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O cuidado informal a pessoas idosas dependentes no autocuidado após um acidente vascular cerebral : avaliação do impacto do programa InCARE na capacitação dos cuidadores
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Em Portugal o acidente vascular cerebral (AVC) representa a principal causa de incapacidade nas pessoas idosas. Apesar dos avanços nos cuidados de saúde permitirem que mais sobreviventes deste acidente neurológico vivam no domicílio cuidados pelas famílias, a evidência sugere que os cuidadores pouco capacitados sofrem elevados níveis de sobrecarga, reportam insatisfação com a quantidade e qualidade da informação e com o suporte recebido. A investigação foi realizada com base em três estudos que, embora distintos, são complementares. O Estudo 1, de natureza qualitativa, pretendeu explorar conceitos associados ao autocuidado, tendo sido desenvolvido com recurso à metodologia Focus Group e integrado um painel de nove enfermeiros peritos. O estudo 2, metodológico, teve por objetivo construir e validar um instrumento de aferição das capacidades de cuidadores informais (n=186) de pessoas idosas dependentes no autocuidado após um AVC. O estudo 3, quasi-experimental, foi desenvolvido em contexto comunitário e pretendeu avaliar o impacto do programa de intervenção (InCARE) na capacitação, na redução da sobrecarga e melhoria do estado de saúde dos cuidadores informais de pessoas idosas dependentes no autocuidado após um AVC, bem como, no índice de funcionalidade, no número de readmissões hospitalares e na institucionalização dos sobreviventes deste acidente neurológico (n=174), distribuídos pelo grupo experimental (n=85) e pelo grupo controlo (n=89). Da análise das narrativas das entrevistas dos participantes no estudo 1 emergiram 7 tipologias por semelhança, a partir das quais se construiu, no estudo 2 a Escala de Capacidades do Prestador Informal de Cuidados a Idosos Dependentes por AVC (ECPICID-AVC), a qual traduz consistência interna de α=0,838 e fidelidade de ICC=0,988. Os resultados do programa implementado no Estudo 3 revelam melhor capacitação, melhor estado de saúde (domínio mental) e menor sobrecarga no 1º (M1) e 3º (M2) mês após a intervenção no grupo de cuidadores informais que integraram o grupo experimental quando comparados com os do grupo controlo, contudo a variável funcionalidade dos sobreviventes de AVC que integraram o grupo experimental não revelou uma evolução favorável. No que diz respeito à institucionalização e ao número de internamentos hospitalares das pessoas mais velhas, os resultados não foram claros quanto ao impacto do programa InCARE (M1 e M2) na redução destes indicadores Os dados permitem concluir sobre o contributo e a prioridade da implementação de programas de intervenção estruturada na capacitação dos cuidadores de pessoas idosas dependentes após um AVC, programas que devem ser entendidos, também, como estratégias de intervenção terapêutica para melhorar a saúde e a redução de sobrecarga dos cuidadores informais em geral e dos cuidadores de sobreviventes de AVC, em particular, bem como a saúde, independência e a qualidade de vida das pessoas mais velhas dependentes no autocuidado, após um AVC ou outro evento gerador de dependência neste domínio.
In Portugal cerebrovascular accidents represent the main cause of disability in older people. In spite of the fact that healthcare advances allow survivors of neurological accidents to live at home being cared for by their relatives, evidence suggests that poorly trained caregivers are highly overloaded and dissatisfied with the amount and quality of the information and support they receive. This research was carried out based on three studies which, although different, complement each other. Study 1, of qualitative nature, intended to explore dimensions associated with self-care. Nine expert nurses integrated the Focus Group. Study 2, of methodological type, aimed at building and consolidating an instrument to check the practical skills of caregivers of older stroke survivors (n=186). Study 3, quasi-experimental, was developed in a community context and sought to evaluate the impact of an intervention programme (InCARE) regarding empowerment, reduction of overloading and improvement of caregivers’ health status, as well as the index of functionality, number of hospital readmissions and institutionalization of survivors of neurological accidents (n= 174) distributed in the experimental group (n=85) and in the control group (n=89). Seven dimensions emerged regarding the results obtained from the participants’ interviews carried out under Study 1, from which the ECPICID-AVC was built and validated in Study 2, showing internal consistence (α=0,838) and fidelity (ICC=0,988). The results obtained from the programme implemented in the experimental group in Study 3 revealed that caregivers showed a higher capability and better health status and felt less overloaded in the first (M1) and third month (M2) after intervention when compared to the control group. However, the functionality variable of the stroke survivors who integrated the experimental group did not show a favorable evolution. Regarding institutionalization and number of hospital admissions of older people, the results were not conclusive in relation to the impact of the InCARE programme (M1 and M2) in the reduction of those indicators. The results of this research allow concluding that it is important and vital to implement structured programmes to empower informal caregivers of older people after a stroke. Such programmes must also be considered as therapeutical intervention strategies to enhance the health status and to reduce overload of informal caregivers as well as to enhance health, independence and quality of life of dependent older people, after a stroke or other event causing dependence in self-care.
In Portugal cerebrovascular accidents represent the main cause of disability in older people. In spite of the fact that healthcare advances allow survivors of neurological accidents to live at home being cared for by their relatives, evidence suggests that poorly trained caregivers are highly overloaded and dissatisfied with the amount and quality of the information and support they receive. This research was carried out based on three studies which, although different, complement each other. Study 1, of qualitative nature, intended to explore dimensions associated with self-care. Nine expert nurses integrated the Focus Group. Study 2, of methodological type, aimed at building and consolidating an instrument to check the practical skills of caregivers of older stroke survivors (n=186). Study 3, quasi-experimental, was developed in a community context and sought to evaluate the impact of an intervention programme (InCARE) regarding empowerment, reduction of overloading and improvement of caregivers’ health status, as well as the index of functionality, number of hospital readmissions and institutionalization of survivors of neurological accidents (n= 174) distributed in the experimental group (n=85) and in the control group (n=89). Seven dimensions emerged regarding the results obtained from the participants’ interviews carried out under Study 1, from which the ECPICID-AVC was built and validated in Study 2, showing internal consistence (α=0,838) and fidelity (ICC=0,988). The results obtained from the programme implemented in the experimental group in Study 3 revealed that caregivers showed a higher capability and better health status and felt less overloaded in the first (M1) and third month (M2) after intervention when compared to the control group. However, the functionality variable of the stroke survivors who integrated the experimental group did not show a favorable evolution. Regarding institutionalization and number of hospital admissions of older people, the results were not conclusive in relation to the impact of the InCARE programme (M1 and M2) in the reduction of those indicators. The results of this research allow concluding that it is important and vital to implement structured programmes to empower informal caregivers of older people after a stroke. Such programmes must also be considered as therapeutical intervention strategies to enhance the health status and to reduce overload of informal caregivers as well as to enhance health, independence and quality of life of dependent older people, after a stroke or other event causing dependence in self-care.
Descrição
Tese de doutoramento, Enfermagem, Universidade de Lisboa, com a colaboração da Escola Superior de Enfermagem de Lisboa, 2016
Palavras-chave
Cuidadores Acidente vascular cerebral Idosos Teses de doutoramento - 2016