O cuidado domiciliar transpessoal: vivências do paciente / Transpersonal home care: patient experiences

Resumo: Introdução: O cuidado realizado no domicílio tende a ser mais próximo e orientado às singulares e necessidades dos usuários, que permanecem inseridos em seu contexto de vida, e possibilita inter-relações efetivas entre profissional de saúde, paciente e família. O ser que vivência o cuidado domiciliar deve ser entendido como o protagonista e definidor do seu projeto terapêutico, que assumi a centralidade na produção do seu cuidado, entretanto, pouca voz é dada a este ator para expressar suas opções, sentimentos e experiências vivenciadas. A teoria do cuidado humano, referencial teórico desta tese, propõem que o cuidado transpessoal favorece o crescimento pessoal significativo por meio da ajuda, confiança e liberdade, e promove restauração e integralidade de corpo, mente e espírito como uma unidade, em um processo no qual paciente e profissional de saúde une força para transpor uma situação. Assim, defende-se a tese de que o cuidado domiciliar é desenvolvido em um contexto de reconstituição, no momento do cuidado, e possível pela busca de uma inter-relação transpessoal singular entre quem cuida e quem é cuidado. Objetivos: Desenvolver uma teoria substantiva representativa da vivência do cuidado domiciliar no Brasil e Portugal e propor ações para a prática de enfermagem que conduzam à interação transpessoal com o paciente. Metodologia: Grounded Theory desenvolvida na região sul do Brasil junto a um Serviço de Atendimento Domiciliar e no cenário português junto a uma Unidade Local de Saúde na região do Porto. Os dados foram coletados no período de fevereiro de 2016 a novembro de 2017. A seleção dos participantes foi realizada pela amostragem teórica entre os grupos amostrais: pacientes, familiares cuidadores e profissionais de saúde. A amostra foi constituída por 53 participantes (28 brasileiros e 25 portugueses). A coleta de dados foi realizada por meio de entrevista semiestruturada em profundidade. Para análise e organização dos dados utilizou-se a elaboração de memorandos, diagramas e o software QSR Nvivo 10. A codificação seguiu o modelo glasseriano que ocorre em duas fases: codificação substantiva e teórica, subdividindo-se a primeira em codificação aberta e seletiva. Na codificação teórica evidenciou a interrelação dos conceitos por meio do código teórico família interativa e seis Cs. Resultados: Após o estabelecimento dos dois modelos teóricos (brasileiro e português) realizou-se a integração dos conceitos, especificando propriedade e dimensões aos elementos de sustentação que culminou na teoria substantiva cujo conceito central é "Buscando o cuidado domiciliar transpessoal" causada por "Principiando o cuidado domiciliar" que tem como condição interveniente "Tendo o suporte para o cuidado domiciliar", está inserido no contexto de "Suscitando um ambiente de reconstituição", cuja a consequência é "Concebendo o momento do cuidado". Como contribuições para o desenvolvimento de interações transpessoais no cuidado domiciliar apresenta-se a integração com o ensino por meio de um plano, o uso de modelo de cuidado específico, a utilização de guia prático para o desenvolvimento do cuidado transpessoal e a aplicação de escalas para a avaliação das práticas transpessoais domiciliares. Considerações Finais: Uma situação de desarmonia do copo, mente e/ou espirito pode levar o ser humano, autônomo e livre, a viver em um ambiente restrito domiciliar, dependente de outras pessoas e submetido ao fazer técnico científico das profissões de saúde. No desenvolvimento deste estudo buscou-se saber como estes seres únicos e singulares, presentes no mundo, cuja a possibilidade de falar sobre suas experiências foi proporcionada, agiam, sentiam, experienciavam e enfrentavam o cuidado domiciliar. Estas experiências somada a teoria do cuidado humano proporcionam fundamentação teórica e prática para o desenvolvimento da enfermagem domiciliar.

