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Advisor(s)
Abstract(s)
estudo apresentado inscreve-se no domínio do autocuidado, mais concretamente “na promoção da autonomia da pessoa dependente para o autocuidado”. Emerge de um percurso de investigação-ação (IA), desenvolvido numa Unidade de Convalescença da Rede Nacional de Cuidados Continuados Integrados (RNCCI). Os Cuidados Continuados Integrados estão centrados na recuperação global da pessoa, promovendo a sua autonomia e melhorando a sua funcionalidade, no âmbito da situação de dependência em que se encontra. Os critérios usuais de referenciação para estas unidades contemplam a dependência para o autocuidado em pessoas com necessidades de reabilitação funcional e de treino das atividades básicas de autocuidado (tomar banho, vestir-se e despir-se, arranjar-se, cuidar da higiene pessoal, arranjar-se, alimentar-se, usar o sanitário, transferir-se, virar-se e mover-se em cadeira de rodas), com forte potencial de recuperação. Esta condição conduz para uma transição situacional de saúde/doença que implica um processo, uma direção e aquisição de novos papéis e responsabilidades.
Promover a autonomia da pessoa dependente para o autocuidado, estimulando-a para uma mudança significativa do seu modo de vida e para uma aprendizagem com recurso a estratégias adaptativas, é algo que pode ser facilitado pelos enfermeiros. Para isso é necessário encontrar um modelo capaz de levar a pessoa dependente a atingir o seu máximo de potencial de autonomia para o autocuidado.
O ciclo de IA empreendido gerou mudanças no modelo de cuidados em uso, tendo apelado ao uso de estratégias promotoras da participação e do comprometimento interno dos enfermeiros, com vista à viabilização da mudança. Os resultados permitiram estruturar um conjunto de pressupostos que estão na génese de um modelo de orientação da conceção de cuidados, centrado na promoção da autonomia para o autocuidado. Foi possível partir do que “o que os enfermeiros fazem e como fazem”, para uma estratégia de reflexão “sobre a ação e na ação”, para gerar evidência. Este modelo permite aos enfermeiros compreenderem o que ocorre na prática e organizar de forma critica essa informação, de modo a fundamentar a tomada de decisão que antecede a ação, no sentido da promoção da autonomia da pessoa dependente para o autocuidado.
Os dados iniciais, os diagnósticos de enfermagem, os objetivos e as intervenções de enfermagem constituem os itens de informação característicos para a sistematização da explanação da conceção de cuidados, centrada na promoção da autonomia da pessoa dependente para o autocuidado. Para isso relevam estruturas fundamentais como: a especificação dos dados iniciais sobre a capacidade de autocuidado e integração de dados relativos a focos de atenção de enfermagem centrados nas respostas humanas às transições; a sistematização na explanação da conceção de cuidados, centrada nas respostas humanas às transições; o suporte de dados com integridade referencial entre, diagnósticos, objetivos/resultados e intervenções de enfermagem; a utilização de qualificadores que revelem a identificação de oportunidade de desenvolvimento e mestria que caracteriza o máximo de potencial de autonomia (potencial para adquirir, ou desenvolver, ou melhorar o conhecimento e/ou capacidade para estratégias adaptativas no autocuidado; a integração de intervenções de enfermagem promotoras da autonomia da pessoa, potenciando a utilização de dispositivos de apoio adequados a cada pessoa; a monitorização de padrões de resposta durante o processo de recuperação da autonomia, como uma estratégia para a gestão personalizada dos cuidados.
Um recurso importante para o desenvolvimento do modelo de intervenção é um sistema de informação de suporte à tomada de decisão em enfermagem, sistematizado que permita gerir a informação produzida como expressão adequada da prática clinica.
Este percurso de investigação permitiu: estruturar a ação profissional dos enfermeiros centrada na promoção da autonomia para o autocuidado, tendo por base o seu potencial de recuperação e desenvolver um conhecimento empírico que pretende conduzir a prática profissional, orientada por modelos conceptuais (Teoria do autocuidado de Orem e Teoria das transições de Meleis), tornando-a progressivamente mais significativa para as pessoas.
