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Advisor(s)
Abstract(s)
A doença crónica é hoje no mundo e, em particular na Europa, a responsável por grande parte da mortalidade e morbilidade, prevendo-se uma acentuação deste cenário nos próximos anos. Com frequência a doença crónica e suas co morbilidades representam a causa de episódios de internamento, por descompensação da doença e, ou, das suas consequências. Este é um fenómeno complexo e não se explica através de um único fator; no entanto, sabe-se que uma gestão inadequada da doença e do regime terapêutico recomendado é uma das causas apontada com maior frequência. O elevado número de episódios de repetição de internamento demonstra carências em cuidados que os evitem e diminuam os custos sociais e económicos que lhes estão inerentes para além da qualidade de vida perdida.
Este estudo equaciona as questões da gestão da doença e do regime terapêutico enquanto atividades de autocuidado (autogestão), partindo do pressuposto que a forma como é vivida a transição saúde/doença influencia a forma como se desenvolverão os processos adaptativos, de desenvolvimento da mestria e de uma identidade fluída que incorpore a doença como parte integrante do “eu”.
Finalidade: Criar um modelo explicativo sobre a gestão do regime terapêutico levada a cabo por pessoas com manifestação de ineficácia dessa gestão, tendo em vista inferir os elementos de uma intervenção em saúde promotora de uma gestão responsável do autocuidado.
Participantes e métodos: Uma análise no número de internamentos de pessoas que, no ano de 2006 e/ou de Janeiro de 2007 até 30 de Setembro do mesmo ano, tenham tido “mais que um episódio de internamento”, na Unidade Local de Saúde de Matosinhos (Hospital Pedro Hispano), revela a existência de 8695 registos de episódios de internamento (englobando os que entretanto faleceram); destes, 3004 correspondem a clientes sobre os quais não existe assento de falecimento e que correspondem a 7027 episódios de internamento, com um máximo de onze durante o período considerado. Para o estudo foram selecionados os que apresentavam doença crónica, mais que cinco episódios de internamento e que pertenciam à área de abrangência dos Centros de Saúde da ULS Matosinhos. Após análise dos processos clínicos hospitalares, da tentativa de contato e de verificação de todos os critérios de inclusão foram selecionados vinte e dois participantes que aceitaram participar no estudo e que apresentavam reinternamentos relacionados direta ou indiretamente com a(s) mesma(s) doença(s), que se presumiu pudessem estar relacionadas com uma gestão ineficaz do regime terapêutico Estes vinte e dois participantes foram acompanhados, por um período máximo de cerca de um ano e meio, num estudo longitudinal, constituindo vinte e dois “casos” – estudo multicasos. Os dados foram obtidos pela análise de documentação, designadamente consulta de processos clínicos e por observação participante. Foram realizadas entrevistas aos participantes e acompanhados em contexto familiar e/ou institucional.
Os dados foram analisados de acordo com o método proposto por Strauss e Corbin para gerar uma Grounded Theory. Iniciando-se por uma microanálise que se organizou numa codificação aberta, agrupando os conceitos e verificando as relações que mantinham entre si através de uma análise axial e, finamente, sintetizando os dados elaborando a sua redução teórica numa codificação seletiva, apresentando-se, finalmente, a teoria.
Resultados: Neste estudo emergem duas condições face à autogestão: o padrão de complexidade do regime terapêutico e o padrão de vulnerabilidade. O padrão de vulnerabilidade e, por oposição, o padrão de resiliência, resultam de duas condições: a contextual e a pessoal.
O contexto de maior vulnerabilidade que emerge no estudo é o socioeconómico e cultural – a pobreza, sendo o contexto familiar o fator discriminatório face ao anterior; enquanto o suporte familiar é o fator protetor que emerge com maior ênfase nos relatos dos participantes e na síntese da observação.
Da análise das condições pessoais, pela atitude face à vida e à doença e aos atributos pessoais, resultou um agrupamento em quatro padrões, que denominamos como “estilos de gestão”: responsável; independente; formalmente guiado; negligente.
