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Advisor(s)
Abstract(s)
As alterações da capacidade de deglutição constituem um problema de alta morbilidade,
mortalidade e custos, frequentemente relacionado com consequências graves na saúde dos
afectados mas que não tem merecido particular atenção, tanto por parte de programas de
gestão de risco ou de qualidade de cuidados.
Os enfermeiros são profissionais de saúde que pelo seu perfil técnico e de proximidade com os
utentes podem intervir de forma eficaz na diminuição do risco de complicações e assim
aumentar a segurança à alimentação dos utentes.
A nossa intervenção em saúde foi desenvolvida junto da Equipa de Cuidados Continuados
Integrados (ECCI) da Unidade de Cuidados na Comunidade (UCC) Gentes de Loulé, Portugal.
Na implementação deste projecto estabeleceu-se como meta desenvolver as competências da
equipa de enfermagem da ECCI na sua intervenção na capacidade de deglutição, aumentando
para 20% a frequência de registo dessa intervenção, até Janeiro 2013.
Foram definidos os seguintes objectivos:
1. Implementar um programa de formação sobre a capacidade de deglutição de forma a
desenvolver competências teórico-práticas de intervenção de enfermagem nesta área,
obtendo 60% de taxa de respostas correctas em questionário de avaliação teórica e 60%
de concordância na avaliação prática;
2. Criar um instrumento de suporte à intervenção e registo de enfermagem relacionado com a
capacidade de deglutição e testa-lo;
3. Melhorar a frequência de registo das intervenções de enfermagem relacionadas com a
capacidade de deglutição, passando de 6,3% para 20%.
Foi seguida a metodologia de planeamento em saúde. Realizou-se uma revisão sistemática da
literatura sobre metodologia de avaliação clínica da capacidade deglutição. Realizaram-se dois
estudos epidemiológicos, um de diagnóstico e outro de avaliação. Foi criado um instrumento de
apoio à intervenção de enfermagem que foi testado nos seus atributos de validade de conteúdo
e confiabilidade pela objectividade inter-observadores. Implementou-se um programa de
formação teórica e prática que foi avaliado. Realizaram-se reuniões formais e informais com a
ECCI.
Quanto a resultados, na avaliação do programa de formação obteve-se 37% de taxa de
melhoria de conhecimentos teóricos e proporção de concordância de 93,4% na avaliação da
prática. Na testagem do instrumento obtiveram-se os seguintes resultados globais: Po = 93,4%,
excelente; ICC = 0,927, excelente; Kendall ! – b = 0,875, excelente; Kappa (p) = 1,000,
excelente. Da revisão da literatura efectuada concluiu-se não haver consenso nem na
metodologia mais adequada nem nos itens a incluir para avaliação da capacidade de
deglutição. Os estudos epidemiológicos efectuados mostraram, entre outros dados, que 86%
da população da ECCI apresenta antecedentes de risco para alterações na capacidade de
deglutição. A prevalência daquela alteração foi, no 1º estudo, de 6,8% e de 18,3% no 2º
estudo. A frequência de registo de intervenções de enfermagem relacionadas com as
alterações da deglutição aumentou para 37%.
Concluiu-se que os objectivos e a meta foram alcançados. Acreditamos que o valor da
intervenção de enfermagem na alimentação pode ser capaz de traduzir ganhos em segurança,
logo em qualidade de cuidados e portanto, ganhos em saúde das pessoas, o que, por sua vez,
pode representar ganhos económicos significativos no SNS.
