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O contributo da prática especializada na qualidade e segurança dos cuidados
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O presente relatório foi elaborado no âmbito da Unidade Curricular "Estágio Final e Relatório", integrada no 17.º Curso de Mestrado em Enfermagem com Especialização em Enfermagem Médico-Cirúrgica, na área de Enfermagem à Pessoa em Situação Crítica, do Instituto de Ciências da Saúde da Universidade Católica Portuguesa no período de 02 de setembro de 2024 a 26 de março de 2025. O documento reflete o percurso formativo desenvolvido ao longo desta unidade curricular, evidenciando o processo de aquisição e consolidação de competências inerentes ao exercício do Enfermeiro Especialista e Mestre, bem como o impacto destas no desempenho profissional em contexto clínico diferenciado. O processo formativo decorreu em dois contextos complementares: um Serviço de Medicina Intensiva Polivalente e em Emergência Extra-Hospitalar, permitindo vivenciar a complexidade da prestação de cuidados à Pessoa em Situação Crítica, desde a abordagem inicial em situações de emergência e instabilidade aguda, até à fase de monitorização intensiva e intervenção contínua perante disfunções multiorgânicas, reforçando a importância da atuação especializada, adaptada à complexidade clínica e à necessidade de respostas céleres e eficazes. A metodologia adotada foi descritiva e reflexiva, incluindo análise crítica da prática, dos objetivos delineados e das atividades desenvolvidas. A fundamentação teórica sustenta-se nos domínios das competências comuns e específicas do Enfermeiro Especialista, conforme definido pela Ordem dos Enfermeiros, abordadas de forma articulada e contextualizada. As atividades desenvolvidas são analisadas à luz das competências adquiridas, com especial destaque para o contributo no desenvolvimento de projetos de melhoria contínua da qualidade, no reforço das aprendizagens profissionais e na promoção de cuidados especializados. É ainda enfatizada a importância da tomada de decisão baseada na melhor evidência científica, promovendo práticas clínicas seguras e fundamentadas no seio das equipas multidisciplinares. Com base na análise da prática, delineou-se uma proposta de melhoria da qualidade focada na manutenção da permeabilidade da sonda nasojejunal à Pessoa em Situação Crítica com Nutrição Entérica e no âmbito do desenvolvimento das aprendizagens profissionais e enfoque na melhoria da qualidade assistencial foi desenvolvida uma proposta de Debriefing no Extra-Hospitalar, visando a reflexão estruturada, a segurança e a melhoria do desempenho das equipas. Cuidar da pessoa em situação crítica requer uma base de conhecimento aprofundada, capacidade de avaliação holística e antecipação de deterioração clínica, o que diferencia a intervenção do Enfermeiro Especialista. Este percurso formativo permitiu reconhecer o contributo da Enfermagem enquanto disciplina científica no desenvolvimento do conhecimento aplicado, reforçando um compromisso contínuo com a excelência, a inovação e a segurança nos cuidados em saúde.
This report was prepared as part of the “Final Internship and Report” curricular unit, integrated into the 17th master’s Degree in Medical-Surgical Nursing, in the area of Nursing for the Critically Ill Patient, of the Nursing School (Porto) of Universidade Católica Portuguesa, from September 2, 2024 to March 26, 2025. The document reflects the training path developed during this curricular unit, highlighting the process of acquiring and consolidating the skills inherent to the practice of the Specialist Nurse and Master, as well as their impact on professional performance in a differentiated clinical context. The training process took place in two complementary contexts: a Polyvalent Intensive Care Medicine Service and an Out-of-Hospital Emergency Department, allowing us to experience the complexity of providing care to the Critically Ill Patient, from the initial approach in emergency situations and acute instability, to the intensive monitoring phase and continuous intervention in the face of multi-organ dysfunctions, reinforcing the importance of specialized action, adapted to clinical complexity and the need for rapid and effective responses. The methodology adopted was descriptive and reflective, including a critical analysis of the practice, the objectives outlined and the activities carried out. The theoretical basis is based on the common and specific competences of the specialist nurse, as defined by the Order of Nurses, approached in an articulated and contextualized way. The activities carried out are analyzed in the light of the skills acquired, with special emphasis on the contribution to the development of continuous quality improvement projects, the reinforcement of professional learning and the promotion of specialized care. The importance of decision-making based on the best scientific evidence is also emphasized, promoting safe and well-founded clinical practices within multidisciplinary teams. Based on the analysis of practice, a proposal was drawn up for quality improvement focused on maintaining the permeability of the nasojejunal tube in the Critically Ill Patient with enteric nutrition. As part of the development of professional learning and a focus on improving the quality of care, a proposal was developed for Out-of-Hospital debriefing, aimed at structured reflection, safety and improving team performance. Caring for people in critical situations requires an in-depth knowledge base, the ability to assess holistically and anticipate clinical deterioration, which differentiates the intervention of the Specialist Nurse. This training path has made it possible to recognize the contribution of Nursing as a scientific discipline in the development of applied knowledge, reinforcing a continuous commitment to excellence, innovation and safety in healthcare.
This report was prepared as part of the “Final Internship and Report” curricular unit, integrated into the 17th master’s Degree in Medical-Surgical Nursing, in the area of Nursing for the Critically Ill Patient, of the Nursing School (Porto) of Universidade Católica Portuguesa, from September 2, 2024 to March 26, 2025. The document reflects the training path developed during this curricular unit, highlighting the process of acquiring and consolidating the skills inherent to the practice of the Specialist Nurse and Master, as well as their impact on professional performance in a differentiated clinical context. The training process took place in two complementary contexts: a Polyvalent Intensive Care Medicine Service and an Out-of-Hospital Emergency Department, allowing us to experience the complexity of providing care to the Critically Ill Patient, from the initial approach in emergency situations and acute instability, to the intensive monitoring phase and continuous intervention in the face of multi-organ dysfunctions, reinforcing the importance of specialized action, adapted to clinical complexity and the need for rapid and effective responses. The methodology adopted was descriptive and reflective, including a critical analysis of the practice, the objectives outlined and the activities carried out. The theoretical basis is based on the common and specific competences of the specialist nurse, as defined by the Order of Nurses, approached in an articulated and contextualized way. The activities carried out are analyzed in the light of the skills acquired, with special emphasis on the contribution to the development of continuous quality improvement projects, the reinforcement of professional learning and the promotion of specialized care. The importance of decision-making based on the best scientific evidence is also emphasized, promoting safe and well-founded clinical practices within multidisciplinary teams. Based on the analysis of practice, a proposal was drawn up for quality improvement focused on maintaining the permeability of the nasojejunal tube in the Critically Ill Patient with enteric nutrition. As part of the development of professional learning and a focus on improving the quality of care, a proposal was developed for Out-of-Hospital debriefing, aimed at structured reflection, safety and improving team performance. Caring for people in critical situations requires an in-depth knowledge base, the ability to assess holistically and anticipate clinical deterioration, which differentiates the intervention of the Specialist Nurse. This training path has made it possible to recognize the contribution of Nursing as a scientific discipline in the development of applied knowledge, reinforcing a continuous commitment to excellence, innovation and safety in healthcare.
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Enfermeiro especialista Pessoa em situação crítica Competências Prática baseada na evidência Melhoria contínua da qualidade Segurança dos cuidados Specialist nurse Critically ill patient Skills Evidence-based practice Continuous improvement Safety of care
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