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Cuidado à pessoa com demência
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Esta é a tese final do mestrado em Saúde Mental e Enfermagem Psiquiátrica, curso n.º
309456, que analisa criticamente o desenvolvimento de competências especializadas no
cuidado de pessoas com demência em dois contextos clínicos complementares: o Serviço de
Cuidados Domiciliários para a Demência (DCSS) da Santa Casa da Misericórdia de
Mogadouro e a Unidade de Psiquiatria e Saúde Mental (PMH) do Hospital Distrital de
Bragança. Um quadro conceptual, juntamente com uma análise dos estágios clínicos, o
desenvolvimento de competências de enfermagem comuns e especializadas e a componente
de investigação aplicada foram todos integrados no relatório. Foram utilizadas evidências
recentes para reforçar o quadro teórico, juntamente com a perspetiva disciplinar da
enfermagem, que se baseou na teoria das relações interpessoais de Hildegard Peplau, com
ênfase na relação terapêutica, na comunicação, na segurança e dignidade e nos cuidados
centrados na pessoa. Durante os estágios clínicos, foram adquiridas competências para
avaliar comportamentos de várias formas, gerir os sintomas comportamentais e psicológicos
da demência, intervir com estratégias não farmacológicas, apoiar os cuidadores, tomar
decisões éticas, trabalhar com especialistas e planear a continuidade dos cuidados. Além
disso, foi realizado um estudo quantitativo, descritivo e retrospetivo com 121 residentes da
rede de serviços comunitários de Mogadouro, que foram acompanhados durante a prestação
de um serviço comunitário de demência. Os resultados indicaram uma elevada proporção de
indivíduos de meia-idade e idosos, bem como a doença de Alzheimer e demências mistas
como os diagnósticos mais comuns, e um nível de dependência que variava de leve a
moderado. As conclusões sublinham ainda mais a importância de um programa de apoio
social baseado na comunidade, apoiado por enfermeiros, concebido para satisfazer as
necessidades da pessoa com demência e da sua família — especificamente adaptado ao
estágio da demência, ao risco clínico, ao fardo e às necessidades da comunidade. Existem
limitações metodológicas: a utilização de uma amostra de conveniência, a natureza descritiva
do estudo e a ausência de inferência causal. O panorama geral apresentado no relatório é de
rigor clínico, pensamento crítico e uma base ética, sensibilidade relacional e prática baseada
em evidências na enfermagem especializada em saúde mental para cuidados de demência.
Palavras-chave: Demência; Enfermagem em Saúde Mental; Cuidados comunitários;
Competências especializadas.
ABSTRACT This is the final thesis for a master’s degree in Mental Health and Psychiatric Nursing, course number 309456, which critically analyzes the development of specialized skills in caring for people with dementia in two complementary clinical healthcare settings: the Dementia Home Care Service (DCSS) at Santa Casa da Misericórdia de Mogadouro and the Psychiatry and Mental Health Unit (PMH) at Bragança District Hospital. A conceptual framework, along with an analysis of clinical placements, the development of common and specialized nursing competencies, and the applied research component were all integrated into the report. Recent evidence was used to reinforce the theoretical framework, along with the disciplinary perspective of nursing, which was based on Hildegard Peplau’s theory of interpersonal relations, with an emphasis on the therapeutic relationship, communication, safety and dignity, and person-centered care. During clinical placements, competencies were acquired to assess behaviors in various ways, manage the behavioral and psychological symptoms of dementia, intervene with non-pharmacological strategies, support caregivers, make ethical decisions, work with specialists, and plan for continuity of care. In addition, a quantitative, descriptive, and retrospective study was conducted on 121 residents of the community services network in Mogadouro, who were monitored during the provision of a community dementia service. The results indicated a high proportion of middle-aged and elderly individuals, as well as Alzheimer’s disease and mixed dementia as the most common diagnoses, and a level of dependency ranging from mild to moderate. The conclusions further underscore the importance of a community-based social support program, supported by nurses, designed to meet the needs of the person with dementia and their family—specifically tailored to the stage of dementia, clinical risk, burden, and community needs. There are methodological limitations: the use of a convenience sample, the descriptive nature of the study, and the absence of causal inference. The overall picture presented in the report is one of clinical rigor, critical thinking, and an ethical foundation, relational sensitivity, and evidence-based practice in specialized mental health nursing for dementia care. Keywords: Dementia; Mental Health Nursing; Community Care; Specialist Competences.
ABSTRACT This is the final thesis for a master’s degree in Mental Health and Psychiatric Nursing, course number 309456, which critically analyzes the development of specialized skills in caring for people with dementia in two complementary clinical healthcare settings: the Dementia Home Care Service (DCSS) at Santa Casa da Misericórdia de Mogadouro and the Psychiatry and Mental Health Unit (PMH) at Bragança District Hospital. A conceptual framework, along with an analysis of clinical placements, the development of common and specialized nursing competencies, and the applied research component were all integrated into the report. Recent evidence was used to reinforce the theoretical framework, along with the disciplinary perspective of nursing, which was based on Hildegard Peplau’s theory of interpersonal relations, with an emphasis on the therapeutic relationship, communication, safety and dignity, and person-centered care. During clinical placements, competencies were acquired to assess behaviors in various ways, manage the behavioral and psychological symptoms of dementia, intervene with non-pharmacological strategies, support caregivers, make ethical decisions, work with specialists, and plan for continuity of care. In addition, a quantitative, descriptive, and retrospective study was conducted on 121 residents of the community services network in Mogadouro, who were monitored during the provision of a community dementia service. The results indicated a high proportion of middle-aged and elderly individuals, as well as Alzheimer’s disease and mixed dementia as the most common diagnoses, and a level of dependency ranging from mild to moderate. The conclusions further underscore the importance of a community-based social support program, supported by nurses, designed to meet the needs of the person with dementia and their family—specifically tailored to the stage of dementia, clinical risk, burden, and community needs. There are methodological limitations: the use of a convenience sample, the descriptive nature of the study, and the absence of causal inference. The overall picture presented in the report is one of clinical rigor, critical thinking, and an ethical foundation, relational sensitivity, and evidence-based practice in specialized mental health nursing for dementia care. Keywords: Dementia; Mental Health Nursing; Community Care; Specialist Competences.
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Palavras-chave
Competência profissional Cuidados de enfermagem Demência Enfermagem psiquiátrica Modelos de enfermagem Planeamento de cuidados ao doente Dementia Models nursing Nursing care Patient care planning Professional competence Psychiatric nursing