During my academic training I haven´t any training in Palliative Care. But in the beginning of the training, as Internal Family medicine,I had the opportunity to choose between performing a stage of Oncology at the Hospital of Tras-os-Montes and Alto Douro or a stage of Palliative Care, to be carried out at the Portuguese Institute Oncology of Porto, so I chose the last because the of possibility to returning to the city of Porto. At the time I thought that in terms of objectives and work dynamics, the stages would be similar. Just when I started the internship I started to see the difference and what was "palliative care". The stage was short-lived. Three weeks "only" served to the awareness of the importance of palliative care and some basic principles for managing pain. Because "sometimes a chance never comes alone," these principles, very little has sedimented, were soon to be used in the following weeks. I was general internal medicine and family, working on a range of health, in the week that my supervisor was on vacation, my counselor training and a nurse came to me in consultation, one patient with a sarcoma in advanced stage was in severe pain. This patient wanted to stay home, but was in terrible suffering. With the use of the basic principles seized during stage I did a good control of the pain from this patient. However, after controlling pain came the will to do more. Although the patient was very grateful to the management of pain, felt that there was still much to do, from pain management to communication and psychosocial support. At this moment I felt the need to supplement my academic training. For financial reasons I didn´t sign up right at the master's hospice. First tried a post graduate degree in geriatrics, thinking that it would address many of the principles of palliative care. Unfortunately it didn´t, by ending the post graduate degree in geriatrics I decided to sign up for Masters in Palliative Care at Catholic University. At this time, and again, "sometimes a chance never comes alone," I had the opportunity to meet in a Congress of Family Medicine, who was to became my mentor Master, Professor José Luís Pereira. Hearing him talk about his experience in Canada led me right to initiate contacts for a possible realization of a internship of palliative care in their unit. When after the first year of the Masters, which included a strong theoretical component I was given the opportunity to conduct a thesis or an internship report, I didn´t think twice. The ability to apply the knowledge acquired through the completion of an internship was more attractive. So it was, I went to Ottawa, Canada. The integration was easy, for the great hospitality of all the people contacted. I began my internship at the Palliative Care Unit of Bruyère, where they were admitted patients with severe symptomatic uncontrolled. Here I had the opportunity to accompany Dr. Katie and Dr Marchington. Paula Enright. All very young but very competent and a huge concern in meeting my doubts. Then spent three weeks in the Hospital-Team Civic Hospital, with Dr. John Scott, a very similar hospital, the type of patients and pathologies, the Hospital Santa Luzia, the referral hospital for the region of Alto Minho. Here I could see the importance of communication skills to promote patient's autonomy and to define the goal of care. On General Hospital, Dr. Edward Fitzggibon followed in their daily activities, Relatório de Estágio observacional em Cuidados Paliativos na Unidade de Bruyère6accompanying patients to greater complexity in terms of symptom control, requiring the use of drugs such as ketamine and anesthesia techniques for satisfactory pain control. I finished the stage with a brief passage by the support team in the community, the PPSMCS (Palliative Pain and Symptom Management Consultation Service), following Dr. Jill Rice and emphysema. Marysse Bouvette on your support to patients in the community, through consulting their family doctors. In several conversations I had with my advisor, Prof. José Luís Pereira and the Nurse. Marrysse Bouvette could realize the importance of working closely with family doctors, because only that way you can train them to follow autonomously, the vast majority of their patients, allowing teams of palliative care for patients with more complex . In all services that I've experience, I trie to realize the different dynamics and needs for a proper functioning of the teams, in order to achive a project to implement a team of Support in Palliative Care Unit of the Local Health Alto Minho, with a hospital support component and a support component in the community. This project is described in Annex 1.
| Date of Award | 15 Apr 2016 |
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| Original language | Portuguese |
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| Awarding Institution | - Universidade Católica Portuguesa
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| Supervisor | José Luís Pereira (Supervisor) |
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