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Abstract(s)
Introdução: A Rede Nacional de Cuidados Continuados Integrados é uma realidade do Ser-viço Nacional de Saúde, que teve o seu início em 2006. As Equipas de Cuidados Continua-dos Integrados (ECCI) são uma estrutura da rede orientada para a assistência em contexto domiciliário, com foco na ajuda às famílias que integram pessoas dependentes no autocuida-do. Dadas as características das necessidades em cuidados daqueles clientes, é bem evidente a centralidade dos cuidados de enfermagem para a construção de respostas de qualidade às necessidades dos clientes das ECCI. No contexto da saúde, a satisfação dos clientes é uma das variáveis essenciais a incluir nos modelos de gestão e governo da qualidade dos servi-ços. Apesar da qualidade em saúde ser influenciada por múltiplos fatores, entre os quais o exercício de profissionais de diferentes áreas, esclarecer o contributo particular de cada gru-po profissional para a qualidade global é um imperativo de cada uma daquelas áreas e/ou domínios do conhecimento. Desenvolver metodologias válidas e fiáveis de avaliação da sa-tisfação dos clientes com os cuidados de enfermagem prestados nas ECCI é tarefa para o domínio disciplinar da enfermagem e também, por essa via, um contributo para a melhoria da qualidade dos cuidados prestados nas ECCI.
Material e métodos: Foi desenvolvido um percurso de investigação alicerçado em dois es-tudos. O primeiro - do tipo metodológico - orientado para a construção e validação de um instrumento de avaliação da satisfação dos clientes com os cuidados de enfermagem presta-dos pelas ECCI (SATENF - ECCI). Recorremos a 11 entrevistas exploratórias com clientes de ECCI e a um painel de nove peritos de enfermagem para definir os conteúdos e modelo de instrumento para aquela avaliação da satisfação. Após, com recurso aos dados oriundos de uma amostra de 222 casos, procedemos ao estudo da fiabilidade do instrumento construí-do – SATENF - ECCI. Verificada a fiabilidade e validade do SATENF - ECCI, evoluímos para o segundo estudo – do tipo exploratório, descritivo e correlacional – com base na mes-ma amostra de casos utilizados na segunda etapa do primeiro estudo; a partir de quatro ECCI de uma Unidade Local de Saúde do Norte de Portugal. No segundo estudo, para além de descrevermos e explorarmos a satisfação dos clientes com os cuidados, procedemos à análi-se da sua associação aos indicadores de ganhos em saúde, nos termos preconizados pela Or-dem do Enfermeiros. Resultados: Os conteúdos da primeira versão do formulário SATENF – ECCI, de acordo com o que emergiu na primeira etapa do estudo metodológico, concretizaram-se em 59 itens, organizados em sete dimensões: Acesso aos Cuidados; Envolvimento e Participação dos Clientes; Cuidados de Enfermagem Esperados na ECCI; Competências do Enfermeiro; In-tensidade do Acompanhamento; Organização dos Cuidados; e, Continuidade dos Cuidados. O estudo da fiabilidade e validade de constructo do instrumento permitiu reter seis dimen-sões, fruto da agregação da Organização dos Cuidados e da Intensidade do Acompanhamen-to. As restantes dimensões foram retidas nos termos do referencial teórico que lhe deu ori-gem. Deste processo resultou um formulário final com 34 itens e seis dimensões; cada uma delas sob a forma de uma subescala, com níveis de consistência interna elevados. Os resul-tados do segundo estudo tornaram evidente que a satisfação dos clientes, em cada uma das seis subescalas adotadas, era elevada. Os melhores resultados verificaram-se nas dimensões: Competências dos enfermeiros; Organização dos cuidados e intensidade do acompanha-mento; e, Acesso aos cuidados de enfermagem. As dimensões com valores médios de satis-fação “menos elevados” foram: Cuidados de enfermagem prestados; Envolvimento e parti-cipação dos clientes; e, Continuidade dos Cuidados de Enfermagem. Os scores elevados de satisfação, em parte, poderão ser explicados por aquilo que, à partida, eram as expectativas dos clientes, até em função do que emergiu das entrevistas exploratórias realizadas na fase inicial da investigação. A correlação entre os níveis de satisfação dos clientes, nas diferentes dimensões estudadas, e os ganhos em saúde tem pouco significado, o que nos leva a admitir que, por agora, a satisfação dos clientes ainda está pouco dependente dos resultados em saú-de.
