Pessoas em hemodiálise e cuidados de enfermagem: estudo de método misto

Abstract

Introduction: The number of people undergoing dialysis treatment in Brazil in 2014 was 112,004 people, of whom 91.4% were in the hemodialysis modality. Objective: To understand the perception of people on hemodialysis on hemodialysis, hemodialysis treatment and nursing care, and analyze work practices from the perspective of nursing records. Methods and techniques: Mixed method study outlined in the Social Representations and sectional study, based on the Theories of Social Representations and Betty Neuman, carried out in a nephrological clinic in Minas Gerais. Participated patients on hemodialysis (census criterion) and nursing records (two moments: census criteria and random sample). Data were collected from July/2017 to April/2018, using instruments for people on hemodialysis (sociodemographic characterization, sectional study, and structural and processual approach using free word association technique and individual interview with audio recording) and nursing records (local, legal aspects and contents). Data collected with the Open Data Kit (ODK) program and consolidated in the SPSS, EVOC and Nvivo® programs. In compliance with the ethical and legal recommendations of research with human beings. Results: Partcipated 143 people: 60.8% women, 42.7% between 65 and 80 years old, 48.3% married, 59.4% with 0-5 years of schooling, 75.5% retired, and 49% with arterial hypertension Systemic. The triangulation of the structural and processal approaches allowed to identify that the hemodialysis was portrayed by the participants as a "difficult" situation to be experienced and the adaptation of the treatment routine emerged as a "disorder". However the "chance-hope" cognema has emerged as a possibility of life-sustaining and cure. From the term inductor hemodialytic treatment HD people evoked the "remedy-recipe" and the "needle-venous access" as symbolic objects consolidated by the group. Regarding nursing care, the mentioned cognems showed evaluative aspects. The evaluation of the care they received was positive and the interpersonal relationships significant, being such information corroborated by fragments of the participants' speeches. We analyzed 871 records (1st stage) and 184 (2nd stage) performed during hemodialysis routinely addressing care content and technical procedures with emphasis on the physiological, mental and functional domains. Absence of registration of nursing diagnoses and results and without standardized taxonomy. Intrapersonal, interpersonal and extrapersonal stressors were identified. Conclusion: The focus of nursing documentation is centered on procedures and physiological aspects of the individual, revealing traces of the biomedical and hospital-centered model. Structural and processual approaches and the sectional study allowed the identification of human responses in which there are (im)explicit stressors whose analysis according to Neuman made it possible to make a situational diagnosis and identify the need to redirect the focus of the records and to approach the identified stressors therapeutically favoring the confrontation of the disease and treatment engagement.