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ESTÁGIO III – Estágio de natureza profissional em Enfermagem de Cuidados à Família em contexto de USF ou UCSP
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Enquadramento: A saúde das famílias é influenciada pelo meio que as envolve, onde a crescente modernização dos meios tecnológicos e consequente digitalização a que se assiste na sociedade têm exposto as gerações mais jovens a novas patologias como a adição sem substâncias. Esta problemática pode originar Necessidades de Saúde Especiais (NSE) nas crianças, impactando a dinâmica familiar e levando a stress, sobrecarga e outras comorbilidades para a família. O Enfermeiro Especialista em Enfermagem de Saúde Familiar detém as competências técnicas e científicas para intervir junto destas famílias, baseando a sua prática em modelos teóricos de Enfermagem fundamentados e na evidência científica. O presente relatório debruça-se sobre o percurso académico relativo ao Mestrado em Enfermagem Comunitária na área de Enfermagem de Saúde Familiar, sendo composto por uma contextualização da prática de Enfermagem de Saúde Familiar, nos Cuidados de Saúde Primários, em particular a Unidade de Saúde Familiar (USF) L, onde decorreram os ensinos clínicos em que foi possível desenvolver esta prática. Segue um capítulo dedicado aos modelos teóricos que guiaram a atividade desenvolvida. Posteriormente, debruça-se sobre as competências do enfermeiro especialista, gerais e específicas, e a forma como foram trabalhadas ao longo do percurso académico. De seguida, apresenta-se o capítulo sobre a Prática Especializada Baseada na Evidência, em que se desenvolveu a componente da investigação, complementando as bases teóricas com a dimensão prática.
Objetivos: Foram realizados 2 estudos correlacionados. O primeiro – Estudo 1 -, tem por objetivo identificar crianças com NSE na USF L. O segundo – Estudo 2 – pretende avaliar a estrutura, o desenvolvimento e a funcionalidade de uma família com uma criança com NSE, particularmente adição sem substâncias.
Métodos: Estudo 1 - quantitativo e descritivo, baseado na aplicação do Children with Special Health Care Needs (CSHCN) Screener a crianças entre os 3 e os 17 anos e 364 dias de idade inscritas e a frequentar consultas de Saúde Infanto-Juvenil na USF L. Estudo 2 - estudo de caso, de natureza qualitativa, baseado na avaliação familiar de uma família com filho com NSE, particularmente adição sem substâncias, utilizando o Modelo de Calgary de Avaliação e Intervenção Familiar, a escala de APGAR Familiar, a Escala de Risco Familiar de Segovia Dreyer e a Escala de Risco Familiar de García-Gonzalez.
Resultados: Estudo 1 – Constatou-se que 58,3% (n= 7) da amostra (n=12) respondeu positivamente a pelo menos 1 das perguntas contempladas no CSHCN Screener, classificando-se como portadoras de NSE, com maior representação do sexo masculino (71,4%). 5 (41,7%) responderam positivamente à necessidade de toma de medicação prescrita e à utilização de serviços de saúde, saúde mental ou serviços educacionais, 4 (33,3%) à necessidade de terapia específica e 3 (25%) à limitação funcional e à existência de problema de saúde que requer acompanhamento ou tratamento. 2 crianças apresentaram necessidade de saúde especial associada a apenas uma dimensão contemplada no Screener, 1 (8,3%) da dependência e 1 (8.3%) da utilização de serviços. 3 crianças apresentaram necessidade associada a duas dimensões, em particular 2 (16,3%) na dependência e utilização de serviços e 1 (8,3%) na limitação funcional e utilização de serviços. 2 crianças apresentaram necessidade associada às três dimensões (16,7%).
Estudo 2 – Realizou-se a avaliação de uma família reconstruída, composta por 5 elementos, tendo sido possível constatar comprometimento na ligação mãe/filho entre a mãe e a criança com adição sem substâncias, com relação de dependência, stress, sobrecarga e sono comprometido da mãe, comunicação verbal da criança com adição sem substâncias comprometida, coping familiar comprometido e satisfação com os cuidados de saúde comprometida. Obtiveram-se pontuações finais de 9 pontos na escala de APGAR Familiar. Não se identificou risco familiar através das escalas de risco familiar nomeadas, mostrando que a presença de NSE num elemento da família não implica necessariamente a existência de risco familiar, perante estas escalas.
