<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>2184-3023</journal-id>
<journal-title><![CDATA[Revista Portuguesa de Enfermagem de Reabilitação]]></journal-title>
<abbrev-journal-title><![CDATA[RPER]]></abbrev-journal-title>
<issn>2184-3023</issn>
<publisher>
<publisher-name><![CDATA[Associação Portuguesa de Enfermagem de Reabilitação]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2184-30232023000100206</article-id>
<article-id pub-id-type="doi">10.33194/rper.2023.316</article-id>
<title-group>
<article-title xml:lang="pt"><![CDATA[Traçado da intervenção do Enfermeiro de Reabilitação - organização de cuidados para um envelhecimento saudável e ativo]]></article-title>
<article-title xml:lang="es"><![CDATA[Seguimiento para la intervención de la Enfermera de Rehabilitación - organización asistencial para el envejecimiento activo y saludable]]></article-title>
<article-title xml:lang="en"><![CDATA[Outline for the intervention of the Rehabilitation Nurse - organization of care for healthy and active aging]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Vieira]]></surname>
<given-names><![CDATA[Monica]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Martins]]></surname>
<given-names><![CDATA[Maria Manuela]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Martins]]></surname>
<given-names><![CDATA[Rita]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Fernandes]]></surname>
<given-names><![CDATA[Carla]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Centro Hospitalar Universitário de São João  ]]></institution>
<addr-line><![CDATA[Porto ]]></addr-line>
<country>Portugal</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Universidade do Porto Instituto de Ciências Biomédicas Abel Salazar ]]></institution>
<addr-line><![CDATA[Porto ]]></addr-line>
<country>Portugal</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,Escola Superior de Enfermagem do Porto  ]]></institution>
<addr-line><![CDATA[Porto ]]></addr-line>
<country>Portugal</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>06</month>
<year>2023</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>06</month>
<year>2023</year>
</pub-date>
<volume>6</volume>
<numero>1</numero>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_arttext&amp;pid=S2184-30232023000100206&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_abstract&amp;pid=S2184-30232023000100206&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_pdf&amp;pid=S2184-30232023000100206&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="pt"><p><![CDATA[RESUMO  Introdução: O envelhecimento ativo é uma preocupação europeia que exige aos profissionais de saúde e sociais repensar as suas práticas.  Metodologia: Procuramos compreender o modelo de assistência dos idosos num Agrupamento de Centros de Saúde (ACES) do Norte de Portugal para deduzir o papel dos enfermeiros de reabilitação na comunidade. Realizamos um estudo qualitativo, do tipo fenomenológico. A amostra não probabilística intencional foi constituída por oito Médicos, oito Enfermeiros e oito Assistentes Sociais que desenvolvem a sua atividade para pessoas com mais de 65 anos num ACES. A recolha de dados foi elaborada através de uma entrevista semi-estruturada, constituindo os resultados do corpo da análise que sustenta esta pesquisa.  Resultados: 83% dos participantes não possuíam formação em gerontologia. Havia focos de avaliação da assistência, em que todos os profissionais estimavam os mesmos dados, mas havia dados necessários ao acompanhamento dos idosos que não eram avaliados por nenhum profissional. A partilha da informação para a assistência, quando ocorria, recaía nas situações de doença ou de alterações do contexto social.  Discussão: Foi possível verificar que em todas as temáticas há informação que converge nos três grupos de profissionais, principalmente nos dados colhidos na avaliação inicial. Tal como defendem alguns autores a partilha de informação e divisão do trabalho de equipa é importante para uma intervenção mais especializada e dirigida principalmente nesta faixa etária.  Conclusão: Desta forma foi possível perceber que o trabalho dos três grupos de profissionais entrevistados muitas vezes se cruza e que há necessidade de partilha de dados entre a equipa multidisciplinar, sendo valorizado e importante o trabalho especializado do Enfermeiro de Reabilitação.]]></p></abstract>
