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O estertor na pessoa em situação paliativa – o papel do enfermeiro especialista na gestão e facilitação da aceitação deste sinal
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Abstract(s)
O presente relatório de estágio foi desenvolvido no período da unidade curricular Estágio de
Natureza Profissional com Relatório – Módulo II, do Mestrado em Enfermagem Médico-Cirúrgica,
na área de Enfermagem à Pessoa em Situação Paliativa, na Escola Superior de Enfermagem do
Porto.
Foram concretizadas duas conceções de dois casos clínicos reais, envolvendo os doentes, seus
cuidadores e famílias, utilizando a estrutura formatada do plano de cuidados na plataforma
e4nursing. A prática clínica, decorreu numa Equipa Intra-Hospitalar de Suporte em Cuidados
Paliativos e numa Equipa Comunitária de Suporte em Cuidados Paliativos, com a duração total
de 340 horas.
Durante o tempo de estágio pude desenvolver e aprimorar competências desta área de
especialização, podendo fazer parte, como membro integrante de cuidados, nestas equipas
multidisciplinares e dessa forma desenvolver as áreas fundamentais do cuidar em cuidados
paliativos como o trabalho em equipa, o controlo sintomático, a comunicação e o apoio à
família.
A fase agónica e situação de últimos dias e horas de vida do doente paliativo assumem o tema
central deste relatório por ser uma fase sensível no cuidar e as intervenções de enfermagem
adotarem maior importância no que toca à promoção do conforto e bem-estar tanto no doente
como na família. Foi abordado o estertor como um sinal comum na fase terminal da pessoa, com
a intenção de fornecer informações para as intervenções mais adequadas a serem realizadas
pela equipa de enfermagem, visando minimizá-lo.
Exercer funções em cuidados paliativos, numa Unidade de Internamento de Oncologia e
Cuidados Paliativos de um hospital privado desde 2016, facilitou a razão da escolha do tema
deste projeto de estágio, pois entendo que o surgimento deste sinal, desencadeia, tanto aos
familiares como aos profissionais de saúde, sentimentos de sofrimento, ansiedade, angústia e
inquietação.
Logo, com base numa Scoping Review realizada antes de iniciar o estágio sobre o tema, que se
revelou uma mais valia, assim como na observação da prática clínica, foram abordadas as
necessidades do doente com estertor e das suas famílias, bem como as dificuldades dos
profissionais que prestam cuidados a estes doentes.
O facto de me integrar nas equipas dos contextos anteriormente mencionados permitiu-me
recolher informação imprescindível para refletir e, dessa forma, desenvolver as competências especificas pretendidas do enfermeiro especialista em enfermagem médico-cirúrgica na área de
enfermagem à pessoa em situação paliativa. As competências adquiridas foram todas
fundamentais para o meu desenvolvimento pessoal e profissional
The present internship report was developed during the Professional Internship with Report - Module II course, as part of the Master's program in Medical-Surgical Nursing, specializing in Palliative Care Nursing, at the Porto Nursing School. Two real clinical cases were implemented, involving patients, their caregivers, and families, using the structured care plan framework on the e4nursing platform. The clinical practice took place in both an In-Hospital Palliative Care Support Team and a Community Palliative Care Support Team, totaling 340 hours. During the internship period, I was able to develop and enhance skills in this specialization area, becoming an integral member of these multidisciplinary teams and thereby developing the core areas of palliative care, such as teamwork, symptom management, communication, and family support. The agonic phase and the patient's last days and hours of life in palliative care are the central themes of this report, as it is a sensitive phase in caregiving, and nursing interventions become particularly important in promoting comfort and well-being for both the patient and the family. The "death rattle" was addressed as a common sign in the terminal phase of a person's life, with the intention of providing information for the most appropriate nursing interventions to minimize it. Working in palliative care in an Oncology and Palliative Care Inpatient Unit of a private hospital since 2016 influenced the choice of the internship project theme. I understand that the emergence of this sign triggers feelings of suffering, anxiety, anguish, and restlessness in both family members and healthcare professionals. Therefore, based on a Scoping Review conducted before starting the internship on the subject, which proved to be valuable, as well as clinical practice observation, the needs of patients with the death rattle and their families, as well as the challenges faced by professionals providing care to these patients, were addressed. Being part of the teams in the aforementioned contexts allowed me to gather essential information for reflection and, thus, develop the specific skills expected of a nurse specialist in medical-surgical nursing in the field of palliative care. The acquired skills were all essential for my personal and professional development.
The present internship report was developed during the Professional Internship with Report - Module II course, as part of the Master's program in Medical-Surgical Nursing, specializing in Palliative Care Nursing, at the Porto Nursing School. Two real clinical cases were implemented, involving patients, their caregivers, and families, using the structured care plan framework on the e4nursing platform. The clinical practice took place in both an In-Hospital Palliative Care Support Team and a Community Palliative Care Support Team, totaling 340 hours. During the internship period, I was able to develop and enhance skills in this specialization area, becoming an integral member of these multidisciplinary teams and thereby developing the core areas of palliative care, such as teamwork, symptom management, communication, and family support. The agonic phase and the patient's last days and hours of life in palliative care are the central themes of this report, as it is a sensitive phase in caregiving, and nursing interventions become particularly important in promoting comfort and well-being for both the patient and the family. The "death rattle" was addressed as a common sign in the terminal phase of a person's life, with the intention of providing information for the most appropriate nursing interventions to minimize it. Working in palliative care in an Oncology and Palliative Care Inpatient Unit of a private hospital since 2016 influenced the choice of the internship project theme. I understand that the emergence of this sign triggers feelings of suffering, anxiety, anguish, and restlessness in both family members and healthcare professionals. Therefore, based on a Scoping Review conducted before starting the internship on the subject, which proved to be valuable, as well as clinical practice observation, the needs of patients with the death rattle and their families, as well as the challenges faced by professionals providing care to these patients, were addressed. Being part of the teams in the aforementioned contexts allowed me to gather essential information for reflection and, thus, develop the specific skills expected of a nurse specialist in medical-surgical nursing in the field of palliative care. The acquired skills were all essential for my personal and professional development.
Description
Keywords
Cuidados paliativos Intra-hospitalar Domicílio Estertor Competências Relatório de estágio