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Master's Dissertation
DOI
https://doi.org/10.11606/D.7.2019.tde-09122019-181732
Document
Author
Full name
Elisângela Azevedo Domingues
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2019
Supervisor
Committee
Ciosak, Suely Itsuko (President)
Matsuba, Claudia Satiko Takemura
Nichiata, Lucia Yasuko Izumi
Serpa, Letícia Faria
Title in Portuguese
Paciente idoso desospitalizado: a continuidade da terapia nutricional enteral domiciliar
Keywords in Portuguese
Cuidado Domiciliar
Desospitalização
Enfermagem
Idoso
Sistema Único de Saúde
Sonda Nasoenteral
Terapia Nutricional Enteral
Abstract in Portuguese
Introdução: o aumento do uso de Terapia Nutricional Enteral em pacientes internados e que muitas vezes necessitam dar continuidade da terapêutica no domicílio, faz com que a alta hospitalar seja estimulada como parte da oferta de cuidados em rede pelo Sistema Único de Saúde, nos diferentes pontos da Rede de Atenção à Saúde. Objetivo: verificar o uso e a continuidade da Terapia Nutricional Enteral Domiciliar do paciente idoso desospitalizado. Metodologia: pesquisa exploratória, prospectiva e descritiva sob os pressupostos da pesquisa quantitativa e qualitativa, para melhor compreensão da situação da Terapia Nutricional Enteral Domiciliar, dos pacientes idosos desospitalizados. A coleta de dados foi realizada entre agosto a outubro de 2018, através de entrevistas individuais, previamente agendadas, com idosos de 60 anos e mais, de ambos os sexos, que tiveram alta do Centro Hospitalar do Município de Santo André. Atendendo a Resolução 466/12, o estudo foi aprovado pelo Comitê de Ética em Pesquisa da Escola de Enfermagem da USP e da Instituição Pública, Todos os participantes assinaram o Termo de Consentimento Livre e Esclarecido. Foi utilizado um instrumento com questões para captar os dados Sociodemográficos e questões norteadoras para captar a realidade do uso da Terapia de Nutrição Enteral Domiciliar. Resultados: participaram do estudo 67 pacientes, sendo 55,2% do sexo masculino e 44,8% feminino, do total 40,3% ficaram internados até 20 dias. Os principais diagnósticos na admissão para internação foram acidente vascular encefálico com 62,7% e 19,4% com câncer. Das co-morbidades destacaram-se a hipertensão arterial com 61,2% dos pacientes e 29,9% que possuíam hipertensão arterial e diabetes melittus. Dos participantes 76,1% eram acamados, em relação aos cuidadores 73,1% eram familiares e 19,4% formais, 47,8% dos participantes informaram que receberam orientações sobre os cuidados pós-alta por Enfermeiro e Nutricionista. Quanto à Terapia Nutricional Enteral Domiciliar 100% dos participantes faziam uso regular da dieta, 46,3% estavam em uso entre um a três meses e 23,9% no período de seis a 11 meses, a dieta industrializada liquida era utilizada por 74,6% dos pacientes de forma exclusiva. Em relatos 89,6% dos pacientes recebiam as dietas e insumos fornecidos pelo programa de SAD. Ao buscar conhecer a experiência do uso da Terapia no Domicílio emergiram as categorias: processo educativo em saúde, as falas expressaram muitas informações ao mesmo tempo. Na vivência com a TNED, observou-se expressões de discernimento da necessidade da nova fase pela qual passavam com o despertar na pluralidade de sentimentos dos novos desafios; enfrentamento das complicações com a TNED, mesmo com as orientações fornecidas no pré alta hospitalar as complicações não deixaram de ocorrer. Quanto ao sistema de referência e contrarreferência, verificou-se que apesar das dificuldades os pacientes estão sendo acolhidos pela Rede. Conclusão: Considerando que todos os pacientes com indicação da Terapia Nutricional Enteral Domiciliar receberam as orientações para o cuidado no domicílio, observou-se da importância do acolhimento e suporte assistencial na Rede para a continuidade da Terapia ao paciente desospitalizado, que mesmo com as dificuldades os pacientes fazem uso da TNED, sem relatos de reinternações.
Title in English
Dehospitalized Elderly Patient: The Continuity of Home Enteral Nutritional Therapy
Keywords in English
Dehospitalisation
Elderly
Enteral Nutritional Therapy
Home Care
Nasoenteral Feeding Tube
Nursing
Unique Health System
Abstract in English
Introduction: the increase in the use of Enteral Nutritional Therapy in inpatients, who often need to continue their treatment at home, means that hospital discharge is encouraged as part of the network of care provided by the Unique Health System at the various points of the Health Care Network. Objective: To evaluate the use and continuity of Home Enteral Nutritional Therapy in dehospitalized elderly patients. Methodology: Exploratory, prospective and descriptive research under the assumptions of quantitative and qualitative research, to better understand the situation of Home Enteral Nutritional Therapy, with dehospitalized elderly patients. Data collection was carried out from August to October 2018, through previously scheduled individual interviews with elderly individuals aged 60 years and older, of both genders, who were discharged from the Hospital Center of the Municipality of Santo André. In compliance with Resolution 466/12, the study was approved by the Research Ethics Committee of the School of Nursing of USP and the Private Institution. All the participants signed the Free and Informed Consent Form. An instrument was used with questions to capture the sociodemographic data and guiding questions to capture the reality of the use of Home Enteral Nutrition Therapy. Results: 67 patients participated in the study, 55,2% male and 44,8% female, of which 40,3% were hospitalized for 20 days. The main diagnoses at admission for hospitalization were cerebral vascular accident with 62,7% and 19,4% with cancer. Among the comorbidities, arterial hypertension stood out with 61,2% of the patients and 29,9% who had arterial hypertension and diabetes melittus. Of the participants, 76,1% were bedridden, in relation to the caregivers 73.1% were family members and 19.4% were formal caregivers, 47,8% of the participants reported that they received guidance on post-discharge care from Nurse and Nutritionist. As for Home Enteral Nutritional Therapy, 100% of the participants made regular use of the diet, 46,3% were in use between one and three months and 23,9% over a period of six to 11 months, and the liquid industrialized diet was used by 74,6% of the patients exclusively. In reports 89,6% of patients received the diets and inputs provided by the SAD program. When seeking to know the experience of the use of Therapy at Home, the following categories emerged: educational process in health, the speeches expressed a lot of information at the same time. In the experience with HENT, there were expressions of discernment of the needs of the new phase they went through with the awakening in the plurality of feelings of the new challenges; facing complications with HENT, even with the guidance provided in the pre-hospital discharge the complications did not fail to occur. As for the system of reference and counter-reference, it was found that despite the difficulties the patients are being welcomed by the Network. Conclusion: Considering that all patients with indication of Home Enteral Nutritional Therapy received the guidelines for home care, it was observed the importance of the reception and assistance support in the Network for the continuity of Therapy to the dehospitalized patient, that even with the difficulties the patients make use of HENT, without reports of readmissions.
 
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Publishing Date
2019-12-19
 
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