<abstract abstract-type="short" xml:lang="es"><p><![CDATA[RESUMEN  Introducción:  El envejecimiento activo es una preocupación europea que requiere que los profesionales sociales y de la salud reconsideren sus prácticas.  Metodología:  Buscamos comprender el modelo de atención a los ancianos en un Grupo de Centros de Salud (ACES) en el Norte de Portugal para deducir el papel de las enfermeras de rehabilitación en la comunidad. Realizamos un estudio cualitativo, fenomenológico. La muestra no probabilística intencional estuvo constituida por ocho Médicos, ocho Enfermeros y ocho Trabajadores Sociales que desarrollan su actividad para personas mayores de 65 años en un ACES. La recolección de datos se realizó a través de una entrevista semiestructurada, constituyendo los resultados del cuerpo de análisis que sustenta esta investigación.  Resultados:  El 83% de los participantes no tenían formación en gerontología. Existían focos de evaluación del cuidado, en los que todos los profesionales estimaban los mismos datos, pero había datos necesarios para el seguimiento de los ancianos que no eran evaluados por ningún profesional. El intercambio de información para la asistencia, cuando ocurrió, cayó en situaciones de enfermedad o cambios en el contexto social.  Discusión:  Fue posible verificar que en todos los temas hay informaciones que convergen en los tres grupos de profesionales, principalmente en los datos recogidos en la evaluación inicial. Como defienden algunos autores, compartir información y dividir el trabajo en equipo es importante para una intervención más especializada dirigida principalmente a este grupo de edad.  Conclusión:  De esa forma, fue posible percibir que el trabajo de los tres grupos de profesionales entrevistados muchas veces se entrecruza y que existe la necesidad de compartir datos entre el equipo multidisciplinario, siendo valorado e importante el trabajo especializado de la Enfermera de Rehabilitación.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[ABSTRACT  Introduction:  Active aging is a European concern that requires health and social professionals to rethink their practices.  Methodology:  We seek to understand the care model for the elderly in a Group of Health Centers (ACES) in the North of Portugal to deduce the role of rehabilitation nurses in the community. We carried out a qualitative, phenomenological study. The intentional non-probabilistic sample consisted of eight Doctors, eight Nurses and eight Social Workers who develop their activity for people over 65 years old in an ACES. Data collection was carried out through a semi-structured interview, constituting the results of the body of analysis that sustains this research.  Results:  83% of participants had no training in gerontology. There were care evaluation focuses, in which all professionals estimated the same data, but there were data necessary for monitoring the elderly that were not evaluated by any professional. The sharing of information for assistance, when it occurred, fell into situations of illness or changes in the social context.  Discussion:  It was possible to verify that in all themes there is information that converges in the three groups of professionals, mainly in the data collected in the initial evaluation. As advocated by some authors, sharing information and dividing teamwork is important for a more specialized intervention aimed mainly at this age group.  Conclusion:  In this way, it was possible to perceive that the work of the three groups of professionals interviewed often intersects and that there is a need for data sharing between the multidisciplinary team, with the specialized work of the Rehabilitation Nurse being valued and important.]]></p></abstract>
<kwd-group>
<kwd lng="pt"><![CDATA[Idoso]]></kwd>
<kwd lng="pt"><![CDATA[Assistência]]></kwd>
<kwd lng="pt"><![CDATA[Modelos]]></kwd>
<kwd lng="pt"><![CDATA[Reabilitação]]></kwd>
<kwd lng="pt"><![CDATA[Enfermagem]]></kwd>
<kwd lng="pt"><![CDATA[Promoção da Saúde]]></kwd>
<kwd lng="es"><![CDATA[Ancianos]]></kwd>
<kwd lng="es"><![CDATA[Asistencia]]></kwd>
<kwd lng="es"><![CDATA[Modelos]]></kwd>
<kwd lng="es"><![CDATA[Rehabilitación]]></kwd>
<kwd lng="es"><![CDATA[Enfermería]]></kwd>
<kwd lng="es"><![CDATA[Promoción de la Salud]]></kwd>
<kwd lng="en"><![CDATA[Elderly]]></kwd>
<kwd lng="en"><![CDATA[Assistance]]></kwd>
<kwd lng="en"><![CDATA[Models]]></kwd>
<kwd lng="en"><![CDATA[Rehabilitation]]></kwd>
<kwd lng="en"><![CDATA[Nursing]]></kwd>
<kwd lng="en"><![CDATA[Health Promotion]]></kwd>
</kwd-group>
</article-meta>
</front><back>
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