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Authors
Abstract(s)
O Enfermeiro Especialista em Saúde Materna e Obstétrica (EESMO) deve
demonstrar competências nos domínios da responsabilidade profissional, ética e legal,
melhoria contínua da qualidade dos cuidados, da gestão de cuidados e do desenvolvimento
das aprendizagens profissionais, incluindo a aquisição e desenvolvimento das
competências específicas da área da especialidade. O Estágio de Natureza Profissional
(ENP) permitiu desenvolver e aprofundar essas competências e conhecimentos sobre o
procedimento da episiotomia.
Objetivo: Realizar uma análise crítica e reflexiva sobre as atividades desenvolvidas ao
longo do ENP com vista à apresentação e discussão pública. Contextualizar a aquisição
das práticas do EESMO e refletir sobre as mesmas baseadas na evidência científica e,
ainda, demonstrar competências no domínio da investigação em enfermagem dando
resposta ao problema colocado de modo a conseguir resolver problemas em situações
novas de um modo auto-orientado e autónomo.
Metodologia: Foi feita uma contextualização do ENP. Seguiu-se uma análise critica e reflexiva
sobre as atividades desenvolvidas, de acordo com a sequência, estabelecida pela Ordem dos
Enfermeiros (OE), para as competências especificas em Enfermagem de Saúde Materna e
Obstétrica. Foram apresentadas as experiências exigidas de acordo com a legislação
Europeia e Nacional e realizada uma reflexão sobre as mesmas.
Desenvolveu-se também um estudo de carater observacional, analítico e transversal com uma
amostra de mulheres internadas num serviço de Obstetrícia do Norte de Portugal, durante
o período de 12 de maio a 12 de julho de 2024. Para a recolha de dados foram selecionados
dois instrumentos de dados (Anexo B): Um questionário para a recolha de dados
sociodemográficos e questões relacionadas com a saúde sexual e reprodutiva da mulher,
outro para avaliação da Função sexual da mulher através do Índice de Funcionamento
Sexual Feminino (FSFI) cuja versão portuguesa foi validada por Pechorro et al., 2009.
Os dados foram codificados e inseridos numa base de dados no software Statistical
Package for the Social Sciences (SPSS) versão 26.0. Foi realizada a análise descritiva.
Determinou-se o coeficiente Alpha de Cronbach para avaliar a consistência interna das
dimensões da escala, Hill & Hill (2005) e usados os testes não paramétricos: Mann-
Whitney para comparação de médias entre dois grupos independentes. Recorreu-se ao
coeficiente de correlação de Spearman, para medir a relação linear entre as dimensões da
escala. O valor de significância foi de 5,00%. O estudo obteve parecer favorável da
Comissão Ética da Unidade Hospitalar. Os resultados permitiram afirmar que foram obtidas as competências
especificas do EESMO bem como a aquisição e reflexão das experiências mínimas
obrigatórias, solidificadas neste relatório.
O estudo revelou que, em média, a Função sexual das mulheres que fizeram episiotomia
foi considerada menos satisfatória em comparação com as que não fizeram episiotomia
(27,73 ± 4,58 vs. 28,97 ± 4,31), sendo que em todas as Dimensões as pontuações mais
altas indicaram melhores níveis de funcionamento sexual.
A taxa de episiotomia encontrada na amostra foi de 52,10%. As mulheres que fizeram
episiotomia relataram uma média menor de Desejo (3,68 ± 1,06 vs. 4,08 ± 1,03),
Excitação sexual (4,46 ± 0,91 vs. 4,75 ± 0,91) menor Lubrificação (4,68 ± 0,97 vs. 5,09
± 0,80) redução na frequência e intensidade dos Orgasmos (4,79 ± 0,99 vs. 5,01 ± 0,78)
e na Dor (4,67 ± 1,28 vs. 4,73 ± 1,32). A única Dimensão do IFSF que apresentou uma
média mais elevada foi a Satisfação sexual (5,45 ± 0,81 vs. 5,32 ± 0,96).
De acordo com a realização de episiotomia, considerando variáveis como Idade,
Habilitações literárias, Número de partos e Temporalidade do Parto anterior, apenas
foram verificadas diferenças estatisticamente significativas para as variáveis Habilitações
literárias e Número de partos. As mulheres com pelo menos Ensino Secundário que
fizeram episiotomia apresentaram médias mais baixas nas Dimensões Desejo (3, 71 ±
1,10 vs. 4, 47 ± 0,99; p= 0,009), Excitação (4,60 ± 0,83 vs. 5,10 ± 1,06; p= 0,023) e
Lubrificação (4,73 ± 0,93 vs. 5,33 ± 0,72; p= 0,021) em comparação com as que não
fizeram episiotomia. Também as mulheres com dois partos que fizeram episiotomia
apresentaram médias mais baixas na Dimensão Lubrificação (4,57 ± 1,01 vs. 5,20 ± 0,81;
p= 0,026), em comparação com as que não fizeram episiotomia.
