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Autogestão do regime medicamentoso: Terapia Inalatória: Desenvolvimento de competências clínicas especializadas na área de Enfermagem de Reabilitação
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No âmbito da Unidade Curricular – Estágio de Natureza Profissional com Relatório – Módulo II, do
Mestrado em Enfermagem de Reabilitação, no ano letivo 2024/2025, foi elaborado o presente
relatório com o título “Autogestão do Regime Medicamentoso: Terapia Inalatória -
Desenvolvimento de Competências Clínicas Especializadas na Área de Enfermagem de
Reabilitação”.
A ventilação pulmonar é essencial para a renovação contínua do ar que entra nas vias aéreas e
para viabilizar as trocas gasosas a nível alveolar, ocorrendo um comprometimento desta função
no caso das doenças respiratórias crónicas, como as bronquiectasias. No caso da pessoa com
bronquiectasias acresce ao exposto o compromisso da capacidade para limpar a via aérea. O
regime de tratamento farmacológico da doença recorre à terapia inalatória para a deposição
direta de fármacos nas vias aéreas inferiores. O sucesso da terapêutica farmacológica
administrada através da via aérea esta intimamente relacionado com a técnica de inalação
executada pela pessoa. Uma técnica de inalação não otimizada contribui para o não controlo da
doença e, consequentemente para a redução da qualidade de vida e da funcionalidade; e para o
risco aumentado de exacerbação e de consumo de recursos de saúde.
O Enfermeiro Especialista em Enfermagem de Reabilitação oferece cuidados especializados
visando a promoção da qualidade de vida, restaurando a funcionalidade quando possível,
promovendo o autocuidado, prevenindo complicações e maximizando capacidades. Este tem um
papel preponderante como agente facilitador no processo de transição saúde/doença,
capacitando a pessoa com alterações da funcionalidade, para a autogestão, considerando o seu
projeto de saúde, promovendo maior autonomia e reintegração social.
Assim, e no contexto da pessoa com bronquiectasias, a intervenção especializada do Enfermeiro
Especialista em Enfermagem de Reabilitação, para além da intervenção no domínio da
ventilação e limpeza da via aérea, assume especial relevância no contributo para o
desenvolvimento de competências de autogestão da doença, entre as quais se enquadra a
capacidade da pessoa para implementar no dia a dia, com mestria, a técnica de inalação.
Para a realização deste relatório de estágio definiram-se como objetivos gerais: desenvolver
competências comuns de Enfermeiro Especialista de acordo com o Regulamento nº140/2019;
desenvolver competências especıfí cas de Enfermeiro Especialista de Enfermagem de
Reabilitação de acordo com o Regulamento nº392/2019; desenvolver competências especıfí cas
de Enfermeiro Especialista de Enfermagem de Reabilitação na otimização da ventilação
promovendo a autogestão do regime medicamentoso – terapia inalatória.
Para alcançar os dois primeiros objetivos delineados, utilizamos uma abordagem crítica e
reflexiva sobre o desenvolvimento das competências comuns e específicas do Enfermeiro
Especialista em Enfermagem de Reabilitação adquiridas nos diversos contextos clínicos, o que
permitiu desenvolver competências para intervir junto da pessoa e/ou da família, em situações
de doença aguda ou crónica, concebendo planos de reabilitação visando a maximização do
potencial funcional e promovendo a autonomia, a qualidade de vida e a reintegração social.
Para dar resposta ao terceiro objetivo, apresentamos a tomada de decisão clínica, referente a
um cenário clínico, com recurso à plataforma e4nursing cuja a intencionalidade é suportada pela
Teoria Geral do Autocuidado, pela Teoria das Transições, na melhor evidência científica, e
sustentado nas competências especializadas e nos padrões de qualidade dos cuidados
especializados em Enfermagem de Reabilitação.
O Estágio de Natureza Profissional permitiu o desenvolvimento das competências comuns e
específicas de enfermeiro especialista, bem como, de Mestre em Enfermagem de Reabilitação
com ênfase no domínio da ventilação, promovendo a autogestão do regime medicamentoso -
terapia inalatória.
