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Abstract(s)
As quedas, nos idosos, são um grave problema de saúde pública, pelas consequências no declínio na funcionalidade, aumento da morbilidade, do isolamento social e da mortalidade, contribuindo ou sendo causa única para a decisão de ser institucionalizado num equipamento para idosos, onde a incidência é superior à da comunidade. O aumento do número de idosos e da longevidade torna este foco de atenção para a prática de enfermagem num desafio, de difícil resolução. Apesar de existir evidência sobre os fatores de risco e medidas preventivas, os resultados dos estudos não são suficientes para compreender a complexidade deste fenómeno, sobretudo com idosos institucionalizados, onde para além da multiplicidade de fatores de risco (intrínsecos e extrínsecos), as práticas e os comportamentos dos idosos e seus cuidadores aumentam as variáveis na génese da queda. Esta investigação teve como objetivos gerais: determinar a prevalência e características das quedas em equipamentos para idosos; construir e validar instrumentos para avaliar as práticas e comportamentos de gestão das quedas por parte de idosos e ajudantes de ação direta; avaliar as práticas e comportamentos de gestão de risco; estudar algumas variáveis e angariar contributos dos enfermeiros sobre como deve ser efetuada a gestão de risco de queda em equipamentos para idosos. Com os resultados dos diversos estudos realizados definiu-se uma proposta. de protocolo de intervenção para a gestão do risco de queda em equipamentos para idosos. As amostras foram constituídas por ajudantes de ação direta; idoso, enfermeiros e registos efetuados pelos profissionais dos equipamentos onde foram realizados os diversos estudos. Os instrumentos de colheita de dados foram entrevistas, questionários e grelhas de observação/registo. Os resultados permitem afirmar que as quedas nos equipamentos para idosos têm uma prevalência elevada, são recorrentes, acontecem nas 24 horas e predominantemente no quarto e na casa de banho. Após a queda o idoso solicita ajuda com maior frequência e restringe ou é-lhes restringida a atividade. A restrição física da mobilidade é usada como medida preventiva. As escalas de práticas e comportamentos de gestão do risco por parte dos idosos e das ajudantes de ação direta construídas apresentam boas características psicométricas permitindo que sejam utilizadas na prática clínica, formação e investigação. Os fatores de risco que com maior frequência são identificados pelos idosos como contribuindo para a queda são as alterações de marcha, diminuição da força muscular e as alterações de equilíbrio. As idosas valorizam a informação dos fatores de risco e os idosos valorizam as práticas e comportamentos de segurança. As ajudantes de ação direta decidem as medidas de prevenção após a identificação dos riscos, conhecem e utilizam os recursos da instituição para a prevenção, mas as práticas e comportamentos nem sempre são mantidos, na execução de cuidados ao idoso. Os indicadores que obtiveram média mais baixa são a seleção do calçado adequado, o programar idas regulares à casa de banho nas pessoas incontinentes, o colocar sapatos fechados e com sola antiderrapante. As práticas relacionadas com o ambiente físico são globalmente boas. Nem sempre a equipa discute e decide as medidas preventivas de queda a aplicar a cada idoso. Existe relação estatisticamente significativa entre a Escala de Práticas e Comportamentos da Equipa para a Prevenção de Queda e as outras escalas aplicadas às ajudantes de ação direta, o que reforça a necessidade das equipas investirem na manutenção de práticas e comportamentos de segurança. Os enfermeiros consideram importante a existência de um modelo de intervenção para a gestão do risco de queda em EPI, para controlar os incidentes e possibilitar a ação terapêutica. Os achados permitiram o desenho de um protocolo de gestão de risco de queda. Neste protocolo são atribuições do enfermeiro: preparar a institucionalização; avaliar o risco individual de queda; gerir o risco de queda ao longo do tempo de institucionalização; avaliar as práticas e comportamentos na gestão do risco de queda; educar a equipa multidisciplinar; decidir as medidas preventivas de queda a ser implementadas; implementar terapêuticas de enfermagem baseadas na evidência; gerir o autocuidado do idoso institucionalizado; selecionar produlos de apoio promotores de um autocuidado seguro; clarificar o processo de delegação de tarefas por forma a garantir a segurança; monitorizar a ocorrência de quedas; avaliar o impacto da queda na funcionalidade do idoso; implementar estratégias para controlar as consequências da queda e prevenir o declínio de funcionalidade pós-queda; avaliar o impacto das intervenções implementadas e realizar estudos epidemiológicos. Emergem sugestões para a prática, a investigação e a formação.
