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Processo de tomada decisão em enfermagem de reabilitação nas Unidades de Cuidados Intensivos: perspetiva do enfermeiro especialista em enfermagem de reabilitação
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Authors
Abstract(s)
Decorrente do envelhecimento populacional, dos novos tratamentos que vão
surgindo e da expansão das chamadas doenças da civilização, tem aumentado o número de
internamentos em Unidades de Cuidados Intensivos (UCI). Estes, podem provocar efeitos
deletérios que resultam em situações de incapacidade e elevada dependência, que persistem
por tempo prolongado. A reabilitação precoce pode prevenir ou limitar essas situações
(Azevedo & Gomes, 2015) e, neste sentido, o Enfermeiro Especialista em Enfermagem de
Reabilitação (EEER) apresenta um papel relevante na conceção de planos de intervenção
diferenciados durante os processos de transição, assumindo a premissa de tomar decisões.
Esta investigação teve o propósito de compreender, sob o ponto de vista dos EEER,
qual o processo de tomada de decisão nas UCI e, a partir deste ponto, construir linhas
orientadoras para uma prática efetiva de Enfermagem de Reabilitação (ER) na área.
Considerando a ótica dos participantes, os objetivos delineados para este estudo foram:
perceber o conceito de processo de tomada de decisão; identificar quais os focos e
diagnósticos de enfermagem utilizados; analisar as intervenções de ER; analisar como são
definidos os resultados a obter; identificar quais os fatores que influenciam o processo de
tomada de decisão; identificar quais as dificuldades sentidas no processo de tomada de
decisão; e identificar quais os referenciais teóricos que fundamentam e sustentam a sua
prática de cuidados.
Quanto ao método de pesquisa, realizou-se uma revisão da literatura recorrendo a
duas bases de dados de referência em saúde, a EBSCO e a PubMed, incluindo artigos
publicados no período de 2009 a 2019. Adicionalmente, foram consultados outros estudos,
teses de doutoramento e dissertações de mestrado, bem como documentos reguladores da
prática profissional dos enfermeiros e do ministério da saúde português.
Posteriormente, procedeu-se a um estudo de cariz qualitativo, exploratório e
descritivo, através de uma sessão de focus group onde participaram 6 EEER, que
exercessem funções especializadas há um ano ou mais em UCI. Os dados foram tratados
utilizando a técnica de análise de conteúdo de Bardin. Dos resultados obtidos emergem oito
áreas major: o processo de tomada de decisão; competências do EEER nas UCI; focos de
atenção; intervenções; avaliação; fatores que influenciam a tomada de decisão; sistemas de
informação; e referenciais teóricos orientadores da prática.
Due to population aging, to the emergence of new treatments and to the expansion of the so-called civilisation diseases, the number of hospitalisations in Intensive Care Units (ICU) has increased. These can cause deleterious effects that result in situations of disability and high dependence, which persist for a long time. Early rehabilitation can prevent or limit these situations (Azevedo & Gomes, 2015) and, in this sense, the Certified Rehabilitation Registered Nurse (CRRN) has a relevant role in the design of differentiated intervention plans during the transition processes, assuming the premise of making decisions. This investigation had the purpose of understanding which is the decision-making process in the ICUs from the CRRN’s point of view and, from this point on, to build guidelines for an effective practice of Rehabilitation Nursing (RN) in the area. Considering the perspective of the participants, the aims outlined for this study were: understand the concept of the decision-making process; identify which nursing diagnosis focuses are used; analyse RN interventions; analyse how the results to be obtained are defined; identify which factors influence the decision-making process; identify which difficulties are felt in the decision-making process; and identify which theoretical frameworks justify and support their care practice. As for the research method, a literature review was carried out using two health reference databases, EBSCO and PubMed, including articles published from 2009 to 2019. Additionally, other studies were consulted, doctoral theses and master's dissertations, as well as documents regulating the professional practice of nurses and the Portuguese Ministry of Health. Subsequently, a qualitative, exploratory and descriptive study was carried out, through a focus group session in which 6 CRRNs participated, who had performed specialized functions for a year or more in ICU. The data were treated using Bardin's content analysis technique. From the results obtained, eight major areas emerge: the decision-making process; competences of the CRRNs in the ICUs; focuses of attention; interventions; evaluation; factors that influence decision making; information systems; and theoretical references guiding practice.
Due to population aging, to the emergence of new treatments and to the expansion of the so-called civilisation diseases, the number of hospitalisations in Intensive Care Units (ICU) has increased. These can cause deleterious effects that result in situations of disability and high dependence, which persist for a long time. Early rehabilitation can prevent or limit these situations (Azevedo & Gomes, 2015) and, in this sense, the Certified Rehabilitation Registered Nurse (CRRN) has a relevant role in the design of differentiated intervention plans during the transition processes, assuming the premise of making decisions. This investigation had the purpose of understanding which is the decision-making process in the ICUs from the CRRN’s point of view and, from this point on, to build guidelines for an effective practice of Rehabilitation Nursing (RN) in the area. Considering the perspective of the participants, the aims outlined for this study were: understand the concept of the decision-making process; identify which nursing diagnosis focuses are used; analyse RN interventions; analyse how the results to be obtained are defined; identify which factors influence the decision-making process; identify which difficulties are felt in the decision-making process; and identify which theoretical frameworks justify and support their care practice. As for the research method, a literature review was carried out using two health reference databases, EBSCO and PubMed, including articles published from 2009 to 2019. Additionally, other studies were consulted, doctoral theses and master's dissertations, as well as documents regulating the professional practice of nurses and the Portuguese Ministry of Health. Subsequently, a qualitative, exploratory and descriptive study was carried out, through a focus group session in which 6 CRRNs participated, who had performed specialized functions for a year or more in ICU. The data were treated using Bardin's content analysis technique. From the results obtained, eight major areas emerge: the decision-making process; competences of the CRRNs in the ICUs; focuses of attention; interventions; evaluation; factors that influence decision making; information systems; and theoretical references guiding practice.
Description
Curso de Mestrado ministrado em parceria com Escola Superior de Enfermagem S. José de Cluny e Escola Superior de Enfermagem Dr. José Timóteo Montalvão Machado
Keywords
Tomada de Decisão Processo de Enfermagem Unidades de Cuidados Intensivos Enfermagem de reabilitação