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A desadequação dos cuidados ao doente em fim de vida no contexto do Serviço de Urgência
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Abstract(s)
No âmbito da Unidade Curricular 11 – Estágio Profissional com Relatório Final, lecionada no 1º semestre do 2º ano, do curso de Mestrado em Cuidados Paliativos, da Escola Superior de Saúde Dr. Lopes Dias do Instituto Politécnico de Castelo Branco, sob a orientação e supervisão da docente Ângela Simões, elaborei o presente trabalho de relatório da prática clínica. Os Cuidados Paliativos são considerados essenciais a um Serviço Nacional de Saúde de qualidade, devendo ser prestados em continuidade nos cuidados de saúde, a todas as pessoas com doenças muito graves e/ou avançadas e progressivas, que deles necessitem, e onde quer que se encontrem, designadamente nos cuidados de saúde primários, hospitalares ou continuados integrados.
Uma reflexão crítica sobre todo o percurso percorrido é necessária para a realização de uma autoavaliação e análise associada aos sucessos obtidos e/ou oportunidades para melhorar. Assim o presente relatório procura descrever de forma critico-reflexiva todo o percurso percorrido nos últimos meses, incluindo as trezentas horas de estágio e a aplicação do plano de intervenção. Enquanto enfermeira do Serviço de Urgência várias são as colaborações solicitadas à Equipa Intra-Hospitalar de Suporte em Cuidados Paliativos através da referenciação de doentes. Por isso, escolhi realizar o estágio do mestrado nesta equipa com o intuito de conhecer a sua realidade, funcionamento e adquirir novas competências e conhecimentos. As competências específicas do enfermeiro especialista em Enfermagem em Pessoa em Situação Crónica e Paliativa são: cuida de pessoas com doença crónica, incapacitante e terminal, dos seus cuidadores e familiares, em todos os contextos de prática clínica, diminuindo o seu sofrimento, maximizando o seu bem -estar, conforto e qualidade de vida; e, estabelece relação terapêutica com pessoas com doença crónica incapacitante e terminal, com os seus cuidadores e familiares, de modo a facilitar o processo de adaptação às perdas sucessivas e à morte. Assim no presente relatório demonstro, pormenorizadamente, como as competências instrumentais, interpessoais e sistémicas foram adquiridas nas quatro áreas chave dos Cuidados Paliativos – controlo de sintomas, comunicação, apoio à família e trabalho em equipa. O plano de intervenção foi aplicado no Serviço de Urgência acerca da desadequação dos cuidados ao doente em fim de vida neste contexto. No Serviço de Urgência são admitidos vários doentes em situação de doença aguda, incluindo-se também doentes em situação de doença incurável ou grave, em fase avançada e progressiva com sintomas não controlados.
O Serviço de Urgência tem como missão a prestação de cuidados em situações de urgência e emergência médica numa perspetiva curativa. Porém, atualmente existe um aumento de admissões de pessoas em situação paliativa, o que exige uma mudança na filosofia do cuidar e inovação da prática clínica, pois subsiste uma lacuna acerca deste tipo de cuidados nos profissionais de saúde dos serviços de urgência. As equipas precisam de reconhecer a importância dos Cuidados Paliativos neste âmbito, redirecionando a perspetiva curativa para o cuidado que preserve a dignidade humana.
