critical condition at the end of life, with which they feel unprepared, due to the difficulty in limiting curative interventions and its replacement by end-of-life care that preserves dignity and promotes comfort. Thus, there is an appeal to nursing, insofar as, as a science, it has been assuming a differentiated and complex nature, requiring nurses to be equipped with more specific and complex skills in order to respond to the multidimensionality of the critical person and at end of life. The competent and specialized role of the nurse, in approaching the person in a critical condition at the end of life, is a key point for the recognition that palliative interventions can and should exist in intensive care settings, requiring an exercise of judgment clinical, in situations that are ambiguous and often fraught with value conflicts. The general objective of this report was to develop specialized nursing skills in the provision of end-of-life critical condition person care, based on activities carried out in a hospital context, developed in a Palliative Care Unit (PCU), Intensive Care Unit (ICU) and Emergency Service (SU). All practice produced in the internship context was supported and analyzed based on scientific evidence as well as through the theoretical references Technological Competency as Caring in Nursing, by Rozzano Locsin and Kolcaba's Theory of Comfort, and the Dreyfus model applied to nursing by Benner for the development of professional skills. The experience resulting from this process made it possible to mobilize and acquire new theoretical knowledge, consolidate communication and relational skills and reinforce critical-reflective reasoning in the care provided, developing specialized master's skills in caring for the critical condition person. The training path allowed for the mobilization of knowledge acquired based on constant problematization, observing the critical condition person as a whole, providing my professional growth and translating into the improvement of the quality of care provided.
The increase in life expectancy, social and scientific evolution, has placed death as something to “fight”. However, more and more, health professionals are faced with the need to care for people in a critical condition at the end of life, with which they feel unprepared, due to the difficulty in limiting curative interventions and its replacement by end-of-life care that preserves dignity and promotes comfort. Thus, there is an appeal to nursing, insofar as, as a science, it has been assuming a differentiated and complex nature, requiring nurses to be equipped with more specific and complex skills in order to respond to the multidimensionality of the critical person and at end of life. The competent and specialized role of the nurse, in approaching the person in a critical condition at the end of life, is a key point for the recognition that palliative interventions can and should exist in intensive care settings, requiring an exercise of judgment clinical, in situations that are ambiguous and often fraught with value conflicts. The general objective of this report was to develop specialized nursing skills in the provision of end-of-life critical condition person care, based on activities carried out in a hospital context, developed in a Palliative Care Unit (PCU), Intensive Care Unit (ICU) and Emergency Service (SU). All practice produced in the internship context was supported and analyzed based on scientific evidence as well as through the theoretical references Technological Competency as Caring in Nursing, by Rozzano Locsin and Kolcaba's Theory of Comfort, and the Dreyfus model applied to nursing by Benner for the development of professional skills. The experience resulting from this process made it possible to mobilize and acquire new theoretical knowledge, consolidate communication and relational skills and reinforce critical-reflective reasoning in the care provided, developing specialized master's skills in caring for the critical condition person. The training path allowed for the mobilization of knowledge acquired based on constant problematization, observing the critical condition person as a whole, providing my professional growth and translating into the improvement of the quality of care provided.
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Palavras-chave
Enfermagem de cuidados intensivos Enfermeiras especialistas Cuidados paliativos em fim de vida