Support and training of family caregivers: nursing intervention program

Introduction: With an aging population and improvements in health care, there is an increase in the number of dependents who require more support to meet their needs. Family caregivers (FC) are essential to guarantee continuity of care, even though it is an exhausting process with consequences for their health. A properly structured nursing intervention program (NIP) is shown to be important in this context. Objective: To develop and implement a NIP to support and train the FC of dependent people. Methods: An integrative literature review (ILR) was conducted to identify the main caregiver needs. Afterwards, a NIP was structured in the areas of emotional and instrumental support. It was then validated by experts in the field using the Delphi technique. This was implemented and evaluated, using a quasi-experimental study, with a pre and post intervention evaluation. Results: From the ILR, 21 articles were stood out for highlighting the main needs manifested by FC. Through the Delphi technique an NIP was obtained with 93 nursing interventions. Its implementation led to a general improvement in the FC’s state of health, a reduction of the overload manifested and a greater use of coping strategies. Conclusion: Structured and contextualized nursing interventions, directed to supporting and empowering FC, facilitate the transition to this role with an impact on their health and the care provided.info:eu-repo/semantics/publishedVersio

De aluno a enfermeiro: desenvolvimento de competências em contexto de ensino clínico

Doutoramento em Ciências da SaúdeA formação em enfermagem tem acompanhado a evolução sociocultural e científico-tecnológica procurando dar resposta às exigências dos utentes e, sobretudo, à complexidade e à imprevisibilidade dos contextos de prestação de cuidados. Segundo os novos paradigmas de formação, pretende-se que os alunos desenvolvam competências que lhes permitam “agir em situação”. Neste estudo procurámos compreender de que forma os alunos desenvolvem as suas competências em contextos de ensino clínico e quais os factores que, à luz da perspectiva bioecológica de desenvolvimento humano (Bronfenbrenner e Morris, 1998) e do seu modelo PPCT (Pessoa, Processo, Contexto e Tempo), se constituem como facilitadores ou inibidores desse desenvolvimento. Optámos por uma metodologia predominantemente qualitativa, através de um estudo de caso, referente ao 2º Curso de Licenciatura em Enfermagem da Escola Superior de Saúde da Universidade de Aveiro (2002-2003 a 2005- 2006). Para além da análise documental para contextualização do ensino clínico no currículo do curso, foram recolhidas narrativas dos alunos e supervisores relativas às suas vivências em ensino clínico durante todo o percurso formativo. Os resultados da análise de conteúdo das narrativas, de natureza qualitativa, foram triangulados com as classificações dos alunos nas grelhas de avaliação de competências e respectivos relatórios e procuraram responder à primeira questão de investigação que visava analisar o desenvolvimento de competências e as perspectivas dos actores envolvidos nesse processo. A resposta à segunda questão, que incidia sobre os factores de desenvolvimento à luz do modelo PPCT, foi baseada essencialmente na análise das narrativas. Os resultados obtidos permitem-nos concluir que o desenvolvimento de competências ocorre de forma integradora, combinando sinergeticamente diferentes dimensões (cognitiva, atitudinal, comunicacional e técnica) ao longo dos ensinos clínicos, num processo dinâmico, dialéctico e progressivo. E ainda que, à luz do modelo PPCT, sobressaem determinados factores influenciadores do desenvolvimento de competências. Assim, relativamente à Pessoa, emergem as características pessoais, os papéis desempenhados, a interpessoalidade, o contacto com a morte e com situações de sofrimento, sendo também significativa a emergência de uma componente afectivo-emocional. Quanto ao Processo, (que assume especial relevância), destacam-se as actividades e os processos proximais, as estratégias supervisivas, as dificuldades sentidas pelos supervisores, de entre as quais sobressai a falta de preparação para a tarefa. A análise dos Contextos revela que, no microsistema, o destaque vai para as especificidades de cada contexto e a atmosfera envolvente enquanto que, no mesosistema, a participação multicontextual e o conhecimento intercontextual se manifestam como relevantes. No exosistema, salienta-se a importância do relacionamento interinstitucional e dos modelos de parceria e, ao nível macrosistémico, emergem de forma subtil, indícios da influência das políticas de gestão hospitalar e da formação assim como da matriz conceptual de enfermagem. No que se refere ao Tempo, a importância da continuidade dos processos proximais (microtempo) e a periodicidade dos ensinos clínicos (mesotempo) mereceram referências significativas.Nursing education has followed the sociocultural and scientific