ARTIGO DE INVESTIGAÇÃO RIIS | Vol.4(2), 7-18
7
RIIS
Re is a de In es igação & Ino ação em Saúde
SELF-CARE DEFICIT VERSUS THE POTENTIAL TO IMPROVE SELF-CARE: EXPLANATION OF THE NURSE'S
CLINICAL JUDGMENTS
Comp omisso no au ocuidado e sus po encial pa a melho a o au ocuidado: Explanação do juízo clínico do
en e mei o
Comp omiso con el au ocuidado e sus po encial pa a mejo a el au ocuidado: explicación del juicio clínico
de las en e mei as
Ma isa Lou enço*, Paula Enca nação**, Te esa Ma ins***, Fá ima A aújo****, Paulo Machado*****
ABSTRACT
Backg ound: people who become unc ionally dependen due o se ious illness and/o he wo sening o a ch onic illness ha e
di e en eco e y pa hs. The a ibu ion o he nu sing diagnosis o sel -ca e de ici e sus po en ial o imp o e sel -ca e equi es, on
he pa o he nu se, a igo ous clinical judgmen , o which a se o diagnos ic ac i i ies is necessa y. Objec i es: he p esen s udy
sough o iden i y he assump ions used by expe nu ses when o mula ing he clinical judgmen o sel -ca e de ici e sus he
po en ial o imp o e sel -ca e Me hodology: quali a i e design. Da a we e gene a ed in wo ocus g oup mee ings ha included
ele en nu ses expe ienced in ca ing o pe sons wi h unc ional dependence and sel -ca e de ic . P e iously p epa ed s uc u ed
ques ions we e used o acili a e discussion. The ocus g oup mee ings we e eco ded in audio and ansc ibed. Induc i e con en
analysis was used o iden i y eme ging hemes. The checklis Consolida ed C i e ia o Repo ing Quali a i e Resea ch (COREQ) was
also used. Resul s: nu ses` decision-making depends: he ac o s o in luencing he po en ial o imp o e sel -ca e abili ies o a pe son
wi h unc ional dependence, he domain o in luence o hese ac o s, and h ee undamen al aspec s o conside when e alua ing a
pe son wi h unc ional dependence. Conclusions: he absence o eco e y po en ial can a ely be deduced. People wi hou cogni i e
impai men o wi h mild cogni i e impai men p esen highes po en ial o eco e y.
Keywo ds: nu sing diagnosis; sel -ca e; unc ional dependence; decision making
RESUMO
Enquad amen o: as pessoas em si uação de dependência uncional, de ido a doença g a e e ou
ag a amen o de doença c ónica, êm pe cu sos di e en es no p ocesso de ecupe ação. A omada de
decisão do en e mei o pa a melho a a au onomia da pessoa, es á sujei a aos dados de a aliação do
seu po encial de ecupe ação. Obje i os: iden i ica os p essupos os u ilizados pelos en e mei os
pa a enuncia o juízo clínico: au ocuidado comp ome ido e sus o po encial pa a melho a o
au ocuidado. Me odologia: es udo quali a i o. Os dados o am ge ados em duas euniões de ocus
g upo com onze en e mei os, com expe iência no cuida da pessoa com dependência uncional e
comp omisso no au ocuidado. Fo am di ecionadas algumas pe gun as p e iamen e es u u adas pa a
acili a a discussão. As e lexões o am g a adas em áudio e ansc i as. Análise de con eúdo indu i a
oi usada pa a iden i ica os emas eme gen es. U ilizada a lis a de e i icação Consolida ed C i e ia
o Repo ing Quali a i e Resea ch (COREQ). Resul ados: a omada de decisão dos en e mei os
depende: dos a o es que in luenciam o po encial pa a melho a as capacidades pa a o au ocuidado
de uma pessoa com dependência uncional, do domínio de in luência desses a o es e dos
p essupos os u ilizados pa a a alia as capacidades da pessoa com dependência uncional.
Conclusão: a ausência de po encial de ecupe ação a amen e pode se deduzida. Pessoas sem
comp ome imen o cogni i o ou com comp ome imen o cogni i o le e, ap esen am maio po encial
de ecupe ação.
