Cuidado de enfermería del paciente con trastorno mental en atención domiciliaria: revisión narrativa / Nursing care of the patient with mental disorder in home care: narrative review

INTRODUCCIÓN: El manejo integral del paciente con trastorno mental desde enfermería, incluye abordajes que son llevados a cabo en la atención domiciliaria permitiendo así desarrollar actividades de valoración, seguimiento y atención al paciente y su familia. MATERIALES Y MÉTODOS: Se realizó una búsqueda estratégica en Medline, Epistemonikos, Base JBI, Biblioteca Virtual en Salud, utilizando los términos "mental disease", "mental illness", "homecare", "nursing". La extracción y análisis de los datos se dio acorde a los planteamientos del JBI, RESULTADOS: Se identificaron 25 artículos que cumplían con los criterios de inclusión y se clasificaron en 4 temas: 1. La experiencia del cuidado en el domicilio del paciente con trastorno mental. 2. Adherencia a la medicación de pacientes con trastorno mental que reciben tratamiento en casa. 3. El adulto mayor con trastorno mental y 4. Estrategias tecnológicas para dar atención domiciliaria al paciente con trastorno mental. CONCLUSIONES: Para abordar integralmente el cuidado del paciente con trastorno mental en el domicilio se deben incluir intervenciones de cuidado soportadas en la evidencia que incluyan la instrucción al cuidador familiar, por lo que es central el rol de enfermería teniendo en cuenta la creciente demanda de intervenciones domiciliarias en psiquiatría basadas en la evidencia, teniendo en cuenta el impacto de la trastorno mental, así como con los desafíos sociales y económicos que conlleva el padecer una trastorno mental para el paciente y su familia.

INTRODUCTION: The comprehensive management of the patient with mental disorder from nursing, includes approaches that are carried out in home care, thus allowing the development of assessment, monitoring and care activities for the patient and his family. MATERIALS AND METHODS: A strategic search was carried out in Medline, Epistemonikos, JBI Database, Virtual Health Library, using the terms "mental disease", "mental illness", "homecare", "nursing". The extraction and analysis of the data occurred according to the approaches of the JBI. RESULTS: 25 articles were identified that met the inclusion criteria and were classified into 4 themes: 1. The experience of care at home for patients with mental disorder. 2. Medication adherence of patients with mental disorder receiving treatment at home. 3. The elderly with mental disorder and 4. Technological strategies to provide home care to patients with mental disorder. CONCLUSIONS: In order to comprehensively address the care of patients with mental disorder at home, care interventions supported by evidence should be included, including instruction for the family caregiver, so the role of nursing is central, taking into account the growing demand for interventions evidence-based psychiatry home care, taking into account the impact of mental disease, as well as the social and economic challenges that mental disease entails for the patient and their family.

Nursing diagnoses in a home-based program: cross-mapping and NANDA-I Taxonomy / Diagnósticos de enfermería en un programa domiciliar: mapeo cruzado y Taxonomía de la NANDA-I / Diagnósticos de enfermagem em programa domiciliar: mapeamento cruzado e Taxonomia da NANDA-I

ABSTRACT Objective: to identify Nursing diagnoses in patients in home care by cross-mapping terms obtained in the anamnesis and clinical examination, with NANDA-I Taxonomy. Method: descriptive exploratory study, transversal type, performed with 131 patients from a home health care program in northern Minas Gerais State. With the aid of an instrument based on the theoretical model of Basic Human Needs, the terms indicators of conditions that required nursing interventions were extracted. The cross-mapping of these terms was also performed with NANDA-I Taxonomy diagnoses. Results: 378 terms and expressions referring to 49 different diagnoses were identified in 11 of the 13 domains of NANDA-I Taxonomy. Conclusion: the profile of identified nursing diagnoses can contribute to care management and organizational processes of nurses who provide care to patients in home care.

RESUMEN Objetivo: identificar diagnósticos de enfermería en pacientes en atención domiciliaria por medio del mapeo cruzado de términos obtenidos en la anamnesis y el examen clínico, con la Taxonomía de la NANDA-I. Método: estudio exploratorio descriptivo, del tipo transversal, realizado con 131 pacientes de un programa de atención domiciliaria de salud del norte del estado de Minas Gerais. Con el auxilio de un instrumento basado en el modelo teórico de las Necesidades Humanas Básicas se extrajeron los términos indicadores de condiciones que demandaban intervenciones de enfermería. Se realizó, también, el mapeo cruzado de esos términos con los diagnósticos de la Taxonomía de la NANDA-I. Resultados: se identificaron 378 términos y expresiones que se referían a 49 diferentes diagnósticos en 11 de los 13 dominios de la Taxonomía de la NANDA-I. Conclusión: el perfil de diagnósticos de enfermería identificado puede contribuir a la gestión de la atención y de los procesos organizacionales de enfermeros que prestan asistencia a pacientes en atención domiciliaria.

