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Rumo à prestação do cuidado seguro
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| 1.94 MB | Adobe PDF |
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O presente relatório enquadra¬se no curso de Mestrado em Enfermagem, na área de Especialização em Enfermagem Médico¬Cirúrgica, na vertente da Pessoa em Situação Crítica, da Escola de Enfermagem de Lisboa, do Instituto de Ciências da Saúde da Universidade Católica Portuguesa. Decorre do desenvolvimento de três estágios com foco no cuidado à pessoa em situação crítica: experiência I – Bloco operatório, experiência II – Serviço de atendimento permanente e o estágio realizado na Unidade Cuidados Intensivos Cirúrgicos Cardiotorácica (estágio opcional). A realização dos estágios e sobre os quais incide o presente relatório decorreram na área urbana de Lisboa, no período compreendido entre o dia 2 de junho de 2020 e 15 de janeiro 2021. Numa análise reflexiva sobre o contexto de cuidados e no âmbito da promoção da qualidade e segurança dos cuidados surgiu o interesse pelo tema das boas práticas clínicas, concretamente no que respeita à sua adesão e efeitos, porque nem sempre os enfermeiros fazem aquilo que sabem. A forma de atuação dos profissionais de saúde relaciona¬se com a qualidade do cuidado prestado e com a satisfação e benefício da pessoa doente. Assim, para as boas práticas/práticas baseadas em evidência converge uma multiplicidade de fatores. Perante o exposto e de modo a fundamentar a prática com a melhor evidência científica foi realizada uma revisão de literatura, do tipo scoping review, tendo sido definida como questão de investigação: Quais os fatores que influenciam a adesão dos enfermeiros às boas praticas clínicas? O relatório que ora se apresenta possui o objetivo de descrever as atividades desenvolvidas e que viabilizaram a aquisição de competências especializadas nos diferentes contextos da prática clínica, recorrendo ao pensamento crítico, reflexivo e a uma atitude de proatividade e permanente questionamento das práticas profissionais. Assim, o desenvolvimento de competências compatíveis com o nível de enfermeiro especialista em Enfermagem Médico Cirúrgica constitui¬se como um caminho, inacabado e que foi sendo construído ao longo deste percurso formativo, e sobre o qual versa este relatório. Com vista ao relato fiel e próximo da realidade experienciada, caracterizou¬se, não só as atividades desenvolvidas confrontadas com transições de vida, momentos da vida em que se verificam grandes níveis de vulnerabilidade e assim, consequentemente, de risco para a saúde, mas também o fundamento inerente ao processo de tomada de decisão. O referencial teórico adotado foi a teoria da transição de Alaf Meleis. A análise crítica e reflexiva acerca das competências comuns e específicas, que se encontram descritas ao longo deste relatório, revela¬se construtiva e enriquecedora, contribuindo para o meu crescimento pessoal e profissional através da consciencialização das minhas capacidades enquanto futura enfermeira especialista bem como dos domínios que carecem de investimento no futuro. Importa referir que identifico como limitação e constrangimento à realização dos estágios supracitados, a situação pandémica atual, manifestada por exaustão das equipas multidisciplinares e aumento do volume de trabalho relacionado especialmente com o controlo da pandemia e tratamento das pessoas doentes com diagnóstico clínico de SARS Cov2.
