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Percursos de assistência dos enfermeiros de reabilitação numa equipa de cuidados continuados integrados
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Advisor(s)
Abstract(s)
A especialidade de enfermagem de reabilitação tem uma expressão assimétrica a nível
mundial. Na europa, Portugal é o único país que possui esta área de especialidade. A criação
da Rede Nacional de Cuidados Continuados Integrados (RNCCI), no ano de 2006, surgiu para
colmatar a necessidade de cuidados de saúde decorrentes da dependência no autocuidado,
considerando o perfil epidemiológico da população atual. As Equipas de Cuidados
Continuados Integrados (ECCI) atuam em ambiente domiciliário, sendo um dos contextos
assistenciais privilegiados do desempenho da atividade profissional dos Enfermeiros
Especialistas em Enfermagem de Reabilitação (EEER).
Com a finalidade de contribuir para melhorar a organização dos cuidados prestados pelos
EEER nas ECCI, a partir do Sistema de Informação em Enfermagem (SIE) em uso, objetivamos
caracterizar o perfil dos utentes que integram as ECCI ao cuidado dos EEER, analisar os focos
e os diagnósticos de enfermagem bem como as intervenções documentadas, e identificar o
percurso dos cuidados prestados pelos EEER aos utentes a partir dos registos de
enfermagem. Desenvolvemos, para isso, um estudo exploratório, descritivo, retrospetivo e
de carácter misto.
A amostra do estudo é constituída por 590 casos pertencentes a 496 utentes, com uma média
de 76,18 anos de idade, sendo que o sexo feminino assume maior representatividade
(63,4%). Os cuidados de reabilitação foram a tipologia de cuidados preponderante como
motivo de admissão em ECCI e, do total da amostra, a maioria dos casos teve alta com os
objetivos atingidos. A média de dias de internamento em ECCI foi de 61,42.
Da análise documental e estatística aos registos de enfermagem nas ECCI, percecionou-se
que os EEER prestam cuidados comuns e cuidados inerentes às suas competências
específicas. Dos focos de enfermagem mais relevantes para a sua prática profissional,
agrupados pelas suas competências específicas, emergiram o Autocuidado, o Andar, o
Transferir-se, a Obstipação, a Aspiração, a Memória, o Andar com Auxiliar de Marcha, o Papel
Prestador de Cuidados, o Usar a Cadeira de Rodas, a Interação Social, a Comunicação
Expressiva, o Movimento Muscular, a Queda, o Equilíbrio Corporal, a Ventilação e a Limpeza
das Vias Aéreas. O desenvolvimento da competência “maximiza a funcionalidade
desenvolvendo as capacidades da pessoa” sobressaiu com maior representatividade no seio
dos cuidados de enfermagem de reabilitação prestados nas ECCI e Atender foi o tipo de ação
no qual se incluíram a maioria das intervenções dos EEER.
Consolidamos que os registos de enfermagem efetuados pelos EEER vão de encontro às suas
competências específicas. Admitimos, contudo, que um maior equilíbrio entre estas deveria
coexistir, a par do desenvolvimento em maior profundidade dos focos e dos diagnósticos
inerentes a cada competência. A inclusão do cuidador nos cuidados ao utente poderá ser
também uma realidade mais trabalhada futuramente bem como a documentação no âmbito
da capacitação e da aquisição de conhecimentos. Áreas de atenção ligadas à cognição, à
comunicação, à socialização e à acessibilidade/inclusão social enquadram-se também no
leque de competências específicas dos EEER que, embora presentes na documentação,
sobressaíram pela diminuta expressão. Consideramos, contudo, que, por motivos vários,
uma parte dos cuidados desempenhados pelos EEER nas ECCI possam não estar
documentados no SIE em uso.