RESUMO Objetivo: identificar diagnósticos de enfermagem em pacientes em atenção domiciliar por meio do mapeamento cruzado de termos obtidos na anamnese e o exame clínico, com a Taxonomia da NANDA-I. Método: estudo exploratório descritivo, do tipo transversal realizado com 131 pacientes de um programa de atenção domiciliar à saúde do norte de Minas Gerais. Com o auxílio de um instrumento embasado no modelo teórico das Necessidades Humanas Básicas extraíram-se os termos indicadores de condições que demandavam intervenções de enfermagem. Realizou-se, também, o mapeamento cruzado desses termos com os diagnósticos da Taxonomia da NANDA-I. Resultados: foram identificados 378 termos e expressões que se referiam a 49 diferentes diagnósticos em 11 dos 13 domínios da Taxonomia da NANDA-I. Conclusão: o perfil de diagnósticos de enfermagem identificado pode contribuir para a gestão do cuidado e dos processos organizacionais de enfermeiros que prestam assistência a pacientes em atenção domiciliar.

Home-Based Care for Patients with Lysosomal Storage Disease: Experiences in Argentina

ABSTRACT Enzyme replacement therapy (ERT) is a long term treatment for patients who suffer from lysosomal storage disease. A transversal descriptive study was conducted to evaluate advantages and disadvantages of a home-based care program for patients with Gaucher, Fabry and Mucopolysaccharidosis II (MPS II) diseases. A survey among patients and nurses involved in healthcare delivery at home was utilized for this study. The adherence rate was 92.9% over the study period. Eighty six point nine percent chose to carry out the treatment at home and 88.5% felt that their quality of life had improved. Additional advantages reported were: comfort (77%), treatment adjustment to daily activities (69%) and flexibility (58%). Disadvantages expressed were: lack of confidence with the health care provider at home (1.6%) and a shortage of disposable materials available (1.6%). The main benefits of home-based treatment were the high treatment adherence and the improvement in quality of life.

Survey on Assistive Devices Utilization for Old Adults Supported by Community-based Homecare in Dongcheng, Beijing / 中国康复理论与实践

Objective:To investigate the awareness, use, price acceptance, satisfaction, feedback on quality problems, compliance and access methods of assistive devices for the old adults in Dongcheng, Beijing. Methods:From April to December, 2017, 166 homecare old adults from six communities of Dongcheng, Beijing accepted assistive devices after adaption, and were taught how to use. They were followed up once half a month for six months to investigate activities of daily living, satisfaction, awareness and expectation for their assistive devices. Results:There were 22% of them never used their assistive devices. For those assistive devices had been used, 62% were mobile products, 48% were homecare products, 44% were visual products, 20% were hearing products, and 4% were other products. The score of Quebec User Evaluation of Satisfaction with Assistive Technology was (4.04±0.46) in total, with 2% abandoning. Practicalness, good quality, multi-function and high performance-cost were the most important factors in mind to buy the assistive products. Common quality problems were infirmness of assembly (43%), rough appearance (27%), damaged parts (15%), hidden danger (13%), unsuitable size (3%), poor reliability (3%) and lack of structural strength (3%). The ways to obtain assistive devices included self-purchase (80%), government adaptation (13%), family and friends giving (6%), and lease (0%). Conclusion:Assistive devices can improve quality of life for the old adults. They prefer to choosing assistive devices of multi-function, cost-effective, for daily living, communication and homecare. Professional fitting, regular visit and maintenance can increase the satisfaction, and reduce abandonment of assistive devices. Assistive devices leasing service may help to promote the access of assistive devices.

Alternative class III distributed polysomnography system

Abstract Introduction Impairment of sleep quality directly increases the risk of heart attack, obesity, and stroke, among other conditions, which makes polysomnography (PSG) an important public health tool. However, the inherent problems with PSG render the correct diagnosis of sleep diseases a difficult task. As a novel alternative to the class II PSG system, this work presents a distributed system composed of three modules, which together are capable of the simultaneous monitoring of environmental variables and patient signals. This system could reduce the distress of a PSG exam in certain cases, dismiss the need for an overnight sleep in a healthcare/sleep centre, and facilitate self-setup and internet-based diagnosis. Methods Hardware and software capable of synchronously monitoring, processing and logging into a µSD card environmental parameters (temperature, humidity, visible light intensity and audible noise level) and directly measured patient signals (electrocardiogram, electrooculogram, and body and limb posture) were designed and implemented. Results A novel alternative to the class III PSG system was demonstrated with independent boards capable of operating for more than 16 hours powered by a 750 mAh/3.7 V battery with 0.003% data loss during preliminary PSG exams. Additionally, a computer-based library capable of reading, decoding, estimating respiration through ECG, and calculating the heart rate was developed and described. Conclusion This article contributes to PSG research through the development of a new PSG system and the improvement of patient comfort. All software and hardware developed are fully open source and available on GitHub.

