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Avaliação e intervenção familiar em famílias migrantes : Contributo do enfermeiro de família
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Introdução: Nos últimos anos, Portugal tornou-se um destino cada vez mais atrativo para migrantes de diversas partes do mundo. Esta nova realidade apresenta desafios e oportunidades, tanto para população que é recebida como para a população que os acolhem. Para famílias migrantes com crianças pequenas, os desafios são ainda mais significativos, abrangendo áreas críticas como educação, integração social e saúde. Esses desafios podem afetar gravemente o seu bem-estar e dificultar a sua integração na sociedade portuguesa. Neste contexto, a Enfermagem de Saúde Familiar assume um papel fundamental na identificação de necessidades e na promoção de ganhos em saúde.
Objetivos: O presente estudo teve como objetivos: avaliar as famílias migrantes à luz do Modelo Dinâmico de Avaliação e Intervenção Familiar (MDAIF); identificar necessidades nas diferentes dimensões da estrutura e funcionamento familiar; e implementar planos de intervenção em Enfermagem de Saúde Familiar, construídos em colaboração com as famílias, culturalmente sensíveis e ajustados ao seu ciclo de vida.
Métodos: Trata-se de uma investigação qualitativa, sustentada em quatro estudos de caso individuais com famílias migrantes acompanhadas por uma Unidade de Saúde Familiar (USF) integrada na Unidade Local de Saúde (ULS) Viseu Dão Lafões. A seleção das famílias foi intencional, tendo por base o respetivo ficheiro clínico. A recolha de dados decorreu em diferentes contextos (consultas presenciais, visitas domiciliárias e videochamadas), e recorreu a instrumentos como o MDAIF, Genograma, Ecomapa, Escala de Graffar, FACES II e a Escala de Risco Familiar de Segovia-Dreyer e de Garcia-Gonzalez. As áreas de atenção em destaque foram: Planeamento Familiar Não Eficaz, Papel Parental Não Adequado e Gravidez Não Adequada.
Resultados: Os resultados evidenciam a eficácia do Modelo Dinâmico de Avaliação e Intervenção Familiar (MDAIF) na prática de enfermagem centrada na família migrante. A abordagem colaborativa entre enfermeiro e família destacou-se como essencial para identificar focos de atenção, definir prioridades e implementar intervenções eficazes. A utilização de instrumentos como o Genograma, Ecomapa e escalas de avaliação familiar permitiu uma leitura holística e detalhada das dinâmicas familiares, facilitando planos de cuidados individualizados. O enfermeiro de família revelou-se peça-chave, promovendo educação, empoderamento e autonomia das famílias, mesmo perante os desafios inerentes ao processo migratório. A flexibilidade do MDAIF permitiu adaptar intervenções ao contexto sociocultural, reforçando a pertinência de uma abordagem culturalmente sensível. A análise evidenciou lacunas nos ficheiros familiares, sublinhando a importância de uma avaliação abrangente que contemple toda a rede familiar, incluindo membros não registados formalmente. Apesar das limitações do estudo (pequena amostra e contexto específico), os resultados reforçam o valor da intervenção sistémica e holística em enfermagem de saúde familiar, apontando caminhos para investigações futuras com amostras mais amplas e diversificadas.
Conclusões: Este estudo reforça a importância de uma abordagem holística e sistémica da família na prática de Enfermagem de Saúde Familiar. Reconhecer a família como unidade dinâmica, com recursos, vulnerabilidades e contextos próprios, permite ao enfermeiro intervir de forma mais personalizada, culturalmente sensível e orientada para ganhos efetivos em saúde. A proximidade e o vínculo terapêutico estabelecido foram elementos-chave para o sucesso das intervenções e para a promoção da autonomia e da resiliência familiar.
