Contributos para a definição de um modelo organizacional dos cuidados às pessoas dependentes no autocuidado e seus cuidadores, em contexto domiciliário

: estudo realizado nas ECCI do ACES do Baixo Mondengo

Abstract

Background: The aging of the Portuguese population will accentuate in the future (INE, 2020) and will be, potentially, accompanied by the increase in the prevalence of dependent people in self-care and care of third parties. This situation is likely to result in an increased need for continued care. As there is a growing consensus, the idea that the answer in continuous care should prioritize and privilege home care. This reality will require new models of care and/or reform of existing ones. Thinking about them requires research that allows for a better understanding of the needs of people dependent on living at home, and how to ensure complete care.
Objective: Identify the care needs of dependent people in self-care who live in their homes, what care is actually provided to them, and who provides it.
Material and methods: Investigation in 2 phases. Phase 1: observational, quantitative, descriptive and cross-sectional study, in a sample of people assisted in 13 ECCIs from a group of Health Centres in Portugal, which consisted of evaluating the necessary care of 130 dependent people in self-care, by using of a form. Phase 2: a “focus group”, seeking to understand the social phenomena observed, was carried out.
Results: The dependent people in self-care, assisted in studied ECCI, are mostly men, with an average age of 77 years, married/domestic partners, retired, with lower education, with average dependency for 2.5 years. 77.7% are “bedridden”. Families constituted by the couple, in which the wife, woman, Portuguese, with an average age of 67 years, is the main caregiver, where 1/3 are over 75 years of age, having an impact on the inability to ensure the care that progresses with age. A high percentage shows commitments in the evaluated focuses of attention: walking (96.2%); personal hygiene (91.5%); dressing and undressing (82.3%); balance (81.5%); self-management of the therapeutic regime (76.9%); transfer (71.5%); disuse (66.2%); ventilation and turning around, (64.6%); sitting (58.5%), joint stiffness (47.7%), chewing (42.3%); pain (41.5%) urinary incontinence (37.7%), intestinal incontinence and food (33.1%), swallowing (30.0%), impaired consciousness (28.5%), paresis (26.2% ); activity intolerance (25.4%); dehydration (24.6%); communication, cleaning of the airways and hyperglycaemia (23.8%), tissue perfusion (22.3%), pressure ulcers (21.5%). The global average of the proportion of implementation of the interventions needed by the people evaluated compared to what was expected was 66.7%. It was found that 33.3% of the care considered to be necessary remained to be done. Nurses explain the reasons for incomplete care for two main reasons: “lack of time” and because “the family is unable to exercise the role”. The incomplete care is a process that generates malaise in nurses and feelings of helplessness and anguish.
Conclusion: The phenomenon of care needs for dependent people in self-care living at home and their provision revealed themselves to be complex and multidimensional realities, with the completion of care not being guaranteed.

Date of Award	22 Jul 2021
Original language	Portuguese
Awarding Institution	Universidade Católica Portuguesa
Supervisor	Abel Avelino Paiva e Silva (Supervisor)