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Desenvolvimento de competências de enfermagem especializadas em cuidados paliativos: A pessoa com doença renal crónica terminal
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Advisor(s)
Abstract(s)
O presente relatório foi desenvolvido no âmbito do Mestrado em Enfermagem
Médico-Cirúrgica, na Área de Enfermagem à Pessoa em Situação Paliativa e teve como
objetivo descrever e analisar o processo de aquisição de competências gerais e específicas
do enfermeiro especialista, e o desenvolvimento de competências de mestre.
A doença renal crónica é uma questão de saúde pública e a sua evolução ocorre em
5 estadios. Quando o doente atinge o estadio 5 está perante uma falência total do rim, sendo
necessário decidir qual a terapia de substituição que é mais adequada para a pessoa
sobreviver. A hemodiálise é a opção mais comum, porém, nem sempre a que oferece maior
qualidade de vida ao doente. A terapia de substituição da função renal impacta
significativamente a vida do doente e da sua família, exigindo várias restrições alimentares
e mudanças no estilo de vida. Estas adaptações implicam um elevado consumo de recursos
especializados, essenciais para ajudar o doente a ajustar-se a esta nova realidade. Ao longo
dos diversos ensinos clínicos, e na elaboração deste relatório, baseei-me nos princípios da
Teoria do Conforto de Kolcaba para o planeamento e execução de cuidados.
Privilegiou-se uma metodologia descritiva, analítica e reflexiva para a descrição do
processo de aquisição de competências. Alguns dos trabalhos realizados serviram como
ponte entre os conhecimentos teóricas adquiridos em contexto de aulas e as práticas em
contexto clínico. Destaco o projeto de autoformação, a realização de uma revisão integrativa
da literatura publicada numa revista científica, um estudo de caso (aceite para publicação),
um mapa concetual e a elaboração de posters de cariz científico a serem apresentados em
congressos nacionais.
Elaborou-se ainda uma scoping review sobre os instrumentos para avaliação de
necessidades da pessoa com doença renal crónica terminal a qual integra este relatório em
formato de artigo. Nesta revisão conclui-se que, apesar da panóplia de instrumentos de
avaliação de necessidades, apesar de existirem alguns instrumentos para avaliação de
necessidades de cuidados paliativos ao doente em geral, são poucos aqueles que são
específicos para o doente renal crónico terminal. O Integrated Palliative Care Outcome –
Renal foi o instrumento mais mencionado nos estudos analisados pela sua praticabilidade e
relevância atualmente.
This report was developed within the scope of the Master's Degree in Medical Surgical Nursing, in the Area of Nursing for People in Palliative Situations, and aimed to describe and analyse the process of acquiring general and specific skills of the specialist nurse, and the development of master's skills. Chronic kidney disease is a public health issue and its evolution occurs in 5 stages. When the patient reaches stage 5 he is facing total kidney failure, and it is necessary to decide which replacement therapy is most suitable for the person to survive. Haemodialysis is the most common option; however, it is not always the one that offers the best quality of life for the patient. Renal function replacement therapy significantly impacts the lives of the patient and their family, requiring several dietary restrictions and lifestyle changes. These adaptations involve a high consumption of specialized resources, essential to help the patient adjust to this new reality. Throughout the various clinical trainings, and in the preparation of this report, I based myself on the principles of Kolcaba's Comfort Theory for planning and implementing care. A descriptive, analytical and reflective methodology was used to describe the process of acquiring competences. Some of the work carried out served as a bridge between the theoretical knowledge acquired in the classroom and the practices in a clinical context. I would like to highlight the self-training project, the completion of an integrative review of the literature published in a scientific journal, a case study (accepted for publication), a conceptual map and the preparation of scientific posters to be presented at national conferences. A scoping review was also prepared on the instruments for assessing the needs of people with end-stage chronic kidney disease, which is part of this report in article format. In this review it is concluded that, despite the range of needs assessment instruments, although there are some instruments for assessing palliative care needs for patients in general, there are few that are specific to end-stage chronic renal patients. The Integrated Palliative Care Outcome – Renal was the most cited instrument in the studies analysed due to its practicality and relevance today.
This report was developed within the scope of the Master's Degree in Medical Surgical Nursing, in the Area of Nursing for People in Palliative Situations, and aimed to describe and analyse the process of acquiring general and specific skills of the specialist nurse, and the development of master's skills. Chronic kidney disease is a public health issue and its evolution occurs in 5 stages. When the patient reaches stage 5 he is facing total kidney failure, and it is necessary to decide which replacement therapy is most suitable for the person to survive. Haemodialysis is the most common option; however, it is not always the one that offers the best quality of life for the patient. Renal function replacement therapy significantly impacts the lives of the patient and their family, requiring several dietary restrictions and lifestyle changes. These adaptations involve a high consumption of specialized resources, essential to help the patient adjust to this new reality. Throughout the various clinical trainings, and in the preparation of this report, I based myself on the principles of Kolcaba's Comfort Theory for planning and implementing care. A descriptive, analytical and reflective methodology was used to describe the process of acquiring competences. Some of the work carried out served as a bridge between the theoretical knowledge acquired in the classroom and the practices in a clinical context. I would like to highlight the self-training project, the completion of an integrative review of the literature published in a scientific journal, a case study (accepted for publication), a conceptual map and the preparation of scientific posters to be presented at national conferences. A scoping review was also prepared on the instruments for assessing the needs of people with end-stage chronic kidney disease, which is part of this report in article format. In this review it is concluded that, despite the range of needs assessment instruments, although there are some instruments for assessing palliative care needs for patients in general, there are few that are specific to end-stage chronic renal patients. The Integrated Palliative Care Outcome – Renal was the most cited instrument in the studies analysed due to its practicality and relevance today.
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Keywords
Conforto Hemodiálise Doença Renal Crónica Terminal Cuidados Paliativos
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