Modelo de autocuidado para pessoas com 65 e mais anos de idade, necessidades de cuidados de enfermagem

Tese de doutoramento, Enfermagem, Universidade de Lisboa, com a participação da Escola Superior de Enfermagem de Lisboa, 2014Constatamos que a população com 65 e mais anos de idade tende a, exponencialmente, ter uma maior representatividade demográfica a nível mundial, sendo que tal se observa especialmente nos países do sul da Europa, sobretudo em Portugal. Várias organizações e diversas teorias sugerem o estudo do comportamento de autocuidado como um indicador de previsão das necessidades de cuidados daquele grupo etário em distintos contextos, para a reorganização dos cuidados de saúde em geral e de enfermagem em particular. Objetivos: Avaliar a funcionalidade das pessoas com 65 e mais anos de idade da região do Alentejo; Padronizar a funcionalidade em função da idade; Definir as necessidades de cuidados de enfermagem em função dos diferentes níveis de funcionalidade, com base num modelo de autocuidado. Metodologia: Estudo I: estudo transversal, descritivo; amostra aleatória, estratificada, com 931 pessoas com 65 e mais anos de idade; nível de confiança de 95%; margem de erro de 3,2%; levado a cabo na região do Alentejo. Estudo II: estudo transversal, descritivo; amostra de conveniência, com 427 pessoas com 65 e mais anos de idade; levado a cabo nas ECCI’s de Odivelas e da região do Alentejo Litoral, na UCC do Redondo e no Lar de Idosos dos SAMS. No decurso dos estudos, utilizámos diversas técnicas que permitiram construir e analisar a sensibilidade, fidelidade e validade do Core set dos Idosos (CSI) e do Elderly Nursing Core Set (ENCS). Resultados: Na região do Alentejo, do ponto vista médio, em relação ao comportamento de autocuidado, as pessoas no grupo etário dos 65 aos 84 anos de idade situam-se em autocuidado na atividade e as pessoas com 85 e mais anos de idade situam-se em défice de autocuidado terapêutico moderado. No cômputo geral, as pessoas do sexo feminino, com o estado civil de viuvez, que não sabem ler/ não frequentaram a escola, com 85 e mais anos de idade, baixo peso (IMC), com défices emocionais e auditivos e com situação económica não conducente à satisfação das necessidades de alimentação, habitação e saúde, apresentam maior nível de problema. No segundo estudo, verificámos diferenças estatisticamente significativas entre as necessidades de cuidados de enfermagem, ao nível dos sistemas de apoio educativo e de compensação parcial ou total, e o contexto onde a pessoa está inserida. Observámos necessidades de cuidados de enfermagem mais evidentes ao nível da ECCI da região do Alentejo Litoral e de Odivelas, seguidas do Lar de Idosos dos SAMS e, por fim, da UCC do Redondo. Conclusão: Propomos a avaliação das necessidades de cuidados de enfermagem das pessoas com 65 e mais anos de idade com base na apreciação do comportamento de autocuidado, descrito no M65+Autocuidado por uma estrutura conceitual em que se integra a avaliação do autocuidado, a capacidade funcional e capacidade de conhecimento.We assumed that the population over 65 years old tend have an exponentially superior demographic representation worldwide, particularly in the southern countries of Europe and mainly in Portugal. A number of organizations and different theories propose that the study of the behavior of self-care can result in a predictive indicator of care needs for that age group in different contexts, as a mean for the reorganization of health care in general, above all as far as nursing is concerned. Objectives: To assess the functionality of people over 65 years old in the region of Alentejo (Portugal); To standardize the concept of functionality depending on age; To describe the needs for nursing care according to the different levels of functionality, established on a model of self-care. Methodology: Study I: cross-sectional, descriptive, stratified random sample, with 931 people over 65 years of age; confidence level of 95 %, a margin of error of 3.2 %; carried out in the Alentejo (Portugal). Study II : cross-sectional, descriptive, convenience sample, with 427 people over 65 years of age, carried out in the Continuing Care Units (CCU) of Odivelas (Portugal) and Alentejo Litoral (Portugal), in the CCU of Redondo (Portugal) and in a Home for the Elderly of SAMS (Medical and Social Assistance Services). Throughout our studies, we applied several techniques which allowed building and analyzing sensitivity, reliability and validity of Core Set of Indicators for the Elderly (CSI) and the Elderly Nursing Core Set (ENCS). Results: In Alentejo and regarding self-care behavior, people in the age group 65 to 84 years old show self-care activity and those who have 85 years old and more present moderate therapeutic self-care deficit. Overall, females, widows, who cannot read/ did not attend school, with 85 and more years old, underweight (BMI), with deficits and impaired emotional and economic situation that cannot satisfy needs of food, housing and health, show higher levels of problems. In the second study, we found statistically significant differences between the needs for nursing care, the level of educational support systems and partial or total compensation as well as the insertion context. The needs for nursing care are more evident at the level of the CCU region of Alentejo Litoral and Odivelas, followed by the Nursing Home of SAMS and, finally, by the CCU of Redondo. Conclusion: We recommend the evaluation of nursing care needs of people over 65 years of age based on the assessment of self-care behavior, described in M65+SelfCare for a conceptual framework which would incorporate the assessment of self-care, functional capacity and knowledge capacit

