Gerenciando as ações de cuidado de enfermagem ao paciente submetido à hemodiálise

Abstract

As transformações econômicas e sociais do Brasil ocasionaram modificações no perfil demográfico e de morbimortalidade da população, aumentando a expectativa de vida e a ascensão das doenças crônicas, dentre as quais se destaca a doença renal. O portador de doença renal crônica pode ser tratado conservadoramente, enquanto a qualidade de vida estiver preservada. As modalidades para o tratamento da doença renal crônica são a hemodiálise, diálise peritoneal ou transplante renal. Em face aos aspectos inerentes ao cuidado do paciente com doença renal crônica em hemodiálise, é fundamental conhecer a percepção dos enfermeiros quanto aos cuidados oferecidos a esses pacientes durante a hospitalização. A hemodiálise exige cuidado especializado, sendo um grande desafio para os enfermeiros. Esta pesquisa teve como objetivo construir coletivamente um plano de ações de cuidados de enfermagem pré e pós-diálise ao paciente hospitalizado submetido à Hemodiálise. Trata-se de um estudo de caráter descritivo e construtivo com abordagem qualitativa, inspirado nos fundamentos e instrumentos da pesquisa-ação. Para uma melhor compreensão e sustentação teórica, foi fundamentado também no pensamento complexo proposto principalmente por Edgar Morin. Para a coleta de dados foi utilizado um roteiro semiestruturado constituído de duas partes: a primeira referente a características sóciodemográficas e profissionais dos participantes e a segunda com perguntas abertas para conduzir o grupo focal. Esse foi desenvolvido em dois momentos. O primeiro foi realizado com o intuito de identificar a percepção dos enfermeiros em relação ao cuidado de enfermagem ao paciente hospitalizado submetido à hemodiálise, bem como os cuidados de enfermagem pré e pós-diálise. O segundo momento consistiu em elaborar, implementar e avaliarum plano de ações de cuidados de enfermagem ao paciente hospitalizado com doença renal crônica submetido à Hemodiálise. A pesquisa foi realizada em um hospital escola do sul do país, no período de novembro de 2012 a julho de 2013. Participaram treze enfermeiros que atuam nas unidades de internação médica I, II e III e unidade de internação cirúrgica I e II. Para análise dos dados qualitativos foram utilizados os princípios da Análise de Conteúdo descrita por BARDIN. A partir dos relatos construíram-se os seguintes manuscritos: I - Cuidado de enfermagem ao paciente hospitalizado submetido à hemodiálise: percepção dos enfermeiros e II - Ações de cuidado de enfermagem ao paciente hospitalizado submetido à hemodiálise: uma construção coletiva. Conclui-se que a complexidade do sistema de saúde, a falta de acesso para o diagnóstico e tratamento, a mudança no estilo de vida do paciente e da família geram grande angústia não só ao paciente como para toda equipe de saúde por sentir a necessidade de uma rede de apoio e por perceber uma expectativa frustrada de cura por parte dos pacientes. O estudo realizado possibilitou aos enfermeiros a oportunidade de repensar a prática. Os enfermeiros necessitam de instrumentalização para cuidar e planejar o cuidado, sendo que o plano de ações de cuidados de enfermagem elaborado mostrou-se um aliado para sistematização da assistência de enfermagem de qualidade, orientando as ações necessárias para o cuidado ao paciente com doença renal crônica submetido à hemodiálise.<br>

