Famílias que integram pessoas dependentes no autocuidado

: estudo exploratório de base populacional no concelho de Paços de Ferreira

Abstract

Background: The integration of a dependent person in self-care within the household, involves a past, present and future reality. Population aging has accentuated the proliferation of chronic diseases and, with this, the increase of dependent people in self-care. These new scenarios of health care needs demand an urgent critical reflection, both for the opportunity to develop the core knowledge of the Nursing discipline, and for the possibility of sustaining Nurses' models of action, which are more meaningful for people.
Objectives: As part of this project, we started a study in the municipality of Paços de Ferreira that aimed at characterizing: the classic families that included dependent people in self-care; dependent person; family caregiver; the resources used; and, the improvement of the understanding of this phenomenon with regard to the family caregiver's experience about assuming and exercising the role.
Material and methods: With the target population of the classic families living in the municipality of Paços de Ferreira, a research plan was devised that included two successive stages. At first, a descriptive and correlational study, which fits into the population-based quantitative research models. A probabilistic, random, areolar, stratified and proportional sample was created based on the parish of residence, through a geographic information system. Data collection was carried out door-to-door by nurse-researchers using a form, an instrument that constitutes a tool of clinical utility in the perspective of the multidimensional assessment of the phenomenon in question. In the following moment, a second qualitative study was carried out, for which 6 semi-structured interviews were carried out with family caregivers who were part of the first study, referred to as privileged informants, in order to increase the understanding of the problem.
Results: Of the 2126 classic families that are part of the study, 11,73% integrated at least one dependent person in self-care, with 39,8% being over 80 years old and the main situation that led to the dependency is chronic diseases (63,6%), with its gradual installation in 66,5% of cases. With regard to the degree of dependence, given the domain of global self-care, 91,7% needed help from people, 0,4% only needed equipment, with 7,9% being totally dependent, not participating, “ bedridden ”. We thus found that 99,6% of dependents needed, at least, the help of a person to carry out at least one self-care activity. Family caregivers are mostly female (89,6%), with an average age of 56 years, mostly married (75,9%), son / daughter of the dependent person (42,7%), and 89,4% lived with the dependent. The results of this study also demonstrated that the overall rate of use of resources is 53,5%, which means that just over half are used, with significant differences between the different areas of self-care. Of the reasons mentioned for not using the resources, the most significant is the economic reason. The Nurse appeals to 67,2% of families, who take the Doctor as their main professional resource (92,9%). Family caregivers grant different meanings to the care they provide, recognizing, however, that the effort rate, the demand and the vulnerability inherent in this process, makes the exercise of the role difficult and critical, implying a constant concern, both for diversity and complexity care they provide, either because of the changes that this situation triggers in their own life processes.
Conclusions: The phenomenon of dependency in self-care is today undoubtedly an emerging theme that needs to be scrutinized. The changing and complex nature of the care needs of dependent people requires that Nurses recognize the inevitable sense of change and thus can generate it, in order to apply the discipline's own knowledge. The dependent person in self-care preferably continues to be integrated into the family context, and this framework leads to the transition of the family caregiver, associated with the exercise of the role. Families play a vital role as an indispensable resource, as they guarantee and ensure that the needs of dependent members are met. Family caregivers mostly assume the relationship of care provided with skills that they have acquired through their experience throughout life and through “trialand-error”, being certain that sometimes, even doing “everything they can and know”, it proves to be totally insufficient to respond to the dependent's real needs. The professionalization of care could leverage this process for greater gains in health, namely sensitive to the care of Nurses, either in the reconstruction of autonomy / independence possible in the self-care of dependents, or by facilitating the healthy transition of family caregivers.

Date of Award	20 Jul 2021
Original language	Portuguese
Awarding Institution	Universidade Católica Portuguesa
Supervisor	Abel Avelino Paiva e Silva (Supervisor)