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Dispneia em cuidados paliativos num serviço de medicina interna : o que informam os registos de enfermagem
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A avaliação da dispneia, relatada pelo próprio, permite adequar a prestação de cuidados de enfermagem às necessidades do doente. Painéis de peritos recomendam, tal como na dor, a avaliação quantitativa da dispneia seguida de registos escritos para uma monitorização contínua.
Este estudo quantitativo sob a forma de uma pesquisa descritiva, transversal e observacional tem como objetivo comparar os registos de enfermagem e a auto-avaliação da dispneia por indivíduos, internados em serviços de Medicina Interna, com doenças crónicas, progressivas e avançadas com necessidades paliativas.
Foi constituída uma amostra de 77 sujeitos admitidos em 2016 em dois serviços de Medicina Interna que avaliou a sua dispneia em repouso e funcional através de escalas de avaliação numérica. Concomitantemente consultaram-se os processos de enfermagem da amostra, registando a informação em documento criado para o efeito.
Mais de metade da amostra nega a presença de dispneia e os seus registos de enfermagem confirmam apesar destes serem realizados sem recurso a escala de avaliação. A maioria dos indivíduos com diagnóstico de dispneia nos registos de enfermagem tem intervenções autónomas de enfermagem associadas. As intervenções autónomas de enfermagem não abrangem todas as dimensões da dispneia total e inexiste um plano terapêutico diferenciado para o controlo sintomático de diferentes intensidades da dispneia.
Recomenda-se a realização de mais estudos sobre esta problemática. Considera-se necessária uma abordagem mais sistematizada da dispneia em indivíduos com doenças crónicas, progressivas e avançadas com necessidades paliativas.
By evaluating dyspnea, based on what is reported by the patient, allows us to adapt and implement nursing care. The same way pain is evaluated, experts recommend a quantitative evaluation of dyspnea based on written documentation for continuous monitoring. This quantitative study is based on a descriptive, transverse and observational research. It´s goal is to compare nursing documentation with self-evaluation of dyspnea reported by patients that were hospitalized in a Medicine ward with a chronic progressive disease and in need of palliative care. A sample of 77 individuals admitted in 2016 in two Internal Medicine wards where selected to evaluate their dyspnea at rest and on exertion through a numerical data scale. Simultaneously, nursing documentation of the individuals were reviewed and that was noted in a document created for that purpose. More than half of the sample denies the presence of dyspnea. However their nursing documentation proves otherwise although an evaluation scale was not in use. The majority of the individuals diagnosed with dyspnea based on nursing documentation have independent nursing interventions. These independent nursing interventions do not include all the aspects associated to total dyspnea and there is no specialized therapeutic plan that includes the symptomatic control of dyspnea in all its different levels of severity. It is recommended that more studies are accomplished on this subject. A systematic approach of dyspnea in patients with a chronic progressive disease and in need of palliative care is considered essential.
By evaluating dyspnea, based on what is reported by the patient, allows us to adapt and implement nursing care. The same way pain is evaluated, experts recommend a quantitative evaluation of dyspnea based on written documentation for continuous monitoring. This quantitative study is based on a descriptive, transverse and observational research. It´s goal is to compare nursing documentation with self-evaluation of dyspnea reported by patients that were hospitalized in a Medicine ward with a chronic progressive disease and in need of palliative care. A sample of 77 individuals admitted in 2016 in two Internal Medicine wards where selected to evaluate their dyspnea at rest and on exertion through a numerical data scale. Simultaneously, nursing documentation of the individuals were reviewed and that was noted in a document created for that purpose. More than half of the sample denies the presence of dyspnea. However their nursing documentation proves otherwise although an evaluation scale was not in use. The majority of the individuals diagnosed with dyspnea based on nursing documentation have independent nursing interventions. These independent nursing interventions do not include all the aspects associated to total dyspnea and there is no specialized therapeutic plan that includes the symptomatic control of dyspnea in all its different levels of severity. It is recommended that more studies are accomplished on this subject. A systematic approach of dyspnea in patients with a chronic progressive disease and in need of palliative care is considered essential.
Descrição
Tese de mestrado, Cuidados Paliativos, Universidade de Lisboa, Faculdade de Medicina, 2016
Palavras-chave
Dispneia Avaliação da dispneia Registos de enfermagem Cuidados paliativos Teses de mestrado - 2016