<p>Objetivo: compreender a influência da comunicação enquanto instrumento básico de Enfermagem na promoção da dignidade em Cuidados Paliativos. Método: reflexão teórica mediante revisão da literatura e com recurso ao Modelo da Dignidade de Chochinov. A pesquisa de artigos científicos foi realizada na biblioteca do conhecimento online, na base de dados das publicações Elsevier e na plataforma agregadora de bases de dados EBSCO Host Web, publicados durante o período 2010-2016. Resultados: identificou-se intervenções associadas às competências comunicacionais dos enfermeiros que promovem a dignidade dos clientes em cuidados paliativos. As intervenções comunicacionais que mais promovem a dignidade são as que transmitem ao cliente paliativo o respeito pela sua individualidade e valorização da sua história pessoal. Conclusão: o enfermeiro deve adotar uma postura de compreensão empática, escuta ativa, disponibilidade, atenção às necessidades emocionais, aos componentes não verbais (como a presença física e o contacto visual), à gestão de expectativas e o incentivo do autocuidado.</p><p>Descritores: Enfermagem. Cuidados Paliativos. Comunicação. Dignidade Humana.</p>

Introduction: We discuss knowledge and expectations of services and other help available in the community to informal caregivers of stroke patients in Portugal, and their perceptions on actual experience within the next six months after patient discharge from the acute care hospital.

PurposeTo report on stroke patients’ pathways to rehabilitation in Portugal, in light of an ongoing EHSD procedure.Theory and methodsThe Portuguese government has created the National Network of Continuous Integrated Care (RNCCI) to reduce costly acute care and length of stay in hospitals by substituting less costly care closer to the community. The network is based on establishing protocols with existing institutions, designated according to the kind of services they provide as convalescence, medium-term and rehabilitation, long-term and maintenance, palliative care unit and day care and autonomy promotion units. Home care is supposed to be one important element in this network, but implementation only now is starting. Integration outside the RNCCI and between the RNCCI and other levels of care is still low, especially between health and social institutions and between formal and informal care. The study is based on an RCT encompassing patients admitted to a stroke unit. Those fulfilling admission criteria are randomised to the intervention group or the control group. In the control group patients receive traditional care. In the intervention group patients receive EHSD services. All are followed for 6 months after discharge. Data are collected regarding outcomes and patients’ pathways.ResultsPreliminary results confirm the existence of a very fragmented and complex setting.Conclusions and discussionBeside the benefit that might accrue to patients receiving home rehabilitation, the simple fact of having someone assisting them navigate the system play a significant role in patient and family motivation, satisfaction and quality of life.

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PurposeTo systematize the content of home-care interventions for stroke patients in Portugal and assess their relevance, feasibility and acceptability from the perspective of care professionals.TheoryResearch seems to show that Integrated Home Care (IHC) is an excellent form of rehabilitation as the domicile is the place where the patient feels safe, participate most and have direct feedback from ADL training [1]. Moreover, recent results show that IHC has the potential to lower the costs of post-stroke rehabilitation [2]. Cost-effectiveness analysis would then be an important tool for decision-makers regarding alternative IHC interventions. However, in practice the realization of the potential benefits of IHC has to overcome serious barriers and the dissemination of IHC in the European Union will depend “on the upgrade of health professionals from a defensive kind of monodisciplinary professionalism towards an open-ended multidisciplinary professionalism” [1]. Therefore, it is fundamental to assess health professionals’ perceptions and experiences regarding the relevance, feasibility and acceptability of home-based rehabilitation and their willingness to participate.MethodsIn Portugal, the home rehabilitation teams include a gerontologist which is the case manager, a physiotherapist, an occupational therapist and a psychologist. A mixed method was used to analyse the teams’ interventions at home. Information about each session was recorded by all professionals in a standardized form. Additionally, case managers have written qualitative reports, according to a pre-defined minimum structure and the psychologist has written patient specific psychology reports. We analysed the sessions’ reports of 80 patients who have received rehabilitation services at home. This information was coded, keyed into a database and analyzed with PASW Statistics 18. In the qualitative phase, we have explored health professional’s perceptions on experiences with home-care rehabilitation process. Data were collected within a focus group composed by two physiotherapists, two occupational therapists, a psychologist and two gerontologists. A group of three researchers with specific roles joined the focus group, namely a moderator, a recorder and a coordinator. The session’s content was recorded, transcript and analyzed with NVivo 9.Results and conclusionsQuantitative results consist on the average number of sessions at home per specialty, the duration of sessions, the reasons for therapeutic rehabilitation, the type of intervention executed by the professionals, the specific content of treatments in home care and strategies used by professionals in this type of rehabilitation. Qualitative results include health professionals individual and collective understanding of patients’ achievements and effort required from the professionals and their assessment of the measures used to evaluate the results.