Abstract: Introduction: Home care tends to be more oriented to users' singularities and needs, who remain within their living context, and enables effective interrelationships between health professionals, patients and families. The being experiencing home care must be understood as the protagonist and designer of his/her therapeutic projects, taking over the centrality in care delivery, however, little voice is provided to that actor to express his/her options, feelings and lived experiences. The Theory of Human Caring, theoretical background of this thesis, claims that the transpersonal caring fosters meaningful personal growth by means of help/trust/freedom, and promotes the restoration and integrality of body, mind and spirit as a unit, in a process where patients and health professionals join to overcome a situation. Thus, it is advocated the thesis that home care is developed in a context of reconstitution, during the moment of caring, and it is possible by means of searching for a singular transpersonal interrelationship between the one who cares, and the one who is cared. Objectives: to develop a substantive theory, representative of the home care in Brazil and Portugal; and to propose actions for nursing practice, which lead to the transpersonal interaction with patients. Methodology: Grounded Theory developed in Southern Brazil at a Home Care service, and in Portuguese settings at a local healthcare unit in the region of Porto. Data were collected between February 2016 and July 2017. The selection of the research participants was carried out by means of theoretical sampling among the sample groups: patients, family caregivers and health professionals. Sampling comprised 53 participants (28 Brazilian and 25 Portuguese subjects). Data collection was held by means of in-depth semi-structured interview. For data analysis and organization, the elaboration of memos, diagrams and QSR Nvivo 10 software were used. Coding was grounded in Glaser model, being held in two steps: substantive and theoretical coding, the former subdivided in open and selective coding. In the theoretical coding, the relations were evidenced by means of the theoretical interactive coding family and the six Cs. Results: After establishing both theoretical models (Brazilian and Portuguese), concept integration was carried out, attributing property and dimensions to the supporting elements, culminating with the final substantive theory titled "Searching for transpersonal home caring" caused by "Beginning home care", which has "Having the support for home care" as the intervention condition, inserted in the context of "Fostering a reconstitution environment," whose consequence is "Conceiving the caring moment." A teaching plan, the use of a specific caring model, the use of a practical guide for the development of the transpersonal caring, and application of scales to assess home care transpersonal practices are the proposed contributions to the development of transpersonal home caring interactions. Final Considerations: An imbalancing situation of body, mind and/or spirit may lead autonomous, free human beings to live in a restricted household environment, dependent on others, and submitted to the technical performance of healthcare professions. During the development of this study, it was objectified the realization of how such unique and singular beings, present in the world, who were provided with the possibility to talk about their experiences, would act, feel, experience and cope with home care. Such experiences, in addition to the Theory of Human Caring, provide theoretical and practical grounding for the development of home care nursing.