Conclusões e implicações para a prática clínica: Deste estudo conclui-se que enquanto para os profissionais o foco se situa na preparação da pessoa para a mestria, as pessoas com doença crónica se focalizam na vivência da própria transição e no desejo de manter a continuidade na sua vida. A incorporação de necessidades de autogestão da doença e do regime terapêutico é realizada de acordo com as condições pessoais e contextuais, sendo que algumas destas condições são pouco propícias a uma transição saudável e constituem por isso verdadeiros desafios à prática de enfermagem
Chronic disease is responsible in the world, and particularly in Europe, for much of the mortality and morbidity, it is expected an increase of this scenario in the coming years. Often chronic disease and its comorbidities represent the cause of episodes of hospitalization for lack of disease control, or its consequences. Hospital readmissions is a complex phenomenon and cannot be explained by a single fator, however it is known that inadequate management of the disease and ineffectiveness of self-management are reasons pointed out more often in studies. The high number of episodes of hospital care, show deficiencies in primary care that should prevent and minimize the social and economic costs associated with them, and improve the quality of life of the persons with chronic illness. This study issues on disease management and treatment regimen, as a self-care activities (self-management), assuming that the way the health/disease transition is experienced influences the way the adaptive processes move on, the development of mastery and a fluid identity, that incorporates the disease as part of the "self". Purpose: Create an explanatory model on the management of therapeutic regimen carried out by people with demonstration of ineffectiveness of self-management, in order to infer the elements of a health intervention that promotes a responsible self-management. Methods and Participants: An analysis of the number of hospitalizations of people who, in 2006 and / or January 2007 to September 30 of that year, have had "more than one episode of internment" in the Local Health Unit Matosinhos (Hospital Pedro Hispano), reveals the existence of records of 8695 inpatient episodes (though covering those who died) and of these, 3004 represent clients on which there is no seat of death and which correspond to 7027 episodes of hospitalization, with a maximum of eleven during the period considered. Selected for study were those with chronic illness, more than five episodes of hospitalization and who belonged to the catchment area of the health centers of the ULS Matosinhos. After analysis of hospital medical records, the attempt to contact and check all the inclusion criteria were selected twenty-two participants who agreed to participate in the study and who had re-hospitalization related diretly or indiretly with chronic disease(s), which was assumed could be related to inefficient self-management. These twenty-two participants were followed for a maximum of a year and a half, in a longitudinal study, like twenty-two "cases" - multicases study. Data were obtained from the analysis of documentation, including clinical documentation and participant observation. Participants were interviewed and followed in family or institutional context. The data were analyzed according to the method proposed by Strauss and Corbin, to generate a Grounded Theory. Beginning with a microanalysis, which was organized in an open coding, than grouping the concepts and their relationships through an axial analysis, and summarizing the data, drawing up theoretical reduction in a selective coding, finally, presenting the theory. Results: In this study two conditions emerge face to self-management: the complexity of the treatment regimen and the pattern of vulnerability. The pattern of vulnerability and, in the opposite, the pattern of resilience, is the result of two conditions: a contextual and personal. The context of greater vulnerability that emerges in the study is the socio-economic and cultural - poverty, family background and the discriminatory fator compared to the previous, while family support is a protective fator that emerges with greater emphasis on participants' reports and the synthesis of observation. From the analysis of personal circumstances, attitude to life and illness, and personal attributes, participants grouped in four patterns, which we named to as "management styles": responsible, independent, formally guided, negligent.. Conclusions and implications for clinical practice: This study concludes that while the focus for professionals is situated in preparation for mastery, people with chronic disease focus on the experience of the transition itself, and in the desire to maintain continuity in his life. The incorporation of self-management needs of the disease and the treatment regimen is carried out according to the personal and contextual fators, and some of these conditions are hardly conducive to a healthy transition, and so are real challenges to the practice of nursing
Chronic disease is responsible in the world, and particularly in Europe, for much of the mortality and morbidity, it is expected an increase of this scenario in the coming years. Often chronic disease and its comorbidities represent the cause of episodes of hospitalization for lack of disease control, or its consequences. Hospital readmissions is a complex phenomenon and cannot be explained by a single fator, however it is known that inadequate management of the disease and ineffectiveness of self-management are reasons pointed out more often in studies. The high number of episodes of hospital care, show deficiencies in primary care that should prevent and minimize the social and economic costs associated with them, and improve the quality of life of the persons with chronic illness. This study issues on disease management and treatment regimen, as a self-care activities (self-management), assuming that the way the health/disease transition is experienced influences the way the adaptive processes move on, the development of mastery and a fluid identity, that incorporates the disease as part of the "self". Purpose: Create an explanatory model on the management of therapeutic regimen carried out by people with demonstration of ineffectiveness of self-management, in order to infer the elements of a health intervention that promotes a responsible self-management. Methods and Participants: An analysis of the number of hospitalizations of people who, in 2006 and / or January 2007 to September 30 of that year, have had "more than one episode of internment" in the Local Health Unit Matosinhos (Hospital Pedro Hispano), reveals the existence of records of 8695 inpatient episodes (though covering those who died) and of these, 3004 represent clients on which there is no seat of death and which correspond to 7027 episodes of hospitalization, with a maximum of eleven during the period considered. Selected for study were those with chronic illness, more than five episodes of hospitalization and who belonged to the catchment area of the health centers of the ULS Matosinhos. After analysis of hospital medical records, the attempt to contact and check all the inclusion criteria were selected twenty-two participants who agreed to participate in the study and who had re-hospitalization related diretly or indiretly with chronic disease(s), which was assumed could be related to inefficient self-management. These twenty-two participants were followed for a maximum of a year and a half, in a longitudinal study, like twenty-two "cases" - multicases study. Data were obtained from the analysis of documentation, including clinical documentation and participant observation. Participants were interviewed and followed in family or institutional context. The data were analyzed according to the method proposed by Strauss and Corbin, to generate a Grounded Theory. Beginning with a microanalysis, which was organized in an open coding, than grouping the concepts and their relationships through an axial analysis, and summarizing the data, drawing up theoretical reduction in a selective coding, finally, presenting the theory. Results: In this study two conditions emerge face to self-management: the complexity of the treatment regimen and the pattern of vulnerability. The pattern of vulnerability and, in the opposite, the pattern of resilience, is the result of two conditions: a contextual and personal. The context of greater vulnerability that emerges in the study is the socio-economic and cultural - poverty, family background and the discriminatory fator compared to the previous, while family support is a protective fator that emerges with greater emphasis on participants' reports and the synthesis of observation. From the analysis of personal circumstances, attitude to life and illness, and personal attributes, participants grouped in four patterns, which we named to as "management styles": responsible, independent, formally guided, negligent.. Conclusions and implications for clinical practice: This study concludes that while the focus for professionals is situated in preparation for mastery, people with chronic disease focus on the experience of the transition itself, and in the desire to maintain continuity in his life. The incorporation of self-management needs of the disease and the treatment regimen is carried out according to the personal and contextual fators, and some of these conditions are hardly conducive to a healthy transition, and so are real challenges to the practice of nursing
Description
Keywords
Transição Doença crónica Gestão do regime terapêutico Autocuidado Autogestão Empowermen Vulnerabilidade Resiliência Transition Chronic disease Chronic illness Chronic conditions Self-care Therapeutic regime management Self-management Vulnerability Resilience