Análise do perfil epidemiológico e compreensão da experiência de cuidadores informais de pacientes em pós-AVC: Estudo multimétodos
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2021-02-19
Autores
Sá, Flavia Mendes de
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Universidade Estadual Paulista (Unesp)
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Introdução: estudo multimétodos composto pela análise do perfil epidemiológico de cuidadores informais de pacientes em domicílio com histórico de Acidente Vascular Cerebral; avaliação da sobrecarga dos cuidadores informais por meio da Escala de Burden; elaboração de duas revisões integrativas de literatura com perguntas norteadoras, sendo a primeira relacionada ao perfil microbiológico e incapacidade física do paciente com acidente vascular cerebral, e a segunda, referente à como se configura o cuidado domiciliar no pós-AVC em relação às infecções e ao papel do cuidador. O estudo qualitativo versou sobre a compreensão da experiência de cuidadores informais de pacientes em domicílio. A fundamentação teórica do estudo pautou-se na Teoria do Autocuidado de Orem. Objetivo geral: Conhecer os fatores intervenientes nos cuidados no pós-AVC na perspectiva do cuidador informal. Métodos: para a execução e elaboração das duas revisões integrativas foram utilizadas as etapas desse método, a partir de perguntas norteadores formuladas pela estratégia PICO e os descritores em português e inglês para a busca em bases de dados nacionais e internacionais e plataformas On-line, para identificar os artigos em períodos de anos. Os dados epidemiológicos e sociodemográficos dos pacientes e cuidadores foram coletados por instrumento formulado e aplicado pela pesquisadora, durante as entrevistas agendadas com o pacientes e seus respectivos cuidadores em domicílio ou em ambulatório. Foi utilizada a Escala de Burden para identificar a sobrecarga do cuidador. A coleta dos dados qualitativos foi realizada por meio das mesmas entrevistas e foram audiogravadas e direcionadas pela pergunta norteadora: “Conte-me a respeito de sua experiência em cuidar do paciente em fase de pós-AVC?” Utilizou-se a Análise de Conteúdo para a interpretação do corpus das entrevistas e a vertente temática para a análise e inferências que foram nomeadas por categorias e temas. Resultados: as revisões integrativas identificaram evidências e lacunas na literatura sobre os respectivos temas. Foram entrevistados 18 pacientes e 17 respectivos cuidadores. A maioria dos cuidadores familiares era do sexo feminino, residiam com o paciente e eram responsáveis pelas atividades de cuidado diário. Evidenciaram-se escores de baixa e moderada sobrecarga de cuidador associada ao cuidado diário. Não apresentaram histórico de infecções na internação hospitalar. O nível de escolaridade variou de fundamental incompleto até ensino superior completo. Emergiram categorias como: providências durante o momento do AVC; apoio da família ao paciente com AVC; impacto financeiro, dependência/independência do cuidador relacionado às sequelas do AVC; suporte religioso; comportamento do paciente no pós-AVC; aspectos sentimentais/comportamento do papel do cuidador. Os temas inferidos foram: Papel do cuidador formal ou informal; Comportamento do paciente; Enfrentamento/Suporte familiar; Vivenciando o cuidado do paciente com AVC ou pós-AVC. Considerações finais: os pacientes e cuidadores familiares necessitam de suporte da equipe multiprofissional e apoio da rede de atenção do Sistema Único de Saúde. São necessárias ações educativas que auxiliem no processo de cuidar em saúde e enfermagem. Salienta-se a necessidade de promover o autocuidado para esses pacientes, minimizando a sobrecarga dos cuidadores familiares, além de propor intervenções eficazes no controle de infecção, assim prevenindo as reinternacoes hospitalares.
