Contributos para um modelo de gestão da qualidade dos cuidados de enfermagem nas equipas de cuidados continuados integrados

Abstract

In the OECD countries, the elderly population is growing. Therefore, there is very important to find new ways to provide care for people with chronic diseases, self-care dependency and their families. It will be imperative to find new metrics to measure the impact of this care on health and well-being of dependent persons and family caregivers. It is important monitoring the health professional’s performance in this context. Long-term care will tend to increase, and consequently, the costs will increase. The purpose of the research was to improve the quality of nursing care provided to families who take care of a dependent family member by contributing to build a nursing care model in this context. Initially, we tried to understand who the potential patients of long-term care services would be. To use this valid information as the beginning of the action-research process, carrying out a population-based study in Matosinhos municipality. The study focused on reflection based on valid information translated into nursing care outcome to rethink the quality of nurses' professional practice in this context. For this, an action-research cycle was designed. The reflection about the opportunities, from Argyris & Schon's (model II) based on valid information conduct to changes and modifications. In Matosinhos, 9.5% of the classic families have a person with dependency on self-care. The dependents were women (58%), the installation of dependency was gradual (52%), have body processes commitment (80.2%), such as joint stiffness, and 42.15% were highly dependent or bedridden. Family caregivers are women (81%) who cohabit with the dependent person (78%), sisters or daughters, married, without professional occupation, and lower education levels. They provide survival care, as feeding, to his family member. It was possible to obtain sensitive nursing outcomes in eight domains - tegument, self-care, muscle movement, body balance, airway clearance, pain, joint movement and respiration, related to the dependent person and the family caregiver about preparation for taking care. It was noticed that the reflection led to a paradigm shift in the provision of care from the focus on the treatment of pressure ulcers or medication administration to an emphasis on the transitions experienced by people and families, with new central concepts emerging, such as awareness and attitude towards care. Reflection about the basic needs of patients who require complex nursing care, such as positioning, transferring, performing joint muscle movements, with the intention of replacing the person when he is unable and promoting independence when possible, is a reality. In addition, the family caregiver's empowerment to perform their role and the awareness of the changes and implications in the individual and family life were a constant. Achieving relevant nursing outcomes in the area of nursing decision-making is very suitable. The fact that results refer to the core of the nursing knowledge makes them even more relevant. We highlight the outcomes that reflect positive changes in the area of self-care and in the capacity and knowledge of the dependent person, as well as the training of the family caregiver to perform their role. Action-reflection as a pillar of the improvement of quality care leads to significant changes and new nurses' action perspectives.

Date of Award	14 Jun 2021
Original language	Portuguese
Awarding Institution	Universidade Católica Portuguesa
Supervisor	Abel Paiva (Supervisor)