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Advisor(s)
Abstract(s)
O presente relatório pretende descrever o percurso académico realizado nos dois contextos de estágio da unidade curricular “Estágio Final e Relatório”, relatando o processo de aquisição das competências definidas pela Ordem dos Enfermeiros em 2019, para o Enfermeiro Especialista. Os contextos de estágio consistiram numa Unidade de Cuidados Intermédios Polivalente e num Serviço de Medicina Intensiva, nos quais foi possível refletir e adquirir conhecimentos e prática em Enfermagem Médico-Cirúrgica face à pessoa em situação crítica. A metodologia escolhida foi a descritiva e crítico-reflexiva e o relatório está cronologicamente estruturado por introdução, início do percurso e competências, estando ainda subdividido pelos 4 domínios das Competências Específicas do Enfermeiro Especialista em Enfermagem à Pessoa em Situação Crítica. Em cada Domínio e para cada objetivo especificado, realizou-se uma análise crítico-refletiva sobre as atividades e os aspetos mais relevantes do estágio. Por fim, encontra-se a conclusão. Enquanto futura Enfermeira Especialista, os temas aprofundados permitiram-nos obter aptidões capazes de darem resposta à pessoa em situação crítica nos processos de transição, através das propostas de melhoria sobre a gestão de risco na preparação medicamentosa e a comunicação efetiva com a implementação da ferramenta ISBAR, digitalmente. Realizou-se ainda uma revisão da literatura sobre os critérios atribuídos à pessoa em situação critica, em fim de vida na triagem de um serviço de urgência. Destacamos as reflexões críticas produzidas sobre as práticas seguras e o percurso para o desenvolvimento de competências capazes de darem respostas à pessoa em situação crítica e/ou família. Na prática profissional, ética e legal, promoveu-se propostas de melhoria, contribuiu-se para as dinâmicas funcionais e organizacionais; desenvolveu-se estratégias de tomadas de decisões alicerçadas nos princípios, valores e normas deontológicas e demonstrou-se discernimento crítico face aos problemas da prática profissional. No domínio da qualidade, propôs-se programas de melhoria, geriu-se a comunicação interpessoal, situações de instabilidade e geriu-se a medicação emergente com práticas seguras, fundamentadas pela aquisição de conhecimento científico. Na gestão de cuidados de enfermagem, geriu-se também a comunicação interpessoal; garantiu-se a segurança e a qualidade na prestação de cuidados; refletiu-se sobre a adequação dos recursos. Por último, o desenvolvimento de aprendizagens na prestação de cuidados de qualidade permitiu-nos contribuir para a resolução de problemas com assertividade e responsabilidade perante situações de risco, otimizando o trabalho da equipa e promovendo intervenções baseadas na evidência junto das pessoas em situação crítica em fim de vida. Também a proatividade na procura de evidência para a promoção e implementação das melhores técnicas e normas científicas, nos permitiu colaborar com intervenções orientadas para uma melhoria nas vigilâncias, monitorizações e gestão da terapêutica, bem como na monitorização invasiva, monitorização de eletrocardiograma, a hemofiltração, a colocação do cateter venoso central, entre outras intervenções. Estas aprendizagens contribuíram para uma enfermagem avançada, segura e diferenciadora perante as necessidades da pessoa em situação crítica e através da reflexão-critica das experiências vivenciadas foi possível expor os desafios ultrapassados e as oportunidades proporcionadas para a aquisição de competências diferenciadoras na prestação de cuidados à pessoa em situação crítica
This report aims to describe the academic path carried out in the two internship contexts of the curricular unit "Final Internship and Report", reporting the process of acquiring the competencies defined by the Order of Nurses in 2019, for the Specialist Nurse. The two internship contexts took place in a Multipurpose Intermediate Care Unit and an Intensive Care Service, in which it was possible to reflect and acquire knowledge and practice in Medical-Surgical Nursing to the person in critical situation. The methodology chosen was descriptive and critical and the report is chronologically structured by introduction, beginning of the route and competencies, being subdivided by the 4 domains of the Specific Competencies of nursing specialist nurses to the person in critical situation. In each Domain and for each specified objective, a critical-reflective analysis was carried out on the activities and the most relevant aspects of the internship. Finally, there is the conclusion. As a future Specialist Nurse, the indepth themes have allowed us to obtain skills capable of responding to the critical person in the transition processes, through proposals for improvement on risk management in drug preparation and effective communication with the implementation of the ISBAR tool, digitally. A literature review was also carried out on the criteria attributed to the end-of-life person in the screening. We highlight the critical reflections produced on safe practices and the path to the development of skills capable of giving answers to the person in critical situation and/or family. In professional, ethical and legal practice, proposals for improvement were promoted, and functional and