Pala as-Cha e: diagnós ico de en e magem; au ocuidado; dependência uncional; omada de
decisão
RESUMEN
Ma co con ex ual: las pe sonas que se uel en uncionalmen e dependien es debido a una
en e medad g a e o al empeo amien o de una en e medad c ónica ienen di e en es ías de
ecupe ación. La oma de decisiones del en e me o pa a mejo a la au onomía del pacien e, es á
suje a a la e aluación de da os de su po encial de ecupe ación. Obje i os: iden i ica los supues os
u ilizados po las en e me as pa a enuncia el juicio clínico: au ocuidado comp ome ido e sus
po encial pa a mejo a el au ocuidado. Me odología: diseño cuali a i o. Los da os se gene a on en
dos euniones de g upos ocales que incluye on a once en e me as con expe iencia en el cuidado de
pe sonas con dependencia uncional, comp omiso con el au ocuidado. Se u iliza on p egun as
es uc u adas p e iamen e p epa adas pa a acili a la discusión. Las euniones de los g upos ocales
se g aba on en audio y se ansc ibie on. Se u ilizó el análisis de con enido induc i o pa a iden i ica
emas eme gen es. También se u ilizó la lis a de e i icación Consolida ed C i e ia o Repo ing
Quali a i e Resea ch (COREQ). Resul ados: la oma de decisiones de las en e me as depende: los
ac o es que in luyen en el po encial pa a mejo a las habilidades de au ocuidado de una pe sona con
dependencia uncional, el dominio de in luencia de es os ac o es y los supues os que se hacen al
e alua las capacidades de una pe sona con dependencia uncional. Conclusión: a a ez se puede
deduci la ausencia de po encial de ecupe ación. Las pe sonas sin de e io o cogni i o o con de e io o
cogni i o le e p esen an el mayo po encial de ecupe ación.
Palab as Cla e: diagnós ico de en e me ía; au ocuidado; dependencia uncional; oma de decisiones
*PhD, associa e p o esso and esea che a
Po o Nu sing College and esea che a
CINTESIS - h ps://o cid.o g/0000-0001-5953-
788X - Au ho 's con ibu ion: Concep ion and
s udy design, Da a Collec ion, Da a analysis and
in e p e a ion, D a ing he manusc ip , C i ical
e ision o he in ellec ual con en
**PhD, associa e p o esso a School o Nu sing,
Uni e si y o Minho, and esea che a Coimb a
Nu sing College - h ps://o cid.o g/0000-0002-
7458-8105 - Au ho 's con ibu ion: Concep ion
and s udy design, Da a analysis and
in e p e a ion, C i ical e ision o he in ellec ual
con en
*** PhD, coo dina ing p o esso , a Po o
Nu sing College and esea che a CINTESIS -
h ps://o cid.o g/0000-0003-3395-7653 -
Au ho 's con ibu ion: Concep ion and s udy
design, Da a Collec ion, Da a analysis and
in e p e a ion, D a ing he manusc ip , C i ical
e ision o he in ellec ual con en
**** PhD, associa e p o esso , a Po o Nu sing
College and esea che a CINTESIS -
h ps://o cid.o g/0000-0002-3059-7480 -
Au ho 's con ibu ion: Concep ion and s udy
design, Da a Collec ion, C i ical e ision o he
in ellec ual con en
***** PhD, coo dina ing p o esso , a Po o
Nu sing College and esea che a CINTESIS -
h ps://o cid.o g/0000-0002-3187-6860 -
Au ho 's con ibu ion: Concep ion and s udy
design, Da a Collec ion
Como e e encia :
Lou enço, M., Enca nação, P., Ma ins, T.,
A aújo, F., & Machado, P. (2021). Sel -ca e
de ici e sus he po en ial o imp o e sel -ca e:
explana ion o he nu se's clinical judgmen s.
Re is a de In es igação & Ino ação em Saúde,
4(2) 7-18
Recebido pa a publicação: 01/07/2021
Acei e pa a publicação: 23/11/2021
Sel -ca e de ici e sus he po en ial o imp o e sel -ca e: explana ion o he nu se's clinical judgmen s
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Re is a de In es igação & Ino ação em Saúde
INTRODUCTION
Loss o unc ional capaci y (physical and
psychological) may be associa ed wi h he
de e io a ion o a ch onic disease condi ion, which
may condi ion he pe son o unc ional dependence
and sel -ca e de ici , ha is, o he need o someone
o help in sel -ca e ac i i ies. Sel -ca e is conside ed
he aking ca e o wha is needed o main ain onesel ,
keep onesel going and handle basic indi idual and
in ima e necessi ies and ac i i ies in daily li e
(In e na ional Council o Nu ses [ICN], 2019).
