Nursing practice in home care: the mediation of care by reflexivity

Abstract

Objective: To analyze the practice of nurses in home care, considering the mediation of care by reflexivity. Method: Unique, qualitative case study, anchored in the dialectical framework. The participants were 13 nurses who work in home care in Minas Gerais. Data were obtained by participant observation and interview, and submitted to critical discourse analysis. Results: Nursing care at home involves the repetitions of everyday actions and a degree of unpredictability. Reflexivity, according to Schön’s theoretical framework, emerges as a component of professional practice that leads to the practice of care as a continuous assessment of work, and also to reflection on the challenges imposed by conflicting situations. Reflexivity also stems from professionals’ search for improvements in their practices. Final considerations: We identified the presence of actions and knowledge mobilized by the reflexivity of the nurse in the home care setting. The following were the elements of this reflexive practice: knowing-in-action, reflection-in-action and reflection reflection-in-action.

Constituição do sujeito cuidador na atenção domiciliar: dimensões psicoafetiva, cognitiva e moral

“…17,25 Among the members of the HC team, the nurse's central position is emphasized, with a responsibility to promote health education for users, family and caregivers, including the training of these caregivers. 26 The caregiver's learning occurred in the middle of his/her constitution process, unexpectedly, abruptly or progressively. This made it possible to show anguish, fear and frustrations due to the lack of experience.…”

Validation of nursing diagnosis for nursing consultation on home visit to adults

“…The data collection instrument allowed judges indicate new diagnoses for further validation, as specified: I) Reproductive System: risk of sexually transmitted infection, presence of climacteric, menopause and andropause; II) Respiratory System: To be continued needs and the respective possibilities of intervention, which differ according to local, sociodemographic, sanitary, and plurality of family dynamics (8,(18)(19)(20)(21) . Home care, while National public policy is wide, involves multiple health promotion, prevention, treatment, and rehabilitation actions, carried out by several health professionals (8) .…”

Standards of Knowledge That Found Nursing Performance in Home Care

“…the handling of imprecise cases derived from the unpredictability present in the home setting is manifested in the nurses' daily action. 11 Nurses continue to constantly develop their practice of home care, through learning by reflective practice. 11 With regard to the lack of knowledge, the statements highlight challenges inherent to the complexity of the nurse's performance in HC, through recognition of the insufficiency of academic training to work in this area.…”

“…11 Nurses continue to constantly develop their practice of home care, through learning by reflective practice. 11 With regard to the lack of knowledge, the statements highlight challenges inherent to the complexity of the nurse's performance in HC, through recognition of the insufficiency of academic training to work in this area. Studies indicate the invisibility of the context of HC in the training processes of nurses, 2,8 not being prepared to work in HC, with regard to its particularities.…”

“…10 It is emphasized that the home environment challenges the professional to develop adaptations and inventions that arise due to the context of the HC, 9 which can be creative, intuitive, innovative and flexible when faced with the demands presented. 4,7,9,11 The lack of academic training of nurses working in HC is reinforced, reflecting a lack of knowledge which in turn affects home care. 9,12 Concerning the work of nurses in HC, specific knowledge is required regarding the provision of care [8][9]13 , especially in relation to therapeutic projects, interpersonal relationships with users, family members and the multidisciplinary team, as well as technical and scientific knowledge specific to the field.…”