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Publication
Gestão da dor na pessoa em situação crítica
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Authors
Abstract(s)
A dor constitui o principal motivo para a procura de cuidados de saúde por
parte da população em geral, sendo comum na pessoa em situação crítica em
repouso e durante procedimentos. A dor não controlada nos doentes irá resultar na
deterioração das funções respiratórias e cardíacas, aumentar a morbilidade e a
mortalidade, prolongar o período de recuperação e aumentar os custos com a
assistência médica. É considerada um dos focos de atuação do enfermeiro, sendo o
seu controlo um direito das pessoas e um dever dos profissionais de saúde.
A gestão da dor implica a deteção, avaliação, monitorização e controlo, bem
como a educação da pessoa e da família e o registo das intervenções realizadas,
sendo que, a chave para a gestão da dor é avaliar, intervir e reavaliar após cada
intervenção implementada. A avaliação da dor fundamenta e serve de suporte às
intervenções dos profissionais de saúde no seu controlo, sendo que este
controlo/gestão é considerado um indicador de qualidade dos cuidados de
enfermagem, no que concerne à satisfação do doente, prevenção de complicações e
ao bem-estar e auto-cuidado do doente. Um compromisso de equipa na abordagem
da dor é fundamental, devendo incluir a participação da pessoa em situação crítica
que sente dor e família, enquanto parceiros de cuidados, tendo por base a teoria de
enfermagem Technological Competency as Caring in Nursing de Rozzano Locsin. O desenvolvimento deste tema surge enquanto estratégia para o
desenvolvimento de competências especializadas de enfermagem na área da PSC, dando resposta às competências preconizadas pelos descritores de Dublin
referentes ao 2º ciclo de estudos e também às competências propostas pela ESEL, referentes ao mestrado, de forma a adquirir o grau académico de mestre e título
profissional de especialista, tendo em conta as competências comuns e específicas
do enfermeiro especialista em enfermagem na área da PSC. O processo de
desenvolvimento de competências teve como base o modelo de Dreyfus de
aquisição de competências, adaptado por Benner para a prática de enfermagem,
que enfatiza a importância da experiência e do domínio das competências, numa
perspetiva evolutiva, visando o desenvolvimento e otimização da prática de
prestação de cuidados.
Com o objetivo de desenvolver competências na gestão da dor na pessoa em
situação crítica, o percurso de desenvolvimento de competências que aqui se
documenta decorreu por intermédio dos estágios realizados nos contextos de
serviço de urgência e unidade de cuidados intensivos, este último numa unidade de
queimados. São apresentadas as principais atividades realizadas e os resultados
obtidos nos contextos, com recurso à prática reflexiva para o desenvolvimento
competências. Para além das competências inerentes à gestão da dor, foram ainda
desenvolvidas competências na antecipação de situações de instabilidade e
soluções para as questões complexas, optimização de competências no âmbito da
comunicação com o doente e sua família, bem como ferramentas e estratégias de
gestão na área da saúde.
Pain is the main reason for seeking health care by the general population, being common in critically ill patients at rest and during procedures. Uncontrolled pain in patients will result in deterioration of respiratory and cardiac functions, increase morbidity and mortality, prolong the recovery period and increase health care costs. It is considered one of the nurses' focus of activity, and its control is a right of people and a duty of health professionals. Pain management implies the detection, evaluation, monitoring and control, as well as the education of the person and the family and the documentation of the interventions performed. The key to pain management is to assess, intervene and reassess after each intervention implemented. Pain assessment underlies and supports the interventions of health professionals in their control, and this control / management is an indicator of nursing care quality, with regard to patient satisfaction, prevention of complications, well-being and self-care. A team commitment in addressing pain is essential, and it must include the participation of the person in a critical situation who feels pain and family, as care partners, based on the theory of nursing Technological Competency as Caring in Nursing by Rozzano Locsin. The pain control was central point for the development of specialized nursing skills in critically ill patients. This was done responding to the competencies advocated by Dublin descriptors for the 2nd cycle of studies and thoseproposed by ESEL. Aiming to acquire also the professional title of specialist, the common and specific skills produced by Ordem dos Enfermeiros to the specialist nurse in critically ill patients nursing. The process of skills development was based on the Dreyfus model of skills acquisition, adapted by Benner for nursing practice, which emphasizes the importance of experience and mastery of skills, in an evolutionary perspective, aiming at the development and optimization of practice care delivery. In order to develop skills in critically ill patients’ pain management, the pathway of skills development documented here took place through the internships carried out in the contexts of emergency and intensive care unit, the latter in a burn unit. The main activities carried out and the results obtained in the contexts are presented, using reflective practice in skills development. In addition to the skills inherent in pain management, skills were also developed in anticipating hypotheses of instability and solving of complex issues, optimizing competencies in the communication process with the patient and his family, as well as other management tools and strategy in healthcare.
Pain is the main reason for seeking health care by the general population, being common in critically ill patients at rest and during procedures. Uncontrolled pain in patients will result in deterioration of respiratory and cardiac functions, increase morbidity and mortality, prolong the recovery period and increase health care costs. It is considered one of the nurses' focus of activity, and its control is a right of people and a duty of health professionals. Pain management implies the detection, evaluation, monitoring and control, as well as the education of the person and the family and the documentation of the interventions performed. The key to pain management is to assess, intervene and reassess after each intervention implemented. Pain assessment underlies and supports the interventions of health professionals in their control, and this control / management is an indicator of nursing care quality, with regard to patient satisfaction, prevention of complications, well-being and self-care. A team commitment in addressing pain is essential, and it must include the participation of the person in a critical situation who feels pain and family, as care partners, based on the theory of nursing Technological Competency as Caring in Nursing by Rozzano Locsin. The pain control was central point for the development of specialized nursing skills in critically ill patients. This was done responding to the competencies advocated by Dublin descriptors for the 2nd cycle of studies and thoseproposed by ESEL. Aiming to acquire also the professional title of specialist, the common and specific skills produced by Ordem dos Enfermeiros to the specialist nurse in critically ill patients nursing. The process of skills development was based on the Dreyfus model of skills acquisition, adapted by Benner for nursing practice, which emphasizes the importance of experience and mastery of skills, in an evolutionary perspective, aiming at the development and optimization of practice care delivery. In order to develop skills in critically ill patients’ pain management, the pathway of skills development documented here took place through the internships carried out in the contexts of emergency and intensive care unit, the latter in a burn unit. The main activities carried out and the results obtained in the contexts are presented, using reflective practice in skills development. In addition to the skills inherent in pain management, skills were also developed in anticipating hypotheses of instability and solving of complex issues, optimizing competencies in the communication process with the patient and his family, as well as other management tools and strategy in healthcare.
Description
Keywords
Enfermagem de cuidados intensivos Cuidados críticos Terapia da dor Cuidados de enfermagem