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A perda da via oral no doente oncológico em fase terminal, como despoletador da consciencialização sobre a iminência da perda da vida para o doente e família: Projeto de desenvolvimento de competências clínicas especializadas em Enfermagem Médico-Cirúrgica, na área de Enfermagem à Pessoa em Situação Paliativa
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Advisor(s)
Abstract(s)
O presente relatório foi elaborado no âmbito da Unidade Curricular de Estágio de
Desenvolvimento Profissional com Relatório Módulo II do 2º Curso de Mestrado em Enfermagem
Médico-Cirúrgica, na área de Enfermagem à Pessoa em Situação Paliativa (MEMCPSPA) da
Escola Superior de Enfermagem do Porto (ESEP), do ano letivo 2023/2024. Esta narrativa é de
carácter reflexivo e a sua finalização tem em vista a conclusão do segundo ciclo de estudos e,
consequente, obtenção do grau de Mestre em Enfermagem Médico-Cirúrgica, na área de
Enfermagem à Pessoa em Situação Paliativa.
O relatório foi executado de modo a responder aos objetivos gerais do curso de mestrado, que
visam a aplicação integrada de conhecimento disciplinar específico, com vista à aquisição de
competências clínicas nesta área do exercício profissional avançado, relacionados com a
aquisição e desenvolvimento de competências comuns e de competências específicas do
enfermeiro especialista na área de enfermagem à pessoa em situação paliativa, as quais
orientaram o desenvolvimento da prática clínica nos diferentes campos de estágio e a redação
do relatório. Este estágio decorreu em dois contextos clínicos: Equipa Intra-Hospitalar de
Suporte em Cuidados Paliativos (EIHSCP) e Unidade de Cuidados Paliativos de Elevada
Diferenciação (UCPED). O método utilizado para a elaboração deste documento foi o descritivo e
reflexivo. O processo de reflexão crítica é sustentado na prática clínica, nas experiências e nos
cenários vivenciados nos diferentes contextos clínicos e na análise da consecução dos objetivos
delineados. O suporte teórico, por sua vez, é fundamentado numa revisão de literatura,
seguindo os princípios de uma scoping review, na evidência científica mais atual e disponível, na
contextualização dos factos e no desenvolvimento de competências, tendo por base, o exposto
nos regulamentos.
O interesse neste tema basilar dos cuidados paliativos: a "perda” da via oral no doente
oncológico em fase terminal, como despoletador da consciencialização sobre a iminência da
perda da vida para o doente e família, foi surgindo ao longo da componente teórica do
Mestrado, mas também pela ânsia de adquirir competências especializadas numa área de
relevante interesse pessoal e profissional, e desde há muito ambicionado. Ao longo do meu
percurso profissional, fui confrontada com diversas situações clínicas integradas no contexto da
“perda” da via oral do doente oncológico em fase terminal e da família/cuidador, em que o
predomínio do modelo biomédico e do encarniçamento terapêutico são uma realidade que se
sobrepõe ao conforto, à dignidade e à qualidade de vida. Consistindo, por isso, numa
oportunidade de aquisição de novos conhecimentos e competências, inerentes ao grau
académico sobre a filosofia e o modus operandi dos cuidados paliativos. No que diz respeito à temática por mim explanada, a identificação das necessidades da pessoa
em situação paliativa, em fase terminal, e da sua família/cuidador no contexto da “perda” da via
oral e iminente perda da vida, deve ser feita o mais precocemente possível através de uma
correta avaliação da pessoa e família/cuidador e da sua inclusão no processo de tomada de
decisão. A elaboração do plano individual de cuidados deve ter como objetivo dar resposta às
necessidades da pessoa e família. A comunicação em cuidados paliativos é um dos pilares dos
cuidados e a principal ferramenta que os profissionais utilizam na identificação das
necessidades. Destacam-se as entrevistas clínicas e as conferências familiares como meios
imprescindíveis na identificação de necessidades e mediação do processo de doença e de
tomada de decisão. Como principais estratégias implementadas pelos enfermeiros, no contexto
da “perda” da via oral, salientam-se o controlo dos sintomas, a gestão das expectativas, o
fomento da participação ativa da pessoa e dos seus familiares no processo de tomada de
decisão sobre os cuidados no fim da vida e a promoção da aquisição do conhecimento e da
confiança da pessoa e família/cuidador sobre o processo fisiológico associado à gradual
diminuição da ingestão alimentar inerente à progressão da doença, proporcionando uma
adequada transição saúde-doença, com aceitação e atribuição de um significado, de finitude, à
“perda” da via oral, consciencialização e aceitação da morte.