Abstract : Social and economic transformations of Brazil caused changes in the demographic profile and in the morbidity and mortality of the population, increasing life expectancy and the rise of chronic diseases, where it is highlighted the kidney disease. The bearer of chronic kidney disease can be treated conservatively, while the quality of life is preserved. The modalities for the treatment of chronic kidney disease are hemodialysis, peritoneal dialysis or kidney transplant. In relation to aspects inherent in the care of the patient with chronic kidney disease on hemodialysis, it is essential to meet the nurses' perception as to the care offered to these patients during hospitalization. Hemodialysis requires specialized care being a big challenge for nurses. This research aimed to build collectively a plan of nursing care actions pre and post dialysis to hospitalized patients undergoing hemodialysis. This is a descriptive and constructive character study with a qualitative approach, inspired in the foundations and instruments of action research. For a better understanding and theoretical support, it was based on the proposed Edgar Morin´s complex thinking. For data collection a semi-structured script consisting of two parts was used: the first concerns the socio demographic and professional characteristics of the participants and the second with open-ended questions to conduct the focus group. This one it was developed in two phases. The first was conducted in order to identify the perceptions of nurses in relation to nursing care for hospitalized patients undergoing hemodialysis and nursing care pre and ost-dialysis. The second time was to develop, implement and evaluate an action plan of nursing care to hospitalized patients with chronic kidney disease undergoing Hemodialysis. The research was carried out in a teaching hospital in the south of the country, in the period of November 2012 to July 2013. Thirteen nurses working in inpatient units I, II, and III medical and surgical inpatient unit I and II have participated. For the analysis of qualitative data the principles of Content Analysis described by BARDIN were used. From the reports the following manuscripts were built: I - Nursing Care for hospitalized patients undergoing hemodialysis: perceptions of nurses and II - Nursing care actions to hospitalized patients undergoing to hemodialysis: a collective construction. It is concluded that the complexity of the health system, the lack of access to diagnosis and treatment, the change in the lifestyle of the patient and family generate great anxiety not only to the patient as to all health team for feeling the need for a support network and by realizing a frustrated expectation of cure on the part of patients. The study made it possible to nurses the opportunity to rethink the practice. Nurses need to take care of instrumentalization and plan for care, and the elaborated nursing care plan of action was an ally for systematization of nursing care quality, guiding the actions needed for the care of the patient with chronic renal disease undergoing to hemodialysis.

Social and economic transformations of Brazil caused changes in the demographic profile and in the morbidity and mortality of the population, increasing life expectancy and the rise of chronic diseases, where it is highlighted the kidney disease. The bearer of chronic kidney disease can be treated conservatively, while the quality of life is preserved. The modalities for the treatment of chronic kidney disease are hemodialysis, peritoneal dialysis or kidney transplant. In relation to aspects inherent in the care of the patient with chronic kidney disease on hemodialysis, it is essential to meet the nurses' perception as to the care offered to these patients during hospitalization. Hemodialysis requires specialized care being a big challenge for nurses. This research aimed to build collectively a plan of nursing care actions pre and post dialysis to hospitalized patients undergoing hemodialysis. This is a descriptive and constructive character study with a qualitative approach, inspired in the foundations and instruments of action research. For a better understanding and theoretical support, it was based on the proposed Edgar Morin´s complex thinking. For data collection a semi-structured script consisting of two parts was used: the first concerns the socio demographic and professional characteristics of the participants and the second with open-ended questions to conduct the focus group. This one it was developed in two phases. The first was conducted in order to identify the perceptions of nurses in relation to nursing care for hospitalized patients undergoing hemodialysis and nursing care pre and ost-dialysis. The second time was to develop, implement and evaluate an action plan of nursing care to hospitalized patients with chronic kidney disease undergoing Hemodialysis. The research was carried out in a teaching hospital in the south of the country, in the period of November 2012 to July 2013. Thirteen nurses working in inpatient units I, II, and III medical and surgical inpatient unit I and II have participated. For the analysis of qualitative data the principles of Content Analysis described by BARDIN were used. From the reports the following manuscripts were built: I - Nursing Care for hospitalized patients undergoing hemodialysis: perceptions of nurses and II - Nursing care actions to hospitalized patients undergoing to hemodialysis: a collective construction. It is concluded that the complexity of the health system, the lack of access to diagnosis and treatment, the change in the lifestyle of the patient and family generate great anxiety not only to the patient as to all health team for feeling the need for a support network and by realizing a frustrated expectation of cure on the part of patients. The study made it possible to nurses the opportunity to rethink the practice. Nurses need to take care of instrumentalization and plan for care, and the elaborated nursing care plan of action was an ally for systematization of nursing care quality, guiding the actions needed for the care of the patient with chronic renal disease undergoing to hemodialysis.