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Advisor(s)
Abstract(s)
A qualidade tornou-se uma questão intemporal e um fenómeno de crescente interesse nas organizações de
saúde. No entanto, a qualidade não se pode avaliar apenas a partir de apreciações subjetivas, e por isso,
requer estratégias de monitorização e de avaliação.
A produção de informação válida e fiável é crucial para a avaliação da qualidade em saúde. Em Portugal, o
Departamento da Qualidade na Saúde tem como missão promover e disseminar, nas instituições prestadoras
de cuidados de saúde, uma cultura de melhoria contínua da qualidade, traçando linhas orientadoras sobre as
áreas consideradas mais relevantes para a qualidade na saúde. O contributo da enfermagem para a qualidade
na saúde é colocado no desafio de acrescentar valor à qualidade em saúde, através de um paradigma de
enfermagem centrado nos processos de transição que as pessoas vivenciam em resultado de eventos na sua
saúde ou na incorporação de novos papéis.
O percurso de investigação que desenvolvemos centrou-se na reflexão a partir de informação válida traduzida
em indicadores de enfermagem enquanto estratégia para aumentar a qualidade do exercício profissional dos
enfermeiros, permitindo o desenvolvimento de um modelo de melhoria contínua da qualidade. Neste
contexto desenhou-se um ciclo investigação-ação como o método adequado aos propósitos do estudo.
A informação válida produzida pelos enfermeiros permitiu a reflexão em torno de oportunidades de
desenvolvimento, a partir do modelo II de Argyris & Schön (1982), que conduzissem a mudança no exercício
profissional dos enfermeiros. A melhoria da qualidade no contexto de ação pressupõe o questionamento e a
reflexão dos modelos em uso, de modo a que estes se aproximem dos modelos expostos. Os modelos que
enformam a ação decorrem de processos lentos e graduais de desenvolvimento profissional e da capacidade
individual de autoquestionamento que permite o distanciamento reflexivo capaz de traduzir mudança efetiva.
As áreas de enfermagem assumidas para se incluírem no programa de melhoria contínua da qualidade
inscrevem-se no âmbito do autocuidado e do desempenho do papel do membro da família prestador de
cuidados. Os ganhos em saúde sensíveis aos cuidados de enfermagem onde se verificaram melhorias
integram os aspetos relativos à preparação do membro da família para o desempenho do papel de prestador
de cuidados. A promoção da autonomia das pessoas com dependência para o autocuidado não revelou ganhos
significativos, dadas as modificações nos contextos organizacionais e a integração destes doentes na rede de
cuidados continuados, o que reduziu o impacto dos resultados nesta área e neste contexto clínico.
Reconhece-se que o valor atribuído à documentação recai essencialmente, sobre o valor legal da informação
e sobre a continuidade de cuidados. A reflexão-ação em que assentou o processo de melhoria contínua da
qualidade, potencia modificações e gera novas perspetivas de ação, não significando, no entanto, mudanças
imediatas, mas conduz a mudanças internalizadas e de caráter duradouro.
Quality has become a timeless question and a phenomenon of increasing interest in health organizations. However, quality cannot be evaluated only by subjective appraisals and, therefore, requires monitoring and evaluation strategies. The production of valid and reliable information is crucial for the evaluation of quality in health. In Portugal, the Health Quality Department has the mission of promoting and disseminate, in the national health care institutions, a culture of continuous quality improvement, tracing guidelines about the areas considered as most relevant to the health quality. The contribution of nursing to health quality is placed on the challenge of adding value to quality in health, through a nursing paradigm centered on transition processes that people experience as a result of events in their health or in the incorporation of new roles. The course of investigation that we developed focused on the reflection departing from valid information translated into nursing indicators, as a strategy to increase the quality in the professional exercise of nurses, allowing the development of a model of continuous improvement of quality. In this context, an actionresearch cycle was drawn as the suitable method to the study purposes. The valid information produced by nurses allowed the reflection around development opportunities, as from the Argyris & Schön model II (1982), which would lead to change in the professional exercise of nurses. The quality improvement in the context of action presupposes the questioning and the reflection of the models in use, in a way that these come closer to the models exposed. The models that shape the action derive from slow and gradual processes of professional development and from the individual ability of self-questioning that allows the reflexive distancing capable of translating into an effective change. The areas of nursing assumed to be included in the continuous quality improvement program are inserted in the domain of self-care and family caregiver role performance. The nursing care sensitive health outcomes where improvements have been observed integrate the aspects related to the preparation of family caregiver in the performance of caretaking activities. The promotion of autonomy in individuals with self-care dependency didn’t reveal significant gains, given the modifications in organizational contexts and their integration in the long-term care network, which reduced the impact of the results in this area and in this clinical context. It is recognized that the value attributed to documentation lies essentially upon the legal value of the information and the continuity of care. The reflection-in-action that based the continuous quality improvement process potentiates modifications and generates new perspectives of action, not meaning, however, immediate changes, but leading to internal changes with long lasting character.
Quality has become a timeless question and a phenomenon of increasing interest in health organizations. However, quality cannot be evaluated only by subjective appraisals and, therefore, requires monitoring and evaluation strategies. The production of valid and reliable information is crucial for the evaluation of quality in health. In Portugal, the Health Quality Department has the mission of promoting and disseminate, in the national health care institutions, a culture of continuous quality improvement, tracing guidelines about the areas considered as most relevant to the health quality. The contribution of nursing to health quality is placed on the challenge of adding value to quality in health, through a nursing paradigm centered on transition processes that people experience as a result of events in their health or in the incorporation of new roles. The course of investigation that we developed focused on the reflection departing from valid information translated into nursing indicators, as a strategy to increase the quality in the professional exercise of nurses, allowing the development of a model of continuous improvement of quality. In this context, an actionresearch cycle was drawn as the suitable method to the study purposes. The valid information produced by nurses allowed the reflection around development opportunities, as from the Argyris & Schön model II (1982), which would lead to change in the professional exercise of nurses. The quality improvement in the context of action presupposes the questioning and the reflection of the models in use, in a way that these come closer to the models exposed. The models that shape the action derive from slow and gradual processes of professional development and from the individual ability of self-questioning that allows the reflexive distancing capable of translating into an effective change. The areas of nursing assumed to be included in the continuous quality improvement program are inserted in the domain of self-care and family caregiver role performance. The nursing care sensitive health outcomes where improvements have been observed integrate the aspects related to the preparation of family caregiver in the performance of caretaking activities. The promotion of autonomy in individuals with self-care dependency didn’t reveal significant gains, given the modifications in organizational contexts and their integration in the long-term care network, which reduced the impact of the results in this area and in this clinical context. It is recognized that the value attributed to documentation lies essentially upon the legal value of the information and the continuity of care. The reflection-in-action that based the continuous quality improvement process potentiates modifications and generates new perspectives of action, not meaning, however, immediate changes, but leading to internal changes with long lasting character.
Description
Keywords
Informação válida Indicadores de qualidade de enfermagem Reflexão-ação Melhoria contínua da qualidade Valid information Quality nursing indicators Reflection-in-action Continuous quality improvement