Falls in the elderly are a major public health problem through the consequences on the decline in functionality, increased morbidity, social isolation and mortality, contributing or being the single cause for the decision to be institutionalized in equipment for the elderly, where incidence is higher than in the community. The increasing number or elderly and longevity makes this focus for nursing practice in a challenge difficult to resolve. Although there is evidence on the risk fators and preventive measures, the results of the studies are not sufficient to understand the complexity of this phenomenon, especially in institutionalized elderly, where apart from multiplicity of risk factors (intrinsic and extrinsic). the practices and behaviors of the elderly and their caregivers increase the variables in the genesis of the fall. This investigation had the following general objectives: determine the prevalence and characteristics of falls in equipment for the elderly; construct and validate tools to assess management practices and behaviors or falls by seniors and direct action helpers; evaluate the practices and behaviors of risk management; study some variables and garner the nurses contributions about what should be done to manage fall risk in equipments for the elderly. With the studies’ results a proposal of protocol intervention was defined for the fall risk management in equipment for the elderly.The samples included direct action helpers, elderly, nurses and records made by the professional from the equipments for the elderly where the studies were held. The instruments of data collection were interviews. questionnaires and observation/ registration grids. The results indicate that falls in equipments for the elderly have a high prevalence, are recurrent, occur all day long and take place predominantly in the bedroom and bathroom. After the fall the elderly calls for help more often and restricts actively or that is restricted to him. Physical restraint of mobility is used as a preventive measure. The scales of practices and behaviors of risk management by the elderly and direct action helpers have good psychometric characteristics allowing them to be used in clinical practice, education and research. The risk fators that are most frequently identified by the elderly as contributing to falls are changes in walking, decreased muscle strength and balance changes. Female elderly value information of the risk fators and the male elderly value the practices and safety behaviors. The direct action helpers decide prevention measures alter identifying risk, they know and use the prevention resources of the institution, but their practices and behaviors are not always kept in the course of care for the elderly. The indicators that had lower average are selecting the proper shoes, schedule regular trips to the bathroom in incontinent persons and put on closed and non-slip soles shoes. Practices related to the physical environment, are generally good. Not always the team discusses and decides preventive measures to apply to each elderly. There is a statistically significant relation between the Scale of Practice and Team Behaviors for Prevention of Falls and other scales applied to direct action helpers, which reinforces the teams' need to invest in maintaining practices and safety behaviors. Nurses consider important the existence of a protocol of intervention for management of fall risk in UPI, to control incidents and allow the therapeutic action. The results allowed the design of a protocol for managing fall risk. ln this model the nurse functions are: Prepare institutionalization; Assess individual fall risk; Manage fall risk over time of institutionalization; Evaluate practices and behaviors in managing the fall risk; Educate the multidisciplinary team; Decide on fall preventive actions to be implemented; Implement evidence-based nursing therapies; Manage institutionalized elderly self-care; Select support items that promote a secure self-care; Clarify task delegation process to ensure safety; Monitor the occurrence of falls; Assess the impact of fall in the elderly functionality; implement strategies to control the consequences of fall and prevent the decline of functionality post fall; Assess the impact of implemented interventions and conduct epidemiological studies. Suggestions for practice, research and training emerge.
Falls in the elderly are a major public health problem through the consequences on the decline in functionality, increased morbidity, social isolation and mortality, contributing or being the single cause for the decision to be institutionalized in equipment for the elderly, where incidence is higher than in the community. The increasing number or elderly and longevity makes this focus for nursing practice in a challenge difficult to resolve. Although there is evidence on the risk fators and preventive measures, the results of the studies are not sufficient to understand the complexity of this phenomenon, especially in institutionalized elderly, where apart from multiplicity of risk factors (intrinsic and extrinsic). the practices and behaviors of the elderly and their caregivers increase the variables in the genesis of the fall. This investigation had the following general objectives: determine the prevalence and characteristics of falls in equipment for the elderly; construct and validate tools to assess management practices and behaviors or falls by seniors and direct action helpers; evaluate the practices and behaviors of risk management; study some variables and garner the nurses contributions about what should be done to manage fall risk in equipments for the elderly. With the studies’ results a proposal of protocol intervention was defined for the fall risk management in equipment for the elderly.The samples included direct action helpers, elderly, nurses and records made by the professional from the equipments for the elderly where the studies were held. The instruments of data collection were interviews. questionnaires and observation/ registration grids. The results indicate that falls in equipments for the elderly have a high prevalence, are recurrent, occur all day long and take place predominantly in the bedroom and bathroom. After the fall the elderly calls for help more often and restricts actively or that is restricted to him. Physical restraint of mobility is used as a preventive measure. The scales of practices and behaviors of risk management by the elderly and direct action helpers have good psychometric characteristics allowing them to be used in clinical practice, education and research. The risk fators that are most frequently identified by the elderly as contributing to falls are changes in walking, decreased muscle strength and balance changes. Female elderly value information of the risk fators and the male elderly value the practices and safety behaviors. The direct action helpers decide prevention measures alter identifying risk, they know and use the prevention resources of the institution, but their practices and behaviors are not always kept in the course of care for the elderly. The indicators that had lower average are selecting the proper shoes, schedule regular trips to the bathroom in incontinent persons and put on closed and non-slip soles shoes. Practices related to the physical environment, are generally good. Not always the team discusses and decides preventive measures to apply to each elderly. There is a statistically significant relation between the Scale of Practice and Team Behaviors for Prevention of Falls and other scales applied to direct action helpers, which reinforces the teams' need to invest in maintaining practices and safety behaviors. Nurses consider important the existence of a protocol of intervention for management of fall risk in UPI, to control incidents and allow the therapeutic action. The results allowed the design of a protocol for managing fall risk. ln this model the nurse functions are: Prepare institutionalization; Assess individual fall risk; Manage fall risk over time of institutionalization; Evaluate practices and behaviors in managing the fall risk; Educate the multidisciplinary team; Decide on fall preventive actions to be implemented; Implement evidence-based nursing therapies; Manage institutionalized elderly self-care; Select support items that promote a secure self-care; Clarify task delegation process to ensure safety; Monitor the occurrence of falls; Assess the impact of fall in the elderly functionality; implement strategies to control the consequences of fall and prevent the decline of functionality post fall; Assess the impact of implemented interventions and conduct epidemiological studies. Suggestions for practice, research and training emerge.
Description
Keywords
Idoso Queda Equipamentos Gestão do risco Práticas Elderly Fall Equipments for elderly Risk management Practices