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Advisor(s)
Abstract(s)
Problemática: A integração de uma pessoa dependente no autocuidado no seio do agregado familiar, comporta uma realidade passada, presente e futura. O envelhecimento populacional tem vindo a acentuar a proliferação de doenças crónicas e com isso, o incremento de pessoas dependentes no autocuidado. Estes novos cenários de necessidades em cuidados de saúde, reivindicam uma premente reflexão crítica, quer pela oportunidade de desenvolvimento do core de conhecimentos da disciplina de Enfermagem, quer pela possibilidade de sustentação de modelos de ação dos Enfermeiros, mais significativos para as pessoas.
Objetivos: No âmbito deste projeto partiu-se para um estudo no concelho de Paços de Ferreira que visava a caracterização: das famílias clássicas que integravam pessoas dependentes no autocuidado; da pessoa dependente; do cuidador familiar; dos recursos utilizados; e, o melhoramento da compreensão deste fenómeno no que se reporta à experiência do cuidador familiar acerca da assunção e exercício do papel.
Material e métodos: Tendo como população-alvo as famílias clássicas residentes no concelho de Paços de Ferreira, concebeu-se um plano de investigação que incluía duas etapas sucessivas. Num primeiro momento, um estudo de caráter descritivo e correlacional, que se enquadra nos modelos de investigação quantitativa de base populacional. Foi constituída uma amostra probabilista, aleatória, areolar, estratificada e proporcional com base na freguesia de residência, através de um sistema de informação geográfica. A recolha de dados foi realizada porta a porta por investigadoras-Enfermeiras com recurso a um formulário, instrumento esse que constitui uma ferramenta de utilidade clínica na perspetiva da avaliação multidimensional do fenómeno em questão. No momento seguinte levou-se a cabo um segundo estudo de natureza qualitativa, realizando-se para o efeito 6 entrevistas semiestruturadas a cuidadores familiares que integraram o primeiro estudo, referenciados como informantes privilegiados, no sentido de ampliar a compreensibilidade da problemática.
Resultados: Das 2126 famílias clássicas que fazem parte do estudo, 11,73% integravam pelo menos uma pessoa dependente no autocuidado, sendo que 39,8% tem mais de 80 anos e a principal situação que originou a dependência são as doenças crónicas (63,6%), sendo a sua instalação gradual, em 66,5% dos casos. No que diz respeito ao grau de dependência, face ao domínio do autocuidado global, 91,7% tinham necessidade de ajuda de pessoa, 0,4% só necessitavam de equipamento, sendo que 7,9% eram totalmente dependentes, não participantes, “acamadas”. Constatamos assim que 99,6% dos dependentes necessitavam, no mínimo, de ajuda de pessoa para realizar, pelo menos, uma atividade do autocuidado. Os cuidadores familiares são na sua maioria do sexo feminino (89,6%), com uma média de idades de 56 anos, na sua maioria casada (75,9%), filho/filha da pessoa dependente (42,7%), e em 89,4% coabitavam com o dependente. Os resultados deste estudo demonstraram ainda que a taxa global de utilização dos recursos é de 53,5% o que significa que são utilizados pouco mais de metade, havendo diferenças significativas entre os diferentes domínios do autocuidado. Das razões referidas para a não utilização dos recursos, a mais significativa é a razão económica. Ao Enfermeiro recorrem 67,2% das famílias, que assumem o Médico como principal recurso profissional (92,9%). Os cuidadores familiares outorgam diferentes significados aos cuidados que prestam, reconhecendo no entanto que, a taxa de esforço, a exigência e a vulnerabilidade inerentes a este processo, torna o exercício do papel difícil e crítico, implicando uma preocupação constante, quer pela diversidade e complexidade de cuidados que prestam, quer pelas mudanças que esta situação despoleta nos seus próprios processos de vida.
