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Continuidade em cuidados domiciliários : o papel do enfermeiro
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Orientador(es)
Resumo(s)
O panorama das necessidades de saúde é marcado pela alteração das curvas de transição epidemiológica e
demográfica o que, a par da precocidade das altas hospitalares, determina o incremento dos cuidados de
saúde domiciliários. A literatura sobre o papel do enfermeiro no domicílio é variada (ainda que escassa), foca
os múltiplos contornos neste contexto, considerado como representando novos desafios e reporta-se a
realidades diferentes da nacional, não se encontrando referência a intervenções conducentes à manutenção
da continuidade de cuidados.
Com este estudo pretendeu-se compreender como é que, no domicílio, é assegurada a continuidade dos
cuidados de saúde, tendo por base a questão: Qual o papel singular do enfermeiro na construção da
continuidade dos cuidados de saúde no domicilio?
A investigação decorreu sob o referencial teórico do Interaccionismo Simbólico. Foi utilizada, como
metodologia de análise, a “Grounded Theory” de Glaser e Strauss (1967). O trabalho de campo foi
autorizado e decorreu num Centro de Saúde com um Programa de Cuidados Continuados Domiciliários. Os
dados foram colhidos através de entrevistas qualitativas (enfermeiros, equipa, Direcção do Centro de Saúde,
autarcas, utentes e cuidadores), observação participante e entrevista de grupo focal (Focus Group).
Os achados elucidam sobre a natureza e o processo de construção da continuidade dos cuidados: em
resposta às condições contextuais do domicilio, o enfermeiro Recria o Papel assumindo-se como Mediador
entre as necessidades e os recursos e o Apoio Técnico-Cientifico e Emocional da pessoa e da família. Recriar
o Papel, resulta do entrecruzar da Conciliação do Papel do enfermeiro com as expectativas dos
intervenientes, adopção de Praxis Crítica como singularidade do fazer e Encontro de Alteridades como a
especificidade da relação com a pessoa e família. Da recriação do papel resulta a construção de uma
parceria: o enfermeiro constitui-se Parceiro da Família cuidadora. A continuidade dos cuidados resulta de Co-
Construção família-enfermeira. Co-Construção é o constructo que responde à questão de partida e envolve,
além dos anteriores, novos conceitos como "Trabalho sem Rede", "Ciclo Informação-Acção" e "Lastro
Residual de Relação" predicativos da singularidade do fazer enfermagem neste contexto.
Foram identificadas as implicações do estudo para a profissão e para a academia de enfermagem.
The panorama of health needs is marked by a change in the epidemiological and demographic transition curves which, together with early hospital discharge, lead to an increase in in-home care. The literature on the nurse’s role in home health care is diverse (although scarce), focusing on the multiple aspects of this field, considered as representing new challenges, but on situations very different from the Portuguese reality. No references were found on interventions leading to the maintenance of care continuity. This study aimed to understand how the continuity of care is ensured at home based on the following question: What is the role of the individual nurse in the continuity of health care at home? This study was based on the theoretical framework of Symbolic Interactionism. The method of analysis used was the Grounded Theory by Glaser and Strauss (1967). The fieldwork was authorized and carried out in a Health Centre with an In-home Continuing Care Program. Data were collected based using qualitative interviews (nurses, team, Health Centre Administration, local politicians, users and carers), participant observation and focus groups. The findings explain the nature and the process of construction of care continuity: in response to the conditions at home, the nurse Recreates the Role as a Mediator between the needs and resources and the Technical-Scientific and Emotional Support of the person and family. Recreating the Role results from the Conciliation between the nurse’s Role and the expectations of the people involved, the adoption of Critical Praxis, as singularity of “doing”, and the Meeting of Alterities, as the specificity of the individual-family relationship. The recreation of this role results in the creation of a partnership: the nurse becomes a Partner of the caring Family. The continuity of care results from the family-nurse Co-Construction. This construct is the answer for our starting question and, in addition to these previous concepts, it involves new ones such as “Network”, “Information-Action Cycle” and “Relationship Residual Basis”, predictors of the singularity of the nursing intervention in this context. The implications of this study for the nursing profession and nursing science were identified.
The panorama of health needs is marked by a change in the epidemiological and demographic transition curves which, together with early hospital discharge, lead to an increase in in-home care. The literature on the nurse’s role in home health care is diverse (although scarce), focusing on the multiple aspects of this field, considered as representing new challenges, but on situations very different from the Portuguese reality. No references were found on interventions leading to the maintenance of care continuity. This study aimed to understand how the continuity of care is ensured at home based on the following question: What is the role of the individual nurse in the continuity of health care at home? This study was based on the theoretical framework of Symbolic Interactionism. The method of analysis used was the Grounded Theory by Glaser and Strauss (1967). The fieldwork was authorized and carried out in a Health Centre with an In-home Continuing Care Program. Data were collected based using qualitative interviews (nurses, team, Health Centre Administration, local politicians, users and carers), participant observation and focus groups. The findings explain the nature and the process of construction of care continuity: in response to the conditions at home, the nurse Recreates the Role as a Mediator between the needs and resources and the Technical-Scientific and Emotional Support of the person and family. Recreating the Role results from the Conciliation between the nurse’s Role and the expectations of the people involved, the adoption of Critical Praxis, as singularity of “doing”, and the Meeting of Alterities, as the specificity of the individual-family relationship. The recreation of this role results in the creation of a partnership: the nurse becomes a Partner of the caring Family. The continuity of care results from the family-nurse Co-Construction. This construct is the answer for our starting question and, in addition to these previous concepts, it involves new ones such as “Network”, “Information-Action Cycle” and “Relationship Residual Basis”, predictors of the singularity of the nursing intervention in this context. The implications of this study for the nursing profession and nursing science were identified.
Descrição
Tese de doutoramento, Enfermagem, Universidade de Lisboa, com a participação da Escola Superior de Enfermagem, 2011
Palavras-chave
Cuidados domiciliários Continuidade Papel do enfermeiro Teses de doutoramento - 2010