The swallowing dysfunction constitutes a problem of high morbidity, mortality and costs, often associated with serious consequences for the health of those affected, however it has not deserved a particular attention, both by risk management and quality of care programs. Nurses are the health professionals that due to their technical profile and patients’ proximity who can further and effectively interfere in order to reduce the risk of complications and, thus, increasing the patient safety to feeding. Our health intervention was developed with a home team of long term health care (ECCI) of the Community Care Unit (CCU) Gentes de Loulé, Portugal. With the implementation of this project the goal was to develop the nursing team skills regarding its intervention in swallowing capacity, and increasing up to 20% the registration frequency of intervention, until January 2013. The objectives were defined as follows: 1. To implement a training program on swallowing capacity in order to develop theoretical and practical nursing skills intervention in the area, achieving a rate of correct answers of 60% through a theoretical evaluation questionnaire and 60% of agreement in the practical assessment; 2. To create a tool to support nursing intervention and registration related to swallowing capacity and to test it; 3. To improve recording frequency of nursing interventions related to swallowing capacity, going from 6,3% to 20%. It was followed the health planning methodology. It was carried out a systematic review of the literature on clinical evaluation methodology concerning swallowing capacity. They were held two epidemiological studies, one diagnostic and other for evaluation. It was created a tool to support nursing intervention that has been tested regarding its attributes of content validity and interrater reliability. It was implemented a program of theoretical and practical training that has been evaluated. They were held formal and informal meetings with the ECCI. As results, in the evaluation of the training program, it was achieved 37% of theoretical knowledge improvement rate and an agreement proportion of 93.4% in the evaluation of the procedures. Testing the tool, the following overall results were obtained: Po = 93.4%, excellent; ICC = 0.927, excellent; Kendall`! - b = 0.875, excellent; Kappa (p) = 1.000, excellent. The literature review concluded that there is no consensus regarding the most appropriate methodology and about the items to be included to evaluate the swallowing capacity. The epidemiological studies have shown, among other data, that 86% of the ECCI population presents antecedents considered of risk concerning swallowing dysfunction. The prevalence of this dysfunction was, in the first study, of 6.8% and 18.3% in 2nd study. The frequency of registration of nursing interventions related to swallowing disorders increased to 37%. As conclusions, the objectives and the goal were achieved. We believe that the value of nursing intervention in feeding may be converted into gains in safety, thus in care quality, and therefore, gains in peoples health, which, in turn, may represent significant economic gains for the NHS.
The swallowing dysfunction constitutes a problem of high morbidity, mortality and costs, often associated with serious consequences for the health of those affected, however it has not deserved a particular attention, both by risk management and quality of care programs. Nurses are the health professionals that due to their technical profile and patients’ proximity who can further and effectively interfere in order to reduce the risk of complications and, thus, increasing the patient safety to feeding. Our health intervention was developed with a home team of long term health care (ECCI) of the Community Care Unit (CCU) Gentes de Loulé, Portugal. With the implementation of this project the goal was to develop the nursing team skills regarding its intervention in swallowing capacity, and increasing up to 20% the registration frequency of intervention, until January 2013. The objectives were defined as follows: 1. To implement a training program on swallowing capacity in order to develop theoretical and practical nursing skills intervention in the area, achieving a rate of correct answers of 60% through a theoretical evaluation questionnaire and 60% of agreement in the practical assessment; 2. To create a tool to support nursing intervention and registration related to swallowing capacity and to test it; 3. To improve recording frequency of nursing interventions related to swallowing capacity, going from 6,3% to 20%. It was followed the health planning methodology. It was carried out a systematic review of the literature on clinical evaluation methodology concerning swallowing capacity. They were held two epidemiological studies, one diagnostic and other for evaluation. It was created a tool to support nursing intervention that has been tested regarding its attributes of content validity and interrater reliability. It was implemented a program of theoretical and practical training that has been evaluated. They were held formal and informal meetings with the ECCI. As results, in the evaluation of the training program, it was achieved 37% of theoretical knowledge improvement rate and an agreement proportion of 93.4% in the evaluation of the procedures. Testing the tool, the following overall results were obtained: Po = 93.4%, excellent; ICC = 0.927, excellent; Kendall`! - b = 0.875, excellent; Kappa (p) = 1.000, excellent. The literature review concluded that there is no consensus regarding the most appropriate methodology and about the items to be included to evaluate the swallowing capacity. The epidemiological studies have shown, among other data, that 86% of the ECCI population presents antecedents considered of risk concerning swallowing dysfunction. The prevalence of this dysfunction was, in the first study, of 6.8% and 18.3% in 2nd study. The frequency of registration of nursing interventions related to swallowing disorders increased to 37%. As conclusions, the objectives and the goal were achieved. We believe that the value of nursing intervention in feeding may be converted into gains in safety, thus in care quality, and therefore, gains in peoples health, which, in turn, may represent significant economic gains for the NHS.