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Publication
Avaliação e controlo da dispneia em cuidados paliativos
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| 2.4 MB | Adobe PDF |
Authors
Advisor(s)
Abstract(s)
A realização deste Relatório é parte integrante dos pressupostos necessários à
obtenção do grau de Mestre em Cuidados Paliativos pela Escola Superior de Saúde Dr.
Lopes Dias do Instituto Politécnico de Castelo Branco. Nele são descritos os objetivos
e atividades planeadas em sede de Projeto de Prática Clínica e Relatório, e
desenvolvidas no âmbito da Prática Clínica, realizada ao longo de 25 turnos numa
equipa de Cuidados Paliativos sediada na Comunidade Autónoma da Extremadura,
Espanha, e mediante a concretização de um projeto de intervenção no serviço de
origem subordinado à temática da Avaliação e Controlo da Dispneia em Cuidados
Paliativos.
Segundo a Organização Mundial de Saúde (2002), os Cuidados Paliativos visam
melhorar a qualidade de vida dos doentes, e das suas famílias, que enfrentam
problemas decorrentes de uma doença incurável e / ou grave e com prognóstico
limitado, através da prevenção e alívio do sofrimento, com recurso à identificação
precoce e tratamento rigoroso dos problemas não só físicos, como a dor, mas também
dos psicossociais e espirituais. Essa intervenção assenta em quatro grandes pilares de
igual importância e valorização: controlo sintomático, comunicação adequada, apoio à
família e trabalho em equipa. As atividades realizadas na prática assistencial
pretenderam a obtenção das competências necessárias para a atuação em cada uma
dessas quatro áreas fundamentais, sem esquecer a necessária articulação e
enquadramento com a equipa de acolhimento no seu contexto geográfico e
assistencial.
A dispneia é um dos sintomas mais desestabilizadores e frequentes em doentes
com doença crónica, progressiva e incurável nos seus estádios mais avançados, com
um aumento de prevalência e intensidade ao longo das últimas semanas de vida. Essa
perceção é influenciada por diversos fatores inerentes a cada doente, que interagem
dinamicamente entre si. A sua avaliação com recurso a uma escala quantitativa, sendo
reconhecida como uma prioridade na qualidade assistencial em saúde, apenas é feita
em 8,5% dos registos clínicos (Mularski et al, 2010). Foi introduzido no contexto do
serviço de origem (uma Unidade de Cuidados Continuados Integrados com duas
tipologias) um guia orientador na avaliação e controlo da dispneia, com incorporação
da escala de Borg, e alteração das folhas de registo para a sua sistematização. Numa
das unidades, foi aprovado um novo protocolo de atuação em caso de dispneia, que
incorpora a filosofia dos Cuidados Paliativos. Passado um mês da implementação, os
resultados mostram, para além de uma boa aceitação da importância e pertinência do
projeto por parte dos profissionais da Unidade, que a avaliação quantitativa da
dispneia é já uma prática emergente numa das tipologias, sendo necessária uma
posterior avaliação continuada para confirmar a consolidação da sua implementação.
ABSTRACT: This Report is an integral part of the necessary conditions to obtain the degree of Master in Palliative Care by Escola Superior de Saúde Dr. Lopes Dias, Instituto Politécnico de Castelo Branco. In it are described the objectives and planned activities based on Project Report and Clinical Practice, and developed within the Practice, held over 25 rounds in a Palliative Care team based in the Autonomous Community of Extremadura, Spain, and upon completion of an intervention project in my original service subject to the issue of Evaluation and Control of Dyspnea in Palliative Care. According to the World Health Organization (2002), Palliative Care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual. This approach is based on four pillars of equal importance and valuation: symptomatic control, proper communication, family support and teamwork. The activities carried out in healthcare practice intended to obtain the necessary skills for working in each of these four key areas, without forgetting the necessary articulation and framing with the host team in its geographical and healthcare context. Dyspnea is one of the most destabilizing and frequent symptoms in patients with chronic, progressive and incurable disease in its later stages, with an increase in prevalence and severity over the past few weeks of life. This perception is influenced by several factors inherent to each patient, which dynamically interact with each other. Their evaluation using a quantitative scale, being recognized as a priority in health care quality, is only made in 8,5% of clinical records (Mularski et al, 2010). Was introduced in the context of the original service (one Unit of Continued Care with two typologies) guiding a guide in the evaluation and control of dyspnea, incorporating the Borg scale, and alteration of the record sheets for their systematization. In one of the units, a new protocol has been approved for dyspnea management, which incorporates the philosophy of Palliative Care. After a month of implementation, the results show, in addition to a good acceptance of the importance and relevance of the project by the Unit’s professionals, the quantitative evaluation of dyspnea is now an emerging practice in one typologie, requiring further evaluation continued to confirm the consolidation of this implementation.
ABSTRACT: This Report is an integral part of the necessary conditions to obtain the degree of Master in Palliative Care by Escola Superior de Saúde Dr. Lopes Dias, Instituto Politécnico de Castelo Branco. In it are described the objectives and planned activities based on Project Report and Clinical Practice, and developed within the Practice, held over 25 rounds in a Palliative Care team based in the Autonomous Community of Extremadura, Spain, and upon completion of an intervention project in my original service subject to the issue of Evaluation and Control of Dyspnea in Palliative Care. According to the World Health Organization (2002), Palliative Care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual. This approach is based on four pillars of equal importance and valuation: symptomatic control, proper communication, family support and teamwork. The activities carried out in healthcare practice intended to obtain the necessary skills for working in each of these four key areas, without forgetting the necessary articulation and framing with the host team in its geographical and healthcare context. Dyspnea is one of the most destabilizing and frequent symptoms in patients with chronic, progressive and incurable disease in its later stages, with an increase in prevalence and severity over the past few weeks of life. This perception is influenced by several factors inherent to each patient, which dynamically interact with each other. Their evaluation using a quantitative scale, being recognized as a priority in health care quality, is only made in 8,5% of clinical records (Mularski et al, 2010). Was introduced in the context of the original service (one Unit of Continued Care with two typologies) guiding a guide in the evaluation and control of dyspnea, incorporating the Borg scale, and alteration of the record sheets for their systematization. In one of the units, a new protocol has been approved for dyspnea management, which incorporates the philosophy of Palliative Care. After a month of implementation, the results show, in addition to a good acceptance of the importance and relevance of the project by the Unit’s professionals, the quantitative evaluation of dyspnea is now an emerging practice in one typologie, requiring further evaluation continued to confirm the consolidation of this implementation.
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 Prática clínica Avaliação e controlo da dispneia Palliative care Clinic practice Evaluation and management of dyspnea