Conclusão: O ENP e a reflexão crítica sobre o mesmo consolidaram, através da
construção deste Relatório, a aquisição das competências para a prática da ESMO, a
apresentação das experiências mínimas e a produção de material de investigação.
O estudo desenvolvido sugeriu que a realização de episiotomia pode impactar
negativamente a Função sexual nas várias Dimensões. Estes dados reforçaram a
necessidade de adotar práticas baseadas em evidências que priorizem a integridade física
e o bem-estar das mulheres, contribuindo para a melhoria da qualidade dos cuidados em
saúde materna e obstétrica, sendo o papel do enfermeiro fundamental. As políticas e
práticas clínicas devem ser revistas para assegurar que a episiotomia seja utilizada de
forma apropriada e baseada em evidências.
The Maternal and Obstetric Health Nurse Specialist (MASN) must demonstrate competencies in the areas of professional, ethical and legal responsibility, continuous improvement in the quality of care, care management and the development of professional learning, including the acquisition and development of competencies specific to the area of specialty. The Professional Internship allowed me to develop and deepen these skills and knowledge about the episiotomy procedure. Purpose: Carry out a critical and reflective analysis of the activities developed during the ENP with a view to public presentation and discussion. Contextualize the acquisition of EESMO practices and reflect on them based on scientific evidence and also demonstrate skills in the field of nursing research by responding to the problem posed in order to be able to solve problems in new situations in a self-directed and autonomous way. Method: The ENP was contextualized. This was followed by a critical and reflective analysis of the activities carried out, in accordance with the sequence established by the Order of Nurses (OE) for the specific competences in Maternal and Obstetric Health Nursing. The required experiences were presented in accordance with European and national legislation and a reflection was made on them. An observational, analytical and cross-sectional study was also carried out with a sample of women admitted to an obstetrics service in the north of Portugal between May 12 and July 12, 2024. Two data instruments were selected for data collection (Appendix B): One questionnaire to collect sociodemographic data and questions related to women's sexual and reproductive health, the other to assess women's sexual Function through the Female Sexual Functioning Index (FSFI) whose Portuguese version was validated by Pechorro et al., 2009. The data was coded and entered into a database in the Statistical Package for the Social Sciences (SPSS) software version 26.0. A descriptive analysis was carried out. The Cronbach's Alpha coefficient was determined to assess the internal consistency of the scale's dimensions, according to Hill & Hill (2005), and the non-parametric Mann- Whitney test was used to compare means between two independent groups. Spearman's correlation coefficient was used to measure the linear relationship between the scale's dimensions. The significance level was 5.00%. The study was approved by the Hospital Unit's Ethics Committee. The results made it possible to state that the specific competences of the EESMO were obtained, as well as the acquisition and reflection of the minimum mandatory experiences, which are solidified in this report. The study revealed that, on average, the Sexual Function of women who had an episiotomy was considered less satisfactory compared to those who had not had an episiotomy (27.73 ± 4.58 vs. 28.97 ± 4.31), with higher scores in all Dimensions indicating better levels of sexual functioning. The episiotomy rate found in the sample was 52.10%. Women who had undergone episiotomy reported lower mean scores for Desire (3.68 ± 1.06 vs. 4.08 ± 1.03), Sexual Arousal (4.46 ± 0.91 vs. 4.75 ± 0.91), Lower Lubrication (4.68 ± 0.97 vs. 5.09 ± 0.80), Reduced Orgasm Frequency and Intensity (4.79 ± 0.99 vs. 5.01 ± 0.78) and Pain (4.67 ± 1.28 vs. 4.73 ± 1.32). The only IFSF dimension with a higher mean was Sexual satisfaction (5.45 ± 0.81 vs. 5.32 ± 0.96). According to whether or not an episiotomy had been performed, considering variables such as Age, Education, Number of births and Timing of previous birth, statistically significant differences were only found for the Education and Number of births variables. Women with at least secondary education who had an episiotomy had lower mean scores in the Desire (3.71 ± 1.10 vs. 4.47 ± 0.99; p= 0.009), Excitement (4.60 ± 0.83 vs. 5.10 ± 1.06; p= 0.023) and Lubrication (4.73 ± 0.93 vs. 5.33 ± 0.72; p= 0.021) dimensions compared to those who had not had an episiotomy. Women with two births who had an episiotomy also had lower averages in the Lubrication Dimension (4.57 ± 1.01 vs. 5.20 ± 0.81; p= 0.026), compared to those who had not had an episiotomy. Conclusion: The PNS and the critical reflection on it have consolidated, through the construction of this Report, the acquisition of skills for the practice of ESMO, the presentation of minimal experiences and the production of research material. The study suggests that episiotomy can have a negative impact on sexual function in the various dimensions. These data reinforced the need to adopt evidence-based practices that prioritize the physical integrity and well-being of women, contributing to improving the quality of maternal and obstetric health care, with the role of nurses being fundamental. Policies and clinical practices should be reviewed to ensure that episiotomy is used appropriately and based on evidence.
