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Famílias com pessoa idosa dependente: Avaliação e Intervenção do Enfermeiro Especialista em Enfermagem Comunitária na Área de Enfermagem de Saúde Familiar - Projeto de Desenvolvimento de Competências Clínicas Especializadas na Área de Enfermagem de Saúde Familiar
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O presente relatório reporta o percurso académico que esteve na base do desenvolvimento de competências de Enfermagem Especializada em Saúde Comunitária e Saúde Familiar. A sua elaboração contribuiu para uma reflexão crítica sobre o percurso realizado no Estágio de natureza profissional, desenvolvido numa Unidade de Saúde Familiar (USF) na região Norte, no período de entre novembro de 2022 e junho de 2023.
O envelhecimento populacional, verificado a uma escala global, faz-se geralmente acompanhar de uma maior incidência de comorbilidades e de dependência no autocuidado. Os desafios familiares com um familiar idoso dependente podem impactar nas dinâmicas familiares e na gestão da saúde familiar.
Privilegiado por uma relação de proximidade que abarca todo o ciclo vital da família, o Enfermeiro de saúde familiar, tendo a família como unidade de cuidados, é o profissional capaz de liderar os processos de intervenção necessários ao reequilíbrio da saúde familiar, intervindo, de forma eficaz na promoção e na recuperação do bem-estar da família, em situações complexas, podendo assim, constituir um elemento facilitador para processos de transição saudável. Assim, atendendo a um contexto de uma população inscrita de 26,4% de idosos na USF onde decorreu o estágio, o objetivo primordial foi o cuidado das famílias com pessoas idosas dependentes, visando intervir sistemicamente na reestruturação das suas dinâmicas para promover ganhos em saúde. A sensibilização da equipa de enfermagem para aprimorar a avaliação e intervenção familiar nas famílias com idosos dependentes, traduzida na melhoria da documentação de cuidados no âmbito da saúde familiar, fez também parte deste trabalho. Em consonância com as diretrizes da Ordem dos Enfermeiros, os objetivos estabelecidos foram: desenvolver competências comuns do enfermeiro especialista no cuidado de famílias com pessoa idosa dependente; desenvolver competências específicas do enfermeiro especialista em enfermagem comunitária na área da saúde familiar, no cuidado de famílias com pessoas idosas dependentes. O Modelo Dinâmico de Avaliação e Intervenção Familiar (MDAIF), fundamentado no Modelo de Calgary (Wright & Leahey, 2012), foi adotado como referencial teórico-operativo para conduzir as ações implementadas junto às famílias. Esta intervenção envolveu três famílias, destacando-se os diagnósticos “Papel do prestador de cuidados não adequado" e “Processo Familiar Disfuncional”. Os resultados evidenciaram evolução nos diagnósticos, traduzindo ganhos em saúde para as famílias, sensíveis à intervenção realizada. Concomitantemente, teve lugar uma ação de formação à equipa de enfermagem, resultando numa melhoria do processo de documentação dos cuidados prestados pela equipa no âmbito da "Saúde Familiar" às famílias com pessoas idosas dependentes.
This report presents the academic journey that underpinned the development of specialized nursing skills in Community Health and Family Health. Its preparation contributed to a critical reflection on the path taken during the professional internship, carried out in a Family Health Unit (FHU) in the Northern region, between November 2022 and June 2023. The global phenomenon of population aging is often accompanied by a higher incidence of comorbidities and dependency in self-care. Family challenges with an elderly dependent member can impact family dynamics and family health management. Endowed with a close relationship that spans the entire family life cycle, the family health nurse, considering the family as the unit of care, is the professional capable of leading the necessary intervention processes to rebalance family health, effectively intervening in the promotion and recovery of family well-being in complex situations, thus potentially facilitating healthy transition processes. Therefore, given a context of 26.4% of elderly individuals enrolled in the FHU where the internship took place, the primary objective was the care of families with dependent elderly individuals, aiming to intervene systemically in restructuring their dynamics to promote health gains. Sensitizing the nursing team to enhance family assessment and intervention in families with dependent elderly individuals, reflected in the improvement of care documentation within the scope of family health, was also part of this work. In line with the guidelines of the Nursing Board, the established objectives were: to develop common skills of the specialist nurse in caring for families with dependent elderly individuals; to develop specific skills of the specialist nurse in community nursing in the area of family health in caring for families with dependent elderly individuals. The Dynamic Model of Family Assessment and Intervention (DMFAI), based on the Calgary Model (Wright & Leahey, 2012), was adopted as the theoretical-operational framework to conduct the implemented actions with families. This interventions involved three families, highlighting the diagnoses of "Inadequate Caregiver Role" and "Dysfunctional Family Process". The results showed progress in the diagnoses, translating into health gains for the families responsive to the intervention performed. Simultaneously, a training session was conducted for the nursing team, resulting in an improvement in the documentation process of the care provided by the team within the scope of "Family Health" to families with dependent elderly individuals.
This report presents the academic journey that underpinned the development of specialized nursing skills in Community Health and Family Health. Its preparation contributed to a critical reflection on the path taken during the professional internship, carried out in a Family Health Unit (FHU) in the Northern region, between November 2022 and June 2023. The global phenomenon of population aging is often accompanied by a higher incidence of comorbidities and dependency in self-care. Family challenges with an elderly dependent member can impact family dynamics and family health management. Endowed with a close relationship that spans the entire family life cycle, the family health nurse, considering the family as the unit of care, is the professional capable of leading the necessary intervention processes to rebalance family health, effectively intervening in the promotion and recovery of family well-being in complex situations, thus potentially facilitating healthy transition processes. Therefore, given a context of 26.4% of elderly individuals enrolled in the FHU where the internship took place, the primary objective was the care of families with dependent elderly individuals, aiming to intervene systemically in restructuring their dynamics to promote health gains. Sensitizing the nursing team to enhance family assessment and intervention in families with dependent elderly individuals, reflected in the improvement of care documentation within the scope of family health, was also part of this work. In line with the guidelines of the Nursing Board, the established objectives were: to develop common skills of the specialist nurse in caring for families with dependent elderly individuals; to develop specific skills of the specialist nurse in community nursing in the area of family health in caring for families with dependent elderly individuals. The Dynamic Model of Family Assessment and Intervention (DMFAI), based on the Calgary Model (Wright & Leahey, 2012), was adopted as the theoretical-operational framework to conduct the implemented actions with families. This interventions involved three families, highlighting the diagnoses of "Inadequate Caregiver Role" and "Dysfunctional Family Process". The results showed progress in the diagnoses, translating into health gains for the families responsive to the intervention performed. Simultaneously, a training session was conducted for the nursing team, resulting in an improvement in the documentation process of the care provided by the team within the scope of "Family Health" to families with dependent elderly individuals.
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Família Pessoa idosa Dependência Enfermagem de Saúde familiar Relatório de estágio