Resumen: Introducción: El cuidado realizado en el domicilio tiende a ser más próximo y orientado a las singularidades y necesidades de los usuarios, que permanecen dentro de su contexto de vida, y posibilita interrelaciones efectivas entre el profesional de salud, el paciente y la familia. El ser que vivencia el cuidado domiciliar debe ser entendido como el protagonista y definidor de su proyecto terapéutico, que asume la centralidad en la producción de su cuidado, sin embargo, a este actor le es dada poca voz para expresar sus opciones, sentimientos y experiencias vividas. La teoría del cuidado humano, referencial o marco teórico de esta tesis, propone que el cuidado transpersonal favorece el crecimiento personal significativo por medio de la ayuda, confianza y libertad, así como también promueve la restauración e integralidad de cuerpo, mente y espíritu como una unidad, en un proceso en el que el paciente y el profesional de salud unen fuerzas para transponer una situación. Así, se defiende la tesis de que el cuidado domiciliar se desarrolla en un contexto de reconstitución, en el momento del cuidado, y es posible por la búsqueda de una interrelación transpersonal singular entre quien cuida y quien es cuidado. Objetivos: Desarrollar una teoría sustantiva representativa de la vivencia del cuidado domiciliar en Brasil y Portugal, y proponer acciones para la práctica de enfermería que conduzcan a la interacción transpersonal con el paciente. Metodología: Grounded Theory desarrollada en la región sur de Brasil en un Servicio de Atendimiento Domiciliar y en el escenario portugués en una Unidad Local de Salud en la región de Porto. La recolección de datos se produjo durante el período de febrero de 2016 a noviembre de 2017. La selección de los participantes se realizó a través de muestreo teórico entre los grupos muestrales: pacientes, familiares cuidadores y profesionales de salud. La muestra la constituyeron 53 participantes (28 brasileños y 25 portugueses). La recolección de datos se realizó por medio de entrevista semiestructurada en profundidad. Para el análisis y organización de los datos se utilizó la elaboración de memorandos, diagramas y el software QSR Nvivo 10. La codificación siguió el modelo glasseriano que consta de dos fases: codificación sustantiva y teórica, con subdivisión de la primera en codificación abierta y selectiva. En la codificación teórica se evidenció la interrelación de los conceptos por medio del código teórico familia interactiva y seis Cs. Resultados: Después de establecer los dos modelos teóricos (brasileño y portugués) se realizó la integración de los conceptos, especificando propiedad y dimensiones de los elementos de sustentación, lo que culminó en la teoría sustantiva final intitulada: "Buscando el cuidado domiciliar transpersonal" causada por "Iniciando el cuidado domiciliar" que tiene como condición interviniente "Teniendo el soporte para el cuidado domiciliar", está inserido en el contexto de "Suscitando un ambiente de reconstitución", cuya consecuencia es "Concibiendo el momento del cuidado". Como contribuciones para el desarrollo de interacciones transpersonales en el cuidado domiciliar se presenta la integración con la enseñanza por medio de un plan, el uso de modelo de cuidado específico, la utilización de guía práctica para el desarrollo del cuidado transpersonal y la aplicación de escalas para la evaluación de las prácticas transpersonales domiciliares. Conclusiones: Una situación de desarmonía del cuerpo, mente y/o espíritu puede llevar al ser humano, autónomo y libre, a vivir en un ambiente restringido domiciliar, dependiente de otras personas y sometido a los quehaceres técnicos de las profesiones de salud. Durante el desarrollo de este estudio se procuró saber cómo estos seres únicos y singulares, presentes en el mundo, a quienes se les proporcionó la posibilidad de hablar sobre sus experiencias, actuaban, sentían, experimentaban y enfrentaban el cuidado domiciliar. Estas experiencias sumadas a la teoría del cuidado humano proporcionan fundamentación teórica y práctica para el desarrollo de la enfermería domiciliar.

Home Care of Elderly with Dysphagia / 대한연하장애학회지

Due to the increase in elderly population, there has been an increase in number of patients with dysphagia in the community. Dysphagia results in aspiration pneumonia and complications such as malnutrition, dehydration in the elderly. These complications increase the hospital admission rates and are often the cause of death. For this reason, the goal of healthcare for elderly with dysphagia living in the community is to select elderly with dysphagia by early screening, maintain adequate nutritious status and prevent future complications. The families of dysphagia elders should be educated and supported in order to successfully care for these patients at home. Severe cases of elderly with dysphagia are to receive health professional service in conjunction with the services from hospital based home care medical center. It also requires governance support so that health professionals such as speech language pathologists will care for dysphagia patients in home.

Study on home health care nursing needs in some provinces / Монголын Анагаах Ухаан