Introduction: a multi-method study comprising the analysis of the epidemiological profile of patients at home with a history of stroke; assessment of the burden of informal caregivers using the Burden Scale; preparation of two integrative literature reviews with guiding questions, the first related to the microbiological profile and physical disability of the patient with stroke, and the second, related to how home care is configured in the post-stroke in relation to infections and the caregiver role. The qualitative study was about understanding the experience of informal caregivers of patients at home. The theoretical foundation of the study was based on Orem's Self-Care Theory. General objective: To know the factors involved in post-stroke care from the perspective of the informal caregiver. Methods: for the execution and elaboration of the two integrative reviews, the steps of this method were used, based on guiding questions formulated by the PICO strategy and the descriptors in Portuguese and English for the search in national and international databases and On-line platforms, for identify articles in periods of years. Epidemiological and sociodemographic data of patients and caregivers were collected using an instrument formulated and applied by the researcher during scheduled interviews with patients and their respective caregivers at home or in an outpatient clinic. The Burden Scale was used to identify the caregiver's burden. The collection of qualitative data was carried out through the same interviews and were recorded and guided by the guiding question: “Tell me about your experience in caring for patients in the poststroke phase?” Content Analysis was used to interpret the corpus of the interviews and the thematic aspect for the analysis and inferences that were named by categories and themes. Results: the integrative reviews identified evidence and gaps in the literature on the respective topics. Eighteen patients and 17 respective caregivers were interviewed, one patient did not need a caregiver. Most family caregivers were female and lived with the patient, and were responsible for daily care activities. Low and modest caregiver burden associated with daily care was evidenced. Most patients and family caregivers are predominantly female and elderly. They did not have a history of infections during hospitalization. The level of education ranged from incomplete elementary to complete higher education. The following categories emerged during the moment of the stroke, family support for the stroke patient, financial impact, dependency/independence of the caregiver related to the stroke sequelae, religious support, post-stroke patient behavior, sentimental aspects / role behavior the caregiver. The inferred themes were: Role of the formal or informal caregiver; Patient behavior; Coping/Family support; Experiencing the care of patients with stroke or post-stroke. Final considerations: patients and family caregivers need support from the multiprofessional team and support from the care system of the Unified Health System. Educational actions are needed to assist in the health and nursing care process. The need to promote self-care for these patients is emphasized, thus minimizing the burden on family caregivers, in addition to proposing effective interventions in infection control, thus preventing hospital readmissions.
Introduction: a multi-method study comprising the analysis of the epidemiological profile of patients at home with a history of stroke; assessment of the burden of informal caregivers using the Burden Scale; preparation of two integrative literature reviews with guiding questions, the first related to the microbiological profile and physical disability of the patient with stroke, and the second, related to how home care is configured in the post-stroke in relation to infections and the caregiver role. The qualitative study was about understanding the experience of informal caregivers of patients at home. The theoretical foundation of the study was based on Orem's Self-Care Theory. General objective: To know the factors involved in post-stroke care from the perspective of the informal caregiver. Methods: for the execution and elaboration of the two integrative reviews, the steps of this method were used, based on guiding questions formulated by the PICO strategy and the descriptors in Portuguese and English for the search in national and international databases and On-line platforms, for identify articles in periods of years. Epidemiological and sociodemographic data of patients and caregivers were collected using an instrument formulated and applied by the researcher during scheduled interviews with patients and their respective caregivers at home or in an outpatient clinic. The Burden Scale was used to identify the caregiver's burden. The collection of qualitative data was carried out through the same interviews and were recorded and guided by the guiding question: “Tell me about your experience in caring for patients in the poststroke phase?” Content Analysis was used to interpret the corpus of the interviews and the thematic aspect for the analysis and inferences that were named by categories and themes. Results: the integrative reviews identified evidence and gaps in the literature on the respective topics. Eighteen patients and 17 respective caregivers were interviewed, one patient did not need a caregiver. Most family caregivers were female and lived with the patient, and were responsible for daily care activities. Low and modest caregiver burden associated with daily care was evidenced. Most patients and family caregivers are predominantly female and elderly. They did not have a history of infections during hospitalization. The level of education ranged from incomplete elementary to complete higher education. The following categories emerged during the moment of the stroke, family support for the stroke patient, financial impact, dependency/independence of the caregiver related to the stroke sequelae, religious support, post-stroke patient behavior, sentimental aspects / role behavior the caregiver. The inferred themes were: Role of the formal or informal caregiver; Patient behavior; Coping/Family support; Experiencing the care of patients with stroke or post-stroke. Final considerations: patients and family caregivers need support from the multiprofessional team and support from the care system of the Unified Health System. Educational actions are needed to assist in the health and nursing care process. The need to promote self-care for these patients is emphasized, thus minimizing the burden on family caregivers, in addition to proposing effective interventions in infection control, thus preventing hospital readmissions.
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Palavras-chave
Autocuidado, Cuidadores familiares, Pós AVC, Cuidados domiciliares, Self-care, Family caregivers, Post-stroke, Home care