Ac i i ies o daily li ing include ea ing, ba hing,
d essing and und essing, using he oile , ge ing
eady, ge ing ou o bed, mo ing be ween bed and
chai and u ning in bed (ICN, 2019). O em is an
impo an e e ence o he de elopmen o he
concep o sel -ca e, ha ing de ined i as a p ac ice o
ac i i ies ha indi iduals ini ia e and ca y ou o
main ain li e, heal h, and well-being (O em, 1991).
He heo y gi es special emphasis on heal h
de ia ions, which is when a pe son is no able o
p omo e he necessa y sel -ca e ac i i ies and
equi es he help o ano he pe son.
Many nu sing he apies aim o e e se unc ional
dependence and sel -ca e de ici as soon as possible.
Assessing he sel -ca e ac i i ies ha he pe son is
able o no o pe o m, acili a ing he de elopmen o
knowledge and new sel -ca e skills, such as he
assessmen and e o mula ion o housing condi ions,
emo ing ba ie s o mobili y, o pu ing hand ailings
in he ba h oom, a e o g ea use when he
dependen pe son has he po en ial o imp o e
(Lou enço, 2015). Fo people wi h unc ional
dependence and a high le el o commi men in sel -
ca e, nu sing in e en ions aim o eplace he pe son
when pe o ming sel -ca e ac i i ies. In o he wo ds,
he nu ses' ac ions a e p edominan ly o he ype o
execu e; o example, posi ion, ba he, d ess, eed
(ICN, 2019). The p esen s udy sough o iden i y he
assump ions used by expe nu ses when o mula ing
he clinical judgmen o sel -ca e de ici e sus he
po en ial o imp o e sel -ca e
BACKGROUND
P omo e sel -ca e is he i s le el o heal hca e
p o ided, and i s scope includes heal h p omo ion,
disease p e en ion, ehabili a ion, and pallia i e ca e
(WHO, 2019). Sel -ca e ac i i ies in a pe son wi h
se e al ch onic condi ions, in an ad anced s age o
he disease, and e idencing cogni i e al e a ions a e a
cu en challenge (Jaa sma e al., 2017). Addi ionally,
he in luence o amily, iends, and heal h
p o essionals in de eloping sel -ca e abili ies needs o
be u he in es iga ed (Riegel e al., 2017). Riegel e
al. (2012), in he Middle-Range heo y on sel -ca e in
he con ex o ch onic illness, based on clinical
p ac ice, de ine sel -ca e as a p ocess o heal h
main enance and disease managemen a he . This
p ocess equi es a pe son o be in ol ed and ac i ely
engaged in hei own heal h-illness ansi ion.
The e o e, sel -ca e is unde s ood as a polysemic
concep and a dynamic p ocess ha depends on a
pe son's will powe . Is in luenced by indi idual needs,
capaci ies, p e iously iden i ied disabili ies, and a
pe cep ion o hei new heal h condi ion.
Hence, some sel -ca e ac i i ies di e acco ding o he
pe son (Riegel e al., 2012).
Sel -ca e de ici e sus he po en ial o imp o e sel -ca e: explana ion o he nu se's clinical judgmen s
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Re is a de In es igação & Ino ação em Saúde
A e he acu e phase o an illness, he onse o he
unc ional dependence and he sel -ca e de ici a e
conside ed p io i ies, meaning ha a pe son mus
ini ia e hei eco e y p ocess. Se e al ac o s can
limi he abili y o a pe son wi h unc ional
dependence o eco e sel -ca e beha io s and
ac ions a indi idual and social le els. As well age,
heal h s a us, decision-making abili y, physical abili y
o pe o m sel -ca e ac ions, cogni i e and emo ional
abili y (Jaa sma e al., 2017), expe ience, mo i a ion,
belie s, cul u al alues, habi s, unc ional and
cogni i e abili ies, suppo sys em, access o ca e and
sel -e icacy (Lou enço, 2015; Riegel e al., 2012,
Vellone e al., 2016).