Enhancing the process of teaching and learning homecare / Mejorar el proceso de enseñar y aprender el cuidado domiciliar / Aprimorando o processo de ensinar e aprender o cuidado domiciliar

ABSTRACT Objective: to identify possibilities for improvement in the process of teaching and learning homecare in nursing, pharmacy, medicine, nutrition, dentistry and occupational therapy courses. Method: qualitative research using the Grounded Theory approach. Sixty-three semi-structured interviews were conducted with students, teachers and graduates of the six mentioned courses at a public university in the south of Brazil. Data analysis was performed through open, axial and selective coding. Results: the possibilities for improving the process of teaching and learning homecare included: scientific production in the area; use of different teaching techniques; development of extracurricular activities; extension projects; curricular reformulation; and laboratory simulation. Final considerations: the strategies cited in this study enable undergraduate courses in health to envisage the possibility of enhance the process of teaching and learning homecare.

RESUMEN Objetivo: señalar posibilidades de mejorar en el proceso de enseñar y aprender el cuidado domiciliar en los cursos de enfermería, farmacia, medicina, nutrición, odontología y terapia ocupacional. Método: pesquisa cualitativa, que utilizó la Teoría Fundamentada en los Datos como método. Fueron realizadas 63 entrevistas semi estructuradas con discentes, docentes y egresos de los seis cursos mencionados de una universidad pública del sur del país. El análisis de los datos ocurrió por medio de la codificación abierta, axial y selectiva. Resultados: se destacan entre las posibilidades de mejorar en el proceso de enseñar y aprender el cuidado domiciliar, la producción científica en el área, utilización de diferentes técnicas de enseñanza, desarrollo de actividades extracurriculares, proyectos de extensión, reformulación curricular y, simulación en laboratorio. Consideraciones finales: l as estrategias citadas en ese estudio permiten a los cursos de graduación en salud vislumbrar la posibilidad de incorporar o incrementar el proceso de enseñar y aprender el CD.

RESUMO Objetivo: apontar possibilidades de aprimoramento no processo de ensinar e aprender o cuidado domiciliar nos cursos de enfermagem, farmácia, medicina, nutrição, odontologia e terapia ocupacional. Método: pesquisa qualitativa, que utilizou a Teoria Fundamentada nos Dados como método. Foram realizadas 63 entrevistas semiestruturadas com discentes, docentes e egressos dos seis cursos mencionados de uma universidade pública do sul do país. A análise dos dados ocorreu por meio da codificação aberta, axial e seletiva. Resultados: destacam-se, entre as possibilidades de aprimoramento no processo de ensinar e aprender o cuidado domiciliar, a produção científica na área, utilização de diferentes técnicas de ensino, desenvolvimento de atividades extracurriculares, projetos de extensão, reformulação curricular e simulação em laboratório. Considerações finais: as estratégias citadas neste estudo permitem aos cursos de graduação em saúde vislumbrar a possibilidade de incorporar ou incrementar o processo de ensinar e aprender o CD.

Demand and willing to pay for oral hygiene service in long-term care insurance of elderly / 대한구강보건학회지

OBJECTIVES: This study was conducted to identify the demand and willingness to pay for oral hygiene services among elderly people with long-term care insurance. METHODS: Our study was a cross-sectional analysis. Subjects comprised 126 elderly individuals from long-term home-care centers. A total of 28 centers were selected through convenience sampling from among 78 centers in ○○. For analysis, semi-structured questionnaires that required about 20–30 minutes to complete were used. Analysis was performed using SPSS 23.0 software. RESULTS: The overall demand for oral hygiene services was 44.4%, and willingness to pay was 31.0%. Thirty-three people (58.9%) of elderly those who have demand for an oral hygiene service were willing to pay for the service, and 64 people (91.4%) who did not have a demand were not willing to pay for it. Among those with partial dependence on brushing, 65.6% had demand for oral hygiene services and 50.0% were willing to pay costs. Among basic livelihood beneficiaries, 69.6% were willing to pay for oral hygiene services; general subjects and relievers were less willing to pay. CONCLUSIONS: The overall demand for oral hygiene services among elderly people was 44.4%, and the willingness to pay was as low as 31.0%.

A Survey on the Current Status of Supporting Home Medication Use by Caregivers and of the Cooperation with Pharmacists / 社会薬学

The questionnaire was distributed to caregivers regarding their management for home medication therapy. The purpose of this questionnaire was to clarify the role of community pharmacists in city “Z”, Hiroshima in supporting this activity. The results were compared among seven administrative zones. The percentage of caregivers who had routinely administered medications to dependent patients was 81%. Of these, the percentage of caregivers who had encountered difficulty in medication administration to dependent patients was 66%. Only 13% of these caregivers had sought assistance from pharmacists in dealing with issues they faced in the administration of medications. The percentage of caregivers who had easy access to pharmacists was 44%. The percentage of caregivers who received pharmacist-initiated information about patients was 23%. Among the 7 administrative zones in city “Z”, the 2 zones (H-zones) with the highest percentage of elderly citizens, 38.7%, were compared with the other 2 zones (L-zones) with the lowest percentage of elderly citizens, 25.7%, regarding medication management by caregivers. It was observed that the frequency of missing side effects or crushing medicines by caregivers was higher in H-zones as compared to L-zones. The results of this research suggest that close cooperation between pharmacists and caregivers improves the quality of medication therapy management. In an aging society, pharmacist intervention could be very beneficial to providing support and information that would improve the quality of patients’ medication therapy.