Conclusão: Os resultados obtidos no Estudo 1 sugerem uma tendência positiva para a presença de NSE na população pediátrica, predominantemente nas crianças do sexo masculino, embora a amostra limita requeira mais estudos e com maior abrangência. Por outro lado, a avaliação familiar realizada no Estudo 2 permitiu constatar o impacto familiar da adição sem substâncias, corroborando a evidência científica. Apesar disto, não se verificou comprometimento da satisfação com o funcionamento familiar ou risco familiar de acordo com as escalas aplicadas. Fomenta-se, assim, a necessidade de mais estudos que abordem a adição sem substâncias em crianças e o seu impacto a nível familiar. A realização deste relatório permitiu não só a consolidação dos conhecimentos e competências adquiridos ao longo dos ensinos clínicos e a mudança do paradigma da pessoa para a família, como mais cimentar a importância do papel do Enfermeiro Especialista em Enfermagem de Saúde Familiar na abordagem das famílias, enquanto elemento de referência na promoção do seu funcionamento adequado.
Background: The health of families is influenced by the environment that surrounds them, where the growing modernization of technological means and consequent digitalization that is currently witnessed in society have exposed the younger generations to new pathologies, namely substance-free addiction. This problem can lead to Special Health Needs (SHN) in children, impacting family dynamics and leading to stress, overload and other comorbidities for the family. The Specialist Nurse in Family Health Nursing has the technical and scientific skills to intervene with these families, basing their practice on Nursing theoretical models and on scientific evidence. This report focuses on the academic path related to the Master's Degree in Community Nursing in the area of Family Health Nursing. It is composed of a contextualization of the practice of Family Health Nursing, in Primary Health Care, in particular the Family Health Unit L, where the clinical teachings took place and in which it was possible to develop this practice. The next chapter is dedicated to the theoretical models that guided the activity developed. Subsequently, it focuses on the general and specific skills of the specialist nurse and the way in which they were worked throughout the academic path. Next, the chapter on Evidence-Based Specialized Practice is presented, in which the research component was developed, complementing the theoretical bases with the practical dimension. Objectives: 2 correlated studies were conducted. The first – Study 1 – aims to identify children with SHN in Family Health Unit L. The second – Study 2 – aims to evaluate the structure, development and functionality of a family with a child with SHN, particularly substance-free addiction. Methods: Study 1 - quantitative and descriptive study, based on the application of the Children with Special Health Care Needs (CSHCN) Screener, to children aged between 3 and 17 years and 364 days enrolled in the aforementioned unit and who attended Child and Youth Health consultations. Study 2 – case study, of qualitative nature, based on the family assessment of a family with a child with SHN, particularly with substance-free addiction, using the Calgary Model of Family Assessment and Intervention, Family APGAR Scale, Segovia Dreyer Family Risk Scale and García-Gonzalez Family Risk Scale. Results: Study 1 - It was found that 58,3% (n=7) of the sample (n=12) answered positively to at least 1 of the questions contemplated in the CSHCN Screener, classifying themselves as having SHN, with a prevalence of males (71,4%). 5 (41,7%) responded positively to the need to take prescribed medication and the use of health, mental health or educational services, 4 (33,3%) to the need for specific therapy and 3 (25%) to functional limitation and the existence of a health problem that requires follow-up or treatment. 2 children had special health needs associated with only one dimension contemplated in the Screener, 1 (8,3%) dependence, and 1 (8,3%) service use. 3 children had needs associated with two dimensions, particularly 2 (16,3%) in dependence and use of services and 1 (8,3%) in functional limitation and use of services. 2 children had needs associated with the three dimensions (16,7%). Study 2 - A reconstructed family composed of 5 elements was evaluated. It was observed that the mother/child connection between the mother and the child with substance-free addiction was compromised, with a relationship of dependence, stress, overload and compromised sleep on the mother’s part, compromised verbal communication of the child with substance-free addiction, compromised family coping, and compromised health care satisfaction. Final scores of 9 points on the Family APGAR scale were obtained. No family risk was identified through the named family risk scales, showing that the presence of SHN in a family member does not necessarily imply the existence of family risk in view of these scales. Conclusion: The results obtained in Study 1 suggest a positive trend for the presence of SHN in the pediatric population, predominantly in male children, although the limited sample requires further and more comprehensive studies. Morever, we validate that substance free-addictions have na impact in family unit (Study 2), despite not observing impairment of satisfaction in family functioning and risk. This dichotomy further highlights the need for further studies in substance-free addiction in children and its impact on the family'. The production of this report allowed not only the consolidation of the knowledge and skills acquired throughout clinical teaching and the change of the paradigm from person to family, but also further cemented the importance of the role of the Specialist Nurse in Family Health Nursing in the approach to families, as a reference element in the promotion of their proper functioning.
