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Avaliação e controlo da dor na pessoa adulta em situação paliativa com alterações cognitivas: Projeto de desenvolvimento de competências clínicas especializadas na área de enfermagem à pessoa em situação paliativa
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| 7.14 MB | Adobe PDF |
Advisor(s)
Abstract(s)
Num contexto onde a sociedade está a envelhecer progressivamente e a enfrentar um aumento
nas doenças crónicas e terminais, os cuidados paliativos têm uma importância vital, tendo por
objetivos prioritários a promoção da qualidade de vida e o bem-estar da pessoa.
Este relatório pretende descrever o trajeto realizado durante o período do ensino clínico. São
concetualizados os Cuidados Paliativos, cuja unidade de cuidados é o doente/família e que
assentam em quatro pilares fundamentais: controlo sintomático, comunicação adequada, apoio
à família/cuidador e trabalho de equipa.
É realizada a caracterização dos contextos clínicos onde se desenvolveu o estágio, e são
apresentados dois casos clínicos para o desenvolvimento de competências profissionais. Através
da sua análise, em ambientes diferentes dos cuidados paliativos, foi possível compreender
melhor a temática da avaliação e gestão da dor e de outros sintomas na pessoa em situação
paliativa. Estes casos revelam que a avaliação sintomática deve ser avaliada individualmente de
forma contínua, quantificada e documentada. A dor não detetada e mal controlada afeta
significativamente a qualidade de vida e aumenta a morbilidade, sendo que o instrumento
adequado para a sua avaliação deve corresponder às capacidades da pessoa. A gestão eficaz da
dor requer habilidades específicas, e a sua gestão apropriada é uma medida de eficácia dos
cuidados paliativos. Os casos clínicos permitiram ainda identificar as necessidades do doente e
dos seus cuidadores/familiares ao nível físico, psico emocional, espiritual e sociofamiliar; avaliar
e controlar adequadamente os sintomas do doente, identificar e antecipar situações de
agudização e atuar em conformidade; promover intervenções baseadas na evidência junto do
doente e dos seus cuidadores/familiares respeitando as suas preferências e valores; envolver os
cuidadores/familiares para otimizar resultados na satisfação das necessidades do doente;
desenvolver uma ação interdisciplinar e em articulação com os outros serviços de apoio,
utilizando estratégias de comunicação na relação com todos os intervenientes no processo de
cuidar e dinamizando o trabalho em equipa; estabelecer relação terapêutica com o doente e
seus cuidadores/familiares, proporcionando suporte no processo de adaptação às perdas
sucessivas, no processo de morrer e de luto; promover parcerias terapêuticas com o doente e
seus cuidadores/familiares; negociar objetivos/metas de cuidados, mutuamente acordadas
dentro do ambiente terapêutico; e reconhecer os efeitos da natureza do cuidar no(s) alvos dos
cuidados e em todos os elementos da equipa.
É efetuada uma exposição e reflexão das atividades concretizadas durante a prática clínica, que
permite dar conta das experiências que contribuíram para atingir os objetivos propostos,
promovendo a aquisição de competências comuns e específicas do enfermeiro especialista em
Enfermagem Médico-cirúrgica na área da pessoa em situação paliativa.
Através da combinação de competências comuns e específicas, o enfermeiro especialista em
cuidados paliativos surge como uma figura central, sendo capaz de ter uma intervenção
diferenciadora na vida da pessoa que enfrenta os desafios de uma doença incurável ou grave,
em fase avançada, progressiva e terminal. Durante a realização do estágio de natureza profissional surgiram algumas dificuldades,
relacionadas nomeadamente com a gestão de tempo para conseguir conjugar o horário de
trabalho com o horário de estágio, para a elaboração de trabalhos durante o estágio (revisão de
literatura, casos clínicos e relatório de estágio) e a vida pessoal.
