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As intervenções de enfermagem na pessoa com delirium, em cuidados paliativos : uma scoping review
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Abstract(s)
Introdução: O delirium é um transtorno neurocognitivo altamente prevalente em cuidados paliativos, mas que se mantem subdiagnosticado e, consequentemente, tratado indevidamente ou não tratado. Esta síndrome acarreta uma grande angústia e sofrimento tanto para os doentes e seus familiares, como para os profissionais de saúde. Os enfermeiros assumem uma posição privilegiada no reconhecimento precoce, na prevenção e na gestão desta síndrome, sobretudo em doentes internados, uma vez que estão presentes em permanência neste contexto. O objetivo deste trabalho foi identificar as intervenções de enfermagem que devem ser implementadas na pessoa com delirium, em cuidados paliativos. Metodologia: Foi conduzida uma scoping review. Incluídos apenas estudos que envolvessem adultos com doença incurável e/ou grave e com prognóstico limitado, em contexto de cuidados paliativos. O conceito abordado foi as intervenções de enfermagem perante episódios de delirium, no doente e família. Foram seguidas as recomendações do JBI, tendo sido realizada uma pesquisa inicial na Pubmed/MEDLINE, CINAHL/EBSCO, COCHRANE e em repositórios científicos, sendo posteriormente revistas as referências bibliográficas dos estudos incluídos. Resultados: Foram incluídos 33 artigos, tratando-se a sua maioria de revisões de literatura narrativa com enfoque em doentes internados. Os resultados encontrados evidenciaram que para gerir eficazmente o delirium é necessária uma abordagem multidimensional que inclui intervenções concomitantes em diferentes áreas, com enfoque no doente, família, equipa e prevenção. Conclusões: Apesar da relevância dos achados, estes apresentam um baixo nível de evidência, existindo por isso um longo percurso a percorrer para testar a sua aplicabilidade e eficácia em estudos de controlo randomizados e permitir, assim, a sua extrapolação para a prática de cuidados. Todavia, pode ser ainda razoável implementar estas medidas quando apropriado, uma vez que têm baixo risco de danos e poderiam fornecer benefícios significativos.
Introduction: Despite delirium is a highly prevalent neurocognitive disorder in palliative care, it remains underdiagnosed and, therefore, is incorrectly treated or untreated. This syndrome causes great anguish and suffering not only in the patients and their families but also in the healthcare professionals. Nurses are in a privileged position regarding the early recognition, prevention and management of this syndrome, especially in inpatients, since they are always present in this context. The goal of this essay is to identify the nursing interventions that should be implemented in patients who suffer from delirium, in the context of palliative care. Methods: A scoping review was carried out. The review only included studies that involved patients with incurable and/or severe illness and with limited prognosis, in the context of palliative care. The concept addressed were the nursing interventions in the face of events of delirium, in the patient and his family. The recommendations of JBI were complied with, where an initial research was conducted in Pubmed/MEDLINE, CINAHL/EBSCO, COCHRANE and in scientific repositories, and the bibliographic references of the studies found were subsequently analysed. Results: 33 articles were included, which, for the most part, correspond to narrative literature reviews with a focus on in-patients. The results show that the effective management of delirium requires a multidimensional approach that includes concomitant interventions in different areas, focusing on the patient, on the family, on the team and on prevention. Conclusions: Despite the findings relevance, these have a low level of evidence, wherefore there is still a long way to go to test their applicability and efficiency in randomized control studies and thus allowing for its extrapolation into care practice. Nevertheless, it may still be reasonable to implement these measures where appropriate, since they have low risk of harm and could provide significant benefits.
Introduction: Despite delirium is a highly prevalent neurocognitive disorder in palliative care, it remains underdiagnosed and, therefore, is incorrectly treated or untreated. This syndrome causes great anguish and suffering not only in the patients and their families but also in the healthcare professionals. Nurses are in a privileged position regarding the early recognition, prevention and management of this syndrome, especially in inpatients, since they are always present in this context. The goal of this essay is to identify the nursing interventions that should be implemented in patients who suffer from delirium, in the context of palliative care. Methods: A scoping review was carried out. The review only included studies that involved patients with incurable and/or severe illness and with limited prognosis, in the context of palliative care. The concept addressed were the nursing interventions in the face of events of delirium, in the patient and his family. The recommendations of JBI were complied with, where an initial research was conducted in Pubmed/MEDLINE, CINAHL/EBSCO, COCHRANE and in scientific repositories, and the bibliographic references of the studies found were subsequently analysed. Results: 33 articles were included, which, for the most part, correspond to narrative literature reviews with a focus on in-patients. The results show that the effective management of delirium requires a multidimensional approach that includes concomitant interventions in different areas, focusing on the patient, on the family, on the team and on prevention. Conclusions: Despite the findings relevance, these have a low level of evidence, wherefore there is still a long way to go to test their applicability and efficiency in randomized control studies and thus allowing for its extrapolation into care practice. Nevertheless, it may still be reasonable to implement these measures where appropriate, since they have low risk of harm and could provide significant benefits.
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Keywords
Delirium Agitação terminal Confusão Intervenções de enfermagem Cuidados paliativos Terminal agitation Confusion Nursing interventions Palliative care