and technological evolution in an attempt to find answer to the client’s demands and mainly to the complexity and unpredictability of the health care context. According to the new educational paradigms, it is intended that the students develop abilities which allow them to “act on situation”. In this study we sought to understand in which way the students develop their abilities on clinical teaching contexts and which are the factors that, under the bioecological human development perspectives (Bronfenbrenner and Morris, 1998) and its PPCT model (Person, Process, Context, Time), are constituted as facilitators or inhibitors of that development. We selected a predominately qualitative methodology, using a case study referring to the 2nd Course of the Nursing Bachelor Degree, in University of Aveiro School of Health (2002-2003 to 2005-2006). In addition to the documental analysis in order to contextualise the clinical teaching on the course curriculum, students and supervisors narratives concerning their experiences on clinical teaching during the entire training course were collected. The content analysis of the narratives, of qualitative nature, were triangulated with the students classifications on the evaluation grids regarding the abilities and respective reports, and tried to answer to the first research question, which aimed to analyse the development of the abilities and perspectives of the actors involved in that process. The answer to the second question, which came across the development factors under the PPCT model, was based chiefly on the analysis of the narratives. The final results allow us to conclude that the development of abilities occurs in an integrating way, combining synergistically different dimensions (cognitive, attitudinal, communicational and technical), throughout the clinical teaching, in a dynamic, dialectic, and progressive process. And also, under the PPCT model, certain factors which influence the development of abilities are highlighted. In what the Person is concerned, personal characteristics come into sight, along with the roles played, the interpersonality and the contact with death and suffering situations, being also significant the emergency of an affective and emotional element. As to the Process (which is of special relevance), the proximal activities and processes are pointed out, as well as strategies of supervision and difficulties experienced by the supervisors, from which the lack of preparation for that task stands out. The content analysis reveals that, in the microsystem, the importance goes to the specificities of each Context and the involving atmosphere, whereas in the mesosystem the importance goes to the multicontextual participation and intercontextual knowledge. In the exosystem, the importance of the interinstitutional relationship and the partnership models is emphasized and, at a macrosystemic level, signs of the influence of the policies of hospital management and training, as well as the conceptual matrix of nursing, are rising in a subtle way. To what the Time is concerned, the importance of the continuity of the proximal processes (microtime) and the periodicity of the clinical teaching (mesotime) deserved significant references

Cuidadores informais de pessoas idosas: caminhos de mudança

O crescente envelhecimento da população traz consigo implicações individuais e sociais às quais emerge dar resposta. Este envelhecimento associado ao aumento das doenças crónicas e incapacitantes traduz-se no incremento do número de pessoas que necessitam de cuidados e/ou apoio nas suas atividades de vida diária, frequentemente em contexto domiciliário, necessitando assim o suporte dos cuidadores informais. (...

Analysis of knowledge, perceptions and self-confidence regarding tobacco control among graduating nursing students in Portugal

In the 20th century, the tobacco epidemic killed around 100 million people worldwide, and in the present century can be the cause of billions of deaths. WHO advocates that the solution to this global epidemic, which is a risk factor for six of the eight leading causes of death in the world, is within our reach. The Government of Portugal signed the Framework Convention of the World Health Organization for Tobacco Control on January 9th, 2004, approving it and transposing it into national law on November 8th, 2005. The National Health Plan 2012-2016 considered smoking a priority health problem, and in 2012 it was created the National Program for Smoking Prevention and Control, a priority health program developed by the Director General of Health (DGS). With reference to this framework, the DGS launched a public tender for the study of evaluation of the acquisition of professional skills in the field of prevention and treatment of smoking during the nursing degree’s final year. This study aims to explore attitudes, knowledge, perceptions of curricula contents and confidence to intervene in tobacco control among graduating nursing students in Portugal