Palavras-Chave - Família, Migração, Enfermagem de família; Modelo Dinâmico de Avaliação e Intervenção Familiar; Intervenção Familiar
Abstract Introduction: In recent years, Portugal has become an increasingly attractive destination for migrants from various parts of the world. This new reality presents both challenges and opportunities, for those who arrive and for those who welcome them. For migrant families with young children, the challenges are even more significant, encompassing critical areas such as education, social integration, and healthcare. These challenges can severely affect their well-being and hinder their integration into Portuguese society. In this context, Family Health Nursing plays a key role in identifying needs and promoting health gains. Objectives: This study aimed to: assess migrant families using the Dynamic Model of Family Assessment and Intervention (MDAIF); identify needs across different dimensions of family structure and functioning; and implement Family Health Nursing intervention plans developed in collaboration with the families, culturally sensitive and adapted to their life cycle. Methods: This is a qualitative investigation, based on four individual case studies involving migrant families followed by a Family Health Unit (USF) of the Viseu Dão Lafões Local Health Unit (ULS). Families were selected intentionally, based on their clinical records. Data collection took place in various contexts (in-person consultations, home visits, and video calls) and employed instruments such as the MDAIF, Genogram, Ecomap, Adapted Graffar Scale, FACES II, and the Family Risk Scale by Segovia-Dreyer and Garcia-Gonzalez. The main areas of attention included: Ineffective Family Planning, Inadequate Parental Role, and Inadequate Pregnancy Planning. Results: The results demonstrate the effectiveness of the MDAIF in family-centered nursing practice with migrant families. The collaborative approach between nurse and family was essential to identify key concerns, set priorities, and implement effective interventions. The use of tools such as the Genogram, Ecomap, and family assessment scales enabled a holistic and detailed understanding of family dynamics, supporting the development of individualized care plans. The family nurse played a central role in promoting education, empowerment, and autonomy, even in the face of challenges inherent to the migration process. The MDAIF’s flexibility allowed for socioculturally sensitive interventions. The analysis revealed gaps in family clinical records, highlighting the importance of comprehensive assessments that include unregistered family members. Despite limitations (small sample and specific context), the study reinforces the value of systemic and holistic intervention in family health nursing, and suggests directions for future research involving larger and more diverse samples. Conclusions: This study reinforces the importance of a holistic and systemic approach to the family in Family Health Nursing practice. Recognizing the family as a dynamic unit, with its own resources, vulnerabilities, and contexts, enables nurses to provide more personalized, culturally sensitive, and health-oriented care. The proximity and therapeutic bond established proved to be key elements in the success of the interventions and in promoting family autonomy and resilience. Keywords: Family, Migration, Family Nursing, Dynamic Model of Family Assessment and Intervention, Family Intervention.
Abstract Introduction: In recent years, Portugal has become an increasingly attractive destination for migrants from various parts of the world. This new reality presents both challenges and opportunities, for those who arrive and for those who welcome them. For migrant families with young children, the challenges are even more significant, encompassing critical areas such as education, social integration, and healthcare. These challenges can severely affect their well-being and hinder their integration into Portuguese society. In this context, Family Health Nursing plays a key role in identifying needs and promoting health gains. Objectives: This study aimed to: assess migrant families using the Dynamic Model of Family Assessment and Intervention (MDAIF); identify needs across different dimensions of family structure and functioning; and implement Family Health Nursing intervention plans developed in collaboration with the families, culturally sensitive and adapted to their life cycle. Methods: This is a qualitative investigation, based on four individual case studies involving migrant families followed by a Family Health Unit (USF) of the Viseu Dão Lafões Local Health Unit (ULS). Families were selected intentionally, based on their clinical records. Data collection took place in various contexts (in-person consultations, home visits, and video calls) and employed instruments such as the MDAIF, Genogram, Ecomap, Adapted Graffar Scale, FACES II, and the Family Risk Scale by Segovia-Dreyer and Garcia-Gonzalez. The main areas of attention included: Ineffective Family Planning, Inadequate Parental Role, and Inadequate Pregnancy Planning. Results: The results demonstrate the effectiveness of the MDAIF in family-centered nursing practice with migrant families. The collaborative approach between nurse and family was essential to identify key concerns, set priorities, and implement effective interventions. The use of tools such as the Genogram, Ecomap, and family assessment scales enabled a holistic and detailed understanding of family dynamics, supporting the development of individualized care plans. The family nurse played a central role in promoting education, empowerment, and autonomy, even in the face of challenges inherent to the migration process. The MDAIF’s flexibility allowed for socioculturally sensitive interventions. The analysis revealed gaps in family clinical records, highlighting the importance of comprehensive assessments that include unregistered family members. Despite limitations (small sample and specific context), the study reinforces the value of systemic and holistic intervention in family health nursing, and suggests directions for future research involving larger and more diverse samples. Conclusions: This study reinforces the importance of a holistic and systemic approach to the family in Family Health Nursing practice. Recognizing the family as a dynamic unit, with its own resources, vulnerabilities, and contexts, enables nurses to provide more personalized, culturally sensitive, and health-oriented care. The proximity and therapeutic bond established proved to be key elements in the success of the interventions and in promoting family autonomy and resilience. Keywords: Family, Migration, Family Nursing, Dynamic Model of Family Assessment and Intervention, Family Intervention.
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Avaliação em enfermagem Enfermagem de família Família Migrantes Modelos teóricos Papel do enfermeiro Vulnerabilidade Family Family nursing Models theoretical Nurse's role Nursing assessment Transient and migrants Vulnerability
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