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Avaliação e controlo da dispneia em cuidados paliativos
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Advisor(s)
Abstract(s)
O presente relatório, foi realizado no âmbito do 1º Mestrado em Cuidados
Paliativos da ESALD, sob orientação da Professora Doutora Paula Sapeta, tendo como
finalidade descrever e analisar as etapas de planeamento, execução e apreciação do
trabalho de projecto proposto para estágio no âmbito de Cuidados Paliativos, e a
Avaliação e Controlo da Dispneia. A realização do presente trabalho visa a obtenção
do Grau de Mestre em Cuidados Paliativos.
No âmbito do cuidar, o objectivo primordial do estágio foi demonstrar
competências no cuidar do doente com doença progressiva e incurável, e seus
familiares, integrada na equipa multidisciplinar da ECCI. Os objectivos específicos
foram: Integrar a equipa multidisciplinar da ECCI na assistência a doentes com
doença terminal e família; Demonstrar competências no controlo de sintomas, no
apoio à família; na preparação e apoio à família no luto; Demonstrar competências
básicas (escuta activa, compreensão empática e feedback) no processo de
transmissão de más notícias; e Demonstrar competências na identificação, avaliação e
controlo da dispneia.
Durante a Prática Clínica foi desenvolvido um Projecto de Intervenção
subordinado: ao tema “Avaliação e Controlo da Dispneia”, a implementar no
respectivo Local de Trabalho. Entende-se por dispneia a “sensação subjectiva de falta
de ar e dificuldade respiratória” ( Azevedo, 2010, p.192).
A TheAmericanThoracicSocietyacrescenta que para além de ser uma experiência
subjectiva de desconforto respiratório, esta caracteriza-se pela presença de sensações
qualitativamente distintas que variam em intensidade. Trata-se de um sintoma
multidimensional, que apenas pode ser verdadeiramente interpretado através de
auto-relato por parte do paciente (Mularskiet al, 2010). Em Cuidados Paliativos, este
conceito assume uma dimensão ainda mais presente, dado ser um sintoma de alta
incidência e de impacto multidimensional no utente e família. Na verdade, de acordo
com Moody e McMillan (2003), na população dos doentes nas suas últimas seis
semanas de vida, a dispneia ocorre em 70% dos casos.
Segundo a Associação Portuguesa de Cuidados Paliativos(APCP)em 2006, todos os
Serviços que prestem cuidados a doentes com doenças incuráveis e progressivas têm
por missão satisfazer as necessidades dos doentes e famílias, respondendo de forma
efectiva às necessidades identificadas, sendo a definição de critérios de qualidade
crucial para a melhoria das práticas desenvolvidas, assim como para a uniformização
de cuidados prestados.
A avaliação da dispneia deverá ser considerada uma prioridade para quem presta
cuidados, ainda mais em Cuidados Paliativos, sendo de extrema importância a sua
avaliação, monitorização e registo.
Durante as 300 horas de estágio, foi realizada prestação directa de cuidados,
pesquisa bibliográfica e colheita de dados mediante a utilização de escalas de
avaliação e outros instrumentos, entre 8 de Abril e 24 de Maio de 2013. Durante esse
período, adquiri as competências necessárias para“melhorar a qualidade de vida dos
doentes que enfrentam problemas decorrentes de uma doença incurável com
prognóstico limitado, e/ou doença grave (que ameaça a vida), e suas famílias, através
da prevenção e alívio do sofrimento, com recurso à identificação precoce, avaliação
adequada, e tratamento rigoroso dos problemas não só físicos, como a dor, mas
também, psicossociais e espirituais” (ANCP, Organização de Serviços em Cuidados
Paliativos, 2006), ou seja, em prestar Cuidados Paliativos qualificados.