Ansiedade associada ao desempenho do papel de cuidador familiar de pessoa dependente

Background: most home care to dependent person is provided by a caregiver, family member of the person being cared for, who provides care in an unpaid manner. Nowadays, there are growing concerns about his mental health, and anxiety and burden are often associated with the caregiver role. Objective: to analyse the relation between sociodemographic variables and caregiver burden and anxiety. Methodology: quantitative, transversal study, with a snowball sample of 85 caregivers. The Zarit Burden Interview Scale and The Depression Anxiety Stress Scale and t Student, Kruskal-Wallis and U Mann-Whitney tests were used. Results: caregivers had a mean age of 51.97 years, were mostly female, married and had education up to nineth grade. It was found that 38.8% of caregivers had anxiety. Those who showed greater anxiety were between 50 and 60 years old (p=0.023) and had higher education (p=0.009). There are no statistically significant differences between other variables. Conclusion: age and education seem to have an influence on caregiver anxiety. Since the caregiver's anxiety can have repercussions on the person being cared for, it is extremely important to prevent and promote their mental health.Marco Contextual: la mayor parte del cuidado proporcionado as personas dependientes en el contexto de su casa es de la responsabilidad de un cuidador, miembro de la familia de la persona que cuida de manera no remunerada. Hoy en día, existe una creciente preocupación sobre su salud mental y la ansiedad y la sobrecarga se asocian con el desempeño del rol de cuidador. Objetivo: analizar la relación entre variables sociodemográficas y sobrecarga y ansiedad del cuidador. Metodología: cuantitativa, transversal, con muestra por redes, de 85 cuidadores. Se utilizaron la Escala de Sobrecarga del Cuidador y la Escala de Ansiedad, Depresión y Estrés y pruebas t de Student, Kruskal-Wallis y U Mann-Whitney. Resultados: os cuidadores tenían una edad media de 51,97 años, eran en su mayoría mujeres, casados y tenían escolaridad hasta el tercer ciclo. Se encontró que 38,8% de los cuidadores presentaban ansiedad. Los que mostraron mayor ansiedad tenían entre 50 y 60 años (p=0.023) y tenían educación superior (p=0.009). No existen diferencias estadísticamente significativas entre otras variables. Conclusión: la edad y la educación parecen influir en la ansiedad del cuidador. Dado que la ansiedad del cuidador puede repercutir en la persona cuidada, es de suma importancia intervenir para prevenir y promover su salud mental.Enquadramento: a maioria dos cuidados prestados a pessoas dependentes em contexto de domicílio é assegurada por um cuidador, familiar da pessoa cuidada, que presta cuidados de forma não remunerada. Atualmente emergem preocupações crescentes com a sua saúde mental e a ansiedade e sobrecarga surgem, muitas vezes, associadas ao desempenho deste papel. Objetivo: analisar a relação entre as variáveis sociodemográficas, sobrecarga e ansiedade do cuidador. Metodologia: quantitativa, transversal, com amostra por redes, de 85 cuidadores. Utilizada a Escala de Sobrecarga do Cuidador e a Escala de Ansiedade, Depressão e Stress e os testes t de Student, Kruskal-Wallis e U Mann-Whitney. Resultados: os cuidadores possuíam uma idade média de 51.97 anos, eram maioritariamente do sexo feminino, casados e apresentavam escolaridade até ao terceiro ciclo. Constatou-se que 38.8% dos cuidadores apresentavam ansiedade. Os que revelavam maior ansiedade tinham entre 50 e 60 anos (p=0.023) e como escolaridade o ensino superior (p=0.009). Não existem diferenças estatisticamente significativas entre outras variáveis. Conclusão: a idade e a escolaridade parecem ter influência na ansiedade do cuidador. Uma vez que a ansiedade do cuidador pode ter repercussões na pessoa cuidada é de extrema importância intervir no sentido da prevenção e promoção da sua saúde mental

