El paciente crítico transportado en helicóptero : historia del pasado reciente y panorama actual

Contexto: A Medicina de Emergência moderna tem as suas raízes na Primeira Guerra Mundial. Em Portugal o primeiro sistema de emergência médica data de 1965, tendo sido inaugurado o Serviço de Helicópteros de Emergência Médica pelo Instituto Nacional de Emergência Médica (INEM) em 1997. Objetivo: Dar a conhecer a história e o panorama atual no que se reporta ao transporte aéreo do doente crítico por helicópteros, através das duas principais entidades em Portugal, o INEM e a Força Aérea Portuguesa (FAP). Metodologia: Estudo de natureza histórica, de abordagem qualitativa, recorreu-se a análise documental através de fontes primárias fornecidas pelo Estado Maior da Força Aérea e pelo Instituto Nacional de Emergência Médica, bem como fontes secundárias. Resultados: Os resultados sugerem que a criação de um modelo de partilha de meios aéreos entre as diversas entidades resulta na eficácia e eficiência no que diz respeito ao transporte do doente crítico. Conclusão: Sugerem-se outros estudos que dêem a conhecer historicamente o papel desempenhado pelas equipas de médicos, enfermeiros, comandantes e pilotos em Portugal.Background: Emergency Medicine has its modern roots in the First World War. In Portugal, the first medical emergency system dates back to 1965. The Helicopter Emergency Medical Service of the National Institute of Medical Emergency (INEM) started operating in 1997. Objective: To inform about the history and current situation of the helicopter aeromedical transport of critically ill patients through the two major institutions in Portugal: the INEM and the Portuguese Air Force (FAP). Methodology: A qualitative historical study was conducted through documental analysis of the primary sources provided by the Portuguese Air Force and the National Institute of Medical Emergency, as well as the secondary sources. Results: The results suggest that the creation of a model for sharing air assets between various institutions leads to a more effective and efficient transport of critically ill patients. Conclusion: Further studies should be conducted to reveal the historical role played by the teams of physicians, nurses, commanders and pilots in Portugal.Marco contextual: La medicina de emergencia moderna tiene sus raíces en la Primera Guerra Mundial. En Portugal, el primer sistema de emergencia médica se remonta al año 1965, después de que el Instituto Nacional de Emergencia Médica (INEM) abriese el servicio de helicópteros de emergencia médica en 1997. Objetivo: Dar a conocer la historia y la situación actual en lo que respecta al transporte aéreo de pacientes en estado crítico en helicóptero, a través de las dos entidades principales en Portugal, el INEM y la Fuerza Aérea Portuguesa (FAP) . Metodología: Estudio de carácter histórico, de enfoque cualitativo, en el que se recurrió al análisis documental de fuentes primarias provistas por el Estado Mayor de la Fuerza Aérea y el Instituto Nacional de Emergencia Médica, así como de fuentes secundarias. Resultados: Los resultados sugieren que la creación de un modelo de intercambio de medios de transporte aéreo entre las diferentes entidades mejora la eficacia y eficiencia del transporte de pacientes críticos. Conclusión: Se sugieren otros estudios que den a conocer históricamente el papel desempeñado por los equipos de médicos, enfermeros, comandantes y pilotos en Portugal

Validación del Nursing Activities Score en unidades de cuidados intensivos portuguesas