A Survey on the Current Status of Supporting Home Medication Use by Caregivers and of the Cooperation with Pharmacists / 社会薬学

The questionnaire was distributed to caregivers regarding their management for home medication therapy. The purpose of this questionnaire was to clarify the role of community pharmacists in city “Z”, Hiroshima in supporting this activity. The results were compared among seven administrative zones. The percentage of caregivers who had routinely administered medications to dependent patients was 81%. Of these, the percentage of caregivers who had encountered difficulty in medication administration to dependent patients was 66%. Only 13% of these caregivers had sought assistance from pharmacists in dealing with issues they faced in the administration of medications. The percentage of caregivers who had easy access to pharmacists was 44%. The percentage of caregivers who received pharmacist-initiated information about patients was 23%. Among the 7 administrative zones in city “Z”, the 2 zones (H-zones) with the highest percentage of elderly citizens, 38.7%, were compared with the other 2 zones (L-zones) with the lowest percentage of elderly citizens, 25.7%, regarding medication management by caregivers. It was observed that the frequency of missing side effects or crushing medicines by caregivers was higher in H-zones as compared to L-zones. The results of this research suggest that close cooperation between pharmacists and caregivers improves the quality of medication therapy management. In an aging society, pharmacist intervention could be very beneficial to providing support and information that would improve the quality of patients’ medication therapy.

Sobrecarga dos cuidadores informais de pacientes de um serviço de atenção domiciliar / Burden of homecare patients' informal caregivers

Introdução: o ato de cuidar de um familiar, embora nobre, reveste-se de risco substancial de doenças, tanto físicas quanto mentais, para aquele que cuida, o cuidador informal. Por ser um processo complexo, pode ocasionar sobrecarga deste cuidador e comprometer sua qualidade de vida. Objetivo: avaliar a sobrecarga de cuidadores informais de pacientes acompanhados em um Serviço de Atenção Domiciliar. Método: pesquisa transversal, descritiva, não experimental, de abordagem quantitativa, com a participação de 79 pacientes e seus respectivos cuidadores informais. Os dados foram coletados por meio de um instrumento de caracterização dos participantes, aplicação do Índice de Desempenho de Karnofsky e Escala de Zarit, Burden Interview, e analisados por estatística descritiva, correlação e comparação de médias. Resultados: entre os cuidadores informais, houve idade média de 55 anos, maioria do sexo feminino (93,70%), casadas (64,60%), ensino médio completo (27,80%) e do lar (19,00%). Dentre os problemas de saúde, predominaram doenças do aparelho circulatório (30,80%) e uso de anti- hipertensivos (30,38%). Identificadas presença de dor (73,42%), classificada como intensa (43,10%), e utilização de serviços públicos de saúde (93,70%), com duas consultas médicas no último ano. Evidenciou-se que 94,90% dos cuidadores informais moravam no mesmo domicílio do paciente, em média três moradores por residência; 67,10% não recebiam apoio do parceiro para o cuidado, porém 63,30% referiram colaboração de alguma pessoa. O tempo médio dedicado ao cuidar foi de 24 horas semanais, 13,90% cuidavam de outras pessoas doentes, e o grau de parentesco predominante foi filho (38,00%). Não foi identificado absenteísmo do trabalho. Entre as tarefas realizadas, teve destaque auxiliar no vestuário (89,90%) e 82,30% mencionaram sono interrompido - média de seis horas por noite. Entre os pacientes, a idade média foi 71 anos, sexo masculino (51,90%), casado/união estável (43,00%), ensino fundamental incompleto (39,20%), média de três filhos, ocupação do lar (17,70%), com residência própria (72,20%), em uso de psicotrópicos e diagnóstico predominante de doenças do sistema nervoso (58,23%). O uso de fralda mostrou-se o dispositivo predominante (72,20%). Identificou-se grau de funcionalidade do paciente, pela Escala KPS, entre 50-60 (70,88%). Com relação à avaliação da sobrecarga do cuidador informal, esta foi classificada como moderada, sendo influenciada pela idade do cuidador (p=0,016), idade do paciente (p=0,047) e utilização do dispositivo gastrostomia (p=0,011). Conclusão: os dados apontam que as equipes multiprofissionais da atenção domiciliar devem propor ações individualizadas aos cuidadores informais, bem como os serviços públicos de saúde devem dispor de espaços capazes de acolhê-los e orientá-los segundo protocolos institucionais direcionados a essa parcela da população, com vistas à redução dos níveis de sobrecarga e consequente melhora da qualidade de vida