The presented study is placed within the domain of self-care, more specifically, “within the promotion of the autonomy of the dependent person for self-care”. It emerges from a course of Action Research (AR), developed in a Convalescence Unit of the National Long Term Care Network (LTC). The Long Term Care is focused on the global recovery of the person, promoting one’s autonomy and improving one’s functionality, within the ambit of his/her dependency situation. The usual referencing criteria for these units contemplate the dependency for self-care in people with needs of functional rehabilitation and of self-care basic activities training (Having a shower, getting dressed and getting undressed, getting ready, taking care of one’s personal hygiene, feeding oneself, using the toilet, turning around and moving in a wheel chair), with a strong potential for recovery. This condition leads to a situational transition of health/ illness that implies a process, a direction and an acquisition of new roles and responsibilities. Promoting a dependent person’s autonomy for self-care, stimulating him/ her for a significant change in his/her way of living and for learning through adaptive strategies are actions that can be facilitated by nurses. To do so, it is important to find a model capable to lead the dependent person to reach his/her maximum autonomy potential for self-care. The undertaken AR cycle has created changes in the care model that was being used, having appealed to the use of promoter strategies of participation and internal commitment by nurses, with the purpose of change. The results have allowed structuring a set of presuppositions that are in the origin of an orientation model of the self-care concept, centered in the promotion of the self-care autonomy. It was possible to start from “what nurses do and how they do it” and reflect “about the action and on the action” to generate evidence. This model allows nurses to understand what occurs in practice and to organize that information in a critical way, in order to justify the decision that precedes an action and to promote the autonomy of the dependent person for self-care. The initial data, the nursing diagnosis, the nursing objectives and interventions constitute the information items that characterize the explanation systematization of the care concept, centered on the promotion of the autonomy of the dependent person for self-care. For that, they reveal fundamental structures like: the initial data specifications about the self-care capability and the integration of data related to the nursing attention focus, centered on human responses to transitions; the explanation systematization of the care concept, centered on human responses to transitions; the data support with referential integrity among diagnosis, objectives/results and nursing interventions; the usage of qualifiers that reveal the identification of development opportunity and skills that characterize the maximum potential of autonomy (potential to acquire, or develop, or improve the knowledge and or capability for adaptive strategies on self-care); the integration of nursing interventions that promote the person’s autonomy, potentiating the usage of support devices suitable for each person; the monitoring of response patterns during the autonomy recovery process, as a strategy for the care personalized management. An important resource for the development of the intervention model is a support information system, in order to help the nurses’ decision, which allows managing generated information as an adequate expression of the clinical practice. This investigation course has allowed: to structure the nurses’ professional action centered on the promotion of autonomy for self-care, having as a basis one’s recovery potential; and to develop an empirical knowledge that intends to lead to a professional practice oriented by conceptual models (Self-care Theory by Orem and Transitions Theory by Meleis), making it progressively more significant for people.
The presented study is placed within the domain of self-care, more specifically, “within the promotion of the autonomy of the dependent person for self-care”. It emerges from a course of Action Research (AR), developed in a Convalescence Unit of the National Long Term Care Network (LTC). The Long Term Care is focused on the global recovery of the person, promoting one’s autonomy and improving one’s functionality, within the ambit of his/her dependency situation. The usual referencing criteria for these units contemplate the dependency for self-care in people with needs of functional rehabilitation and of self-care basic activities training (Having a shower, getting dressed and getting undressed, getting ready, taking care of one’s personal hygiene, feeding oneself, using the toilet, turning around and moving in a wheel chair), with a strong potential for recovery. This condition leads to a situational transition of health/ illness that implies a process, a direction and an acquisition of new roles and responsibilities. Promoting a dependent person’s autonomy for self-care, stimulating him/ her for a significant change in his/her way of living and for learning through adaptive strategies are actions that can be facilitated by nurses. To do so, it is important to find a model capable to lead the dependent person to reach his/her maximum autonomy potential for self-care. The undertaken AR cycle has created changes in the care model that was being used, having appealed to the use of promoter strategies of participation and internal commitment by nurses, with the purpose of change. The results have allowed structuring a set of presuppositions that are in the origin of an orientation model of the self-care concept, centered in the promotion of the self-care autonomy. It was possible to start from “what nurses do and how they do it” and reflect “about the action and on the action” to generate evidence. This model allows nurses to understand what occurs in practice and to organize that information in a critical way, in order to justify the decision that precedes an action and to promote the autonomy of the dependent person for self-care. The initial data, the nursing diagnosis, the nursing objectives and interventions constitute the information items that characterize the explanation systematization of the care concept, centered on the promotion of the autonomy of the dependent person for self-care. For that, they reveal fundamental structures like: the initial data specifications about the self-care capability and the integration of data related to the nursing attention focus, centered on human responses to transitions; the explanation systematization of the care concept, centered on human responses to transitions; the data support with referential integrity among diagnosis, objectives/results and nursing interventions; the usage of qualifiers that reveal the identification of development opportunity and skills that characterize the maximum potential of autonomy (potential to acquire, or develop, or improve the knowledge and or capability for adaptive strategies on self-care); the integration of nursing interventions that promote the person’s autonomy, potentiating the usage of support devices suitable for each person; the monitoring of response patterns during the autonomy recovery process, as a strategy for the care personalized management. An important resource for the development of the intervention model is a support information system, in order to help the nurses’ decision, which allows managing generated information as an adequate expression of the clinical practice. This investigation course has allowed: to structure the nurses’ professional action centered on the promotion of autonomy for self-care, having as a basis one’s recovery potential; and to develop an empirical knowledge that intends to lead to a professional practice oriented by conceptual models (Self-care Theory by Orem and Transitions Theory by Meleis), making it progressively more significant for people.
Description
Keywords
Dependência para o autocuidado Potencial para a autonomia Autonomia para o autocuidado Dependency for self-care Potential for autonomy Autonomy for self-care