Objective: to describe the process of adaptation and validation of the Nursing Activities Score to the Portuguese context. Method: this was a pilot study of adaptation and validation of the Nursing Activities Score with a sample consisting of 67 patients hospitalized in the intensive care units of three Portuguese hospitals. The construct validity was assessed through factor analysis procedures and the internal consistency of the items was measured through the Cronbach’s alpha coeffi cient. Results: a mean workload value of 63.04% (SD = 14.25; Median = 61.30) was obtained. Psychometric data revealed a Cronbach’s alpha of 0.71 in the total scale, indicating an acceptable accuracy. Confi rmatory factor analysis suggested an appropriate adjustment between the model and the data (χ2 (199) = 214.5, p = 0.214; CFI = 0.95; RMSA = 0.035). Conclusion: in the present study, the Portuguese version of the Nursing Activities Score was found to be a valid instrument, enabling a safe assessment of the workload of nurses.Objetivo: descrever o processo de adaptação e validação do Nursing Activities Score para o contexto português. Método: trata-se de um estudo-piloto de adaptação e validação do Nursing Activities Score, com amostra de 67 doentes internados em unidades de cuidados intensivos de três hospitais portugueses. A validade de constructo avaliou-se mediante procedimentos de análise fatorial e a consistência interna dos itens através do coefi ciente Alpha de Cronbach. Resultados: obteve-se um valor médio da carga de trabalho de 63,04% (DP = 14,25; Mediana = 61,30). Os dados psicométricos revelaram um Alpha de Cronbach de 0,71, na escala total, indicando uma fi delidade aceitável. A análise fatorial confi rmatória sugeriu um ajustamento adequado entre o modelo e os dados (χ2(199) = 214,5, p = 0,214; CFI = 0,95; RMSA = 0,035). Conclusão: neste estudo, a versão portuguesa do Nursing Activities Score revelou-se um instrumento válido, permitindo avaliar a carga de trabalho dos enfermeiros com segurançaObjetivo: describir el proceso de adaptación y validación del Nursing Activities Score al contexto portugués. Método: estudio piloto de adaptación y validación del Nursing Activities Score, con muestra de 67 pacientes internados en unidades de cuidados intensivos de tres hospitales portugueses. La validez del constructo se evaluó mediante análisis factorial y por consistencia interna de los ítems evaluados a través del coefi ciente Alpha de Cronbach. Resultados: se obtuvo un valor medio de carga de trabajo de 63,04% (SD=14,25; Mediana=61,30). Los datos psicométricos expresaron un Alpha de Cronbach de 0,71 en la escala total, indicando fi delidad aceptable. El análisis factorial confi rmatorio sugirió un ajuste adecuado entre el modelo y os datos (χ2 (199)=214,5; p=0,214; CFI=0,95; RMSA=0,035). Conclusión: en este estudio, la versión portuguesa del Nursing Activities Score demostró ser un instrumento válido, permitiendo evaluar la carga de trabajo de los enfermeros con precisión

Avaliação dos cuidaos informais aos idosos: estudo do impacte do cuidado no cuidador informal.

Doutoramento em Ciências de Enfermage

The experience of caring for a dependent elderly at home

Publicado em "Livro de atas do 3° Congresso Ibero-Americano em Investigação Qualitativa, Vol. 2 : Artigos de Saúde", ISBN 978-972-891448-6O impacte que os cuidados prestados a idosos dependentes podem ter no sistema familiar tem sido habitualmente reconhecido como uma experiência física e emocionalmente desgastante, que pode afectar o bem-estar psicossocial, a saúde física e a qualidade de vida dos cuidadores. Esta investigação, exploratória e descritiva, de índole qualitativa procura compreender a experiência do cuidado a idosos dependentes não dementes, na perspectiva dos cuidadores informais. Foi utilizada a entrevista aberta constituída pela questão: Genericamente falando, o que tem sido a sua experiência como cuidador de um idoso dependente? Os dados da avaliação subjetiva foram analisados, do ponto de vista qualitativo [6] através de análise de conteúdo [5]. Duzentos e catorze cuidadores informais (n=214) participaram no estudo. Dos resultados emergiram diferentes temas, sendo posteriormente agregados em três categorias: (1) Organização das exigências e estrutura da relação de cuidar; (2) concessões na vida pessoal e social, e percepção de problemas de saúde, (3) percepção da velhice, crenças, valores e sentimentos positivos. As diferentes experiências relativas ao processo de cuidar oferecem uma melhor compreensão dos condicionantes psicossociais do bem-estar subjectivo, da saúde e qualidade de vida dos cuidadores e um leque de possibilidades de intervenção. Este conhecimento é fundamental para ajudar no controlo das emoções negativas e na identificação dos preditores dos ganhos. Uma melhor compreensão da percepção das famílias acerca dos cuidados ajudará também a identificar necessidades, estimular estratégias e a activar e gerar recursos capazes de optimizar a vida quotidiana dos cuidadores que, por escolha ou obrigação, se vêm confrontados com a situação de cuidar um idoso dependente.The impact that taking care of dependent elderly people can have on the family system has been seen as a physically and emotional draining experience, that can affect the psychosocial well -being, physical health and quality of life of the caregivers. This exploratory and descriptive research of qualitative nature aimed to understand the experience of caring for a dependent elderly at home from the informal caregiver·s perspectives. This study was based on open question: Generally speaking, how has been your experience as a caregiver of a dependent elderly? Data from subjective evaluation were analyzed from a qualitative point ofview 161 through a content analysis 151. Two hundred fourteen informal caregivers (n=214) were approached to take part in the study. Themes to emerge from the data were categorized under three headings: (I) demands organization and structure of the relationship of care giving; (2) concessions in personal and social life, and perception of health problems; (3) perception of old age, beliefs, values and positive feelings. The different experiences concerning the process of caregiving allows a better understanding of psychosocial determinants of caregivers' subjective wellbeing, health, and quality of life and a range of possible interventions. This knowledge is fundamental to help control negative emotions and to identify gain predictors. A better understanding of families' perceptions will hclp idcntify needs, promote strategies, and, activate and create resources able to improve the daily lives of caregivers who by choice or obligation are faced with taking care of an elderly dependent person