A componente teórica e a análise crítico-reflexiva dos casos clínicos foram preponderantes para
a aquisição de novas competências. O presente relatório constituiu-se como um instrumento
fundamental no processo de aprendizagem e para a explanação do desenvolvimento de
competências comuns e específicas do enfermeiro especialista em enfermagem médicocirúrgica
em situação paliativa.
The present report has been prepared as part of the Professional Development Internship Course Module II of the 2nd Master's Degree Program in Medical-Surgical Nursing, specializing in Palliative Care Nursing (MEMCPSPA), at the Porto School of Nursing (ESEP), in the academic year 2023/2024. This narrative is reflective in nature, aiming towards the completion of the second cycle of studies and consequently the attainment of the Master's degree in Medical-Surgical Nursing, specializing in Palliative Care Nursing. The report was carried out in order to address the main objectives of the master's course, which aim at the integrated application of specific disciplinary knowledge, towards the acquisition of clinical skills in this area of advanced professional practice, related to the acquisition and development of both common and specific competencies of the specialist nurse in the field of palliative care nursing. These competencies guided the development of clinical practice in different internship settings and the writing of this report. This internship took place in two clinical contexts: the Intra-Hospital Palliative Care Support Team (EIHSCP) and the High Differentiation Palliative Care Unit (UCPED). The method used for developing this document was descriptive and reflective. The process of critical reflection is based on clinical practice, experiences, and scenarios experienced in different clinical contexts, and by the analysis of the achievement of the outlined objectives. The theoretical support, in turn, is based on a literature review, following the principles of a scoping review, on the most current scientific evidence available, on the contextualization of facts, and on the development of competencies, based on the regulations. The interest in this fundamental topic of palliative care - the loss of oral intake in terminal cancer patients, as a trigger for awareness of the imminent loss of life for both the patient and family - emerged throughout the theoretical component of my Master's program. It also arose from a personal and professional desire to acquire specialized skills in an area of significant interest and long-standing ambition. Throughout my professional journey, I have encountered various clinical situations within the context of the loss of oral intake in terminal cancer patients and their families/caregivers, where the predominance of the biomedical model and aggressive therapeutic interventions overshadow comfort, dignity, and quality of life. Therefore, this represents an opportunity for acquiring new knowledge and skills inherent to the academic programme, regarding the philosophy and modus operandi of palliative care. With regard to the subject I have explained, the identification of the needs of individuals in palliative care, in the terminal phase, and of their family/caregiver in the context of the loss of oral intake and imminent loss of life, should be undertaken as early as possible through a thorough assessment of the individual and their family/caregiver, and their inclusion in the decision-making process. The development of the individual care plan should aim to address the needs of the individual and their family. Communication in palliative care is one of the cornerstones of care, serving as the primary tool employed by professionals in identifying needs. Clinical interviews and family conferences stand out as essential means of identifying needs and mediating the illness and decision-making process. As primary strategies implemented by nurses in the context of the loss of oral intake, emphasis is placed on symptom management, expectation management, and fostering active participation of the individual and their relatives in end-of-life care decision-making. Additionally, nurses aim to encourage the acquisition of knowledge and confidence by the individual and their family/caregiver regarding the physiological process associated with the gradual decrease in food intake inherent in disease progression. This facilitates an adequate health-disease transition, fostering acceptance and attributing meaning to the "loss" of oral intake, and raising awareness and acceptance of death. The theoretical component and the critical reflective analysis of clinical cases were paramount in acquiring new competencies. This report served as a fundamental tool in the learning process and in elucidating the development of both common and specific competencies of the specialist nurse in medical-surgical nursing in palliative care situations.