The cu en inc easing need o heal hca e esponses
associa ed wi h unc ional dependence and sel -ca e
de ici is a signi ican challenge o heal h se ices
and, in pa icula , o nu ses. The changes in a
pe son's abili y o pe o m sel -ca e ac i i ies can be
ansla ed in o wo nu sing diagnos ic labels
sus ained on di e en decision-making bases. Fo he
diagnos ic label-impai ed sel -ca e a nu se p esc ibes
nu sing in e en ions ha eplace he pe son in sel -
ca e ac ions. Fo he diagnos ic label-po en ial o
imp o e sel -ca e abili ies a nu se can p esc ibe
in e en ions ha include assis ance, in o ma ion,
and aining o imp o e o egain he pe o mance o
sel -ca e ac i i ies and p omo e au onomy. The
designa ion o po en ial e e s o inhe en e capaci y
o coming in o being (ISO 18104, 2014, p.4) ha is,
he pe son's abili y and he oppo uni y o de elop
new sel -ca e abili ies and, hus, become mo e
au onomous. Quei ós e al., (2021) s a es ha he e
a e wo pe spec i es o diagnos ic easoning, gi en
he uni e sal sel -ca e equi emen s: i) sel -ca e
de ici o ii) he indi idual's oppo uni y o de elop
skills and/o knowledge o deal wi h he sel -ca e
de ici . Highligh ing he indi idual need o acqui e
knowledge and mas e skills o managing a new
challenging condi ion (Quei ós e al., 2021, p.6). In he
long- e m, hese in e en ions will p oduce di e en
ou comes wi h ega ds o a pe son's heal h condi ion.
Howe e , he ques ion emains, which pa ien s ha e
eco e y po en ial? Imp o ing he abili y o a pe son
wi h unc ional dependence o pe o m sel -ca e
ac i i ies implies sys ema izing a p o essional
app oach in o de o egula ly and speci ically assess
he di e en impai men s. Such as physical,
psychological, and o he cons ain s/limi a ions,
ela ed o he momen and con ex expe ienced by
he pe son (Lou enço, 2015). The ac o s ha
posi i ely and nega i ely in luence he sel -ca e
beha io s o a pe son wi h unc ional dependence a e
well known (Schulman-G een e al., 2016). Howe e ,
his e idence has had li le ans e abili y o clinical
nu sing p ac ice (Lou enço, 2015). Despi e he
exis ence o se e al s udies ocused on iden i ying
ac o s ha in luence sel -ca e beha io s o a pe son
wi h unc ional dependence (Jaa sma e al., 2017;
Vellone e al., 2016), in he con ex o clinical p ac ice,
no assessmen ins umen exis s o help nu ses
iden i y he di e en ia ing indica o s o he
diagnoses, sel -ca e de ici o po en ial o imp o e
sel -ca e abili ies.
METHODS
Design
This is an explo a o y s udy, using a quali a i e
me hod comp ising in e iews wi h a ocus g oup.
Sel -ca e de ici e sus he po en ial o imp o e sel -ca e: explana ion o he nu se's clinical judgmen s
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Re is a de In es igação & Ino ação em Saúde
The Consolida ed C i e ia o Quali a i e Resea ch
Repo s (COREQ) checklis was used (Supplemen a y
File 1). The s udy included wo mee ings held in 2019
wi h ele en nu ses expe ienced in he ca e o pe sons
wi h unc ional dependence and sel -ca e de ic . The
mee ings las ed abou wo hou s and 30 minu es
(K uege & Casey, 2014).
Pa icipan s
Pa icipan s we e selec ed by an in en ional sampling
me hod o ob ain de ailed desc ip ions o he wo k
expe ience ele an o he s udy (K uege & Casey,
2014). The selec ion c i e ia we e: a) o be a nu se
wi h ad anced aining in ehabili a ion nu sing,
ecognized by he Na ional O de o Nu ses; b) ha e
a leas h ee yea s expe ience in ca ing o people
wi h unc ional dependency and commi men o sel -
ca e; and c) sign he in o med consen o m,
olun a ily ag eeing o pa icipa e in he s udy and
au ho ize he dissemina ion o he esul s ob ained in
he scien i ic ield. Two weeks be o e he ocus g oup,
pa icipan s we e con ac ed by email, and he
in o med consen o m was sen , cla i ying he
objec i es o he s udy, pa icipa ion c i e ia, s udy
me hods, and he es ima ed du a ion. Th ee days
be o e he ocus g oup was held, pa icipan s we e
con ac ed by elephone o con i m he mee ings. The
place whe e he mee ings we e held was accessible o
all pa icipan s.
Pa icipan s we e mos ly women (82%), aged 36 yea s
o olde , wi h ad anced aining in ehabili a ion
nu sing, and wi h 15 yea s o mo e o p o essional
expe ience. Pa icipan s wo ked in long- e m ca e
uni s o unc ional ehabili a ion and aining in sel -
ca e ac i i ies.
