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Advisor(s)
Abstract(s)
Introdução: O presente relatório surge no âmbito do Curso de Mestrado em Enfermagem Médico-Cirúrgica e no Curso de Pós-Licenciatura em Enfermagem Médico-Cirúrgica e pretende espelhar todo o percurso académico e pessoal desenvolvido, durante os estágios em contexto de urgência e cuidados intensivos, evidenciando o processo de aquisição das competências definidas pela Ordem dos Enfermeiros, tendo em conta os domínios das Competências Comuns do Enfermeiros Especialista e as Competências Específicas do Enfermeiros Especialista em Enfermagem Médico-Cirúrgica, onde foi possível refletir e adquirir conhecimentos consolidados na evidência cientifica. O recurso aos serviços por parte dos doentes em fim de vida é frequente, principalmente quando existem sintomas descontrolados. A abordagem paliativa necessária nesta fase não coincide com o contexto de urgência e limita a intervenção dos cuidados de enfermagem.
Objetivos: Obtenção de Grau de Mestre em Enfermagem Médico-Cirúrgica e aquisição de competências de Enfermeiro Especialista em Enfermagem Médico-cirúrgica. Tem também o propósito de desenvolver a investigação sobre a integração dos doentes em cuidados paliativos no ambiente de serviço de urgência.
Métodos: Este trabalho foi estruturado em duas partes. Na primeira parte foi realizado o mapeamento das competências comuns e especificas de Enfermagem Médico-Cirúrgica, adquiridas e desenvolvidas em cada contexto de estágio, onde foi utilizada a metodologia descritiva e critico-reflexiva, fundamentada com a mais recente evidência científica. Na segunda parte foi desenvolvida uma scoping review de acordo com as etapas preconizadas pela metodologia de Joanna Briggs Institute (JBI), mapeando as intervenções de enfermagem direcionadas a doentes em cuidados paliativos que procuram atendimento no serviço de urgência.
Resultados: Relativamente às competências do enfermeiro especialista, no domínio da prática profissional, ética e legal, desenvolvi estratégias de tomada de decisão tendo em conta os princípios, valores e normas deontológicas. No domínio da qualidade criei estratégias de modo a fortalecer e promover a segurança e qualidade na prestação dos cuidados à pessoa em situação critica. No domínio da gestão de cuidados de enfermagem, refleti sobre a importância do enfermeiro especialista na gestão dos cuidados de saúde perante os recursos existentes. Do domínio prestação de cuidados à pessoa em situação critica e prevenção e controlo de infeção adquiri a capacidade de aplicar e demonstrar conhecimentos específicos de forma continua baseados em fundamentação científica. Relativamente à investigação os resultados demonstram que a integração de doentes paliativos no ambiente de urgência nem sempre é fácil, apresentando complexidades e desafios na prestação de cuidados. Os desafios apontados pelos enfermeiros incluem a falta de formação, de competências e de recursos físicos e humanos, a ambiguidade em relação ao papel dos profissionais, a cultura predominante do serviço de urgência, a falta de tempo e a sobrecarga emocional.
Conclusões: Da análise deste documento considera-se que a aquisição das Competências de Enfermeira Especialista em Enfermagem Médico-Cirúrgica foi demonstrada. Relativamente à investigação espera-se que possa contribuir para a melhoria de diretrizes de excelência, elevação de qualidade e garantia dos cuidados prestados, mesmo perante as complexidades inerentes ao contexto do serviço de urgência.