In the scope of the Curricular Unit (CU) – Professional Nature Internship with Report – Module II, of the Master's in Rehabilitation Nursing, for the academic year 2024/2025, this report was prepared with the title “Self-management of Medication Regimen: Inhalation Therapy - Development of Specialized Clinical Competencies in the Area of Rehabilitation Nursing.” Pulmonary ventilation is essential for the continuous renewal of air entering the airways and for enabling gas exchange at the alveolar level. In chronic respiratory diseases, such as bronchiectasis, this function is compromised. In the case of individuals with bronchiectasis, the ability to clear the airways is also impaired. The pharmacological treatment regimen for this disease relies on inhalation therapy to directly deposit drugs into the lower airways. The success of pharmacological therapy administered via the airway is closely linked to the inhalation technique performed by the individual. A non-optimized inhalation technique contributes to poor disease control and, consequently, to a reduction in quality of life, functionality, and an increased risk of exacerbation and consumption of healthcare resources. The Specialist Nurse in Rehabilitation Nursing provides specialized care aimed at promoting quality of life, restoring functionality when possible, promoting self-care, preventing complications, and maximizing capacities. The nurse plays a key role as a facilitator in the health/disease transition process, empowering individuals with functional impairments to selfmanage, considering their health project, promoting greater autonomy and social reintegration. Thus, in the context of the person with bronchiectasis, the specialized intervention of the Specialist Nurse in Rehabilitation Nursing, in addition to interventions in the domain of ventilation and airway clearance, is of particular relevance in contributing to the development of self-management competencies for the disease. Among these competencies is the individual's ability to effectively implement the inhalation technique in daily life. For the completion of this internship report, the following general objectives were defined: to develop common competencies of the specialist nurse according to Regulation No. 140/2019; to develop specific competencies of the Specialist Nurse in Rehabilitation Nursing according to Regulation No. 392/2019; and to develop specific competencies of the Specialist Nurse in Rehabilitation Nursing in optimizing ventilation by promoting self-management of the medication regimen – inhalation therapy. To achieve the first two defined objectives, a critical and reflective approach was used regarding the development of common and specific competencies of the Specialist Nurse in Rehabilitation Nursing acquired in various clinical contexts. This allowed for the development of competencies to intervene with the person and/or family in acute or chronic disease situations, designing rehabilitation plans aimed at maximizing functional potential and promoting autonomy, quality of life, and social reintegration. To address the third objective, we present clinical decisionmaking regarding a clinical scenario, using the e4nursing platform, which is supported by the General Theory of Self-Care, the Theory of Transitions, the best scientific evidence, and sustained by specialized competencies and quality care standards in Rehabilitation Nursing. The Professional Nature Internship allowed for the development of both common and specific competencies of the specialist nurse, as well as of the Master's in Rehabilitation Nursing, with an emphasis on the domain of ventilation and the promotion of self-management of the medication regimen – inhalation therapy.
In the scope of the Curricular Unit (CU) – Professional Nature Internship with Report – Module II, of the Master's in Rehabilitation Nursing, for the academic year 2024/2025, this report was prepared with the title “Self-management of Medication Regimen: Inhalation Therapy - Development of Specialized Clinical Competencies in the Area of Rehabilitation Nursing.” Pulmonary ventilation is essential for the continuous renewal of air entering the airways and for enabling gas exchange at the alveolar level. In chronic respiratory diseases, such as bronchiectasis, this function is compromised. In the case of individuals with bronchiectasis, the ability to clear the airways is also impaired. The pharmacological treatment regimen for this disease relies on inhalation therapy to directly deposit drugs into the lower airways. The success of pharmacological therapy administered via the airway is closely linked to the inhalation technique performed by the individual. A non-optimized inhalation technique contributes to poor disease control and, consequently, to a reduction in quality of life, functionality, and an increased risk of exacerbation and consumption of healthcare resources. The Specialist Nurse in Rehabilitation Nursing provides specialized care aimed at promoting quality of life, restoring functionality when possible, promoting self-care, preventing complications, and maximizing capacities. The nurse plays a key role as a facilitator in the health/disease transition process, empowering individuals with functional impairments to selfmanage, considering their health project, promoting greater autonomy and social reintegration. Thus, in the context of the person with bronchiectasis, the specialized intervention of the Specialist Nurse in Rehabilitation Nursing, in addition to interventions in the domain of ventilation and airway clearance, is of particular relevance in contributing to the development of self-management competencies for the disease. Among these competencies is the individual's ability to effectively implement the inhalation technique in daily life. For the completion of this internship report, the following general objectives were defined: to develop common competencies of the specialist nurse according to Regulation No. 140/2019; to develop specific competencies of the Specialist Nurse in Rehabilitation Nursing according to Regulation No. 392/2019; and to develop specific competencies of the Specialist Nurse in Rehabilitation Nursing in optimizing ventilation by promoting self-management of the medication regimen – inhalation therapy. To achieve the first two defined objectives, a critical and reflective approach was used regarding the development of common and specific competencies of the Specialist Nurse in Rehabilitation Nursing acquired in various clinical contexts. This allowed for the development of competencies to intervene with the person and/or family in acute or chronic disease situations, designing rehabilitation plans aimed at maximizing functional potential and promoting autonomy, quality of life, and social reintegration. To address the third objective, we present clinical decisionmaking regarding a clinical scenario, using the e4nursing platform, which is supported by the General Theory of Self-Care, the Theory of Transitions, the best scientific evidence, and sustained by specialized competencies and quality care standards in Rehabilitation Nursing. The Professional Nature Internship allowed for the development of both common and specific competencies of the specialist nurse, as well as of the Master's in Rehabilitation Nursing, with an emphasis on the domain of ventilation and the promotion of self-management of the medication regimen – inhalation therapy.
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Palavras-chave
Enfermagem de Reabilitação Reabilitação Respiratória Autogestão Bronquiectasias Terapia Inalatória