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Advisor(s)
Abstract(s)
No âmbito do Curso de Mestrado em Enfermagem com Especialização em
Enfermagem Médico-Cirúrgica na área de Enfermagem à Pessoa em Situação
Crítica, da Universidade Católica de Lisboa, surge a elaboração deste Relatório que
pretende ser o reflexo do percurso realizado onde, através da análise crítica e
reflexiva, nos propomos a descrever as atividades realizadas e as experiências
vivenciadas que se constituíram subsidiarias ao desenvolvimento, competências
instrumentais e teóricas diferenciadas e à consecução dos objetivos delineados. As
competências comuns e específicas do enfermeiro especialista em Enfermagem
Médico-Cirúrgica, na área de Enfermagem à Pessoa em Situação Critica
desenvolvidas, assim como as que subsidiam o título de mestre, serão o foco deste
relatório.
Os contextos de estágio escolhidos foram um Serviço de Urgência Central e
uma Unidade de Cuidados Intensivos Neurocríticos, de um hospital central em
Lisboa. Dado reconhecer a experiência profissional como enfermeira em unidade
de cuidados intensivos, iniciei este percurso formativo com a convicção de que
algumas das competências requeridas, tinham já indicadores adequados para dar
resposta às necessidades de cuidados à Pessoa em Situação Critica
Por ser um tema atual e de grande relevância pelas consequências que
podem advir desta situação clínica, desenvolvi o meu trabalho de investigação
sobre o Tema delirium. Para tal realizei uma revisão integrativa da literatura. Como
resultado desta revisão foi possível sistematizar as intervenções de enfermagem
na identificação, prevenção e controlo da ocorrência do delirium e sublinhar a
importância do papel do enfermeiro.
Com este estudo concluiu-se que o enfermeiro tem um papel muito importante na
prevenção do delirium da PSC, com a adoção de medidas relacionadas com o
ambiente, promoção do sono, intervenção terapêutica, avaliação cognitiva e
orientação dos doentes, protocolos, participação dos familiares, formação dos
enfermeiros e ensino do doente. A implementação deste conjunto de medidas, é
mais eficaz na diminuição da ocorrência do delirium, comparadas com o seu uso
de forma isolada.
No serviço de urgência o foco incidiu no desenvolver competências na
prestação de cuidados à pessoa em situação emergente, com instabilidade
hemodinâmica e risco de falência orgânica, bem como na assistência à família.
Pude divulgar e aplicar algumas das intervenções de enfermagem na prevenção do
delirium no doente critico, tendo por base a revisão bibliográfica realizada.
Relativamente ao serviço de cuidados intensivos, direcionei a minha
experiência para a área da prevenção da lesão secundária do doente neurocrítico,
aplicação de escalas de avaliação de sedação e consciência, onde faço uma
análise critica das várias ferramentas existentes, da sua aplicabilidade e limitações.
Neste contexto, e por se ter manifestado ser um tema de interesse da equipa de
enfermagem realizei uma formação sobre uma escala de sedação a Richmond
Agitation-Sedation Scale.
Este Relatório procura, assim, demonstrar o processo de desenvolvimento
de competências numa envolvência com a evidencia científica, reconhecendo a
importância deste sinergismo para uma prática de cuidados avançada.
