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A família e a gestão da doença crónica: Avaliação e Intervenção do Enfermeiro Especialista em Enfermagem de Saúde Familiar: Projeto de desenvolvimento de competências clínicas especializadas em enfermagem comunitária na área de enfermagem de saúde família
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Abstract(s)
A doença crónica, é considerada um evento stressor, podendo despoletar na família uma transição acidental. Nesse cenário, são inevitáveis alterações na dinâmica familiar, e esta procura ajustar-se às perturbações decorrentes da condição de saúde. Essas adaptações têm como finalidade preservar a estabilidade familiar, promovendo resiliência diante dos desafios impostos pela doença e fortalecendo os laços que unem cada membro desse sistema.
No âmbito das Unidades Curriculares Estágio de Natureza Profissional com Projeto Módulo I e Estágio de Natureza Profissional com Relatório Módulo II, do Curso de Mestrado de Enfermagem Comunitária na área de Enfermagem de Saúde Familiar da Escola Superior de Enfermagem do Porto, foram delineados os seguintes objetivos: caracterizar a família na sua dimensão estrutural; desenvolvimental e estrutural; identificar forças promotoras da adaptação da família à doença crónica; melhorar as competências da família para gerir o impacto da doença crónica; melhorar as competências do elemento com doença crónica para uma autogestão eficaz da doença; dinamizar formação em serviço contribuindo para a melhoria da qualidade na atenção à família com elemento com doença crónica.
O Modelo Dinâmico de Avaliação e Intervenção Familiar, que tem como referencial epistemológico o pensamento sistémico e o Modelo de Calgary, foi usado como recurso na avaliação das famílias. A teoria das Transições de Meleis também serviu de referencial na conceção de cuidados que promovem a capacitação da pessoa e família na adaptação e gestão da doença crónica.
Selecionamos quatro famílias em que exploramos de forma particular os referenciais teóricos e a conceção de cuidados. Estas tinham em comum problemas de autogestão de uma doença crónica em pelo menos um dos seus membros, e as intervenções realizadas tiveram como objetivo capacitar o indivíduo e a família no processo de gestão da doença crónica.
O processo desenvolvido foi importante para o desenvolvimento de competências comuns e específicas inerentes ao enfermeiro especialista que, através de um conhecimento aprofundado das famílias, dos elementos que as constituem e sua dinâmicas, valores e preferências, permitiu a conceção de cuidados adaptados à realidade de cada uma das famílias, contribuindo para melhores resultados e ganhos em saúde.
Chronic illness is considered a stressful event and can trigger an accidental transition in the family. In this scenario, changes in family dynamics are inevitable, and the family tries to adjust to the disturbances resulting from the health condition. The purpose of these adaptations is to preserve family stability, promoting resilience in the face of the challenges posed by the illness and strengthening the ties that bind each member of this system. Within the scope of the Curricular Units Professional Internship with Project Module I and Professional Internship with Report Module II, of the Master's Degree Course in Community Nursing in the area of Family Health Nursing at the Escola Superior de Enfermagem do Porto, the following objectives were outlined: to characterize the family in its structural; developmental and structural dimensions; to identify forces that promote the family's adaptation to chronic illness; to improve the family's skills to manage the impact of chronic illness; to improve the skills of the element with chronic illness for effective self-management of the illness; to streamline in-service training contributing to improving the quality of care for the family with an element with chronic illness. The Dynamic Model of Family Assessment and Intervention, whose epistemological framework is systemic thinking and the Calgary Model, was used as a resource for assessing families. Meleis' Transitions theory was also used as a reference in designing care that promotes the empowerment of the person and family in adapting to and managing chronic illness. We selected four families to explore the theoretical frameworks and the design of care in a particular way. These families shared problems of self-management of a chronic illness in at least one of their members, and the interventions carried out were aimed at empowering the individual and the family in the process of managing the chronic illness. The process developed was important for the development of common and specific skills inherent to the specialist nurse who, through in-depth knowledge of families, their constituent elements and their dynamics, values and preferences, enabled the design of care adapted to the reality of each family, contributing to better results and health gains.
Chronic illness is considered a stressful event and can trigger an accidental transition in the family. In this scenario, changes in family dynamics are inevitable, and the family tries to adjust to the disturbances resulting from the health condition. The purpose of these adaptations is to preserve family stability, promoting resilience in the face of the challenges posed by the illness and strengthening the ties that bind each member of this system. Within the scope of the Curricular Units Professional Internship with Project Module I and Professional Internship with Report Module II, of the Master's Degree Course in Community Nursing in the area of Family Health Nursing at the Escola Superior de Enfermagem do Porto, the following objectives were outlined: to characterize the family in its structural; developmental and structural dimensions; to identify forces that promote the family's adaptation to chronic illness; to improve the family's skills to manage the impact of chronic illness; to improve the skills of the element with chronic illness for effective self-management of the illness; to streamline in-service training contributing to improving the quality of care for the family with an element with chronic illness. The Dynamic Model of Family Assessment and Intervention, whose epistemological framework is systemic thinking and the Calgary Model, was used as a resource for assessing families. Meleis' Transitions theory was also used as a reference in designing care that promotes the empowerment of the person and family in adapting to and managing chronic illness. We selected four families to explore the theoretical frameworks and the design of care in a particular way. These families shared problems of self-management of a chronic illness in at least one of their members, and the interventions carried out were aimed at empowering the individual and the family in the process of managing the chronic illness. The process developed was important for the development of common and specific skills inherent to the specialist nurse who, through in-depth knowledge of families, their constituent elements and their dynamics, values and preferences, enabled the design of care adapted to the reality of each family, contributing to better results and health gains.
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Keywords
Família Gestão da doença Crónica Enfermagem Familiar Cuidados de Saúde Primários Relatório de estágio