Conclusões: O SATENF-ECCI é um instrumento que apresenta uma estrutura multidimen-sional, composta por seis subescalas estabilizadas, robustas concetualmente e fiáveis. O formulário na sua versão “final” é capaz de medir a satisfação dos clientes – pessoas depen-dentes e/ou familiares cuidadores – com os cuidados de enfermagem prestados pelas ECCI. É um instrumento passível de ser administrado de forma relativamente rápida por telefone e, por isso, com baixos custos. A informação gerada com a aplicação do SATENF-ECCI pode constituir um importante recurso para as estruturas de governo da RNCCI, nomeadamente naquilo que se reporta à gestão da qualidade dos cuidados nas ECCI.
Abstract Background: The National Network of Integrated Continuous Care is a reality of the Na-tional Health Service, which began in 2006. Integrated Continuous Care Teams (ICCT) is a structure-oriented network for assistance in home context, focusing in helping families that integrate people dependent on self-care. Given the characteristics of the care needs of those clients, the centrality of the nursing care is evident for building quality responses to the needs of clients of the ICCT. In the health context, client satisfaction is one of the key varia-bles to be included in the models of management and governance of service quality. Despite the quality of health being influenced by multiple factors, including professionals the exer-cise of different areas, to clarify the particular contribution of each professional group to the overall quality is imperative for each of those areas and/or domains of knowledge. To devel-op valid and reliable methodologies for assessing client satisfaction with nursing care in the ICCT is a task for the disciplinary field of nursing and also, in this way, a contribution to the improvement of the quality of care in the ICCT. Methods: We developed a anchored research path in two studies. The first – a methodologi-cal study - oriented to the construction and validation of an assessment instrument of client’s satisfaction with nursing care provided by the ICCT (SATENF - ECCI). We use 11 explora-tory interviews with clients integrated in the ICCT and an expert panel of nine nursing to define the contents and the instrument model for the evaluation of çlient’s satisfaction. Af-ter, using the data from a sample of 222 cases, we proceeded to the reliability of the instru-ment built – SATENF - ECCI. Verified the reliability and validity of SATENF - ECCI, we evolved to the second study - exploratory, descriptive and correlational - based on the same cases sample used in the second stage of the first study; from four ICCT from a Local Health Unit of the North of Portugal. In the second study, as well as we write and explore the cli-ent’s satisfaction with care, we proceed to the analysis of its association with health indica-tors gains, as called by the Portuguese Nursing Association. Results: The contents of the first version of the instrument SATENF - ECCI, according to what emerged in the first stage of the methodological study, were concretized on 59 items and organized into seven dimensions: “Access to nursing care”; “Involvement and participa- tion of clients”; “Expected nursing care in the ICCT”; “Nurse’ skills”; “Intensity of attend-ance”; “Organization of care”; and “Continuity of care”. The study of the reliability and va-lidity of the construction of the instrument allowed to retain six dimensions, that result from the aggregation of the “Organization of Care” and “Intensity of the attendance”. The remain-ing dimensions were retained in accordance with the theoretical framework that led to it. This process resulted in a final application form with 34 items and six dimensions; each one of them in a subscale form with high internal consistency levels. The results of the second study became evident that the client satisfaction was high in each of the six subscales adopt-ed. The best results have been seen in the dimensions: “Nurses’ skills”; “Organization of care” and “Intensity of attendance”; and “Access to nursing care”. The dimensions with av-erage values of "less high" satisfaction were: “Nursing care provided”; “Involvement and participation of clients”; and “Nursing Care Continuity”. The high satisfaction score can be explained by what were the expectations of clients, even in what emerged from the explora-tory interviews in the initial stage of the research. The correlation between client satisfaction levels in different dimensions studied, and the health gains have little meaning, which leads us to admit that, for now, the client satisfaction is still little bit dependent on health gains. Conclusions: SATENF-ECCI is an instrument that has a multidimensional structure, com-posed of six subscales stabilized, conceptually robust and reliable. The application form in its "final" version is able to measure client satisfaction - dependents and/or family caregivers - with nursing care provided by the ICCT. It is a tool capable of being delivered relatively quickly by telephone and therefore with low costs. The information generated from the ap-plication of SATENF-ECCI can be an important resource for the National Network of Inte-grated Continuous Care government structures, particularly in what relates to the manage-ment of the quality of care in the ICCT.