The Rehabilitation Nursing specialty has an asymmetric expression worldwide. In Europe, Portugal is the only country that has this area of expertise. The creation of the National Network of Integrated Continuing Care (RNCCI), in 2006, emerged to fill the need for health care resulting from dependence on self-care, considering the epidemiological profile of the current population. The Integrated Continuing Care Teams (ECCI) work in a home environment, being one of the privileged care contexts for the performance of the professional activity of Nurse Specialists in Rehabilitation Nursing (EEER). In order to contribute to improving the organization of care provided by EEER in ECCI, based on the Nursing Information System (SIE) in use, we aim to characterize the profile of users who integrate ECCI to the care of EEER, analyze the focuses and the nursing diagnoses as well as the documented interventions, and identify the path of care provided by the EEER to the users from the nursing records. For this purpose, we developed an exploratory, descriptive, retrospective and mixed study. The study sample consists of 590 cases belonging to 496 users, with an average age of 76,18 years, with females being more representative (63.4%). Rehabilitation care was the predominant care typology as a reason for admission to ECCI and, of the total sample, most cases were discharged with the objectives achieved. The mean number of days of hospitalization in ECCI was 61,42. From the documental and statistical analysis of the nursing records in the ECCI, it was perceived that the EEER provide common care and care inherent to their specific competences. From the most relevant nursing focuses for their professional practice, grouped by their specific skills, Self Care, Walking, Self Transferring, Constipation, Aspiration, Memory, Walking Using Device, Caregiver Role, Wheelchair Use, Socialising, Communicating, Body Movement, Fall, Balance, Ventilation and Airway Clearance. The development of the competence “maximizes functionality by developing the person's capabilities” stood out with greater representation within the rehabilitation nursing care provided in ECCI and Attending was the type of action in which most of the EEER interventions were included. We consolidate that the nursing records made by the EEER meet their specific competences. We admit, however, that a greater balance between these should coexist, along with the development in greater depth of the focuses and diagnoses inherent to each competence. The inclusion of the caregiver in the care provided to the user may also be a reality that will be further worked on in the future, as well as the documentation within the scope of training and acquisition of knowledge. Areas of attention linked to cognition, communication, socialization and accessibility/social inclusion also fall within the range of specific competences of the EEER which, although present in the documentation, stood out for their small expression. We consider, however, that, for various reasons, part of the care performed by the EEER in the ECCI may not be documented in the SIE in use.
The Rehabilitation Nursing specialty has an asymmetric expression worldwide. In Europe, Portugal is the only country that has this area of expertise. The creation of the National Network of Integrated Continuing Care (RNCCI), in 2006, emerged to fill the need for health care resulting from dependence on self-care, considering the epidemiological profile of the current population. The Integrated Continuing Care Teams (ECCI) work in a home environment, being one of the privileged care contexts for the performance of the professional activity of Nurse Specialists in Rehabilitation Nursing (EEER). In order to contribute to improving the organization of care provided by EEER in ECCI, based on the Nursing Information System (SIE) in use, we aim to characterize the profile of users who integrate ECCI to the care of EEER, analyze the focuses and the nursing diagnoses as well as the documented interventions, and identify the path of care provided by the EEER to the users from the nursing records. For this purpose, we developed an exploratory, descriptive, retrospective and mixed study. The study sample consists of 590 cases belonging to 496 users, with an average age of 76,18 years, with females being more representative (63.4%). Rehabilitation care was the predominant care typology as a reason for admission to ECCI and, of the total sample, most cases were discharged with the objectives achieved. The mean number of days of hospitalization in ECCI was 61,42. From the documental and statistical analysis of the nursing records in the ECCI, it was perceived that the EEER provide common care and care inherent to their specific competences. From the most relevant nursing focuses for their professional practice, grouped by their specific skills, Self Care, Walking, Self Transferring, Constipation, Aspiration, Memory, Walking Using Device, Caregiver Role, Wheelchair Use, Socialising, Communicating, Body Movement, Fall, Balance, Ventilation and Airway Clearance. The development of the competence “maximizes functionality by developing the person's capabilities” stood out with greater representation within the rehabilitation nursing care provided in ECCI and Attending was the type of action in which most of the EEER interventions were included. We consolidate that the nursing records made by the EEER meet their specific competences. We admit, however, that a greater balance between these should coexist, along with the development in greater depth of the focuses and diagnoses inherent to each competence. The inclusion of the caregiver in the care provided to the user may also be a reality that will be further worked on in the future, as well as the documentation within the scope of training and acquisition of knowledge. Areas of attention linked to cognition, communication, socialization and accessibility/social inclusion also fall within the range of specific competences of the EEER which, although present in the documentation, stood out for their small expression. We consider, however, that, for various reasons, part of the care performed by the EEER in the ECCI may not be documented in the SIE in use.
Description
Keywords
Cuidados continuados Enfermagem em Reabilitação Serviços de Assistência Domiciliar Sistemas de Informação em Saúde