Abstract:In the scope of Curricular Unit 11 - Professional Internship with Final Report, taught in the 1st semester of the 2nd year, of the Master Degree Course in Palliative Care, of the Escola Superior de Saúde Lopes Dias of the Polytechnic Institute of Castelo Branco, under the supervision of the teacher Ângela Simões, I elaborated the present work of report of the clinical practice. The Palliative Care is considered essential to a National Health Service of quality, and should be quality National Health Service, and should be provided in continuity in health care, to all people with very serious and/or advanced and progressive illnesses, who need it, and wherever they are, namely in primary, hospital or integrated continuous health care. A critical reflection on the whole pathway crossed is necessary in order to carry out self-evaluation and analysis associated with the successes obtained and/or opportunities for improvement. Therefore, the present report seeks to describe in a critical-reflexive way the whole journey over the last few months, including the three hundred hours of training and the application of the intervention plan. As a nurse in the Emergency Department, various collaborations have been requested from the Intra-hospital Support Team in Palliative Care through the reference of patients. For this reason, I chose to do my master's internship in this team with the aim of getting to know its reality, functioning and to acquire new skills and knowledge. The specific competences of the nurse specialist in Nursing in Chronic and Palliative Care are: cares for people with chronic, disabling and terminal disease and their caregivers and family members, in all contexts of clinical practice, reducing their suffering, maximising their well-being, comfort and quality of life; and, establishes therapeutic relationship with people with chronic, disabling and terminal disease, with their caregivers and family members, in order to facilitate the process of adaptation to successive losses and death. So, in the present report, I demonstrate in detail how the instrumental, interpersonal and systemic competences were acquired in the four key areas of Palliative Care - symptom control, communication, family support and teamwork. The intervention plan was applied in the Emergency Department about the inadequacy of care of the end-of-life patient in this context. In the Emergency Department several patients in acute illness, including patients with incurable or serious disease, in advanced and progressive stages with uncontrolled symptoms. The mission of the Emergency Service is to provide care in situations of medical urgency and emergency in a curative perspective. However, there is currently an increase in admissions of people in palliative situations, which requires a change in the philosophy of care and innovation in clinical practice, as there is a gap in this type of care among health professionals in emergency services. Teams need to recognise the importance of Palliative Care in this area, redirecting the curative perspective to care that preserves human dignity.
Abstract:In the scope of Curricular Unit 11 - Professional Internship with Final Report, taught in the 1st semester of the 2nd year, of the Master Degree Course in Palliative Care, of the Escola Superior de Saúde Lopes Dias of the Polytechnic Institute of Castelo Branco, under the supervision of the teacher Ângela Simões, I elaborated the present work of report of the clinical practice. The Palliative Care is considered essential to a National Health Service of quality, and should be quality National Health Service, and should be provided in continuity in health care, to all people with very serious and/or advanced and progressive illnesses, who need it, and wherever they are, namely in primary, hospital or integrated continuous health care. A critical reflection on the whole pathway crossed is necessary in order to carry out self-evaluation and analysis associated with the successes obtained and/or opportunities for improvement. Therefore, the present report seeks to describe in a critical-reflexive way the whole journey over the last few months, including the three hundred hours of training and the application of the intervention plan. As a nurse in the Emergency Department, various collaborations have been requested from the Intra-hospital Support Team in Palliative Care through the reference of patients. For this reason, I chose to do my master's internship in this team with the aim of getting to know its reality, functioning and to acquire new skills and knowledge. The specific competences of the nurse specialist in Nursing in Chronic and Palliative Care are: cares for people with chronic, disabling and terminal disease and their caregivers and family members, in all contexts of clinical practice, reducing their suffering, maximising their well-being, comfort and quality of life; and, establishes therapeutic relationship with people with chronic, disabling and terminal disease, with their caregivers and family members, in order to facilitate the process of adaptation to successive losses and death. So, in the present report, I demonstrate in detail how the instrumental, interpersonal and systemic competences were acquired in the four key areas of Palliative Care - symptom control, communication, family support and teamwork. The intervention plan was applied in the Emergency Department about the inadequacy of care of the end-of-life patient in this context. In the Emergency Department several patients in acute illness, including patients with incurable or serious disease, in advanced and progressive stages with uncontrolled symptoms. The mission of the Emergency Service is to provide care in situations of medical urgency and emergency in a curative perspective. However, there is currently an increase in admissions of people in palliative situations, which requires a change in the philosophy of care and innovation in clinical practice, as there is a gap in this type of care among health professionals in emergency services. Teams need to recognise the importance of Palliative Care in this area, redirecting the curative perspective to care that preserves human dignity.
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Keywords
Prática clínica Cuidados paliativos Fim de vida Serviço de urgência Clinical practice Palliative care End of life Emergency service