Abstract This report comes within the scope of the Master's Course in Medical-Surgical Nursing and the Post-Graduate Course in Medical-Surgical Nursing and intends to mirror the entire academic and personal path developed during internships in the context of urgency and intensive care, highlighting the process of acquiring the skills defined by the Order of Nurses, taking into account the domains of the Common Skills of Specialist Nurses and the Specific Skills of Specialist Nurses in Medical-Surgical Nursing, where it was possible to reflect and acquire knowledge consolidated in scientific evidence. The use of services by end-of-life patients is frequent, especially when there are uncontrolled symptoms. The palliative approach required at this stage does not coincide with the context of urgency and limits nursing care intervention. Obtain a Master's Degree in Medical-Surgical Nursing and acquire skills as a Specialist Nurse in Medical-Surgical Nursing. It also has the purpose of developing research on the integration of patients in palliative care in the emergency service environment. Methods: This work was structured in two parts. In the first part, the common and specific competences of Medical-Surgical Nursing were mapped, acquired, and developed in each internship context, where the descriptive and critical-reflexive methodology was used, based on the most recent scientific evidence. In the second part, a scoping review was developed according to the steps recommended by the Joanna Briggs Institute (JBI) methodology, mapping the nursing interventions directed at patients in palliative care who seek care in the emergency department. Results: Regarding specialist nurse skills, in the field of professional, ethical, and legal practice, I developed decision-making strategies considering the principles, values and deontological norms. In the domain of quality, I created strategies to strengthen and promote safety and quality in the provision of care to people in critical situations. In the domain of nursing care management, I reflected on the importance of specialist nurses in the management of health care given the existing resources. I acquired the ability to apply and demonstrate specific knowledge in a continuous way based on scientific foundations in the field of care to people in critical situations and infection prevention and control. Regarding the research, results demonstrate that the integration of palliative patients in the emergency environment is not always easy, presenting complexities and challenges in the provision of care. The challenges pointed out by the nurses include the lack of training, skills and physical and human resources, the ambiguity regarding the role of professionals, the predominant culture of the emergency service, lack of time and emotional overload. From the analysis of this document, it is considered that the acquisition of Specialist Nurse Skills in Medical-Surgical Nursing has been demonstrated. Regarding research, it is expected that it may contribute to the improvement of guidelines of excellence, raising the quality and guarantee of the care provided, even in the face of the complexities inherent in the context of the emergency service.
Abstract This report comes within the scope of the Master's Course in Medical-Surgical Nursing and the Post-Graduate Course in Medical-Surgical Nursing and intends to mirror the entire academic and personal path developed during internships in the context of urgency and intensive care, highlighting the process of acquiring the skills defined by the Order of Nurses, taking into account the domains of the Common Skills of Specialist Nurses and the Specific Skills of Specialist Nurses in Medical-Surgical Nursing, where it was possible to reflect and acquire knowledge consolidated in scientific evidence. The use of services by end-of-life patients is frequent, especially when there are uncontrolled symptoms. The palliative approach required at this stage does not coincide with the context of urgency and limits nursing care intervention. Obtain a Master's Degree in Medical-Surgical Nursing and acquire skills as a Specialist Nurse in Medical-Surgical Nursing. It also has the purpose of developing research on the integration of patients in palliative care in the emergency service environment. Methods: This work was structured in two parts. In the first part, the common and specific competences of Medical-Surgical Nursing were mapped, acquired, and developed in each internship context, where the descriptive and critical-reflexive methodology was used, based on the most recent scientific evidence. In the second part, a scoping review was developed according to the steps recommended by the Joanna Briggs Institute (JBI) methodology, mapping the nursing interventions directed at patients in palliative care who seek care in the emergency department. Results: Regarding specialist nurse skills, in the field of professional, ethical, and legal practice, I developed decision-making strategies considering the principles, values and deontological norms. In the domain of quality, I created strategies to strengthen and promote safety and quality in the provision of care to people in critical situations. In the domain of nursing care management, I reflected on the importance of specialist nurses in the management of health care given the existing resources. I acquired the ability to apply and demonstrate specific knowledge in a continuous way based on scientific foundations in the field of care to people in critical situations and infection prevention and control. Regarding the research, results demonstrate that the integration of palliative patients in the emergency environment is not always easy, presenting complexities and challenges in the provision of care. The challenges pointed out by the nurses include the lack of training, skills and physical and human resources, the ambiguity regarding the role of professionals, the predominant culture of the emergency service, lack of time and emotional overload. From the analysis of this document, it is considered that the acquisition of Specialist Nurse Skills in Medical-Surgical Nursing has been demonstrated. Regarding research, it is expected that it may contribute to the improvement of guidelines of excellence, raising the quality and guarantee of the care provided, even in the face of the complexities inherent in the context of the emergency service.
Description
Keywords
Competência clínica Competência profissional Cuidados de enfermagem Enfermagem médico cirúrgica Revisão Serviço de urgência hospitalar Tratamento paliativo Unidades de cuidados intensivos Clinical competence Emergency service, hospital Intensive care units Medical surgical nursing Nursing care Palliative care Professional competence Review