Background: The health of families is influenced by the environment that surrounds them, where the growing modernization of technological means and consequent digitalization that is currently witnessed in society have exposed the younger generations to new pathologies, namely substance-free addiction. This problem can lead to Special Health Needs (SHN) in children, impacting family dynamics and leading to stress, overload and other comorbidities for the family. The Specialist Nurse in Family Health Nursing has the technical and scientific skills to intervene with these families, basing their practice on Nursing theoretical models and on scientific evidence. This report focuses on the academic path related to the Master's Degree in Community Nursing in the area of Family Health Nursing. It is composed of a contextualization of the practice of Family Health Nursing, in Primary Health Care, in particular the Family Health Unit L, where the clinical teachings took place and in which it was possible to develop this practice. The next chapter is dedicated to the theoretical models that guided the activity developed. Subsequently, it focuses on the general and specific skills of the specialist nurse and the way in which they were worked throughout the academic path. Next, the chapter on Evidence-Based Specialized Practice is presented, in which the research component was developed, complementing the theoretical bases with the practical dimension. Objectives: 2 correlated studies were conducted. The first – Study 1 – aims to identify children with SHN in Family Health Unit L. The second – Study 2 – aims to evaluate the structure, development and functionality of a family with a child with SHN, particularly substance-free addiction. Methods: Study 1 - quantitative and descriptive study, based on the application of the Children with Special Health Care Needs (CSHCN) Screener, to children aged between 3 and 17 years and 364 days enrolled in the aforementioned unit and who attended Child and Youth Health consultations. Study 2 – case study, of qualitative nature, based on the family assessment of a family with a child with SHN, particularly with substance-free addiction, using the Calgary Model of Family Assessment and Intervention, Family APGAR Scale, Segovia Dreyer Family Risk Scale and García-Gonzalez Family Risk Scale. Results: Study 1 - It was found that 58,3% (n=7) of the sample (n=12) answered positively to at least 1 of the questions contemplated in the CSHCN Screener, classifying themselves as having SHN, with a prevalence of males (71,4%). 5 (41,7%) responded positively to the need to take prescribed medication and the use of health, mental health or educational services, 4 (33,3%) to the need for specific therapy and 3 (25%) to functional limitation and the existence of a health problem that requires follow-up or treatment. 2 children had special health needs associated with only one dimension contemplated in the Screener, 1 (8,3%) dependence, and 1 (8,3%) service use. 3 children had needs associated with two dimensions, particularly 2 (16,3%) in dependence and use of services and 1 (8,3%) in functional limitation and use of services. 2 children had needs associated with the three dimensions (16,7%). Study 2 - A reconstructed family composed of 5 elements was evaluated. It was observed that the mother/child connection between the mother and the child with substance-free addiction was compromised, with a relationship of dependence, stress, overload and compromised sleep on the mother’s part, compromised verbal communication of the child with substance-free addiction, compromised family coping, and compromised health care satisfaction. Final scores of 9 points on the Family APGAR scale were obtained. No family risk was identified through the named family risk scales, showing that the presence of SHN in a family member does not necessarily imply the existence of family risk in view of these scales. Conclusion: The results obtained in Study 1 suggest a positive trend for the presence of SHN in the pediatric population, predominantly in male children, although the limited sample requires further and more comprehensive studies. Morever, we validate that substance free-addictions have na impact in family unit (Study 2), despite not observing impairment of satisfaction in family functioning and risk. This dichotomy further highlights the need for further studies in substance-free addiction in children and its impact on the family'. The production of this report allowed not only the consolidation of the knowledge and skills acquired throughout clinical teaching and the change of the paradigm from person to family, but also further cemented the importance of the role of the Specialist Nurse in Family Health Nursing in the approach to families, as a reference element in the promotion of their proper functioning.
Descrição
Palavras-chave
Enfermeiros de saúde da família Saúde da criança Saúde da família Modelos de enfermagem Estudo de caso
Contexto Educativo
Citação
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Licença CC
Sem licença CC