A tomada de decisão dos enfermeiros face aos cuidados que prestam no hospital

Dissertação de Mestrado em Comunicação em Saúde apresentada à Universidade AbertaO presente estudo aborda a tomada de decisão dos enfermeiros face aos cuidados que prestam no hospital. Trata-se de um estudo que utiliza um paradigma qualitativo, com uma abordagem fenomenológica e teve como objectivo compreender que decisões são tomadas pelos enfermeiros na sua prática de cuidados, como as fundamentam e que competências utilizam nas suas tomadas de decisão. Como técnica de colheita de dados usámos a entrevista semi-estruturada, tendo sido aplicada a vinte enfermeiros (dez enfermeiros iniciados e dez enfermeiros peritos). As entrevistas foram objecto de gravação áudio e o tratamento dos dados foi efectuado com base na análise de conteúdo. Dos principais resultados encontrados, destacamos: • Os participantes referem tomar decisões sobre as acções: ventilar, orientar antecipadamente o cliente e família, alimentar o cliente, cuidar da higiene, entrevistar o cliente, mobilizar os clientes, transportar o cliente, administrar, administrar oxigénio, informar o cliente, inserir o cateter vesical, trocar o penso; • Os participantes referem não exercer a tomada de decisão perante as acções que executam, como sendo: determinar diagnósticos e prognósticos dos clientes, prescrever, administrar ventilação não invasiva, organizar as rotinas de serviço, determinar a glicemia capilar aos clientes, providenciar a realização de exames auxiliares de diagnóstico em doentes em fase terminal a seu cuidado, registar nos registos profissionais; • Neste estudo, os participantes peritos envolvem-se mais nas tomadas de decisão face às suas intervenções autónomas e intervenções interdependentes, do que os participantes iniciados; • Foram observadas as competências: responsabilidade, prática segundo a ética, colheita de dados, planeamento, execução, avaliação, cuidados de saúde inter/profissionais, delegação e supervisão, utilizadas pelos participantes nas suas tomadas de decisão. Observámos que os participantes peritos identificam as competências descritas de uma forma mais abrangente que os participantes iniciados; • Os participantes utilizam os conhecimentos adquiridos ao longo da sua formação de base (peritos e iniciados) e do Curso Complemento de Formação em Enfermagem (peritos), de forma a fundamentarem as suas tomadas de decisão; • A utilização dos resultados de estudos de investigação e de conteúdos on-line é pouco referida pelos participantes na fundamentação das suas decisões. Os participantes peritos relatam falta de conhecimentos em relação à utilização de conteúdos on-line; • Rácios inadequados de enfermeiros/doentes e métodos de trabalho menos intimistas e mais assentes em tarefas influenciam negativamente as tomadas de decisão por parte dos participantes; • A orientação e supervisão de estudantes de enfermagem em ensino clínico reveste-se de especial importância no que se refere à frequência da tomada de decisão. Após a análise e discussão dos dados, procedemos à apresentação de sugestões que se dirigem, ao nível: da prestação de cuidados de enfermagem e da gestão; da formação de base e continua; e da investigação nesta áreaNotre étude aborde la prise de décision des infirmiers dans le cadre des soins qu’ils administrent à l’hôpital et a pour objectif de comprendre quelles décisions ils prennent lors de leurs interventions, comment ils les justifient et quelles compétences ils utilisent. Pour ce faire, nous avons privilégié un paradigme qualitatif et une approche phénoménologique. Le recueil des données a été fait au travers d’entretiens semi-directifs menés auprès de vingt infirmiers (dix infirmiers débutants, dix infirmiers experts). Les entretiens enregistrés sur magnétophone et le traitement des données ont fait l’objet d’une analyse de contenu. Voici quelques-uns des principaux résultats obtenus : • Les participants déclarent prendre des décisions à propos des actions suivantes : ventiler, orienter de façon anticipée le client et sa famille, alimenter le client, s’occuper de l’hygiène, interroger le client, mobiliser les clients, transporter le client, administrer, administrer l’oxygène, informer le client, insérer le cathéter vésical, changer le pansement ; • Les participants déclarent ne pas exercer leur décision par rapport aux actions qu’ils exécutent, à savoir : faire des diagnostics et des pronostics sur des clients, prescrire, administrer une ventilation non invasive, organiser des routines de service, déterminer la glycémie capillaire chez les clients, pourvoir à la réalisation d’examens auxiliaires de diagnostic chez les malades en phase terminale à leur charge, enregistrer sur les