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Publication
Controlo da fragilidade da pessoa em situação crítica :
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| 2.74 MB | Adobe PDF |
Advisor(s)
Abstract(s)
A fragilidade é um conceito que tem vindo a ser utilizado em diversos contextos
da prática clínica. A fragilidade da pessoa em situação crítica aparenta ser um fator
determinante no seu prognóstico clínico, pois altera a sua capacidade de recuperação
e está associada a resultados indesejáveis como elevados níveis de mortalidade,
utilização frequente dos serviços de saúde e desenvolvimento de incapacidade.
A terapia nutricional surge como intervenção à pessoa em situação crítica na
atenuação da resposta inflamatória e catabólica exagerada à doença crítica através
da seleção e administração, pela via adequada, de nutrientes, vitaminas e outros
elementos de forma individualizada, para atender a necessidades nutricionais
específicas, presentes antes do internamento (obesidade, perda ponderal, etc.) ou
que surgem na sua sequência (doente queimado, politraumatizado, com sepsis, etc.).
A literatura demonstra que os enfermeiros aparentam ter uma atitude passiva e
de desresponsabilização sobre os cuidados na terapia nutricional da pessoa em
situação crítica. No entanto, ocupam uma posição privilegiada na prestação de
cuidados, relativamente a outros grupos profissionais, que pressupõe uma
responsabilidade de advogarem pela qualidade dos cuidados de enfermagem, no
sentido de promover melhores resultados para a pessoa em situação crítica.
O estágio a que se refere este relatório decorreu em dois contextos diferentes,
cujo percurso me permitiu adquirir e desenvolver conhecimentos e competências
especializadas de enfermagem, e cimentar a relação entre os conceitos de pessoa
em situação crítica, terapia nutricional e fragilidade na prática clínica, estabelecida na
revisão de literatura, através da translação do conhecimento. A estruturação e
organização desses conhecimentos e competências especializadas de enfermagem
foi suportada na teoria de enfermagem Fundamentals of Care, que procura captar a
complexidade e multidimensionalidade da prática da enfermagem, focando-se nas
ações do dia-a-dia, integrando-as no pensamento, reflexão e avaliação do enfermeiro.
O meu percurso de estágio permitiu-me concluir que a pessoa em situação crítica
é, efetivamente, frágil, que o grau dessa fragilidade influencia o seu percurso de
doença e de recuperação, e que a terapia nutricional deve constar das prioridades nos
cuidados de enfermagem à pessoa em situação crítica pelo controlo que exerce sobre
o seu grau de fragilidade, constituindo-se como uma prática baseada na evidência.
Frailty is a concept that has been used in many contexts of clinical practice. Frailty in the critically ill seems to be a determinant factor of their prognosis, since it alters their ability to recover and is related to negative outcomes such as high levels of mortality, regular use of health services and growing inability. Nutritional therapy emerges as an intervention in the critically ill scenario as a means to attenuate the exaggerated inflammatory and catabolic response to critical illness, through the selection and administration of nutrients, vitamins, and other elements in an individualized manner, through the appropriate route of administration, to attend the specific nutritional needs, present prior to admission (obesity, weight loss, etc.) or in its sequence (burn patient, multitrauma, sepsis, etc.). Evidence shows that nurses usually adopt a passive attitude and general disclaimer over the care involved in nutrition therapy in the critically ill. However, nurses stand in a privileged position, comparing to other members of the care team, that comes with the responsibility to advocate for the quality of nursing care, to promote outcome improvement. The internship this report refers to took place in two different contexts of care, during which I was able to acquire and develop knowledge and specialized nursing skills, and cement the relationship between the concepts of critically ill, nutritional therapy, and frailty, in the clinical practice, established through my literature review, through knowledge translation. The structuring and organization of said knowledge and skills was supported by the Fundamentals of Care nursing point-of-care theory, which aims to capture the complexity and multidimensionality of the nursing practice, focusing on daily actions, integrated in the nurse’s thoughts, reflection and judgment. With my internship, I was able to arrive to the conclusion that the critically ill patient is fragile, the degree of such frailty influences their course of illness and recovery, and that nutritional therapy must account as a priority in critical care nursing due to the control it exerts over the degree of frailty of those patients, consisting in an evidence-based practice.
Frailty is a concept that has been used in many contexts of clinical practice. Frailty in the critically ill seems to be a determinant factor of their prognosis, since it alters their ability to recover and is related to negative outcomes such as high levels of mortality, regular use of health services and growing inability. Nutritional therapy emerges as an intervention in the critically ill scenario as a means to attenuate the exaggerated inflammatory and catabolic response to critical illness, through the selection and administration of nutrients, vitamins, and other elements in an individualized manner, through the appropriate route of administration, to attend the specific nutritional needs, present prior to admission (obesity, weight loss, etc.) or in its sequence (burn patient, multitrauma, sepsis, etc.). Evidence shows that nurses usually adopt a passive attitude and general disclaimer over the care involved in nutrition therapy in the critically ill. However, nurses stand in a privileged position, comparing to other members of the care team, that comes with the responsibility to advocate for the quality of nursing care, to promote outcome improvement. The internship this report refers to took place in two different contexts of care, during which I was able to acquire and develop knowledge and specialized nursing skills, and cement the relationship between the concepts of critically ill, nutritional therapy, and frailty, in the clinical practice, established through my literature review, through knowledge translation. The structuring and organization of said knowledge and skills was supported by the Fundamentals of Care nursing point-of-care theory, which aims to capture the complexity and multidimensionality of the nursing practice, focusing on daily actions, integrated in the nurse’s thoughts, reflection and judgment. With my internship, I was able to arrive to the conclusion that the critically ill patient is fragile, the degree of such frailty influences their course of illness and recovery, and that nutritional therapy must account as a priority in critical care nursing due to the control it exerts over the degree of frailty of those patients, consisting in an evidence-based practice.
Description
Keywords
Enfermagem de cuidados intensivos Terapia nutricional Fragilidade Enfermagem baseada em evidências Teoria de enfermagem