Supporting older people’s informal caregivers at home through InCARE programme : the study protocol

Introduction: More than 42% of older people (+65) have a stroke and almost all of them require help to self-care at home. Informal caregivers have reported several needs and dissatisfaction with technical and emotional support delivered by a community health team. Furthermore, empowering informal caregivers who take care of older stroke survivors is an important challenge, preventing negative outcomes in themselves, such as burden or anxiety, as well as depression, loss of physical function or hospitalization in older people. Evidence has also shown that telehealth interventions articulated with home visits may be an effective way to achieve health gains. Objective: This pilot study aims at describing a protocol of an intervention based on training and telephone support delivered to informal caregivers who take care of older people after a stroke at home. Methods: A single blinded randomized trial will include 156 eligible informal caregivers. The intervention will be delivered by a community nursing team one week, one and three months after a hospital discharge. In addition, telephone support, counseling caregivers on the 3rd, 6th, 8th and 10th week post discharge will be provided. Results/Conclusions: Data collection started in February and will be concluded in October 2014. InCARE will be the first pilot study ever undertaken in Portugal. It will highlight new ways to support caregivers who take care of older people post-stroke. If successful, this study will be translational and it will also allow disseminate results all over the country and be implemented as a best practice

Guide to preventing falls for older people living in the community

Publicado em “RSP revista de saúde pública”, vol. 48, special number (May 2014), ISSN 0034-8910Introduction: Worldwide high costs are spent with new cases of hospitalization and institutionalization caused by fractures in older people. Although there are several programs to prevent falls, clear guidelines are missing to identify the effectiveness of nursing interventions. Yet, more research is needed to synthetize knowledge, to develop, implement and evaluate interventions to prevent falls and other negative consequences. Objective: The main goal of this research is to develop a guide of good practice for preventing falls in older people at home Methods: After a systematic review, the PPFalls team will develop a focus group who will work with experts in this field, such as nurses and other health professionals from community units and academic experts whose goal is a guide of good practice creation on falls prevention throughout 2014. This guide is also intended to: (1) define the key elements which make fall prevention programs effective; (2) alert older people, informal caregivers about the major intrinsic and extrinsic factors on risk of falling. This guide will become a tool to be used by decision makers and delivered in community-dwelling, especially in the region of Cávado, in Northern Portugal. Results and Conclusions: It is expected that this guide may support older people and informal caregivers to improve falls prevention by emphasizing the individual potential of each older person. Health professionals, in general, and nurses, in particular, have an important role concerning falls prevention, especially those who work in the community counseling and screening older people who have the highest risk of falling

The self-care (re)construction in older people stroke survivors: a literature review

Purpose: Cerebrovascular disorder (Stroke) is the leading cause of morbidity in old people in Portugal, fostering high levels of dependency to self-care. This study aimed to understand the process of (re)construction of self-care in old people stroke survivors. Method: A review followed PIC[O]S method, in MEDLINE and CINAHL databases in the last decade (202-2012). 651 articles were retrieved and only eight were included based on the inclusion criteria established by the authors. Results: The main results suggest he importance of the rehabilitation process within the first few months in old people after a stroke. There were scores of independence in self-care, 3 and 12 months post-discharge. Relevant indicators and influencers were reported in several studies. The nature of the event, functional capacity, satisfaction with life and self-esteem were considered as predictors in self-care performance post-stroke. Conclusion: Despite the results suggesting self-efficacy and ´persistence´ in the recovery process, as key elements in the (re)construction, more research is needed to understand the self-care (re)construction in old people stroke survivors