Da a collec ion
The in e ac ion among he g oup p oduced impo an
in o ma ion ele an o he concep s s udied, and
pa icipan s we e encou aged o discuss and
commen on hough s and expe iences on he opics
unde discussion. P e iously p epa ed ques ions we e
used in a semi-s uc u ed manne o acili a e
discussions. Ques ions we e p epa ed h ough
collabo a ion and inpu o all he au ho s o he
documen ( able 1).
Table 1
Ques ions used in ocus g oup
1-Fo a pe son who su e ed a c i ical episode and became unc ionally dependen , wha ac o s do you ecognize ha could ha e
in luenced his/he abili ies o imp o e sel -ca e?
2-Wha is he domain o in luence o he men ioned ac o s on a pe son's abili y?
3-Iden i y h ee undamen al aspec s o conside when e alua ing a pe son wi h unc ional dependence?
The ques ions ga e ise o aluable discussions and
e lec ions among he pa icipan s. Pa icipan s we e
also allowed o aise ques ions du ing he ocus g oup
in e iews.
The sessions we e mode a ed by he i s au ho o
he pape , who p esen ed he opics o discussion,
kep an ac i e ole in conduc ing and main aining he
discou se, ensu ing ha each pa icipan had he
oppo uni y o expose his o he opinions. Pos -i s
and a whi eboa d we e used o collec opinions abou
he i s ques ion p esen ed by he mode a o . The
pa icipan s eco ded on pos -i s ac o s ha , in hei
Sel -ca e de ici e sus he po en ial o imp o e sel -ca e: explana ion o he nu se's clinical judgmen s
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Re is a de In es igação & Ino ação em Saúde
opinion, in luence he eco e y po en ial o a pe son
wi h unc ional dependence and sel -ca e de ici .
Subsequen ly, hese concep s we e g ouped
hie a chically in o unc ional domains. The o he
au ho s o he pape assis ed in his ask. The
mode a o also p esen ed he o he ques ions. The
pa icipan s discussed hei opinions, which we e
audio- eco ded. A e da a collec ion, he in e iews
we e ansc ibed, and he in o ma ion ob ained was
submi ed o con en analysis, ollowing he S auss &
Co bin (2014) guidelines. The mode a o pe o med
he ansc ip ion because she had inside in o ma ion
abou acial exp essions, ges u es, and one o oice
in which he speeches we e deli e ed. I ems ha
ecei ed a o able ag eemen om a leas six (55%)
o he ele en ocus g oup pa icipan s we e added o
he esul s. The con en analysis esul s we e colla ed
in a epo ha was e u ned o he pa icipan s a
he second ocus g oup mee ing.
The second ocus g oup mee ing s a ed wi h he
pa icipan s eading he epo o 40 minu es. This
was ollowed by a discussion o opinions abou he
alida ion o he in o ma ion. This ocus g oup
mee ing was also audio- eco ded. All sugges ions o
change we e ai h ully ca ied ou in he inal epo
by he mode a o . All igh s ela ed o da a p o ec ion
we e espec ed in he s udy.
Da a analysis
The da a ga he ed om he pa icipan s' discussion
we e a he cen e o he coding wo k om an
induc i e pe spec i e. The knowledge eme ged
p og essi ely and was ma ked by he clinical expe ise
o he p o essionals. The coding p ocess was he i s
phase o he analysis, whe e he subs an i e codes,
p ope ies, and dimensions we e iden i ied. This
phase was ollowed by axial coding. The p e iously
g ouped da a we e eg ouped in o concep s o
iden i y he ca ego ies p esen . The selec i e coding,
which was he las phase o he analy ical p ocess,
included he e inemen o he ca ego ies and
subca ego ies p e iously iden i ied. These we e
compa ed and analyzed con inuously, in eg a ing
some da a, and a cen al ca ego y eme ged (S auss &
Co bin, 2014).
RESULTS
Wi hin he g oup o ele en expe ehabili a ion
nu ses, nine we e women. The a e age age was 42.27
yea s. Mo e han hal he expe s (six) had o e
i een yea s o wo k expe ience, h ee had en yea s,
one nu se had wel e yea s, and ano he nu se had
six yea s. All expe s wo ked on unc ional
ehabili a ion uni s in ei he inpa ien o communi y
con ex s and we e ecognized by hei pee s as ha ing
an ou s anding nu sing esume.
diagnos ic labels ha we e indica i e o he need o
ca e o a pe son wi h unc ional dependence
included sel -ca e de ici o po en ial o imp o e sel -
-making was
dependen on 1) ac o s in luencing he po en ial o
imp o e sel -ca e abili ies o a pe son wi h unc ional
dependence, 2) he domain o in luence o hese
ac o s, and 3) h ee undamen al aspec s o conside
when e alua ing a pe son wi h unc ional dependence
The ac o s ha in luence a pe son wi h unc ional
dependence o imp o e sel -ca e abili ies a e (a)
unc ional capaci y ha includes cogni i e and
physical issues, (b) emo ional ac o s, and (c) suppo

Sel -ca e de ici e sus he po en ial o imp o e sel -ca e: explana ion o he nu se's clinical judgmen s
12
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Re is a de In es igação & Ino ação em Saúde
sys em, which includes amily membe s, heal h p o essionals, ime, and en i onmen ( able 2).