Introduction: In order to Implement the Mongolian government's 2000 provisions for national health care, on May 28,2004, the Health Minister approved the "Home Care Nursing Service and Rules for Caring and Nursing" according to resolution # 136 and indicated that family clinic nurses should provide home care nursing services [6'71. Interestingly, it is noted that throughout the world, nursing home services have not been limited to family clinic nurses but are being delivered by nurses with diverse areas of specialization.Goal: Purpose of the study is to determine needs for making home nursing services to the population in some province and soum.Objectives:1. To comparatively search needs for providing home nursing services to citizens in the province and soum which were involved to the study.2. To determine nursing type which is required at home3. To develop needs of nurses who make home nursing servicesMaterials and Methods: Conducted studies among the 1109 people from the 520 families in 17 soums of five provinces such as Orkhon, Bulgan, Arkhangai, Khuvsgul and Selenge. We have chosen the clients with anamnesis who are repeatedly served and treated at the hospital for our study and had interviews with them. Questionnaire for citizens consists of 2 basic chapters including 17 questions which determine demographic information and needs of home nursing services. We asked and searched about needs of Home Care Nursing assistances under the 3 basic groups such as General nursing, Treatment nursing and Specialized nursing. After inserting study data into the SPSS-17 program, checked it by appropriate statistical methods (t, x2, fisher exact) and checked if difference between groups and relations has statistical truth.Results: 35.89 percent of clients who got involved to the study answered that they are interested in taking nursing and caring services at home. Also we consider needs for having home nursing at home according to numerical indexes in the provinces involved to the study, clients mostly want to be injected by intramuscular (25.88%), intravenous (31.02%) and IV fluid (30.57%). As we consider specialized nursing assistances at home under the types of needs, health education and assistance for people suffered with hemorrhage and injured people occupy major percent. Clients who got involved to the training, were asked question "With whom do you want to be made nursing assistance at home?" and 75.6% of them answered that they prefer nurses of family clinic.Conclusions:1. It was observed that 35.89% of clients who got involved to the survey, want to receive home nursing assistance and demands for home nursing is being increased with aging.2. Also we conclude that nursing after hemorrhage, nursing for injured patients and nursing for patients with cardiovascular disease occupies higher percent and it shows that percent of cardiovascular diseases and injuries is relatively high and clients' needs to receive nursing assistance at home are faced problems after they were discharged from hospital.3. 75.6% of people who got involved to the study are interested in taking home nursing assistance and we reached to conclusion that it is suitable to train nurses according to it.

Research in effectiveness of home protocol nursing on liquid intake compliance improvement of patients undergoing hemodialysis / 中国实用护理杂志

Objective To observe the effect of home nursing based upon protocol nursing theory on liq-uid intake compliance improvement of patients undergoing hemedialysis. Methods Forty-eight HD patients of hquid intake un-compliance were randomized into the observation group and the control group with 24 cases in each group. The control group received routine nursing, the observation group was given home care instruc-tion based upon protocol nursing theory for 1 month. The two groups both received follow-up for 3 months and their liquid intake comphance were evaluated before and after intervention. The relationship between family sup-port and relative increase of body weight during hemodialysis was also evaluated. Results The IDGW relative magnitude was lower, the compliance of liquid intake was higher, the level of family support was higher in the observation group than those of the control group. There was negative correlation between the family support and the IDGW relative magnitude the IDGW relative magnitude, family support, comphance of liquid intake. Conclusions Home care nursing based upon nursing theory facilitate patients to get effect family support, increase the compliance of hquid intake and make IDGW within desirable range.

Needs for Home Care Nursing in the Vulnerable Elderly / 간호학회지

PURPOSE: The purpose of this study was to determine the subjects' health status according to the needs of visiting health and the function of the family in home care nursing. SAMPLE AND METHOD: The data collection period was from 07/01/04 to 10/31/04 and the subjects were 488 of those above 60 years of age staying at home or living alone who registered at a visiting health service of public health center at an urban area in Korea. This survey was carried out by visiting health nurses and participation was agreed on by the elderly people. RESULTS: The extent of the subjects' total health status to the general characteristics had differences according to the age, sex, monthly income, perceived health status, known functional disorder, and yes-or-no for disease. At all health status domains, visiting health need care in the group I was very lower than one in II, III, or IV groups. Also the severe dysfunctional family was lower than lightly dysfunctional family and normal functional family in all health status domains. CONCLUSION: Nurses must provide their characteristics considered nursing intervention for the elderly who have high visiting health needs and severe dysfunctional family with vulnerable health care.