Introduction: the act of caregiving for a relative, despite being a noble attitude, is related to a substantial risk of diseases, physical and mental, to the person who acts as an informal caregiver. Since it is a complex process, it may lead to the caregiver's burden and compromise his or her life quality. Objective: evaluate the burden of informal caregivers of patients who are assisted by a Healthcare Service. Method: cross research, descriptive, not experimental, of quantitative approach, with a group of 79 patients and their respective informal caregivers. Data was obtained by a profiling instrument of the participants, applying of Karnofsky Performance Score (KPS) and Zarit's Scale, Burden Interview, analyzed by descriptive statistics, correlation and comparing of the average results. Results: among the informal caregivers, it was verified that the average age is 55 years, are mostly women (93,70%), married (64,60%), has a high school degree (27,80%) and housewives (19,00%). Among the health diseases, prevail the circulatory system diseases (30,80%) and use of antihypertensive drugs (30,38%). It was identified the occurrence of pain (73,42%), rated as intense (43,10%), and use of public health services (93,70%), with two medical checks last year. It was possible to verify that 94,90% of the informal caregivers lived at the same home as the patient, with an average of 03 people per domicile; 67,10% did not receive the spouse's support for caregiving, but 63,30% of them reported someone else's cooperation. The observed average time of caregiving was of 24 hours per week; 13,90% gives care for other sick people and the prevailing degree of relatedness is son /daughter (38,00%). Absence from work was not identified. Among the reported tasks, helping the person to get dressed stood out (89,90%). 82,30% of the caregivers mentioned the occurrence of interruption of sleeping (82,30%) - average of six hours per night. Among the patients, it was verified that the average age is 71 years, male (51,90%), married /in a stable union (43,00%), did not complete elementary school (39,20%), has an average of 03 sons, househusbands (17,70%), owner of its own domicile place, users of psychotropic substances and prevailing diagnosis of neurological system diseases (58,23%). Use of diapers is the predominant adopted measurement (72,20%). Identified performance status (KPS) between 50-60 (70,88%). About the informal caregiver's burden, it was rated as moderate level, being influenced by the age of the caregiver (p=0,016), age of the patient (p=0,047) and use of the gastrostomy device (p=0,011). Conclusion: collected data indicates that the homecare multiprofessional teams shall propose individual actions to the informal caregivers, as well as the public health services shall have proper places to teach them according to institutional protocols directed to them, aiming to reduce the burden levels and consequently offering a better quality of life

Study on the contents of the Family Type Integration of Medical Care and Health Services in Hangzhou / 中华护理杂志

Objective To develop the contents of Family Type Integration of Medical Care and Health Services in Hangzhou based on the Guiding Opinion on Promoting Integration of Medical Care and Pension issued by the State Council,Promotion Measures of Integration of Medical Care and Health Services in Hangzhou issued by the municipal government,and needs of health services for the elderly living in community.Methods The draft was formulated based on literature review,semi-structured interviews and expert meeting.Then,Delphi technique was used to identify the indicators through two rounds of expert consultation among 16 experts.Results The experts' authority coefficient was 0.790,the coefficient of determination was 0.906,and the familiar coefficient was 0.675.The contents of the Family Type Integration of Medical Care and Health Services in Hangzhou consisted of 8 firstlevel indicators,47 second-level indicators.The coordination coefficients of indicators were 0.341,0.222,and 0.426.Coordination of experts opinion had statistical significance (P＜0.01).Conclusion The contents of the Family Type Integration of Medical Care and Health Services in Hangzhou is reliable and scientific,which can be used as a basis for the formulation of items of the family type integration of medical care and health services in Hangzhou.

Interprofessional education in home-care: Collaboration of medical and rehabilitation students / 医学教育

　In the coming ″Super-aging society″ , collaboration between medical professionals and health workers in home-care will be critical. Thus, undergraduate interprofessional education is important for the improvement of a collaborative attitude. We ran a 2-day IPE program for a medical and a rehabilitation student focused on collaboration for patients who have chronic diseases and problems in Activities of Daily Life (ADL) . As a result, one showed marked improvement in ADL while the other did not. Students learned not only roles and perceptions of other professionals but also a sense of worth and an appreciation of the difficulty of patient-centered home-care.

MODELADO Y SIMULACIÓN DE UN ROBOT PARA CIRUGÍA ENDOSCÓPICA TRANSLUMINAL / EVALUATION METHOD OF THE USE OF MEDICAL DEVICES IN THE HOMECARE ENVIRONMENT

El uso de dispositivos médicos en el hogar, originalmente diseñados para uso hospitalario, ha aumentado. Su uso es complejo e inseguro debido a la inexperiencia del usuario y el entorno no controlado. El objetivo de este estudio es evaluar la seguridad en el uso de este tipo de dispositivos a través de la creación de un modelo conceptual que identifica los riesgos que podrían surgir para un grupo de usuarios inexpertos que los operan. A través de un estudio de usabilidad y siguiendo la metodología Grounded Theory se identificaron problemas y errores que emergen a través del uso en el hogar de dos dispositivos médicos distintos con la finalidad de crear un modelo conceptual. El modelo conceptual obtenido es representado en una herramienta de evaluación, que permite a los interesados identificar el dispositivo médico más apropiado para un usuario específico, detectando las debilidades que pueden llevar a un uso inseguro. La herramienta creada efectivamente permite detectar las características de riesgo, considerando cada situación particular de uso.