The preparation of this Report arises within the scope of the Nursing Masters Course with Medical-Surgical Nursing Specialization in the area of Nursing for People in Critical Situation, of the Catholic University of Lisbon, which intends to reflect the work undertaken whereby, through a critical and reflective analysis, my intention is to describe the activities carried out and experiences gathered subsidiary to the development, instrumental competences and differentiated theories and to the achievement of the goals set out. The common and specific competences of a nurse specialized in Medical-Surgical Nursing in the area of Nursing for People in Critical Situation developed, as well as those required for a Masters Degree, will be the focus of this report. The locations for the internship chosen were an Accident and Emergency Department (A&E) and Neurocritical Intensive Care Unit of a central hospital in Lisbon. Acknowledging the professional experience as a nurse in an intensive care unit, I started this training path convinced that some of the competences required already had adequate indicators to respond to the care needs of a Person in Critical Situation. Being a current topic and of great relevance due to the consequences that may arise from this clinical situation, I developed my work of investigation under the theme Delirium. For that purpose, I proceeded with an integrative revision of literature. As a result of that revision, it was possible to organize nursing interventions in the identification, prevention and control of delirium incidents and to underline the importance of the role of a nurse. With this study, it may be concluded that a nurse has a very important role in the prevention of delirium of PSC, with the adoption of measures related with the environment, sleep promotion, therapeutic intervention, cognitive assessment and patient guidance, protocols, family participation, nurse training and patient education. The implementation of this set of measures is more efficient in the reduction of a delirium incident, compared with its isolated use. At the Accident and Emergency Department (A&E), the focus was based on the development of competences in the care provided to a person in an emerging situation, with hemodynamic instability and a risk of organ failure, as well as in the assistance to the family. I could divulge and apply some of the nursing interventions in the prevention of delirium in the critical patient, based on the bibliographic review made. With respect to the intensive care unit, I directed my experience to the area of prevention of secondary lesions of the neurocritical patient, application of sedation and consciousness evaluation scales whereby I make a critical analysis of the several existing tools, of its applicability and restrictions. In this context and considering that it a subject of interest to the nursing team, I followed a training course on the sedation scale, the Richmond Agitation-Sedation Scale. Consequently, this Report aims to demonstrate the development process of competences in a component with scientific evidence, acknowledging the importance of this synergism for the practice of advanced care.
The preparation of this Report arises within the scope of the Nursing Masters Course with Medical-Surgical Nursing Specialization in the area of Nursing for People in Critical Situation, of the Catholic University of Lisbon, which intends to reflect the work undertaken whereby, through a critical and reflective analysis, my intention is to describe the activities carried out and experiences gathered subsidiary to the development, instrumental competences and differentiated theories and to the achievement of the goals set out. The common and specific competences of a nurse specialized in Medical-Surgical Nursing in the area of Nursing for People in Critical Situation developed, as well as those required for a Masters Degree, will be the focus of this report. The locations for the internship chosen were an Accident and Emergency Department (A&E) and Neurocritical Intensive Care Unit of a central hospital in Lisbon. Acknowledging the professional experience as a nurse in an intensive care unit, I started this training path convinced that some of the competences required already had adequate indicators to respond to the care needs of a Person in Critical Situation. Being a current topic and of great relevance due to the consequences that may arise from this clinical situation, I developed my work of investigation under the theme Delirium. For that purpose, I proceeded with an integrative revision of literature. As a result of that revision, it was possible to organize nursing interventions in the identification, prevention and control of delirium incidents and to underline the importance of the role of a nurse. With this study, it may be concluded that a nurse has a very important role in the prevention of delirium of PSC, with the adoption of measures related with the environment, sleep promotion, therapeutic intervention, cognitive assessment and patient guidance, protocols, family participation, nurse training and patient education. The implementation of this set of measures is more efficient in the reduction of a delirium incident, compared with its isolated use. At the Accident and Emergency Department (A&E), the focus was based on the development of competences in the care provided to a person in an emerging situation, with hemodynamic instability and a risk of organ failure, as well as in the assistance to the family. I could divulge and apply some of the nursing interventions in the prevention of delirium in the critical patient, based on the bibliographic review made. With respect to the intensive care unit, I directed my experience to the area of prevention of secondary lesions of the neurocritical patient, application of sedation and consciousness evaluation scales whereby I make a critical analysis of the several existing tools, of its applicability and restrictions. In this context and considering that it a subject of interest to the nursing team, I followed a training course on the sedation scale, the Richmond Agitation-Sedation Scale. Consequently, this Report aims to demonstrate the development process of competences in a component with scientific evidence, acknowledging the importance of this synergism for the practice of advanced care.
Description
Keywords
Intervenções de enfermagem especializadas Pessoa em situação crítica Delirium Prevenção Specialized nursing interventions Person in critical situation Prevention