Table 2
Fac o s ha in luence he po en ial o imp o e sel -ca e abili ies o a pe son wi h unc ional dependence
Ca ego y Subca ego y Indica o
Func ional capaci y
Cogni i e
Consciousness
O ien a ion: Time, space and sel -pe son
Senso y pe cep ion
Memo y, hough , easoning
A ailabili y
Knowledge (heal h li e acy)
Physical
Balance
Muscle s eng h
Join mo emen
Mo o coo dina ion
Emo ional ac o s
Belie s
Sel -e icacy
Expec a ions
Voli ion: Willpowe , mo i a ion, sel -con ol
Adap a ion, accep ance o he heal h condi ion
Hope
In ol emen
P e ious expe iences
Suppo Sys em
Family
Family in ol emen
Knowledge
A i ude
Expec a ions
Heal h p o essionals
Ca e philosophy (biomedical model)
A i ude
En i onmen
Communi y (Access o nu ses wi h ad anced p ac ice in ehabili a ion)
Household a chi ec u al ba ie s
Lack o ma e ial esou ces (assis i e de ice)
Time Reco e y ime
The p esence o se e e cogni i e impai men (caused
by memo y, hough , o easoning al e a ions) is a
-making
p ocesses, leading hem o op o he diagnos ic label
sel -ca e de ici . Unal e ed unc ional capaci y,
posi i e emo ions, mo i a ion, and ini ia i e,
posi i ely in luence he eco e y p ocess o a
dependen pe son's sel -ca e abili ies. These
indica o s sugges ha a nu se should op o he
diagnos ic label po en ial o imp o e sel -ca e
abili ies. Low willpowe , pe cep ion o low sel -
e icacy, and he absence o li e goals we e
conside ed ac o s ha nega i ely in luence a
pe son's eco e y p ocess. These indica o s e lec
he educed po en ial o he eco e y o sel -ca e
abili ies and a e likely o lead o de ici in sel -ca e,
leading o nu ses deciding on in e en ions ha o en
eplace he pe son in sel -ca e ac ions ( able 3).
Sel -ca e de ici e sus he po en ial o imp o e sel -ca e: explana ion o he nu se's clinical judgmen s
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Re is a de In es igação & Ino ação em Saúde
Table 3
Domains o in luence o iden i ied ac o s on po en ial o imp o e sel -ca e abili ies
Ca ego y Indica o
De e minan ac o Cogni ion: memo y, hough , and easoning
Fac o s o posi i e in luence Func ional capaci y, posi i e emo ions, mo i a ion, and ini ia i e
Fac o s o nega i e in luence Low willpowe , pe cep ion o low sel -e icacy, absence o li e goals
Expe nu ses conside ha he assessmen o he
abili y o a pe son wi h unc ional dependence mus
ake in o accoun h ee o he ollowing aspec s (a)
he iming o he assessmen , wi h he esul s guiding
he le el o assis ance in heal h ca e; (b) he
indica o s o assessmen , which in o m he igo o
nu ses' decision-making and moni o he
e ec i eness o a pe son's esponse du ing he
au onomy eco e y p ocess; and (c) sys ema ic in he
e alua ion, which acili a es he eadjus men o
nu sing in e en ions and espec i e expec ed
ou comes.
DISCUSSION
The p esen s udy sough o iden i y he assump ions
used by expe nu ses when o mula ing he clinical
judgmen o sel -ca e de ici e sus he po en ial o
imp o e sel -ca e. E alua ing whe he o no a pe son
has he po en ial o imp o e sel -ca e abili y in ol es
speci ic c i e ia. A p ese ed cogni i e unc ion is
essen ial o ecei e, decode, and e ain in o ma ion
(Bidwell, 2015). Du e al. (2007) demons a ed ha
impai ed unc ional and cogni i e capabili ies
nega i ely a ec a pe son's abili y and in e es o be
in ol ed in sel -ca e ac i i ies, which may make he
assessmen pa icula ly challenging.