The use of medical devices in the home environment, originally designed for hospital use has increased. Its use is complex and uncertain because of the inexperience of the lay user and the uncontrolled environment. The objective of this study is to evaluate the safety in the use of these devices through the creation of a conceptual model that identifies the risks that could arise for a group of lay users who operate them. Through a usability study and following the Grounded Theory methodology problems and errors were identified emerging through the home use of two different medical devices in order to create a conceptual model. The conceptual model obtained is reified as an evaluation tool that allows stakeholders to identify the most suitable medical device for a specific user, detecting the weaknesses that may lead to an unsafe use. The evaluation tool created effectively allows detecting risky characteristics, considering the particular situation of use.

A construção do cuidado pela equipe de saúde e o cuidador em um programa de atenção domiciliar ao acamado em Porto Alegre (RS, Brasil) / The construction of care by the health team and the caretaker within a home-care program for bedridden patients in Porto Alegre (RS, Brazil)

Este artigo é um estudo de caso cujo objetivo principal foi compreender a construção do cuidado no Programa de Atendimento Domiciliar ao Acamado (PADA) de uma unidade básica de saúde (UBS) em Porto Alegre, RS. Os dados foram obtidos em 13 grupos de cuidadores na UBS e em observação participante registrada em diário de campo nos domicílios. Foi realizada análise das práticas discursivas, inspirada nos conceitos de discurso de Foucault e nos estudos sobre ética e cuidado de si. No transcurso dos grupos, os cuidadores ocuparam um espaço que chamamos metaforicamente de Oráculo de Delfos, lócus de acolhimento, escuta e de suporte. Escutar os diálogos travados entre equipe e cuidadores defrontou-nos com a contradição presente no discurso institucional que ao mesmo tempo que estimula o cuidado de si impõe normas, deveres e fazeres. O cuidado como direito de cidadania em contraposição ao cuidado como submissão e assujeitamento tensionou o grupo em vários momentos. A noção foucaultiana de cuidado compreende uma síntese entre o exercício de uma pessoa sobre ela mesma, tornando-a melhor como ser humano e, ao mesmo tempo, capacitando-a a se tornar melhor como cidadão.

The main objective of this case study was to understand the construction of care in the Homecare Program for Bedridden Patients (PADA) of a basic health unit (UBS) in Porto Alegre, RS. Data were obtained from 13 caretaker groups in the UBS, and participating observation recorded in field diary in the patient's homes. An analysis of the discourse practices was performed inspired in Foucault's discourse concepts speeches and in studies on ethics and self-care. In the groups, the caretaker occupied a space that we metaphorically called the Delphic Oracle, a place for acceptance, listening and support. Hearing the dialogues that took place between the team and the caretakers made us face the contradiction present in the institutional discourse, which both stimulates self-care, and imposes rules, duties, tasks. Care as a citizenship right opposite to care as submission and subjugation created tension inside the group several times. Foucault's notion of care comprises a synthesis of the exercise of a person over his- or herself, making him or her better as a human being and, at the same time, capacitating him or her to become a better citizen.

Fatores potencialmente associados à negligência doméstica entre idosos atendidos em programa de assistência domiciliar / Factors potentially associated to domestic negligence among elders assisted in home assistance program

A violência contra idosos é uma questão social cada vez mais presente em todas as sociedades, até nos países em desenvolvimento. Uma das formas de violência menos conhecidas e denunciadas é a negligência doméstica, especialmente contra idosos que apresentam comprometimento funcional. Este artigo apresenta resultados de um estudo transversal descritivo/analítico realizado com cuidadores familiares de idosos comprometidos atendidos pelo Programa de Assistência Domiciliar a Idosos, da disciplina de geriatria da Escola Paulista de Medicina (Unifesp), com o objetivo de identificar a existência de fatores potencialmente associados à negligência doméstica na situação de cuidados domésticos prestados por familiares. Foram entrevistados quarenta cuidadores, sendo aplicados os questionários de identificação de perfil de idoso e cuidador e o instrumento Caregiver Burden Scale. Os resultados encontrados mostraram a existência de fatores potencialmente associados à negligência doméstica no perfil de idosos e cuidadores e nas correlações significativas entre as variáveis comprometimento funcional do idoso, ações de cuidados e depressão do cuidador, nas dimensões tensão geral e isolamento.

