Enfº Célia Nogueira

Immunoalergology Out-Patient Nursing Consultation

The Immunoalergology nursing consultation
Planning & training

HPA Magazine 16

Allergies are part of the Internal Medicine Medical Specialty and the study of allergies must begin with a fundamental knowledge of Medicine as a whole. The effective treatment of an allergy must include treating the patient as a unique case. (Robert Cooke, 1958).
The first appointment in Allergology in Portugal, in a Hospital context dates back to 1961, with Dr Antero de Palma Carlos PhD, one of the pioneers of this medical specialty. He was also responsible for the recognition of Allergology as a medical specialty by the Medical Association in 1984 and by the Ministry of Health in 1986, culminating in Allergology being recognized as an individually autonomous medical specialty in 1987. 

In line with all the investment and development of the specialty as such, the preponderant role of the Portuguese Society of Allergology and Clinical Immunology (SPAIC), with its 71 years existence, is noteworthy. A highly regarded scientific society, that has privileged intensive training and professional development, instilling in professionals the need for an active and constant scientific investigation. It promotes and finances research projects, publishes and distributes scientific papers, investing in related scientific education. The ultimate goal culminates in improving the care provided and optimizing quality of life for patients and families. As Manuel Branco Ferreira, President of SPAIC, mentioned at the 41st annual meeting of SPAIC, “We must never forget that an allergy is a family of disease, but also a disease of the family”.
Allergic diseases can, from a clinical point of view, be either more or less simple situations, or on the other hand very serious and life-threatening. Allergic pathology compromises, in most cases, the quality of life of the patient and consequently, of the family. Nowadays, allergic diseases represent the 5th most frequent group of chronic diseases in developed countries, including Portugal. About 1/3 of the population is affected by this pathology. For this reason, it is considered one of the “epidemics” of modern civilization.

THE HPA-ALVOR OUT-PATIENTS CONSULTATION DEPT.
The Out-Patients consultation services of the HPA in Alvor has a wide range of medical specialties available, one of them is Immunoalergology.
Dr. Pedro Morais Silva, Immunoalergologist, is responsible for the consultation and actively promotes it, encouraging teamwork and training in the area, always availability to clarify doubts and answer questions, instilling in those who work with him, appreciation and commitment. 

THE IMMUNOALERGOLOGY NURSING CONSULTATION
The nursing provided in the Immunoalergology consultation until the end of 2018 was to carry out specific techniques related to the disease, prescribed by the doctor. There was no nurse assigned to this consultation. Organizational issues and insufficient human resources resulted in management difficulties. 
All nursing interventions ended up being interdependent on the doctor's request and were restricted in relation to autonomous actions. To improve the quality of care provided, it was essential to restructure nursing care, specifically directed to the specialty in question, streamlining, organizing and acquiring management skills, which has resulted in a structured and autonomous nursing consultations. 
All projects are based on essential pillars for their development and, without a doubt, issues such as interest, commitment, dedication and effort are essential in reaching final objective.
With collaboration, teamwork, availability and personal and organizational commitment, it was possible to begin and, as in all areas, training was crucial. It should be noted that in Portugal there is no specific training in Immunoalergology for nurses, which is restricted to doctors. However, SPAIC has already promoted several training programs for nurses who work in this area, facilitating the sharing of experiences and a course on immunotherapy organized by Spanish nurses, who prepared the nurses manual for the course that was previously non-existent. In addition to attending these training courses, I had the opportunity to participate in the 40th Annual Meeting of SPAIC Autumn and Spring School aimed at General and Family Practitioners, and in the Anaphylaxis Course that took place at the Algarve University.
Continuous training has been crucial to this project and whenever the opportunity arises to participate in training events, scientific studies, carrying out internal and external work, for the benefit of the specialty, opportunities are not neglected and are the target of personal, professional and institutional commitment. Countless contributions have been facilitated through SPAIC, resulting in a growing appreciation and motivation to do more and better. The reputation of the institution is the result of the skills, performance, dedication and commitment of its professionals, who contribute daily towards its recognition and quality.

NURSING CARE
To structure and organize the Immunoalergology Nursing Consultation, it was necessary to take into account nursing techniques and care, related to norms, protocols and the internal procedures of this specialty.  
A review and update of the specialty's internal procedure was carried out and the nursing consultation manual was prepared, which includes the description and standardization of the various techniques (skin and respiratory tests, vaccination, provocation tests and intradermal tests). This organization and structuring have permitted the scheduling of nursing techniques to have their own agenda managed by the nurse responsible. 
It should be noted that targeted and personal communication is one of the most important factors in the entire process for it to be effective. Establishing a relationship and a therapeutic alliance with the patient/family, as well as interpersonal and temporal availability and a sense of security and trust in the care which is provided, is crucial. In the Immunoalergology consultation there is a significant number of children and teenagers, for whom we safeguard a targeted service, respecting their physical and cognitive abilities, according to their age, not forgetting the family members who accompany them.

FUTURE PERSPECTIVES 
Continuing the project of the Immunoalergology nursing consultation, the objective is to continuously improve the quality of care provided to its patients through appropriate strategies. Provide continuity to all institutional training opportunities and sharing of knowledge. Creating means of communication for patients to support and reinforce the information provided during the consultation. To create a nursing consultation aimed specifically for patients with asthma. The team also intends to collaborate with SPAIC in the elaboration of a Nursing Manual for Immunoalergology, with the objective of standardizing the practice on a national level.