Func ional capaci y e lec s he di icul ies ha a
pe son may expe ience when pe o ming a ask o
ac ion ha equi es a speci ic cogni i e s a us, which
includes awa eness, o ien a ion, senso y pe cep ion,
memo y, hough , easoning, and knowledge
(in o ma ion acqui ed and/o pe cei ed). Acco ding o
Jaa sma e al. (2017), a pe son needs o ha e speci ic
unc ional and cogni i e skills o become in ol ed in
sel -ca e, including making choices, iden i ying ca e
needs, and knowing how o con ac a heal hca e
p o essional when necessa y. Hence, a pe son needs
o ha e a ce ain deg ee o in ol emen in hei ca e
p ocess and commi o hei heal h and well-being.
Func ional capaci y also includes physical s a us, a
ca ego y iden i ied in ou s udy. Thus, muscle
s eng h, mo o coo dina ion, balance, and join
a e body p ocesses ha , a e being
e alua ed, a e used o de e mine whe he o no a
(N1). Howe e ,
e
di icul ies a pe son aces when pe o ming sel -ca e
ac i i ies (washing he back, d essing om he wais
down, o al hygiene) [...] despi e impai men [...]" (N9).
Sel -ca e de ici e sus he po en ial o imp o e sel -ca e: explana ion o he nu se's clinical judgmen s
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Re is a de In es igação & Ino ação em Saúde
hese ypes o de ici s, expe iencing
hem o a long ime due o ch onic disease si ua ions,
o en adop s a egies o pe o m sel -ca e ac i i ies
(N4).
Emo ional ac o s we e a ca ego y ha eme ged om
his s udy and included mul iple indica o s showing
how a pe son goes h ough he ehabili a ion p ocess
o unc ional capaci y. Mos o he expe nu ses
epo ed ha unc ional capaci y condi ions he
p ocess o sel -ca e eco e y o a dependen pe son.
Mo eo e , hinde ing belie s, o changes in he
pe cep ion o sel -e icacy and demo i a ion, can
indica e I can, bu I do no wan o,
because I am in a denial phase
hand, ha ing expec a ions, mo i a ion, and being
in ol ed is essen ial o he adap a ion o he
cu en heal h condi ion and imp o emen in sel -ca e
au onomy Being ocused on he eco e y o
hei indi idual capaci ies helps a pe son in he
eco e y p ocess. These opinions co obo a e he
esul s o se e al s udies ha demons a e he
in luence ha emo ional ac o s ha e on a pe son's
in ol emen du ing he p ocess o egaining sel -ca e
abili ies (Chang e al., 2017; Sil a, 2019). Hope is also
a ype o emo ion ha , once p esen , allows a pe son
o deal wi h a s ess ul si ua ion mo e e ec i ely
(Pin o e al., 2012). I assumes a he apeu ic ole,
s onge han op imism, and is a ele an coping
s a egy wi h in luence o e a pe son's well-being.
O he in luencing ac o s epo ed by he pa icipan s
we e p e ious expe iences. P e ious expe iences a e
used as e ec i e pa e n iden i ie s ha p o ide
ele an clues, sugges expec ed ou comes associa ed
wi h speci ic esponses, and poin o easonable
objec i es and ac ions in ce ain si ua ions (Jaa sma
e al., 2017). Howe e , hey may also be po en
inhibi o s o he de elopmen o he abili y o
imp o e sel -ca e, as desc ibed by one expe ienced
nu se, I am dealing wi h a pe son who, due o a
p e ious nega i e expe ience, does no cu en ly wan
o be ained on how o ans e om bed o chai ,
because he ell du ing hei p e ious hospi aliza ion
(N11). The challenge o nu ses is o iden i y whe he
p e ious expe iences acili a e o he momen s o
assessmen and he de elop he abili y o pe o m
sel -ca e. These p o essionals ha e a ield o
ac ion ha allows hem o unde s and he expe iences
and adap hem o imp o e indi idual pe o mance
abili ies (N5). Wi hin his domain o emo ional
ac o s, mo al p inciples and belie s ha e also
eme ged, a ibu ing mo e meaning o li e,
o ganizing, and men ally building a balance o eali y
(Lou enço, 2015).
