Nursing Preparation of the Caregiver By Continuous Care Teams: Quality Indicators

Purpose:

The progressive aging of the population associated with the cumulative effect of declining fertility and mortality has resulted in increased life expectancy, along with an improvement in the health status of the population (Decreto-Lei, 2006). It is estimated that the population have become progressively more aging across the European Union (European Comission, 2010). According to data released by the National Statistics Institute (INE, 2011) regarding the 2011 Census of Portugal, for every 100 young people there are 131 elderly (65 years old and over), verifying an increase in the elderly dependency ratio of 25 to 30 per 100 people of working age. Appear linked growing dependence levels either by economic or social factors, whether by disease situations, increasingly a concern for the society to create a network of support that is responsive to the needs of citizens dependent of a third person. Although there is an improvement in the health status of our population over the last 40 years there has been a parallel increase in the prevalence of people with chronic and disabling diseases, so there are gaps at the national level (Portuguese national level ) in providing long-term care (Decreto-Lei, 2006).

Family was established as a privileged mean of supportive care to health and life of its members (Figueiredo, 2009). Nurses, especially those working in primary care, cause the nature of the relationship and proximity of the families may contribute to the improvement of the performance of the caregiver and subsequent lower levels of burden. Caregiver can be understood as "the one who assists in the identification, prevention, or treatment of illness or disability that meets the needs of a dependent" (Conselho Internacional de Enfermeiros, 2010, p.115). It is necessary to prepare the caregiver for his role and for the promotion and maintenance of the quality of life of both, the dependent person and the caregiver's own, so it is crucial the share of information, training and support provided to the caregiver (Guedes, 2011).

To meet these needs the Portuguese government has created the so-called Continuous Care Teams (ECCI). These "direct their multidisciplinary intervention to people experiencing functional dependence, terminal illness, or in process of recovery, with the social support network, whose condition does not require hospitalization" (UMCCI, 2011, p.10). Their mission also support the qualification of caregiving by family members or informal caregivers (UMCCI, 2011).

It has been difficult to objectively translate the contribution of nurses to the gains of their clients' health in the preparation of caregivers, since there is a lack of indicators of their professional practice (Petronilho, 2008). The supervisory dynamics have been proving to be a key factor in the improvement of the quality of care provided by nurses, so that in recent decades have been argued about the relevance of the implementation of policies to promote and improve the quality of professional practice, involving the clinical supervision in nursing as a process that contributes to this goal, governed for this purpose by quality indicators of the clinical practice.

This study comes as part of a project entitled Design of a program of clinical supervision in nursing in the context of primary health care, aiming to provide an input to the construction of a program of clinical supervision in nursing, through the identification of quality indicators of professional practice in the preparation of the caregiver in the primary health care area.

Methods:

The paradigm of research is grounded in qualitative perspective, having a descriptive cross-sectional nature. The study population are the nurses of the ECCI 's Cluster Health Centers of the Alto Tâmega and Barroso, and the participants were selected through a process of non-probability sampling of convenience .

Data were collected through a focus group interview addressing the areas of the preparation of the caregiver, quality indicators and nursing clinical supervision, and lasted about two hours. We used the audio recording as a resource for the documentation of the data collected, with the permission of the participants in the written informed consent model. After transcription of the recorded data, we proceeded to its analysis, through content analysis according to Bardin (2009). From the data analysis emerged around 32 indicators, such as effectiveness in the diagnostic of risk of caregiver’s stress; gains expressed in support perceived by the informal caregiver; gains in knowledge of the caregiver about the treatment management; gains in learning skills of the caregiver to manage the treatment, among others.

In order to respect the ethical principles for conducting this research was requested and obtained the favorable opinion of the National Commission for Data Protection, the Ethics Committee for Health of the North Regional Health Authority, and also by Executive Director and Nurse Supervisor at Cluster Health Centers Alto Tâmega and Barroso.

Results:

After completion of the study it was found that there are still many reserves on the use of quality indicators in nursing, and especially many uncertainties with regard to the implementation of nursing clinical supervision programs. It is safeguarded the importance that the indicators have been assuming in everyday health organizations, however, the results obtained from their use, and method of application are dubious for participants. Nevertheless, several indicators were considered essential by participants in the preparation of caregivers. These indicators are based primarily on gains in knowledge and learning skills of the caregiver in various areas relating to the care of the dependent person and the preparation of the caregiver to the performance of his role, as well as indicators related to the caregiver’s stress. It is noteworthy that the main emphasis is attributed to the involvement and satisfaction of the caregiver, being considered by participants as key areas that should be identified as indicators in their clinical practice.

Conclusion:

With the identification of these indicators we are intended to provide guidance for the work performed by nurses in preparation of the caregiver in ECCI's, in order to highlight the work done by such units with customers, respective families and caregivers, translating it into gains in health and in clarification to the contribution of nurses to the health of their customers.