This report is part of the Master's Degree in Nursing in the area of Specialization in Medical-Surgical Nursing, in the area of Critical Care, of the Nursing School of Lisbon, Institute of Health Sciences of the Portuguese Catholic University. It results from the development of three internships focused on the care of critically ill patients: Experience I Operating Theatre, Experience II Permanent Attendance Service and the internship carried out at the Cardiothoracic Surgical Intensive Care Unit (optional internship). These internships, which are the focus of this report, took place in the urban area of Lisbon, between June 2nd, 2020 and January 15th, 2021. In a reflective analysis of the care context and within the scope of the promotion of quality and safety of care, the interest in the topic of good clinical practices emerged, specifically regarding its adherence and effects, because nurses do not always do what they know. The way health professionals act is related to the quality of care provided and the patient's satisfaction and benefit. Thus, a multiplicity of factors converge for good practices/evidence¬based practices. In view of the above and in order to base practice on the best scientific evidence, a scoping review of the literature was conducted and the following research question was defined: What factors influence nurses' adherence to good clinical practices? This report aims to describe the activities that were developed and enabled the acquisition of specialized skills in different contexts of clinical practice, using critical and reflective thinking and an attitude of proactivity and permanent questioning of professional practices. Thus, the development of competencies compatible with the level of specialist nurse in Medical Surgical Nursing is an unfinished path that was built throughout this formative journey, which is the subject of this report. In order to provide a faithful and close account of the reality experienced, we characterized not only the activities developed confronted with life transitions, moments of life in which there are high levels of vulnerability and thus, consequently, of health risk. Analysis, but also the rationale inherent to the decision making process. The theoretical framework adopted was Alaf Meleis' transition theory. In nursing practice, the focus will be on the human responses of individuals when they are faced with life transitions, moments of life in which there are high levels of vulnerability and, consequently, of health risk. The critical and reflective analysis about the common and specific competencies, which are described throughout this report, has proven to be constructive and enriching, contributing to my personal and professional growth through the awareness of my abilities as a future specialist nurse as well as the areas that need investment in the future. It is important to mention that I identify the current pandemic situation, manifested by the exhaustion of multidisciplinary teams and increased workload related especially to the control of the pandemic and treatment of patients with clinical diagnosis of SARS Cov2, as a limitation and constraint to the completion of the internships mentioned above.
This report is part of the Master's Degree in Nursing in the area of Specialization in Medical-Surgical Nursing, in the area of Critical Care, of the Nursing School of Lisbon, Institute of Health Sciences of the Portuguese Catholic University. It results from the development of three internships focused on the care of critically ill patients: Experience I Operating Theatre, Experience II Permanent Attendance Service and the internship carried out at the Cardiothoracic Surgical Intensive Care Unit (optional internship). These internships, which are the focus of this report, took place in the urban area of Lisbon, between June 2nd, 2020 and January 15th, 2021. In a reflective analysis of the care context and within the scope of the promotion of quality and safety of care, the interest in the topic of good clinical practices emerged, specifically regarding its adherence and effects, because nurses do not always do what they know. The way health professionals act is related to the quality of care provided and the patient's satisfaction and benefit. Thus, a multiplicity of factors converge for good practices/evidence¬based practices. In view of the above and in order to base practice on the best scientific evidence, a scoping review of the literature was conducted and the following research question was defined: What factors influence nurses' adherence to good clinical practices? This report aims to describe the activities that were developed and enabled the acquisition of specialized skills in different contexts of clinical practice, using critical and reflective thinking and an attitude of proactivity and permanent questioning of professional practices. Thus, the development of competencies compatible with the level of specialist nurse in Medical Surgical Nursing is an unfinished path that was built throughout this formative journey, which is the subject of this report. In order to provide a faithful and close account of the reality experienced, we characterized not only the activities developed confronted with life transitions, moments of life in which there are high levels of vulnerability and thus, consequently, of health risk. Analysis, but also the rationale inherent to the decision making process. The theoretical framework adopted was Alaf Meleis' transition theory. In nursing practice, the focus will be on the human responses of individuals when they are faced with life transitions, moments of life in which there are high levels of vulnerability and, consequently, of health risk. The critical and reflective analysis about the common and specific competencies, which are described throughout this report, has proven to be constructive and enriching, contributing to my personal and professional growth through the awareness of my abilities as a future specialist nurse as well as the areas that need investment in the future. It is important to mention that I identify the current pandemic situation, manifested by the exhaustion of multidisciplinary teams and increased workload related especially to the control of the pandemic and treatment of patients with clinical diagnosis of SARS Cov2, as a limitation and constraint to the completion of the internships mentioned above.
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Keywords
Cuidado especializado em enfermagem Qualidade e segurança do cuidado Boas práticas clínicas Specialized nursing care Quality and safety of care Good clinical practice