The cases of abuse against elderly people have been growing significantly throughout the entire world. Among the various forms of abuse, one of the less known and denounced is the domestic negligence. As it occurs mostly inside family and nursing homes, it is hardly identified. This article presents the results of a cross-sectional descriptive/analytical study that pointed out the existing factors potentially associated to domestic negligence towards elderly patients attended by the Elderly Home Care Program as part of the discipline of Geriatrics of the Paulista Medical School, Federal University of São Paulo, Brazil. Interviews were made with 40 familiar caregivers of these patients who had functional disability. The profiles of those patients and their caregivers were identified by questionnaires and the impact on those familiars by the Caregiver Burden Scale. The results revealed the existence of the following factors potentially associated with domestic negligence among elderly people, in the study population: the dimensions general tension and isolation, as well as depression and stress on the caregiver's side, and the elder's functional ability, are the causes that impact the most on caregivers.

Qualitative analysis of the subjective evaluation of home-care training by resident trainees / 医学教育

The aim of this research was to explore the educational effects of home-care training on resident trainees which have not previously been deliberately examined. We performed a qualitative study. Focus-group interviews were conducted to explore the views of residents who underwent medical training in 3 different settings: inpatient, outpatient, and home-care. Analysis of the interview data revealed 8 categories of resident experiences and their views on the effects of home-care training: 1)recognition of the importance of the concerns of the patient and the family in medical communication; 2)development of patient-centered and family-centered attitudes; 3)acquisition of the knowledge and skills of management, other than medical management, in home-care; 4)appropriate cooperation with other health professionals; 5)recognition of options for care settings; 6)knowledge of the community; 7)recognition of healthcare resources in the community; and 8)acquision of effective use of medical knowledge and skills. The findings of this study suggest that home-care training is effective for helping residents to develop patient-centered communication skills and attitudes and to develop management skills for a multidisciplinary team in the community to complement medical training in inpatient and outpatient settings.

Atención domiciliaria de la persona anciana: una perspectiva bioética / Atenção domiciliária da pessoa idosa: uma perspectiva bioética / Home care for the elderly: a bioethical view

Una práctica cada vez más frecuente es la atención domiciliaria de las personas ancianas, la cual genera ciertos problemas que dependen directamente de la longevidad misma, de la patología que pueden padecer y de la actitud que asumen sus familiares o quienes los atienden. El artículo presenta una reflexión sobre esta realidad desde la perspectiva Bioética, con el ánimo de proponer cambios en las actitudes que se adoptan frente al anciano que es atendido en la casa.

A atenção domiciliária das pessoas idosas é uma prática cada vez mais freqüente. Esta origina alguns problemas que dependem diretamente da longevidade do paciente, da patologia que pode sofrer e da atitude que assumam os seus familiares ou quem os cuidam. Neste artigo apresenta-se uma reflexão sobre esta realidade desde a perspectiva bioética, a fim de introduzir mudanças nas atitudes adotadas frente aos idosos cuidados é tratado em casa.

Home care for the elderly is becoming increasingly common. This creates certain problems that are directly dependent on the patient’s longevity, pathology and the attitude assumed by the patient’s family members or caregivers. The article examines the facts of this situation from the standpoint of bioethics, in an effort to propose changes in the attitudes adopted towards the elderly who are cared for at home.

Costo de hospitalización domiciliaria como alternativa de la hospitalización institucional: periodo enero-diciembre de 2007 / Cost of home care as alternative institutional hospitalization: period January-December 2007

Objetivo: Valorar el costo del servicio de hospitalización domiciliaria en comparación a la hospitalización institucional, teniendo en cuenta el perfil epidemiológico y los días estancia. Métodos: Estudio descriptivo, retrospectivo, longitudinal, realizado con pacientes pertenecientes a una compañía de seguros con productos como pólizas de salud y medicina prepagada, que hicieron uso del servicio de hospitalización domiciliaria e institucional en el período comprendido entre enero - diciembre del año 2007. Resultados: Se encontró que el costo de la hospitalización domiciliaria es el 18% del total del costo de la hospitalización institucional. Se evaluó la diferencia por perfil epidemiológico y por número de días estancia. Conclusiones: La hospitalización domiciliaria es una opción para disminuir el costo de la atención y permite la recuperación del paciente en su entorno.

Objective: To evaluate the cost of hospital at home compared to hospital institution, taking into account the epidemiological profile and the days stay. Methods: A retrospective, longitudinal, conducted with patients of an insurance company with products like health insurance and prepaid-medicine, which made use of hospital and institutional home for the period January to December of 2007. Results: We found that the cost of home hospitalization is 18% of the total institutional cost of hospitalization. The difference was evaluated by epidemiological profile and number of days stay. Conclusions: The home care is an option to reduce the cost of care and allows the recovery of the patient in his environment.