ABSTRACT: This report was conducted under the 1st Master in Palliative Care ESALD, under the guidance of Professor Paula Sapeta, and with purpose to describe and analyze the stages of planning, execution and assessment of project work proposed for placements under Palliative Care and Evaluation and Control of Dyspnea. The realization of this work aims at obtaining the Master degree in Palliative Care. Under the care, the primary objective of the internship was to demonstrate competence in the care of patients with incurable progressive disease and their families in integrated multidisciplinary team of ECCI. The specific objectives were: Integrating multidisciplinary team of ECCI in assisting patients with terminal illness and family; Demonstrate skills in controlling symptoms, family support, the preparation and support of the family in mourning; Demonstrate basic skills (active listening, understanding empathic feedback) in the process of breaking bad news, and demonstrate skills in the identification, evaluation and control of dyspnea. During Clinical Practice was developed Intervention Project entitled "Evaluation and Control of Dyspnea", to implement in their Work. It is understood by dyspnoea the "subjective feeling of shortness of breath and difficulty breathing" (Azevedo, 2010, p.192). The American Thoracic Society added that in addition to being a subjective experience of respiratory distress, that is characterized by the presence of qualitatively distinct sensations that vary in intensity. It is a multidimensional symptom, which can only be truly understood through self-reporting by the patient (Mularski et al, 2010). Palliative Care, this concept takes on an even more present as it is a symptom of high incidence and impact on the user and multidimensional family. In fact, according to Moody and McMillan (2003) in the population of patients in their last six weeks of life, dyspnea occurs in 70% of cases. According to the APCP (2006) all services providing care to patients with incurable diseases and progressive whose mission is to meet the needs of patients and families, responding effectively to the needs identified, and the definition of quality criteria crucial to improving practices developed, as well as the standardization of care. The assessment of dyspnea should be considered a priority for those who provide care, especially in palliative care, it is extremely important to their evaluation and monitoring, as well as the registration of that assessment, since only its correct record will reflect that assessment. We performed direct provision of care, literature search and data collection through the use of rating scales and other instruments during the 300 hours of internship between April 8 and May 24, 2013. I feel really competent "improve the quality of life of patients facing problems due to an incurable disease with limited prognosis, and / or serious illness (life-threatening), and their families, through the prevention and relief of suffering, using the early identification, appropriate assessment and rigorous treatment of not only physical problems such as pain, but also psychosocial and spiritual ", (ANCP, 2006), to provide qualified Palliative Care.
ABSTRACT: This report was conducted under the 1st Master in Palliative Care ESALD, under the guidance of Professor Paula Sapeta, and with purpose to describe and analyze the stages of planning, execution and assessment of project work proposed for placements under Palliative Care and Evaluation and Control of Dyspnea. The realization of this work aims at obtaining the Master degree in Palliative Care. Under the care, the primary objective of the internship was to demonstrate competence in the care of patients with incurable progressive disease and their families in integrated multidisciplinary team of ECCI. The specific objectives were: Integrating multidisciplinary team of ECCI in assisting patients with terminal illness and family; Demonstrate skills in controlling symptoms, family support, the preparation and support of the family in mourning; Demonstrate basic skills (active listening, understanding empathic feedback) in the process of breaking bad news, and demonstrate skills in the identification, evaluation and control of dyspnea. During Clinical Practice was developed Intervention Project entitled "Evaluation and Control of Dyspnea", to implement in their Work. It is understood by dyspnoea the "subjective feeling of shortness of breath and difficulty breathing" (Azevedo, 2010, p.192). The American Thoracic Society added that in addition to being a subjective experience of respiratory distress, that is characterized by the presence of qualitatively distinct sensations that vary in intensity. It is a multidimensional symptom, which can only be truly understood through self-reporting by the patient (Mularski et al, 2010). Palliative Care, this concept takes on an even more present as it is a symptom of high incidence and impact on the user and multidimensional family. In fact, according to Moody and McMillan (2003) in the population of patients in their last six weeks of life, dyspnea occurs in 70% of cases. According to the APCP (2006) all services providing care to patients with incurable diseases and progressive whose mission is to meet the needs of patients and families, responding effectively to the needs identified, and the definition of quality criteria crucial to improving practices developed, as well as the standardization of care. The assessment of dyspnea should be considered a priority for those who provide care, especially in palliative care, it is extremely important to their evaluation and monitoring, as well as the registration of that assessment, since only its correct record will reflect that assessment. We performed direct provision of care, literature search and data collection through the use of rating scales and other instruments during the 300 hours of internship between April 8 and May 24, 2013. I feel really competent "improve the quality of life of patients facing problems due to an incurable disease with limited prognosis, and / or serious illness (life-threatening), and their families, through the prevention and relief of suffering, using the early identification, appropriate assessment and rigorous treatment of not only physical problems such as pain, but also psychosocial and spiritual ", (ANCP, 2006), to provide qualified Palliative Care.
Description
Relatório de prática clínica apresentado à Escola Superior de Saúde Dr. Lopes Dias do Instituto Politécnico de Castelo Branco para cumprimento dos requisitos necessários à obtenção do grau de mestre em Cuidados Paliativos
Keywords
Cuidados paliativos Dispneia Controlo de sintomas Cuidados paliativos domiciliários Palliative care Dyspnea Symptom control Palliative home care