Cuidados de enfermagem para transição hospital-domicílio de pessoas idosas

Abstract

Population aging increases the risk of hospitalization for elderly people. As a consequence, they may need to continue care at home after hospital discharge. In that regard, nursing stands out in effectively preparing the elderly person and their family member or caregiver to continue care safely. The objectives of the research and practice of the study were, respectively: understanding how the nursing care for the hospital-home transition of elderly people occurs; and constructing and implementing a nursing care proposal for the hospital-home transition of elderly people. This is a qualitative research of the Convergent Care type, based on Afaf Meleis' Transition Theory. The study was carried out at the General Hospital of Guanambi (Bahia), in the medical and surgical clinic units. The study participants formed the convergence group, which was composed of 19 professionals, 14 nursing technicians and five assistant nurses, who met the inclusion criteria: to participate in the care of hospitalized patients for a minimum period of two months. The professionals who were away, on leave or on vacation during the first meeting of the convergence group were excluded. The research was developed in five stages: 1 – Integrative literature review; 2 – First meeting with the convergence group to understand how hospital-home transition care takes place; 3 – Second meeting with the convergence group to plan and develop a care proposal; 4 – Implementation of the drawn up proposal; 5 – Third meeting with the convergence group to analyze the changes that occurred in the nursing practice. For the data analysis, the MAXQDA software was used, generating codes and subcodes that, subsequently, determined the thematic categories. The project was submitted and approved by the Research Ethics Committee of the State University of Bahia (UNEB), under opinion no. 5.353.963. As a result, the following categories were created: Therapeutic nursing interventions carried out in hospital-home transition care for elderly people; inhibiting factors for the implantation and implementation of the nursing care for the hospital-home transition of elderly people; Therapeutic nursing interventions for hospital-home transition care for elderly people; Proposal for nursing care for the hospital-home transition of elderly people; Evaluation of the changes achieved in the nursing practice. The inhibiting factors for the implantation and implementation of the transitional care referred to the elderly person and to the community. The changes implemented in the short term were related to changes in team behavior regarding the optimization of the guidelines carried out; the use of educational materials and communication improvements between the multidisciplinary team. Nursing is the protagonist throughout the whole process, showing extensive performance in numerous actions. Further changes are now also expected in the medium and long term.