organizational dynamics were contributed; decision-making strategies were developed based on principles, values and ethical norms and a critical discernment was demonstrated for the problems of professional practice. In the domain of quality, improvement programs were proposed, interpersonal communication, situations of instability were managed and emerging medication was managed with safe practices, based on the acquisition of scientific knowledge. In nursing care management, interpersonal communication was managed; safety and quality in care has been ensured; reflected on the adequacy of resources, among others. Finally, the development of learning in the provision of quality care has allowed us to contribute to the resolution of problems with assertiveness and responsibility in situations of risk, optimizing the work of the team and promoting evidence-based interventions among people in critical situations at the end of life. Also the proactivity in the search for evidence for the promotion and implementation of the best techniques and scientific standards, allowed us to collaborate with interventions aimed at improving surveillance, monitoring and management of therapy. Examples of this: invasive monitoring, electrocardiogram monitoring, hemofiltration, placement of the central venous catheter, etc. These learnings contributed to an advanced, safe and differentiating nursing in the needs of the person in critical situation and through the reflection-criticism of the experiences experienced it was possible to expose the outdated challenges and the opportunities provided for the acquisition of differentiating skills in the provision of care to the person in critical situation.
This report aims to describe the academic path carried out in the two internship contexts of the curricular unit "Final Internship and Report", reporting the process of acquiring the competencies defined by the Order of Nurses in 2019, for the Specialist Nurse. The two internship contexts took place in a Multipurpose Intermediate Care Unit and an Intensive Care Service, in which it was possible to reflect and acquire knowledge and practice in Medical-Surgical Nursing to the person in critical situation. The methodology chosen was descriptive and critical and the report is chronologically structured by introduction, beginning of the route and competencies, being subdivided by the 4 domains of the Specific Competencies of nursing specialist nurses to the person in critical situation. In each Domain and for each specified objective, a critical-reflective analysis was carried out on the activities and the most relevant aspects of the internship. Finally, there is the conclusion. As a future Specialist Nurse, the indepth themes have allowed us to obtain skills capable of responding to the critical person in the transition processes, through proposals for improvement on risk management in drug preparation and effective communication with the implementation of the ISBAR tool, digitally. A literature review was also carried out on the criteria attributed to the end-of-life person in the screening. We highlight the critical reflections produced on safe practices and the path to the development of skills capable of giving answers to the person in critical situation and/or family. In professional, ethical and legal practice, proposals for improvement were promoted, and functional and organizational dynamics were contributed; decision-making strategies were developed based on principles, values and ethical norms and a critical discernment was demonstrated for the problems of professional practice. In the domain of quality, improvement programs were proposed, interpersonal communication, situations of instability were managed and emerging medication was managed with safe practices, based on the acquisition of scientific knowledge. In nursing care management, interpersonal communication was managed; safety and quality in care has been ensured; reflected on the adequacy of resources, among others. Finally, the development of learning in the provision of quality care has allowed us to contribute to the resolution of problems with assertiveness and responsibility in situations of risk, optimizing the work of the team and promoting evidence-based interventions among people in critical situations at the end of life. Also the proactivity in the search for evidence for the promotion and implementation of the best techniques and scientific standards, allowed us to collaborate with interventions aimed at improving surveillance, monitoring and management of therapy. Examples of this: invasive monitoring, electrocardiogram monitoring, hemofiltration, placement of the central venous catheter, etc. These learnings contributed to an advanced, safe and differentiating nursing in the needs of the person in critical situation and through the reflection-criticism of the experiences experienced it was possible to expose the outdated challenges and the opportunities provided for the acquisition of differentiating skills in the provision of care to the person in critical situation.
Description
Keywords
Enfermagem médico-cirúrgica Pessoa em situação crítica Unidade de cuidados intensivos Transições saúde-doença Gestão de risco Medical-surgical nursing Critical situation Intensive care unit Health-disease transitions Risk management