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Publication
Continuidade dos cuidados de enfermagem de reabilitação, na transição da pessoa adulta em situação de doença, do contexto hospitalar para a comunidade: proposta de intervenção
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Advisor(s)
Abstract(s)
Relacionado com a continuidade de cuidados, o conceito de transição de cuidados,
segundo vários autores, é descrito como a transmissão de informação entre profissionais de
saúde. Aos profissionais de enfermagem de um modo particular, nos diversos contextos é
lhes reconhecido um papel fundamental na escolha da informação e das intervenções que
são fundamentais para uma efetiva continuidade dos cuidados nas transições intra e inter-
hospitalares, bem como na transição para o contexto de cuidados de saúde primários.
Para conhecer o estado da arte sobre esta temática e simultaneamente dar resposta aos
objetivos propostos para a unidade curricular Estágio Final, revisitou-se a estrutura e funci-
onamento dos contextos de cuidados de saúde, a teoria de Afaf Meleis e foram prestados
cuidados de enfermagem de reabilitação orientados para os resultados a utentes assistidos no
domicílio. Foi ainda elaborada uma proposta de intervenção capaz de contribuir para a me-
lhoria da continuidade dos cuidados e finalmente, a partir da reflexão critica descreveram-
se as intervenções que levaram ao processo de aquisição e desenvolvimento das competên-
cias comuns de enfermeiro especialista, de especialista em enfermagem de reabilitação e de
mestre.
Related to the continuity of care, the concept of care transition, according to several authors, is described as the transmission of information between health professionals. Nurs- ing, in different contexts, are recognized as having a fundamental role in choosing infor- mation and interventions that are fundamental for an effective continuity of care in intra- and inter-hospital transitions, as well as in the transition to the context of primary health care. To know the state of the art on this subject and simultaneously respond to the pro- posed objectives for the Final Internship curricular unit, the structure and functioning of health care settings and Afaf Meleis' theory were revisited, and outcome-oriented rehabili- tation nursing care was provided to users assisted at home. An intervention proposal capable of contributing to improving the continuity of care was also developed. Finally, based on the critical reflection, the interventions that led to the process of acquisition and development of the common competencies of a specialist nurse, a specialist in rehabilitation nursing, and a master's degree were described.
Related to the continuity of care, the concept of care transition, according to several authors, is described as the transmission of information between health professionals. Nurs- ing, in different contexts, are recognized as having a fundamental role in choosing infor- mation and interventions that are fundamental for an effective continuity of care in intra- and inter-hospital transitions, as well as in the transition to the context of primary health care. To know the state of the art on this subject and simultaneously respond to the pro- posed objectives for the Final Internship curricular unit, the structure and functioning of health care settings and Afaf Meleis' theory were revisited, and outcome-oriented rehabili- tation nursing care was provided to users assisted at home. An intervention proposal capable of contributing to improving the continuity of care was also developed. Finally, based on the critical reflection, the interventions that led to the process of acquisition and development of the common competencies of a specialist nurse, a specialist in rehabilitation nursing, and a master's degree were described.
Description
Keywords
Continuidade de cuidados Transição de cuidados Comunicação Contexto comunitário Contexto hospitalar Continuity of care Care transition Communication Community context Hospital context