Authors
Advisor(s)
Abstract(s)
O presente relatório de prática clínica integra-se no plano curricular do Curso de Mestrado em
Enfermagem, área de especialização em Enfermagem Médico-Cirúrgica, do Instituto de
Ciências da Saúde da Universidade Católica Portuguesa no ano lectivo de 2009/2011.
Fundamenta o percurso de aprendizagem que favorece o desenvolvimento de competências
de enfermeiro especialista em enfermagem médico-cirúrgica mediante uma prática reflexiva.
A temática transversal desenvolvida nos vários contextos esteve relacionada com a prestação
de cuidados especializados ao cliente de médio e alto risco e a sua família, em especial ao
cliente do foro nefrológico. O interesse de abordar a temática partiu de uma reflexão crítica
sobre o meu desenvolvimento pessoal e profissional, enquanto enfermeiro num serviço de
hemodiálise. A doença renal pode estar associada a uma lesão aguda, onde o enfermeiro tem
como foco de cuidados o cliente em situação aguda.
Quando a lesão renal apresenta-se com uma sintomatologia aguda, o enfermeiro especialista
tem como foco a prestação de cuidados que visam preservar a vida do cliente.
Dependendo da forma de instalação da doença renal, o cliente pode necessitar de cuidados
imediatos que visam preservar a vida, como ocorre na doença renal aguda, ou de
acompanhamento num processo de mudança de hábitos vida, como sucede na doença renal
crónica.
Os diferentes módulos de prática clínica, permitiram acompanhar a problemática de cada
realidade, identificar necessidades de intervenção e sugerir mudanças que contribuam na
melhoria dos cuidados. Na Unidade de Urgência Médica foram abordadas as necessidades da
família do ponto de vista dos enfermeiros do serviço, foi elaborada uma lista de verificação nos
procedimentos com hemodiálise, foi revista a norma de heparinização do cateter centrais para
hemodiálise e foi proposta uma alteração à folha de registo nas modalidades contínuas de
diálise. No Bloco Operatório foi aprofundada a temática relacionada com a segurança do
cliente cirúrgico, foi elaborada uma carta de alta/transferência de enfermagem para
procedimentos relacionados com acessos vasculares para hemodiálise e foi elaborada uma
listagem para o controlo de stocks e prazos de validade na farmácia do bloco. Por último, no
Serviço de Urgência, colaborou-se com a avaliação da satisfação dos familiares com o
acompanhamento, foi proposto um questionário de satisfação para o cliente face ao
atendimento e foi elaborada uma norma de procedimento nas situações emergentes que
envolvam clientes renais portadores de cateter venoso central tunelizado como acesso
vascular.
Este percurso permitiu desenvolver competências nas áreas de gestão de cuidados, formação
ou investigação. Os principais contributos apontam para a melhoria da prestação de cuidados,
a sua continuidade entre diferentes níveis de saúde e a possibilidade de avaliar a qualidade
dos cuidados prestados mediante inquéritos de satisfação do utente e familiar
This report bases the learning process that favours the development of skills for specialist nurse in medical-surgery specialty nursing, through reflective practice. The cross-theme developed in this context was relationed with the provision of specialized care to the medium and high risk patient and family, specially the nephrological patient. The interest in approaching this thematic, came from a critic reflection about the personal and professional development as a nurse in a haemodialysis service. The renal disease can be associated to a acute injury, where the nurse care has its focus in caring for the patient in acute situation and cooperates when the kidney injury presents itself as acute sintomatology. The specialist nurse has its focus in healing care aimed at preserving the life of the patient. In chronic renal disease, accompanying the patient and its family and promoting self-care it’s the aim of the nurse’s attention. Depending in the way the kidney disease settles, the patient may need immediate care that are aimed at preserving the life, as occurs in acute renal disease. The different stage modules allowed to accompany the problematic in each reality, identify needs to intervene and suggest changes that contribute to the improving of care. In the Medical Emergency Unit, were approached the needs of the family from the nursing point of view, was elaborated a checklist in the haemodialysis procedures, was reviewed the heparinization standard for central haemodialysis catheter and was proposed a change to the continuous dialysis modalities register sheet. In the Operating Room, was deepened the theme relationed with the surgical patient safety, was elaborated a nursing discharge/transfer sheet for procedures related with dialysis vascular accesses and was elaborated a checklist for stock control and expiration dates for the OR pharmacy. For last, in the Emergency Service, there was cooperation with the study in patient accompanying satisfaction evaluation; it was proposed a questionnaire to evaluate the attendance user satisfaction and was elaborated a standard procedure rule for the use of central catheter as vascular access in renal patients. This route allowed the development of skills in the areas of managed care, training or research. The main contributors point to the improvement of care, continuity between different levels of health and the possibility of evaluating the quality of nurse care through surveys of user satisfaction and family.
This report bases the learning process that favours the development of skills for specialist nurse in medical-surgery specialty nursing, through reflective practice. The cross-theme developed in this context was relationed with the provision of specialized care to the medium and high risk patient and family, specially the nephrological patient. The interest in approaching this thematic, came from a critic reflection about the personal and professional development as a nurse in a haemodialysis service. The renal disease can be associated to a acute injury, where the nurse care has its focus in caring for the patient in acute situation and cooperates when the kidney injury presents itself as acute sintomatology. The specialist nurse has its focus in healing care aimed at preserving the life of the patient. In chronic renal disease, accompanying the patient and its family and promoting self-care it’s the aim of the nurse’s attention. Depending in the way the kidney disease settles, the patient may need immediate care that are aimed at preserving the life, as occurs in acute renal disease. The different stage modules allowed to accompany the problematic in each reality, identify needs to intervene and suggest changes that contribute to the improving of care. In the Medical Emergency Unit, were approached the needs of the family from the nursing point of view, was elaborated a checklist in the haemodialysis procedures, was reviewed the heparinization standard for central haemodialysis catheter and was proposed a change to the continuous dialysis modalities register sheet. In the Operating Room, was deepened the theme relationed with the surgical patient safety, was elaborated a nursing discharge/transfer sheet for procedures related with dialysis vascular accesses and was elaborated a checklist for stock control and expiration dates for the OR pharmacy. For last, in the Emergency Service, there was cooperation with the study in patient accompanying satisfaction evaluation; it was proposed a questionnaire to evaluate the attendance user satisfaction and was elaborated a standard procedure rule for the use of central catheter as vascular access in renal patients. This route allowed the development of skills in the areas of managed care, training or research. The main contributors point to the improvement of care, continuity between different levels of health and the possibility of evaluating the quality of nurse care through surveys of user satisfaction and family.