The Maternal and Obstetric Health Nurse Specialist (MASN) must demonstrate competencies in the areas of professional, ethical and legal responsibility, continuous improvement in the quality of care, care management and the development of professional learning, including the acquisition and development of competencies specific to the area of specialty. The Professional Internship allowed me to develop and deepen these skills and knowledge about the episiotomy procedure. Purpose: Carry out a critical and reflective analysis of the activities developed during the ENP with a view to public presentation and discussion. Contextualize the acquisition of EESMO practices and reflect on them based on scientific evidence and also demonstrate skills in the field of nursing research by responding to the problem posed in order to be able to solve problems in new situations in a self-directed and autonomous way. Method: The ENP was contextualized. This was followed by a critical and reflective analysis of the activities carried out, in accordance with the sequence established by the Order of Nurses (OE) for the specific competences in Maternal and Obstetric Health Nursing. The required experiences were presented in accordance with European and national legislation and a reflection was made on them. An observational, analytical and cross-sectional study was also carried out with a sample of women admitted to an obstetrics service in the north of Portugal between May 12 and July 12, 2024. Two data instruments were selected for data collection (Appendix B): One questionnaire to collect sociodemographic data and questions related to women's sexual and reproductive health, the other to assess women's sexual Function through the Female Sexual Functioning Index (FSFI) whose Portuguese version was validated by Pechorro et al., 2009. The data was coded and entered into a database in the Statistical Package for the Social Sciences (SPSS) software version 26.0. A descriptive analysis was carried out. The Cronbach's Alpha coefficient was determined to assess the internal consistency of the scale's dimensions, according to Hill & Hill (2005), and the non-parametric Mann- Whitney test was used to compare means between two independent groups. Spearman's correlation coefficient was used to measure the linear relationship between the scale's dimensions. The significance level was 5.00%. The study was approved by the Hospital Unit's Ethics Committee. The results made it possible to state that the specific competences of the EESMO were obtained, as well as the acquisition and reflection of the minimum mandatory experiences, which are solidified in this report. The study revealed that, on average, the Sexual Function of women who had an episiotomy was considered less satisfactory compared to those who had not had an episiotomy (27.73 ± 4.58 vs. 28.97 ± 4.31), with higher scores in all Dimensions indicating better levels of sexual functioning. The episiotomy rate found in the sample was 52.10%. Women who had undergone episiotomy reported lower mean scores for Desire (3.68 ± 1.06 vs. 4.08 ± 1.03), Sexual Arousal (4.46 ± 0.91 vs. 4.75 ± 0.91), Lower Lubrication (4.68 ± 0.97 vs. 5.09 ± 0.80), Reduced Orgasm Frequency and Intensity (4.79 ± 0.99 vs. 5.01 ± 0.78) and Pain (4.67 ± 1.28 vs. 4.73 ± 1.32). The only IFSF dimension with a higher mean was Sexual satisfaction (5.45 ± 0.81 vs. 5.32 ± 0.96). According to whether or not an episiotomy had been performed, considering variables such as Age, Education, Number of births and Timing of previous birth, statistically significant differences were only found for the Education and Number of births variables. Women with at least secondary education who had an episiotomy had lower mean scores in the Desire (3.71 ± 1.10 vs. 4.47 ± 0.99; p= 0.009), Excitement (4.60 ± 0.83 vs. 5.10 ± 1.06; p= 0.023) and Lubrication (4.73 ± 0.93 vs. 5.33 ± 0.72; p= 0.021) dimensions compared to those who had not had an episiotomy. Women with two births who had an episiotomy also had lower averages in the Lubrication Dimension (4.57 ± 1.01 vs. 5.20 ± 0.81; p= 0.026), compared to those who had not had an episiotomy. Conclusion: The PNS and the critical reflection on it have consolidated, through the construction of this Report, the acquisition of skills for the practice of ESMO, the presentation of minimal experiences and the production of research material. The study suggests that episiotomy can have a negative impact on sexual function in the various dimensions. These data reinforced the need to adopt evidence-based practices that prioritize the physical integrity and well-being of women, contributing to improving the quality of maternal and obstetric health care, with the role of nurses being fundamental. Policies and clinical practices should be reviewed to ensure that episiotomy is used appropriately and based on evidence.
Description
Keywords
Comportamento sexual Episiotomia Mulher Função sexual Sexualidade