The present report has been prepared as part of the Professional Development Internship Course Module II of the 2nd Master's Degree Program in Medical-Surgical Nursing, specializing in Palliative Care Nursing (MEMCPSPA), at the Porto School of Nursing (ESEP), in the academic year 2023/2024. This narrative is reflective in nature, aiming towards the completion of the second cycle of studies and consequently the attainment of the Master's degree in Medical-Surgical Nursing, specializing in Palliative Care Nursing. The report was carried out in order to address the main objectives of the master's course, which aim at the integrated application of specific disciplinary knowledge, towards the acquisition of clinical skills in this area of advanced professional practice, related to the acquisition and development of both common and specific competencies of the specialist nurse in the field of palliative care nursing. These competencies guided the development of clinical practice in different internship settings and the writing of this report. This internship took place in two clinical contexts: the Intra-Hospital Palliative Care Support Team (EIHSCP) and the High Differentiation Palliative Care Unit (UCPED). The method used for developing this document was descriptive and reflective. The process of critical reflection is based on clinical practice, experiences, and scenarios experienced in different clinical contexts, and by the analysis of the achievement of the outlined objectives. The theoretical support, in turn, is based on a literature review, following the principles of a scoping review, on the most current scientific evidence available, on the contextualization of facts, and on the development of competencies, based on the regulations. The interest in this fundamental topic of palliative care - the loss of oral intake in terminal cancer patients, as a trigger for awareness of the imminent loss of life for both the patient and family - emerged throughout the theoretical component of my Master's program. It also arose from a personal and professional desire to acquire specialized skills in an area of significant interest and long-standing ambition. Throughout my professional journey, I have encountered various clinical situations within the context of the loss of oral intake in terminal cancer patients and their families/caregivers, where the predominance of the biomedical model and aggressive therapeutic interventions overshadow comfort, dignity, and quality of life. Therefore, this represents an opportunity for acquiring new knowledge and skills inherent to the academic programme, regarding the philosophy and modus operandi of palliative care. With regard to the subject I have explained, the identification of the needs of individuals in palliative care, in the terminal phase, and of their family/caregiver in the context of the loss of oral intake and imminent loss of life, should be undertaken as early as possible through a thorough assessment of the individual and their family/caregiver, and their inclusion in the decision-making process. The development of the individual care plan should aim to address the needs of the individual and their family. Communication in palliative care is one of the cornerstones of care, serving as the primary tool employed by professionals in identifying needs. Clinical interviews and family conferences stand out as essential means of identifying needs and mediating the illness and decision-making process. As primary strategies implemented by nurses in the context of the loss of oral intake, emphasis is placed on symptom management, expectation management, and fostering active participation of the individual and their relatives in end-of-life care decision-making. Additionally, nurses aim to encourage the acquisition of knowledge and confidence by the individual and their family/caregiver regarding the physiological process associated with the gradual decrease in food intake inherent in disease progression. This facilitates an adequate health-disease transition, fostering acceptance and attributing meaning to the "loss" of oral intake, and raising awareness and acceptance of death. The theoretical component and the critical reflective analysis of clinical cases were paramount in acquiring new competencies. This report served as a fundamental tool in the learning process and in elucidating the development of both common and specific competencies of the specialist nurse in medical-surgical nursing in palliative care situations.
Description
Keywords
Perda de Via oral Alimentação Cuidados Paliativos Fim de vida Relatório de estágio