In a context where society is progressively aging and facing an increase in chronic and terminal illnesses, palliative care is of vital importance, with the priority objectives of promoting the person's quality of life and well-being. This report aims to describe the journey taken during the clinical teaching period. Palliative Care is conceptualized, whose unit of care is the patient/family and which is based on four fundamental pillars: symptomatic control, adequate communication, support for the family/caregiver and teamwork. The clinical contexts where the internship took place are characterized, and two clinical cases are presented for the development of professional skills. Through its analysis, in environments other than palliative care, it was possible to better understand the topic of assessment and management of pain and other symptoms in people in palliative situations. These cases reveal that symptomatic assessment must be individually assessed in a continuous, quantified and documented manner. Undetected and poorly controlled pain significantly affects quality of life and increases morbidity, and the appropriate instrument for its assessment must correspond to the person's capabilities. Effective pain management requires specific skills, and appropriate pain management is a measure of palliative care effectiveness. The clinical cases also made it possible to identify the needs of the patient and their caregivers/family members at a physical, psycho-emotional, spiritual and socio-family level; adequately evaluate and control the patient's symptoms, identify and anticipate worsening situations and act accordingly; promote evidencebased interventions with the patient and their caregivers/family members, respecting their preferences and values; involve caregivers/family members to optimize results in meeting the patient's needs; develop interdisciplinary action in conjunction with other support services, using communication strategies in the relationship with everyone involved in the care process and boosting teamwork; establish a therapeutic relationship with the patient and their caregivers/family members, providing support in the process of adaptation to successive losses, in the process of dying and mourning; promote therapeutic partnerships with the patient and their caregivers/family members; negotiate mutually agreed care objectives/goals within the therapeutic environment; and recognize the effects of the nature of care on the care recipient(s) and all team members. An exhibition and reflection of the activities carried out during clinical practice is carried out, which allows an account of the experiences that contributed to achieving the proposed objectives, promoting the acquisition of common and specific skills of the specialist nurse in Medical-surgical Nursing in the area of the person in situation palliative. Through the combination of common and specific skills, the nurse specialist in palliative care emerges as a central figure, being able to have a differentiating intervention in the life of the person facing the challenges of an incurable or serious illness, in an advanced, progressive and terminal phase. During the professional internship, some difficulties arose, particularly related to time management in order to combine working hours with internship hours, to prepare work during the internship (literature review, clinical cases and clinical report). internship) and personal life.
In a context where society is progressively aging and facing an increase in chronic and terminal illnesses, palliative care is of vital importance, with the priority objectives of promoting the person's quality of life and well-being. This report aims to describe the journey taken during the clinical teaching period. Palliative Care is conceptualized, whose unit of care is the patient/family and which is based on four fundamental pillars: symptomatic control, adequate communication, support for the family/caregiver and teamwork. The clinical contexts where the internship took place are characterized, and two clinical cases are presented for the development of professional skills. Through its analysis, in environments other than palliative care, it was possible to better understand the topic of assessment and management of pain and other symptoms in people in palliative situations. These cases reveal that symptomatic assessment must be individually assessed in a continuous, quantified and documented manner. Undetected and poorly controlled pain significantly affects quality of life and increases morbidity, and the appropriate instrument for its assessment must correspond to the person's capabilities. Effective pain management requires specific skills, and appropriate pain management is a measure of palliative care effectiveness. The clinical cases also made it possible to identify the needs of the patient and their caregivers/family members at a physical, psycho-emotional, spiritual and socio-family level; adequately evaluate and control the patient's symptoms, identify and anticipate worsening situations and act accordingly; promote evidencebased interventions with the patient and their caregivers/family members, respecting their preferences and values; involve caregivers/family members to optimize results in meeting the patient's needs; develop interdisciplinary action in conjunction with other support services, using communication strategies in the relationship with everyone involved in the care process and boosting teamwork; establish a therapeutic relationship with the patient and their caregivers/family members, providing support in the process of adaptation to successive losses, in the process of dying and mourning; promote therapeutic partnerships with the patient and their caregivers/family members; negotiate mutually agreed care objectives/goals within the therapeutic environment; and recognize the effects of the nature of care on the care recipient(s) and all team members. An exhibition and reflection of the activities carried out during clinical practice is carried out, which allows an account of the experiences that contributed to achieving the proposed objectives, promoting the acquisition of common and specific skills of the specialist nurse in Medical-surgical Nursing in the area of the person in situation palliative. Through the combination of common and specific skills, the nurse specialist in palliative care emerges as a central figure, being able to have a differentiating intervention in the life of the person facing the challenges of an incurable or serious illness, in an advanced, progressive and terminal phase. During the professional internship, some difficulties arose, particularly related to time management in order to combine working hours with internship hours, to prepare work during the internship (literature review, clinical cases and clinical report). internship) and personal life.
Description
Keywords
Avaliação da dor Controlo da dor Alterações cognitivas Pessoa em situação paliativa Relatório de estágio