A Comparison between Home Care Nursing Interventions for Hospice and General Patients / 간호학회지

PURPOSE: The purpose of the study was to compare home care nursing intervention activities analyzed by the Nursing Intervention Classification (NIC) system for hospice and general patients. METHOD: For the descriptive survey study, data was collected by reviewing charts of 151 hospice patients and 421 general patients who registered in the department of home health care nursing at K Hospital. RESULTS: According to the NIC system application, there were 2380 total nursing interventions used for the hospice patients and 8725 for the general home care patients. For both sets of patients (hospice vs. general), the most frequently used nursing intervention in level 1 was the Physiological: Complex domain (40.13 vs. 31.06 percent), followed by the Safety domain; in level 2, the Risk Management class (28.4 vs. 27.70 percent), followed by Tissue Perfusion Management; and in level 3, Vital Sign Monitoring (6.18 vs. 4.84 percent), followed by Health Screening. CONCLUSION: The study showed that there was a lack of specialized hospice nursing interventions such as emotional, family and spiritual support, and care for dying hospice patients.

Development and Analysis of Community Based Independent Home Care Nursing Service / 간호학회지

The purpose of this study was to develop the framework of community-based home care nursing delivery system, and to demonstrate and evaluate the efficiency of it. The study was carned out over a period of 3years from September 1996 to August 1999. The researchers developed Standards for operations, this was all aimed toward a home care recording system, and an assessment intervention algorithm for various diseases quality control and standardization. In the center, 185 patients enrolled, and of the enrollments cerebrovascular disorder and cancer were the most prevailment diseases. Also, a home care nursing activity classification was developed in six domains. Those domains were assessment, medication, treatment, education and consultation, emotional care, and referral or follow-up care. Ten sub-domains were divided according to the systematic needs. Among these nursing activities, treatment, assessment, and education and consultation were frequently performed. In sub-domain classification, skin integrity, respiration, circulation, and immobility related care were provided most frequently. The cost of home care nursing per visit was also suggested. The cost include direct and indirect nursing care, management, and transportation cost. Also, the researchers tried to overcome the limitations of hospital-based home care to provide more accessible, efficient, safe, and stable home care nursing. Therefore, clients were referred from other patients, families, public health care centers, industries, and even hospitals. As a result of this study, several limitations of operation were found. First, it was difficult to manage and communicate with doctor in the emergency situations. Second, there was too much time spent for transportation. This was because they are only five nurses, who cover all of the areas of Seoul and nearby cities. Third, preparation for special care of home care nurses was lacking. Fourth, criteria for the termination of care and the frequency of home visits were ambiguous. Finally, interconnection with home care machinery company was so yely needed. New paragraphs' strategies for solving these problems were suggested. This study will be the basis of community-based home care nursing, and the computerized information delivery system for home care nursing in Korea.

Home Care Nursing Needs of Welfare Solitude Elderly Person in Pusan City / 간호학회지

This study was carried out to assess home health care needs for welfare of solitude elderly person. The subjects of this study were 90 welfare solitude elderly person in Pusan City. Data were obtained by interview and observation using a structured questionnaire. The collected data were analyzed by t-test, ANOVA with SAS program. The results are as follows. 1. Among the home care nursing needs, environmental nursing needs topped the list, followed by spiritual, physical, psychological, communication & health knowledge and ADL nursing needs. 2. Home care nursing needs showed a significant differences by the general characteristic of the respondents. -In the age, there were significant differences in physical and communication & health knowledge nursing needs. -In the religion, there were significant differences in spiritual nursing needs. -In the marital status, there were significant differences in environmental nursing needs. -In the nursing provider, there were singificant differences in ADL, environmental and communication & health knowledge nursing needs. -In the medical benefit, there were significant differences in ADL, environmental, physical and communication & health knowledge nursing needs. -In the disease, there were significant differences in ADL nursing needs. -In the household maintenance, there were significant differences in environmental nursing needs.