The suppo sys em ca ego y was s uc u ed in o ou
subca ego ies: amily, heal h p o essionals,
en i onmen , and ime ac o s. Family is conside ed
ca dinal suppo o a dependen pe son (Chen e al.,
2017). Family suppo inc eases pa icipan s'
in ol emen and con idence in he p ocess o
egaining au onomy and p o es o be a acili a ing
esou ce o de elop app op ia e sel -ca e abili ies and
beha io s (Lou enço, 2015; Riegel e al., 2017). Ca ing
o a amily membe wi h unc ional dependence is a
linge ing, pain ul eali y wi hin he amily con ex
(Chen e al., 2017 he lack o amily
esou ces a ec s he unde u iliza ion o heal h
se ices due o he p olonged delay o a pa ien 's
discha ge [...] he ype o amily
ca ing o he dependen pe son has a s ong
(N8). Wi hin hei ca egi e ole, amily
Sel -ca e de ici e sus he po en ial o imp o e sel -ca e: explana ion o he nu se's clinical judgmen s
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Re is a de In es igação & Ino ação em Saúde
membe s mus ge ac i ely in ol ed, be empa he ic,
and a ailable o imp o e hei knowledge.
Some imes we a e aced wi h amily ca egi e s who
do no wan he dependen pe son o be au onomous
[...] o en eplacing hem in hei ac i i ies, like
d essing, ba hing, ea ing and e en choosing hei
clo hes. These amily membe s conside ha he bes
way o show a ec ion is o hem o eplace hei
amily membe in his/he daily li e ac i i ies (N8).
Acco ding o expe nu ses, he philosophy o ca e
and heal hca e p o essionals' a i ude can in luence a
pe son wi h unc ional dependence o de elop sel -
ca e abili ies. When guided by a biomedical model,
nu ses conside ha he main enance o body
p ocesses, managemen o signs and symp oms, and
he apeu ic p esc ip ions a e p io i y a eas. Wha we
wan is o he pe son o keep he body p ocesses
unc ioning and no de elop p essu e ulce s, o
example , a pe son-cen e ed ca e
-making. The
psychological and emo ional aspec s mus be included
and should be conside ed signi ican a eas in he
eco e y p ocess o a pe son wi h unc ional
dependence (Dineen-G i in e al., 2019; Lou enço,
2015). This is con i med by one nu se (N8)
pa icipa ing in ou s udy in addi ion o he
domain o body p ocesses, o he equally impo an
ac o s such as emo ional aspec s, need o be
conside ed when o mula ing a diagnos ic judgmen
o a pe son wi h he po en ial o imp o e sel -ca e
Acco ding o he nu ses in ou s udy, i is
essen ial o adop a mo i a ing a i ude when ca ing
o a pe son wi h unc ional dependence, p omo ing
sel -e icacy and empowe men o egain au onomy.
Nu ses mus be a ailable, a en i e, and cu ious o
explo e he pe son's pe spec i es, in e es s, and
needs. The s udy expe s conside ed language and
a i ude ex emely impo an : "The language we use
wi h [people wi h unc ional dependence] canno be
p essing, igo ous o ocused exclusi ely on
obliga ions o e en on guil The nu se wi h
ad anced aining is mo e con iden in he he apeu ic
ela ionship hey es ablish wi h a (N1). "I is
impo an ha each o us choose a i udes ha help a
pe son imp o e hei sel -e icacy [...]" (N11).
The en i onmen also in luences he abili y o a
pe son wi h unc ional dependence o imp o e sel -
ca e. A chi ec u al ba ie s ha in e e e wi h
accessibili y a home can nega i ely
ehabili a ion p ocess, hinde ing he eco e y o
au onomy (Lee e al., 2018). The lack o ma e ial
esou ces such as assis i e de ices was ound o
hinde he p ocess o a heal hy ansi ion o imp o e
au onomy in sel -ca e (Roelands e al., 2002).
Residency a eas co e ed by egula nu se home isi s
inc eased he pe cep ion o pa ien s and amily
ca egi e ega ding he home-ca e o mal suppo o
heal h p o essionals Sha ing expe iences wi hin
pee g oups, he pa ien 's con ac wi h people who
ha e li ed simila si ua ions and he esul s achie ed,
we e ound o inc ease in ol emen in he p ocess o
acqui ing skills because people el ha i was
possible o o e come he si ua ion (Lou enço, 2015).
Nu ses pa icipa ing in his s udy also conside ed ha
eco e y ime was associa ed wi h he oppo uni y o
eco e y a ying acco ding o each pe son. We
some imes a e in such a hu y ha we do no gi e
people wi h unc ional dependence a chance o ca y
The
wo sening o he disease and he unc ional capaci y