registres professionnels ; • Dans cette étude, les participants experts s’engagent davantage dans les prises de décision lors de leurs interventions autonomes et lors d’interventions interdépendantes, que les participants débutants ; • Ont été observées les compétences suivantes: responsabilité, pratique suivant l’éthique, recueil de données, planification, exécution, évaluation, soins inter/professionnels, délégation et supervision, utilisées par les participants dans leur prises de décision. Nous avons observé que les participants experts identifient les compétences décrites de manière plus articulée que les participants débutants ; • Les participants s’appuient sur les connaissances acquises au long de leur formation de base (experts et débutants) et du Cours Complémentaire de Formation d’Infirmiers (experts), pour effectuer leur prise de décision ; • Les participants mentionnent rarement le rôle de l’utilisation de résultats de recherche et de contenus on-line dans la prise de décisions ; • Des ratios inadaptés infirmiers/malades et des méthodes de travail impersonnelles et reposant surtout sur des tâches ont une influence négative sur la prise de décision des participants ; • Le rôle du tutorat et de la supervision en enseignement clinique des étudiants infirmiers au cours de leur stage acquiert une importance toute particulière en ce qui concerne la fréquence de la prise de décision ; Après l’analyse et la discussion des données, nous procédons à la présentation de suggestions aux niveaux suivants : prestation de soins et gestion ; formation de base et formation continue ; recherches dans ce domaineThe present study deals with decision taking by nurses with regard to the caring services they provide within the hospital. It concerns a study which used a qualitative paradigm, with a phenomenological approach which had as its objective the understanding of the decisions which are taken by nurses when providing care, as well as the reasons and competencies used in decision taking. The data-gathering instrument used was the semi-structured interview, which was given to twenty nurses (ten starting-out nurses and ten expert nurses). The interviews were audiotaped and the processing of the data was carried out using content analysis. From the results obtained, the following aspects can be highlighted: • The participants mention taking decisions about the following actions: ventilating, providing prior counselling to the client and family, feeding the client, taking care of hygiene, interviewing the client, mobilising the client, transporting the client, administering, administering oxygen, informing the client, inserting a vesical catheter, changing a dressing; • The participants mentioned not carrying out the decision taking during the following actions which they undertook: determining diagnoses and prognoses of the clients, prescribing, administering non-invasive ventilation, organising service routines, determining the capillary blood sugar level of the clients, ordering the holding of supplementary diagnostic tests in patients at a terminal phase of their care, registering on professional records; • In this study, the expert participants were involved more in the taking of decisions regarding their own autonomous and interdependent actions, than the starting-out participants; • The following competencies were observed: responsibility, ethical practice, data collection, planning, administration, evaluation, inter/professional health care, delegation and supervision, which were used by the participants in taking decisions. We observed that the expert participants identified the competencies described in a more wide-ranging manner than the starting-out participants; • The participants utilised knowledge acquired throughout their basic training (experts and those starting-out) and the Supplementary Nursing Training Course (experts), so as to provide a basis for their taking of decisions; • Recourse to the results of research studies and online content is hardly mentioned by the participants regarding the establishing of their decisions. The expert participants recounted a lack of knowledge with regard to the use of online content; • Inadequate nurse/patient rations and less intimate and task-centred working methods negatively influenced decision taking by the participants; • The coordination and supervision of nursing students in clinical training gives special importance to what is referred to as the frequency of decision taking. After an analysis and discussion of the date, we shall then present our suggestions which shall be made at the level of the provision of nursing care and its management, basic and in-service training, and research in this are

