Efeito do modelo de enfermeiro de referência nos resultados em saúde da pessoa idosa com multimorbilidade no hospital

: estudo quasi-experimental

Abstract

Introduction: Average life expectancy is increasing, as is the likelihood of chronic disease in the elderly population, which may increase the need for health services. With regard to hospital care and in particular inpatient care, organizing care according to the primary nursing model could be an effective way of improving health outcomes for older people with multimorbidity. Aim: To analyze the effect of the primary nursing care organization model on therapeutic self-care and satisfaction with nursing care in hospitalized elderly people with multimorbidity. Methodology: A quantitative paradigm was used and a quasi-experimental study with a control group was carried out. Two inpatient units with identical characteristics were selected from a private hospital in the Lisbon region. In the intervention unit, the primary nursing model was introduced to organize nursing care, while in the control unit the usual organization of delivering care was maintained. The sample was obtained by convenience, the participants were elderly people with multimorbidity, 106 in the intervention group and 100 in the control group. The Therapeutic Self-Care Scale (Portuguese version) was applied at admission, leaving the unit and follow-up, and the Citizen Satisfaction with Nursing Care Scale (ESCCE) at leaving the unit to participants from both units. Results: The main results showed that on admission to the inpatient unit, participants had different mean self-care scores, which were lower in the intervention group (t (191.045) = - 2.24; p = 0.026). At the time of discharge, the intervention group had a positive and higher variation in mean self-care scores compared to admission than the control group (t (192.67) = 2.28; p = 0.024). At follow-up, there were no significant differences in self-care between the two groups in relation to discharge (t (204.00) = 0.91; p = 0.363). Between follow-up and admission, the intervention group had a positive and higher change in mean self-care scores compared to the control group (t (187.55) = 2.68; p = 0.008). In terms of satisfaction, the intervention group also had higher satisfaction scores than the control group, but the difference was not statistically significant (t (204.00) = 1.09; p = 0.138). Conclusion: Organizing care around the primary nursing model had a positive impact on the health outcomes of hospitalized elderly people with multimorbidity, particularly in terms of therapeutic self-care skills. Although more studies are needed, especially experimental ones, these results already have an impact on clinical practice and the management of nursing services, reflected in quality indicators that are sensitive to x nursing care. In education, the primary nursing model encourages students to focus on continuity and coordination of care, which are essential to caring for elderly people with multimorbidity.

Date of Award	28 May 2025
Original language	Portuguese
Awarding Institution	Universidade Católica Portuguesa
Supervisor	Elisabete Nunes (Supervisor) & Élvio Jesus (Co-Supervisor)