Gestão do cuidado à pessoa idosa hospitalizada: o conforto como resultado essencial

Abstract

Objective: This study aimed to investigate the production of comfort as a therapeutic result of nursing care management. Method: This is an exploratory-descriptive research, based on a qualitative approach, carried out in the clinical and surgical nursing services of a university hospital in the state of Rio de Janeiro. Data collection took place from May to June 2022, with 19 nurses. For data collection, semi-structured interviews were used, subsequently submitted to Bardin's thematic-categorical analysis. The theoretical framework was supported by Kolcaba's Theory of Comfort. The work was approved by the Ethics Committee - Presentation Certificate of Ethical Appreciation nº 57513722.0.0000.5282. Results and discussion: Among the limits for the management of care for hospitalized elderly people, inadequate staffing emerges as the main challenge. The lack of personnel implies a need to prioritize tasks, of which techniques are perceived as the most important. Furthermore, the overload and stress faced by nurses generate discomfort for the team, which is reflected in the care provided. Unpreparedness and lack of knowledge were also identified as important challenges, since professional insecurity causes nurses to opt for restrictive interventions, believing they care about patient safety and end up sacrificing comfort. Among the possibilities, experience emerges as the main element, in addition to leadership and care protocols, which bring legitimacy, autonomy, agility and effectiveness to practice, in addition to being educational tools. The main risks to the hospitalized elderly person identified by the nurses were: falls, pressure injuries and impaired tissue integrity, neurological disorders, particularly delirium and pneumonia, and bronchoaspiration. The main strategies adopted by nurses to ensure the comfort and safety of hospitalized elderly people are related to the environment and encouraging the presence of family members. However, the intervening variables, over which the professional has no influence, were not considered (inadequate physical structure, unavailability of family members and hospital rules), which meant that the interventions were not effective, since they did not change the level of comfort. Conclusion: The analysis of the findings allows us to conclude that, although care management aims to promote comfort, safety and autonomy, nursing practices are highly concerned with patient safety, while comfort and autonomy seem to be sacrificed for the sake of its promotion