Conclusões: O fenómeno da dependência no autocuidado é hoje indubitavelmente uma temática emergente que urge escrutinar. A natureza mutável e complexa das necessidades de cuidados das pessoas dependentes requer que, os Enfermeiros reconheçam o sentido inevitável da mudança e deste modo possam gerar, para aplicar conhecimento próprio da disciplina. A pessoa dependente no autocuidado continua preferencialmente a ser integrada no contexto familiar, e este enquadramento conduz à transição do familiar cuidador, associada ao exercício do papel. As famílias desempenham um papel vital como recurso indispensável, por garantirem e assegurarem a satisfação das necessidades dos membros dependentes. Os cuidadores familiares assumem maioritariamente a relação de cuidados munidos de competências que adquiriram pela sua experiência ao longo da vida e por “tentativa-erro”, sendo certo que por vezes, mesmo fazendo “o tudo que podem e sabem”, se revela cabalmente insuficiente para dar resposta às reais necessidades do dependente. A profissionalização dos cuidados poderia alavancar este processo para maiores ganhos em saúde, designadamente sensíveis aos cuidados dos Enfermeiros, quer na reconstrução da autonomia/ independência possível no autocuidado dos dependentes, quer facilitando a transição saudável do cuidador familiar.
Background: The integration of a dependent person in self-care within the household, involves a past, present and future reality. Population aging has accentuated the proliferation of chronic diseases and, with this, the increase of dependent people in self-care. These new scenarios of health care needs demand an urgent critical reflection, both for the opportunity to develop the core knowledge of the Nursing discipline, and for the possibility of sustaining Nurses' models of action, which are more meaningful for people. Objectives: As part of this project, we started a study in the municipality of Paços de Ferreira that aimed at characterizing: the classic families that included dependent people in self-care; dependent person; family caregiver; the resources used; and, the improvement of the understanding of this phenomenon with regard to the family caregiver's experience about assuming and exercising the role. Material and methods: With the target population of the classic families living in the municipality of Paços de Ferreira, a research plan was devised that included two successive stages. At first, a descriptive and correlational study, which fits into the population-based quantitative research models. A probabilistic, random, areolar, stratified and proportional sample was created based on the parish of residence, through a geographic information system. Data collection was carried out door-to-door by nurse-researchers using a form, an instrument that constitutes a tool of clinical utility in the perspective of the multidimensional assessment of the phenomenon in question. In the following moment, a second qualitative study was carried out, for which 6 semi-structured interviews were carried out with family caregivers who were part of the first study, referred to as privileged informants, in order to increase the understanding of the problem. Results: Of the 2126 classic families that are part of the study, 11,73% integrated at least one dependent person in self-care, with 39,8% being over 80 years old and the main situation that led to the dependency is chronic diseases (63,6%), with its gradual installation in 66,5% of cases. With regard to the degree of dependence, given the domain of global self-care, 91,7% needed help from people, 0,4% only needed equipment, with 7,9% being totally dependent, not participating, “ bedridden ”. We thus found that 99,6% of dependents needed, at least, the help of a person to carry out at least one self-care activity. Family caregivers are mostly female (89,6%), with an average age of 56 years, mostly married (75,9%), son / daughter of the dependent person (42,7%), and 89,4% lived with the dependent. The results of this study also demonstrated that the overall rate of use of resources is 53,5%, which means that just over half are used, with significant differences between the different areas of self-care. Of the reasons mentioned for not using the resources, the most significant is the economic reason. The Nurse appeals to 67,2% of families, who take the Doctor as their main professional resource (92,9%). Family caregivers grant different meanings to the care they provide, recognizing, however, that the effort rate, the demand and the vulnerability inherent in this process, makes the exercise of the role difficult and critical, implying a constant concern, both for diversity and complexity care they provide, either because of the changes that this situation triggers in their own life processes. Conclusions: The phenomenon of dependency in self-care is today undoubtedly an emerging theme that needs to be scrutinized. The changing and complex nature of the care needs of dependent people requires that Nurses recognize the inevitable sense of change and thus can generate it, in order to apply the discipline's own knowledge. The dependent person in self-care preferably continues to be integrated into the family context, and this framework leads to the transition of the family caregiver, associated with the exercise of the role. Families play a vital role as an indispensable resource, as they guarantee and ensure that the needs of dependent members are met. Family caregivers mostly assume the relationship of care provided with skills that they have acquired through their experience throughout life and through “trialand-error”, being certain that sometimes, even doing “everything they can and know”, it proves to be totally insufficient to respond to the dependent's real needs. The professionalization of care could leverage this process for greater gains in health, namely sensitive to the care of Nurses, either in the reconstruction of autonomy / independence possible in the self-care of dependents, or by facilitating the healthy transition of family caregivers.