Abstract Background: The National Network of Integrated Continuous Care is a reality of the Na-tional Health Service, which began in 2006. Integrated Continuous Care Teams (ICCT) is a structure-oriented network for assistance in home context, focusing in helping families that integrate people dependent on self-care. Given the characteristics of the care needs of those clients, the centrality of the nursing care is evident for building quality responses to the needs of clients of the ICCT. In the health context, client satisfaction is one of the key varia-bles to be included in the models of management and governance of service quality. Despite the quality of health being influenced by multiple factors, including professionals the exer-cise of different areas, to clarify the particular contribution of each professional group to the overall quality is imperative for each of those areas and/or domains of knowledge. To devel-op valid and reliable methodologies for assessing client satisfaction with nursing care in the ICCT is a task for the disciplinary field of nursing and also, in this way, a contribution to the improvement of the quality of care in the ICCT. Methods: We developed a anchored research path in two studies. The first – a methodologi-cal study - oriented to the construction and validation of an assessment instrument of client’s satisfaction with nursing care provided by the ICCT (SATENF - ECCI). We use 11 explora-tory interviews with clients integrated in the ICCT and an expert panel of nine nursing to define the contents and the instrument model for the evaluation of çlient’s satisfaction. Af-ter, using the data from a sample of 222 cases, we proceeded to the reliability of the instru-ment built – SATENF - ECCI. Verified the reliability and validity of SATENF - ECCI, we evolved to the second study - exploratory, descriptive and correlational - based on the same cases sample used in the second stage of the first study; from four ICCT from a Local Health Unit of the North of Portugal. In the second study, as well as we write and explore the cli-ent’s satisfaction with care, we proceed to the analysis of its association with health indica-tors gains, as called by the Portuguese Nursing Association. Results: The contents of the first version of the instrument SATENF - ECCI, according to what emerged in the first stage of the methodological study, were concretized on 59 items and organized into seven dimensions: “Access to nursing care”; “Involvement and participa- tion of clients”; “Expected nursing care in the ICCT”; “Nurse’ skills”; “Intensity of attend-ance”; “Organization of care”; and “Continuity of care”. The study of the reliability and va-lidity of the construction of the instrument allowed to retain six dimensions, that result from the aggregation of the “Organization of Care” and “Intensity of the attendance”. The remain-ing dimensions were retained in accordance with the theoretical framework that led to it. This process resulted in a final application form with 34 items and six dimensions; each one of them in a subscale form with high internal consistency levels. The results of the second study became evident that the client satisfaction was high in each of the six subscales adopt-ed. The best results have been seen in the dimensions: “Nurses’ skills”; “Organization of care” and “Intensity of attendance”; and “Access to nursing care”. The dimensions with av-erage values of "less high" satisfaction were: “Nursing care provided”; “Involvement and participation of clients”; and “Nursing Care Continuity”. The high satisfaction score can be explained by what were the expectations of clients, even in what emerged from the explora-tory interviews in the initial stage of the research. The correlation between client satisfaction levels in different dimensions studied, and the health gains have little meaning, which leads us to admit that, for now, the client satisfaction is still little bit dependent on health gains. Conclusions: SATENF-ECCI is an instrument that has a multidimensional structure, com-posed of six subscales stabilized, conceptually robust and reliable. The application form in its "final" version is able to measure client satisfaction - dependents and/or family caregivers - with nursing care provided by the ICCT. It is a tool capable of being delivered relatively quickly by telephone and therefore with low costs. The information generated from the ap-plication of SATENF-ECCI can be an important resource for the National Network of Inte-grated Continuous Care government structures, particularly in what relates to the manage-ment of the quality of care in the ICCT.
Description
Keywords
Satisfação dos clientes Cuidados continuados domiciliários Cuidados de enfermagem Qualidade dos cuidados Gestão dos cuidados de enfermagem Patient satisfaction Home care services Nursing care Quality of health care Nursing care management