Desarrollo de competencias para la promoción de la salud y cambio de modelo de atención

Case study based on the theoretical and methodological framework of dialectics, aimed at analyzing competency building for health promotion, from the perspective of graduates from a nursing course and its relation to change in the care model. Interviews focused on competencies were held with ten graduates. Data were analyzed using critical discourse perspective. The results show that the competencies for health promotion, defined by two internacional consensus, were discussed in the course of the nursing education process. The discourses demonstrate that competency building for health promotion in nursing education can foster change in the care model, despite the challenges in this process. Curricular strategies like contact with reality through the immersion of students in the practical scenario since the beginning of the course and community service and research activities can contribute to competency building for health promotion in nursing education and foster the change in the care model.Estudo de caso ancorado no referencial teórico-metodológico da dialética, com o objetivo de analisar o desenvolvimento de competências para promoção da saúde, na perspectiva dos egressos de um curso de enfermagem, e sua relação com a mudança do modelo de atenção. Foram realizadas entrevistas com foco em competências com dez egressos. Os dados foram analisados pela perspectiva crítica do discurso. Os resultados demonstram que as competências para promoção da saúde, definidas em dois consensos internacionais, foram trabalhadas ao longo do processo de formação. Os discursos produzidos demonstram que o desenvolvimento de competências para promoção da saúde pode favorecer a mudança do modelo assistencial, apesar dos desafios neste processo. As estratégias curriculares de contato com a realidade, por meio da imersão do estudante no cenário de prática, desde o início do curso, e ações de extensão e pesquisa podem contribuir para o desenvolvimento de competências para a promoção da saúde e favorecer a mudança do modelo assistencialEstudio de caso anclado en la dialéctica, con el fin de analizar el desarrollo de competencias para la promoción de la salud, desde la perspectiva de egresos de un programa de enfermería y su relación con el cambio del modelo de atención. Las entrevistas con enfoque en competencias con diez graduados de una licenciatura en enfermería. Los datos fueron analizados por análisis crítico del discurso. Los resultados muestran que competencias para promoción de la salud, definidas en dos consensos internacionales, se trabajaron durante todo el proceso de formación. Los discursos producidos muestran que este desarrollo de competencias puede fomentar el cambio del modelo de atención, a pesar de los desafíos en este proceso. Se necesita mayor cambio de paradigma, ya que el suelo parece fecundo para este proceso. Las estrategias curriculares de contacto con la realidad, a través de la inmersión del estudiante en el escenario de práctica desde el inicio del curso, y las actividades de extensión e investigación pueden contribuir al desarrollo de competencias para la promoción de la salud en la formación de enfermería y fomentar el cambio del modelo de atención