A hipertensão arterial e a família: a necessidade do cuidado familiar / La hipertensión arterial y la familia: la necesidad del cuidado familiar / Arterial hypertension in the family: the need for family care

O estudo, de caráter qualitativo, foi desenvolvido no período de março a julho de 2007, em Maringá - PR, com o objetivo de compreender a experiência da família com a hipertensão arterial (HA), utilizando a Teoria Fundamentada nos Dados como referencial metodológico. Os informantes foram 14 famílias que convivem com diferentes estágios da HA. Os dados foram obtidos por meio de entrevistas abertas. Os resultados revelaram que a participação da família é um importante fator para o tratamento e controle da doença, e que esta atuação é diferenciada quando o indivíduo apresenta alguma dependência. Se ocorre dependência, há sobrecarga do cuidador; quando esta não existe, a participação da família é esporádica, resumindo-se em auxiliá-lo no tratamento medicamentoso e acompanhá-lo em visitas ao médico. Em alguns casos, outros membros familiares apresentam mudanças de hábitos relacionadas à alimentação e à prática de atividades físicas. Os resultados reforçam a necessidade de uma assistência ao hipertenso centrada na família.

This qualitative study was performed from March to July 2007 in the city of Maringá, Paraná State, Brazil, and aimed to understand the family's experience with arterial hypertension (AH), using Grounded Theory as the methodological framework. Informants were 14 families that live with different AH stages. The data were obtained through open interviews. The results showed that family participation is an important factor for disease treatment and control, and that this action is differentiated when individuals present some sort of dependence. If dependence occurs, there is caregiver overload; when dependence does not exist, family participation is sporadic, being limited to helping the patients in the drug treatment and accompanying them to the medical appointment. In some cases, other family members present habit changes relating to food and practicing physical activities. The results reinforce the need for family-centered hypertensive patient care.

El estudio, de carácter cualitativo, fue desarrollado en el período de marzo a julio de 2007, en Maringá - PR, con el objetivo de comprender la experiencia de la familia con hipertensión arterial (HA). La Teoría Fundamentada en los Datos fue utilizada como marco metodológico. Los informantes fueron 14 familias que conviven con diferentes niveles de la HA. Los datos fueron obtenidos por medio de entrevistas abiertas. Los resultados revelaron que la participación de la familia constituye un importante factor para el tratamiento y control de la enfermedad y que esta actuación es diferenciada cuando el individuo presenta alguna dependencia. Si ocurre dependencia, aparece una sobrecarga para el cuidador; cuando esta no existe, la participación de la familia es esporádica, resumiéndose a auxiliarlo en el tratamiento medicamentoso y a acompañarlo en las visitas al médico. En algunos casos, otros miembros familiares presentan un cambio de hábitos, relacionados a la alimentación y a la práctica de actividades físicas. Los resultados refuerzan la necesidad de ofrecer una asistencia al hipertenso centrada en la familia.

Clínica ampliada em saúde mental: cuidar e suposição de saber no acompanhamento terapêutico / Wide-spectrum clinical interventions in mental health: “care” and “subject supposed to know” in therapeutic assistance

Este trabalho investiga o acompanhamento terapêutico, entendido como intervenção em saúde mental baseada em cuidados domiciliares. Destacamos a importância de intervenções comunitárias privilegiando formas de lidar com o sofrimento, seja através de uma concepção médica dos sintomas, fundada na visibilidade, seja valorizando uma leitura psicanalítica que recorre à escuta. Carecendo de teorização independente que fundamente sua prática, o AT (acompanhamento terapêutico) apropria-se de teorias provenientes de outros campos do saber que guardam afinidades. Neste sentido, abordamos a influência da psicanálise e sua participação na clínica ampliada em saúde mental através da prática clínica do AT, utilizando dois conceitos operatórios de amplo alcance, que são: sujeito suposto saber, proveniente da obra de Lacan, e cuidado, derivado de Winnicott. Ambos respondem a questões do campo teórico e orientam a atuação clínica. Concluímos que o AT realiza exigências do manejo transferencial sob a forma do cuidar exercido no cotidiano do sujeito, no qual desejo e subjetividade são necessariamente reconhecidos, sem que se configure como tecnologia psicoterápica, situando-se mais propriamente como sentinela clínica no campo da psiquiatria comunitária e saúde coletiva.

This paper discusses the theme therapeutic assistance (TA), understood as homecare-based mental health intervention. We emphasize the importance of community interventions for dealing with psychic suffering, either through reading the symptoms based on visibility, or through a psychoanalytic approach mainly concerned with listening. Lacking an independent theoretical background to support this practice, therapeutic assistance makes use of theories coming from other related fields of knowledge. Therefore, we discuss the influence of psychoanalysis and its role among broad spectrum mental health practice through clinical interventions belonging to the field of TA, focusing on two long-range operative concepts: Lacan's subject supposed to know and Winnicott's care (or caring process). Both concepts guide the clinical action and provide answers to theoretical problems within the TA field. We conclude that TA meets some requirements of the classical management of transference by means of a complex care process developed in the daily life and environment of the patient, in which desire and subjectivity are necessarily recognized although no psychotherapic setting is intentionally settled. Therapeutic assistance performs the role of an advanced clinical sentinel in the field of community psychiatry and public health.