Portuguese nurses’ stress, anxiety, and depression reduction strategies during the COVID-19 outbreak

The COVID-19 pandemic has contributed to mental health problems worldwide. Nurses are particularly prone to stress because they directly care for individuals with suspected or confirmed cases of COVID-19. The aims of this study were (a) to explore the association between the mental health promotion strategies used by nurses during the COVID-19 outbreak and their symptoms of depression, anxiety, and stress; (b) to compare the symptoms of depression, anxiety, and stress of mental health nurses to those of non-mental health nurses; and (c) to compare the frequency of use of mental health strategies of mental health nurses to those of non-mental health nurses. A cross-sectional study was conducted with a sample of 821 nurses. Univariate and multivariate regression models were developed to identify potential protective factors of depression, anxiety, and stress. The chi-square test was also used to compare the use of strategies among mental health and non-mental health nurses. Portuguese nurses demonstrated high symptoms of depressive symptoms, stress, and anxiety. Healthy eating, physical activity, rest between shifts, maintaining social contacts, verbalizing feelings/emotions, and spending less time searching for information about COVID-19 were associated with better mental health. Mental health nurses had less depression, anxiety, and stress, and used more strategies to promote mental health than other nurses. We consider it important to promote nurses’ mental health literacy by encouraging them to develop skills and strategies aimed at improving their resilience and ability to deal with difficult situations while caring for the population.info:eu-repo/semantics/publishedVersio

The use of mental health promotion strategies by nurses to reduce anxiety, stress, and depression during the COVID-19 outbreak: a prospective cohort study

Objectives: To evaluate and compare nurses' depression, anxiety and stress symptoms at the beginning of the COVID-19 pandemic and after six months; to evaluate and compare the frequency of use of mental health promotion strategies during the same period; and to identify the relationship between the frequency of use of mental health promotion strategies, during the same period, with nurses’ depression, anxiety and stress symptoms. Methods: Data collection was carried out in two moments: at baseline and after six months. An online questionnaire was applied to nurses to assess the frequency of use of some mental health promotion strategies and their depression, anxiety, and stress symptoms (through the Depression Anxiety Stress Scales – short version (DASS-21)). Results: The anxiety and stress symptoms significantly decreased over time. The physical activity increased, and a decrease was observed in the remote social contacts after six months. The stress, anxiety and depression scores were significantly lower in nurses who frequently or always used all strategies compared to participants who never or rarely used them, except for one strategy (rejecting information about COVID-19 from unreliable sources). Conclusions: Mental health promotion strategies, such as physical activity, relaxation activity, recreational activity, healthy diet, adequate water intake, breaks between work shifts, maintenance of remote social contacts, and verbalization of feelings/emotions, are crucial to reduce nurses’ stress, anxiety and depression symptoms during the COVID-19 outbreak.info:eu-repo/semantics/publishedVersio