Construção e validação da escala de literacia em saúde sexual e reprodutiva

Background: Health literacy is fundamental and helps individuals to make informed decisions for health. In this context, sexual and reproductive health literacy enables individuals to experience their sexuality better, as it involves individual behaviors, relationships and protection of physical and mental health. Objectives: To construct and validate a sexual and reproductive health literacy scale (SRHLS). Methodology: This is a quantitative, descriptive and correlational study, with a sample of 924 higher education students. Thevalidation process included the internal consistency study and exploratory and confirmatory factor analysis. Results: We obtained a scale with 15 items, divided into 3 factors (Reproductive, Contraception and STI Literacy; Literacy on the Impact of Teenage Pregnancy; Literacy on Affect, Sexual Abuse and Exploitation and Dating Violence), which explained 77.761% of the variance. The internal consistency of the scale was 0.964. The instrument shows good internal consistency. Conclusion: The instrument proved to be valid and reliable. The development of educational/training programmes on sexual and reproductive health can help young adults to demonstrate greater sexual and reproductive health literacy, with an impact on physical and mental health.Enquadramento: A literacia em saúde é fundamental, e contribui para que os indivíduos tomem decisões fundamentadas para a saúde. Neste âmbito, a literacia em saúde sexual e reprodutiva capacita os indivíduos para uma melhor vivência da sua sexualidade, pois envolve comportamentos individuais, relações e proteção da saúde física e mental. Objetivos: Construir e validar uma escala de literacia em saúde sexual e reprodutiva (ELSSR). Metodologia: Trata-se de um estudo quantitativo, descritivo e correlacional, com uma amostra de 924 estudantes do ensino superior. O processo de validação incluiu o estudo de consistência interna e a análise fatorial, exploratória e confirmatória. Resultados: Obteve-se uma escala de 15 itens, distribuídos por 3 fatores (Literacia em Reproducao, Contracecao e IST; Literacia sobre o Impacto da Gravidez Adolescente; Literacia em Afetos, Abuso e Exploracao Sexual e Violência no Namoro), que explicam 77,761% da variância. A consistência interna da escala foi de 0.964. O instrumento apresenta boa consistência interna. Conclusão: O instrumento revelou-se válido e fiável. O desenvolvimento de programas educativos/formativos sobre saúde sexual e reprodutiva podemajudar os jovens adultos a evidenciar maior literacia em saúde sexual e reprodutiva, com impacto para a saúdefísica e mental

Clinical education reflective ecological model for health science majors

The clinical education is an integral part of the Health Science majors’ curriculum programs of the University of Aveiro’s School of Health (i.e., Nursing, Physical Therapy, Radiology, Radiotherapy and Speech-Language Pathology) and aims to develop clinical competences in order to generate excellent health care professionals. The organization was based on the Ecological Model of Clinical-Reflective Training, which was characterized by inter-institutional interaction and student’s reflection on actions on a professional setting. This study encompassed two moments of clinical internships in the Nursing, Physical Therapy, Radiology and Radiotherapy majors. The Clinical Internship I provided the 123 students with a global view of the health care professional activities. The Clinical Internship II, with 119 students, developed competences of each health professional. Questionnaires with categorical scales from 1 to 5 evaluated the organization and efficiency of the two internships. The results revealed averages over 3 in all items. In conclusion, the Ecological Model of Clinical-Reflective Training was well accepted by students and clinical supervisors. Applications in the health care area were demonstrated

Model of clinical internship: a new approach

Clinical internship is an integral part of the University of Aveiro, School of Health study programs for all majors: Nursing, Physical Therapy, Radiology, Radiotherapy, and Speech-Language Pathology. Clinical internship consists of a learning period where professional skills are integrated and promoted, and expertise is developed. It begins during the first year, and progressively increases in time during the subsequent semesters, until the last year, when it becomes full-time. The clinical internship of each major is a continuous growing process of professional capacities that gradually increases in development expertise, and is cumulative, synergetic and interactive. This new learning approach is common to all the majors, it is characterized by innovation, and it strives to assure the development of professional skills through the integration of knowledge acquired during theoretical lectures. Thus, future professionals should be autonomous, responsible, capable of thought-based critique, fit to implement innovations, and motivated for a life-time of self-learning. Within this context, an ecological model of thought-based clinical practice includes three factors: activities, roles, and interpersonal relationships. It is based on the principles of observation, experience and analysis of the pre-professional practice, thought-based, and systematically orientated by academic faculty and working professionals. The methodology encompasses two areas: multidisciplinary (conceptualisation and organization of the various internships programs, with faculty of the different academic programs as well as working professionals), and management model (forecast of the required material and human resources; creation of a Internship Program Centre; systematic monitoring of the structure, processes and results). Analysis of the first and second clinical internship has shown a great acceptance on behalf of all participants (students, faculty and working professionals). Statistical data will be presented at the conference.publishe