Background: The integration of a dependent person in self-care within the household, involves a past, present and future reality. Population aging has accentuated the proliferation of chronic diseases and, with this, the increase of dependent people in self-care. These new scenarios of health care needs demand an urgent critical reflection, both for the opportunity to develop the core knowledge of the Nursing discipline, and for the possibility of sustaining Nurses' models of action, which are more meaningful for people. Objectives: As part of this project, we started a study in the municipality of Paços de Ferreira that aimed at characterizing: the classic families that included dependent people in self-care; dependent person; family caregiver; the resources used; and, the improvement of the understanding of this phenomenon with regard to the family caregiver's experience about assuming and exercising the role. Material and methods: With the target population of the classic families living in the municipality of Paços de Ferreira, a research plan was devised that included two successive stages. At first, a descriptive and correlational study, which fits into the population-based quantitative research models. A probabilistic, random, areolar, stratified and proportional sample was created based on the parish of residence, through a geographic information system. Data collection was carried out door-to-door by nurse-researchers using a form, an instrument that constitutes a tool of clinical utility in the perspective of the multidimensional assessment of the phenomenon in question. In the following moment, a second qualitative study was carried out, for which 6 semi-structured interviews were carried out with family caregivers who were part of the first study, referred to as privileged informants, in order to increase the understanding of the problem. Results: Of the 2126 classic families that are part of the study, 11,73% integrated at least one dependent person in self-care, with 39,8% being over 80 years old and the main situation that led to the dependency is chronic diseases (63,6%), with its gradual installation in 66,5% of cases. With regard to the degree of dependence, given the domain of global self-care, 91,7% needed help from people, 0,4% only needed equipment, with 7,9% being totally dependent, not participating, “ bedridden ”. We thus found that 99,6% of dependents needed, at least, the help of a person to carry out at least one self-care activity. Family caregivers are mostly female (89,6%), with an average age of 56 years, mostly married (75,9%), son / daughter of the dependent person (42,7%), and 89,4% lived with the dependent. The results of this study also demonstrated that the overall rate of use of resources is 53,5%, which means that just over half are used, with significant differences between the different areas of self-care. Of the reasons mentioned for not using the resources, the most significant is the economic reason. The Nurse appeals to 67,2% of families, who take the Doctor as their main professional resource (92,9%). Family caregivers grant different meanings to the care they provide, recognizing, however, that the effort rate, the demand and the vulnerability inherent in this process, makes the exercise of the role difficult and critical, implying a constant concern, both for diversity and complexity care they provide, either because of the changes that this situation triggers in their own life processes. Conclusions: The phenomenon of dependency in self-care is today undoubtedly an emerging theme that needs to be scrutinized. The changing and complex nature of the care needs of dependent people requires that Nurses recognize the inevitable sense of change and thus can generate it, in order to apply the discipline's own knowledge. The dependent person in self-care preferably continues to be integrated into the family context, and this framework leads to the transition of the family caregiver, associated with the exercise of the role. Families play a vital role as an indispensable resource, as they guarantee and ensure that the needs of dependent members are met. Family caregivers mostly assume the relationship of care provided with skills that they have acquired through their experience throughout life and through “trialand-error”, being certain that sometimes, even doing “everything they can and know”, it proves to be totally insufficient to respond to the dependent's real needs. The professionalization of care could leverage this process for greater gains in health, namely sensitive to the care of Nurses, either in the reconstruction of autonomy / independence possible in the self-care of dependents, or by facilitating the healthy transition of family caregivers.
Description
Keywords
Famílias Dependência Autocuidado Perceção de autoeficácia Familiar cuidador Families Dependence Self-care Perception of self-efficacy Family caregiver