Patient-centered care for people with depression and anxiety: an integrative review protocol

Introduction: Depression and anxiety are mental diseases found worldwide, with the tendency to worsen in the current pandemic period. These illnesses contribute the most to the world’s rate of years lived with disability. We aim to identify and synthesize indicators for the care process of the person with depression and/or anxiety disorders, based on patient-centered care, going through the stages of diagnostic assessment, care planning, and intervention. Methods and analysis: An integrative literature review will be conducted, and the research carried out on the following databases: MEDLINE, PsycINFO, Scopus, and Psychology and Behavioral Sciences Collection, CINAHL, Web of Science, TrialRegistry, and MedicLatina. The research strategy contains the following terms MesH or similar: “patient-centered care”, “depression”, and “anxiety”. Two independent revisers will perform the inclusion and exclusion criteria analysis, the quality analysis of the data, and its extraction for synthesis. Disagreements will be resolved by a third revisor. All studies related to diagnostic assessment, care planning, or intervention strategies will be included as long as they focus on care focused on people with depression and anxiety, regardless of the context. Given the plurality of the eligible studies, we used the narrative synthesis method for the analysis of the diagnostic assessment, the care and intervention planning, and the facilitators and barriers.info:eu-repo/semantics/publishedVersio

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

ATLANTIC EPIPHYTES: a data set of vascular and non-vascular epiphyte plants and lichens from the Atlantic Forest

Epiphytes are hyper-diverse and one of the frequently undervalued life forms in plant surveys and biodiversity inventories. Epiphytes of the Atlantic Forest, one of the most endangered ecosystems in the world, have high endemism and radiated recently in the Pliocene. We aimed to (1) compile an extensive Atlantic Forest data set on vascular, non-vascular plants (including hemiepiphytes), and lichen epiphyte species occurrence and abundance; (2) describe the epiphyte distribution in the Atlantic Forest, in order to indicate future sampling efforts. Our work presents the first epiphyte data set with information on abundance and occurrence of epiphyte phorophyte species. All data compiled here come from three main sources provided by the authors: published sources (comprising peer-reviewed articles, books, and theses), unpublished data, and herbarium data. We compiled a data set composed of 2,095 species, from 89,270 holo/hemiepiphyte records, in the Atlantic Forest of Brazil, Argentina, Paraguay, and Uruguay, recorded from 1824 to early 2018. Most of the records were from qualitative data (occurrence only, 88%), well distributed throughout the Atlantic Forest. For quantitative records, the most common sampling method was individual trees (71%), followed by plot sampling (19%), and transect sampling (10%). Angiosperms (81%) were the most frequently registered group, and Bromeliaceae and Orchidaceae were the families with the greatest number of records (27,272 and 21,945, respectively). Ferns and Lycophytes presented fewer records than Angiosperms, and Polypodiaceae were the most recorded family, and more concentrated in the Southern and Southeastern regions. Data on non-vascular plants and lichens were scarce, with a few disjunct records concentrated in the Northeastern region of the Atlantic Forest. For all non-vascular plant records, Lejeuneaceae, a family of liverworts, was the most recorded family. We hope that our effort to organize scattered epiphyte data help advance the knowledge of epiphyte ecology, as well as our understanding of macroecological and biogeographical patterns in the Atlantic Forest. No copyright restrictions are associated with the data set. Please cite this Ecology Data Paper if the data are used in publication and teaching events. © 2019 The Authors. Ecology © 2019 The Ecological Society of Americ

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men