Home Care Nursing Needs of Welfare Solitude Elderly Person in Pusan City / 간호학회지

This study was carried out to assess home health care needs for welfare of solitude elderly person. The subjects of this study were 90 welfare solitude elderly person in Pusan City. Data were obtained by interview and observation using a structured questionnaire. The collected data were analyzed by t-test, ANOVA with SAS program. The results are as follows. 1. Among the home care nursing needs, environmental nursing needs topped the list, followed by spiritual, physical, psychological, communication & health knowledge and ADL nursing needs. 2. Home care nursing needs showed a significant differences by the general characteristic of the respondents. -In the age, there were significant differences in physical and communication & health knowledge nursing needs. -In the religion, there were significant differences in spiritual nursing needs. -In the marital status, there were significant differences in environmental nursing needs. -In the nursing provider, there were singificant differences in ADL, environmental and communication & health knowledge nursing needs. -In the medical benefit, there were significant differences in ADL, environmental, physical and communication & health knowledge nursing needs. -In the disease, there were significant differences in ADL nursing needs. -In the household maintenance, there were significant differences in environmental nursing needs.

A Study on Prevalence and Nursing Intervention of Bed Sore Patients who Received Regional Home Care Services / 기본간호학회지

This study was to identify the nursing intervention method in finding out the incidence, risk factor, prevention and treatment of bed sore clients who received regional home care nursing services. The eleven home care nurse practitioners took the survey on 97 patients who received home care nursing service from Seoul City Nurses Association for one month from September 26 to October 26 1996. A modified version of Braden's bed sore assessment tool for bed sore risks and a tool for assessment of bed sore stage and measurement bed sore sizes by Bergstrom, Barden, Laguzza and Holman(1987) were as research tools for this study and a questionnaire with 40 questions and 12 items on nursing activities was used to find out the prevention and treatment of bed sores. Also, two open ended questions were used on current approaches and efforts of the treatment being applied to clients. The finding of the study were summarized as following : 1. The rate of bed sore occurrence was 47.4%. 2. The areas of bed sore occurrence were hip(28.9%), sacrum(18.6%), great trochanter(14.4%) and the average number of sore spots were 2.26. 3. Two groups-one with bed sores and the other without were studied to determine prediction factors for bed sore risks. Sensory function, humidity, level of activity, mobility, nutrition, skin friction and chapping and body temperature turned out to be statistically significant factors for bed sores. Also the age of clients turned out to be a individual characteristic variable significantly affecting the rate of bed sore occurrences. 4. The education for clients and family on systematic skin assessment and bed sores and practice of active/passive R.O.M are mainly used as nursing activities for bed sore care. 5. The treatment method varied by stages of bed sores. Sometimes folk remedies like applying the powders of dried elm tree roots to sores were used. Good nutrition, frequent position change and skin care turned to be the most effective means to fast recovery of sores.

The Effects of Hospital Home Nursing Interventions based on the Nursing Diagnosis / 기본간호학회지

Home nursing interventions based on nursing diagnosis were implemented to the patient who are discharged from one hospital often the treatment for chronic neuromuscular system problem, and its effects were studied. The purpose of this study was to find out the effectiveness of hospital bounced home nursing provided by hospital nurses and to categorize home nursing diagnosis and its interventions. Data from experimental group patients were collected at three different time ; at the time of discharge, two weeks after discharge and our weeks after discharge. Data from control group patients were collected twice ; the first one at the time of discharge, and the other one four weeks after discharge. For this study nursing assessment and intervention booklet developed by the research team. There were no significant decrease of the number of nursing problems and life satisfaction. But daily activity level of patients showed the signs of significant improvement at the time of four weeks after discharge. Results of this study indicates that home nursing intervention based on nursing diagnosis provided the patients with noticeable difference in health maintenance, impairment of physical mobility, potential for infection, impaired home maintenance management, health seeking behavior, chronic pain, disuse syndrome, impaired skin integrity.