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Abstract(s)
A partir de investigações nacionais e estrangeiras constata-se a importância em aprofundar conhecimento sobre os componentes e caracteristicasterísticas do Raciocínio Clínico dos Enfermeiros em diferentes contextos. O Raciocínio Clínico dos Enfermeiros (RCE) é um fenómeno central ao exercício profissional e, quando bem praticado confere benefícios às pessoas cuidadas. Assim, esta tese procura responder à questão: Como se desenvolve o Processo de Raciocínio Clínico dos Enfermeiros que trabalham no Serviço de Urgência?
Foi usada uma abordagem de natureza qualitativa e indutiva - Grounded Theory. Para a colheita de dados foram realizadas entrevistas em profundidade e observação participante. As entrevistas feitas a 20 enfermeiros e a observação participante foi sendo realizada ao longo de 6 meses de permanência em campo. Os dados do presente trabalho foram analisados de acordo com o método das comparações constantes, resultando uma teoria de médio alcance sobre o Processo de Raciocínio Clínico dos Enfermeiros com dois componentes, complementares e interrelacionados - Processo de Avaliação Diagnóstica e o Processo de Intervenção Terapêutica de Enfermagem.
Os resultados mostraram que o Processo de Raciocínio Clínico acontece em dois níveis de avaliação e ação. Em primeira instância o enfermeiro atua no Nível I – Riscos de Vida e só depois se dirige ao Nível II – Problemas expressos pela pessoa. Assim, Apura Risco de Vida e Problemas expressos, na intervenção faz Gestão do Risco de Vida (GRV) e dos Problemas expressos (GPE). O contexto foi classificado por ter dois tipos de setores: Primeira abordagem - Salas de emergência e Sala de Triagem e Segunda abordagem - Balcões e Unidade de Observação.
Simultanemente, o Processo de Raciocínio Clínico dos Enfermeiros está imbuído numa Relação Terapêutica (RT) entre dois atores principais: enfermeiro e pessoa cuidada. A relação tem três fases sequenciais: Princípio, Corpo e Fim da relação. O Príncipio da relação, acontece durante a consulta de triagem, onde predomina o Processo de Avaliação Diagnóstica. O Corpo da relação é essencialmente Processo de Intervenção Terapêutica de Enfermagem. O Fim da relação acontece na alta clínica, na transferência para um serviço de internamento ou, no limite, pela morte da pessoa.
From national and foreign investigations, the importance of deepening knowledge about the components and characteristics of the Clinical Reasoning of Nurses in different contexts can be seen. The Clinical Reasoning of Nurses (CRN) is a central phenomenon to the professional exercise, when well practiced it confers benefits to the people cared for. This thesis seeks to answer the question: How is the Clinical Reasoning Process of Nurses working in the Emergency Department developed? A qualitative and inductive approach was used – Grounded Theory. For collection techniques used were in-depth interview and participant observation. The interviews were conducted with 20 nurses and the participant observation was carried out over 6 months in the field. The data of the present study were analyzed according to the constant comparative method, which resulted in a medium range theory on the Clinical Reasoning Process of Nurses consisting of two components, complementary and interrelated - Diagnostic Assessment Process and the Nursing Therapeutic Intervention Process. The results showed that the Clinical Reasoning Process happens before two levels of evaluation and action. In the first instance the nurse acts before the Level I - Risks of Life and then he goes to a second level of which are the Level II - Problems expressed by the person. For this purpose, it determines Life and Problems expressed by the person and for the intervention it does Life Risk Management (LRM) and the Problems expressed (MPP). The context was classified in two types of assistance sectors: First approach - Emergency Rooms and the Screening Room, and the Second approach - Branches and Observation Unit. Also the Clinical Reasoning Process of Nurses is imbued in a Therapeutic Relationship (TR) between two main actors: nurse and the cared person. This relationship have a three sequential phases: Principle, Body and End of the relationship. The first has during the screening consultation, where predominated Diagnostic Evaluation Process. The Body of the relation is essentially of the Process of Therapeutic Intervention of Nursing. The end of the relationship happens now of discharge, of transference to an inpatient service or, in the limit, by the death of the person.
From national and foreign investigations, the importance of deepening knowledge about the components and characteristics of the Clinical Reasoning of Nurses in different contexts can be seen. The Clinical Reasoning of Nurses (CRN) is a central phenomenon to the professional exercise, when well practiced it confers benefits to the people cared for. This thesis seeks to answer the question: How is the Clinical Reasoning Process of Nurses working in the Emergency Department developed? A qualitative and inductive approach was used – Grounded Theory. For collection techniques used were in-depth interview and participant observation. The interviews were conducted with 20 nurses and the participant observation was carried out over 6 months in the field. The data of the present study were analyzed according to the constant comparative method, which resulted in a medium range theory on the Clinical Reasoning Process of Nurses consisting of two components, complementary and interrelated - Diagnostic Assessment Process and the Nursing Therapeutic Intervention Process. The results showed that the Clinical Reasoning Process happens before two levels of evaluation and action. In the first instance the nurse acts before the Level I - Risks of Life and then he goes to a second level of which are the Level II - Problems expressed by the person. For this purpose, it determines Life and Problems expressed by the person and for the intervention it does Life Risk Management (LRM) and the Problems expressed (MPP). The context was classified in two types of assistance sectors: First approach - Emergency Rooms and the Screening Room, and the Second approach - Branches and Observation Unit. Also the Clinical Reasoning Process of Nurses is imbued in a Therapeutic Relationship (TR) between two main actors: nurse and the cared person. This relationship have a three sequential phases: Principle, Body and End of the relationship. The first has during the screening consultation, where predominated Diagnostic Evaluation Process. The Body of the relation is essentially of the Process of Therapeutic Intervention of Nursing. The end of the relationship happens now of discharge, of transference to an inpatient service or, in the limit, by the death of the person.
Description
Keywords
Raciocínio Clínico dos Enfermeiros (RCE) Gestão do Risco de Vida (GRV) Gestão dos Problemas da Pessoa (GPE) Relação Terapêutica (RT) Clinical Reasoning of Nurses (CRN) Life Risk Management (LRM) Management of People's Problems (MPP) Therapeutic Relationship (TR)