Operationality of concepts in Heideggerian phenomenological investigation: epistemological reflection on Nursing / Operación de los conceptos en investigación fenomenológica heideggeriana: reflexión epistemológica en la enfermería / Operacionalidade de conceitos em investigação fenomenológica heideggeriana: reflexão epistemológica na enfermagem

ABSTRACT Objective: To describe the investigative path of analysis and the operationality of concepts based on Martin Heidegger's theoretical and philosophical framework. Method: Theoretical reflection on the phenomenon of pregnancy in a woman with heart disease. Results: Stages of the investigative movement were evidenced based on the pre-reflection related to the object of study and to the search for the phenomenal meaning, using the existential and analytical Hermeneutics as the approach and resulting in the reach of the phenomenal totality. Conclusion: The worldview of the researcher, who considered the subjectivities of the person in a health or disease situation, favored the announcement of the referential by the object of study. Knowledge production in the light of Martin Heidegger's phenomenology unveiled phenomena lived and experienced in the Health and Nursing field, provided of epistemological rigor that demanded appropriation of concepts inherent to the existential analytics.

RESUMEN Objetivo: Describir el camino investigativo de análisis y la operación de los conceptos sostenidos en el referencial teórico-filosófico y metodológico de Martin Heidegger. Método: Reflexión teórica del fenómeno de gestar siendo mujer portadora de cardiopatía. Resultados: Se evidenciaron las etapas del movimiento de investigación a partir del pre-reflexivo relativo al objeto de estudio y de la búsqueda del sentido fenomenal hacia la hermenéutica como analítica existencial, culminando en el alcance de la totalidad fenoménica. Conclusión: La visión de mundo del investigador, que consideró las subjetividades de la persona en situación de salud o enfermedad, favoreció que el objeto de estudio anunciara el referencial. La producción de conocimiento a la luz de la fenomenología de Martin Heidegger desveló fenómenos vividos y vivenciados en el campo de la salud y de la enfermería, mediante rigor epistemológico que exigió apropiación de conceptos inherentes a la analítica existencial.

RESUMO Objetivo: Descrever o caminho investigativo de análise e a operacionalidade de conceitos sustentados no referencial teórico-filosófico e metodológico de Martin Heidegger. Método: Reflexão teórica do fenômeno de gestar sendo mulher portadora de cardiopatia. Resultados: Evidenciaram-se as etapas do movimento de investigação a partir do pré-reflexivo relativo ao objeto de estudo e da busca do sentido fenomenal na direção da hermenêutica como analítica existencial, culminando no alcance da totalidade fenomênica. Conclusão: A visão de mundo do investigador, que considerou as subjetividades da pessoa em situação de saúde ou doença, favoreceu que o objeto de estudo anunciasse o referencial. A produção de conhecimento à luz da fenomenologia de Martin Heidegger desvelou fenômenos vividos e vivenciados no campo da saúde e da enfermagem, mediante rigor epistemológico que exigiu apropriação de conceitos inerentes à analítica existencial.

Low prevalence of relevant findings in inappropriate echocardiograms and discordant perceptions between cardiologists and patients

Complementary examinations are "inadequate" whenever the likelihood of benefits from their indication is lower than the negative results. The low benefit is a result of poor performance in detecting relevant changes that lead to improved behavior. However, inadequate examinations are prevalent and little is known about patients' notions of the usefulness of such indications. The aim of this study was to describe relevant findings in inappropriate echocardiograms and to assess the level of agreement between patients and cardiologists regarding their usefulness. Adults without known cardiovascular disease who were referred for echocardiogram by inappropriate criteria according to the American College of Cardiology were selected. Relevant findings were defined by any change in the degree of moderate to severe, according to the American Society of Echocardiography. We tested the level of agreement between the patients who underwent echocardiographic examination and the physicians who requested the exam through a standard questionnaire. Five hundred patients were included, with average age of 52±17 years (47% males). Only 17 patients had any relevant changes (3.4%, 95%CI=2 to 5.4%). The most frequent alterations included valve changes in 8 and diastolic dysfunction grade II in 6 patients. Eighty-seven examinations were performed to determine the level of agreement between patients and cardiologists. For the question "Is this test really necessary?", 92% of patients responded positively, compared with 5% of cardiologists (Kappa negative 0.04; P=0.01). The frequency of relevant findings was low in inadequate echocardiograms and patients and cardiologists had a different perception regarding its usefulness.

Impacto de un programa de rehabilitación cardiovascular fase II sobre la calidad de vida de los pacientes / Quality of life: impact of a phase II cardiovascular rehabilitation program

Antecedentes: La rehabilitación cardiovascular (RCV) ha demostrado mejorar la capacidad física (CF) y la calidad de vida. La relación de estos aspectos ha sido escasamente reportada en Chile. Objetivos: 1) Determinar el impacto de la RCV fase II sobre la calidad de vida, medida por la encuesta SF36 y, 2) determinar qué factores, relacionados con el paciente, pueden incidir en esta relación. Método: Estudio prospectivo en sujetos que completaron 36 sesiones de un programa de RCV y Prevención Secundaria (PREV2). Se registraron al ingreso y final de la RCV: antecedentes médicos, factores de riesgo cardiovascular (CV), parámetros antropométricos, previsión de salud, CF (determinada por los metros caminados en test de marcha de 6 minutos-TM6) y puntaje en la encuesta SF36. Resultados: 277 sujetos (78% hombres, edad 59 años). Hubo una mejoría significativa en: a) los metros caminados (diferencia final/inicial= 56 metros, p<0.0001), b) puntaje de salud física (68 vs 79; p<0.0001), c) salud emocional (68 vs 78, p<0.0001) del SF36. Los hombres caminaron más metros promedio (p<0.0001). Hubo una asociación significativa entre los deltas del TM6 final-inicial y SF36 final-inicial, sólo para salud física (p<0.01). Por un aumento de 10 metros caminados en el TM6 final se incrementa el puntaje de la SF36 para salud física (Hombres: 0.38/ Mujeres: 1.52). La mejoría en la salud emocional sólo se asoció significativamente con los cambios en la salud física (p<0.0001). Conclusion: Los pacientes que asisten a un programa de RCV mejoran significativamente su capacidad aeróbica, y su percepción de salud física y emocional.

Background: Cardiovascular rehabilitation (CVR) has been shown to improve functional capacity (FC) and quality of life. The relation between these aspects has been scarcely reported in Chile. Objectives: 1) To determine the impact of the CVR phase II program on quality of life as measured by the SF36 survey and 2) to determine which patient related factors can influence this relationship. Method: Prospective study in subjects who completed 36 sessions of an RCV and Secondary Prevention program (PREV2). Medical records, cardiovascular risk factors (CV), anthropometric parameters, health forecast, functional capacity (FC) (determined by meters walked on 6-minute Walking test-TM6) and SF36 scores were recorded at the beginning and end of the CVR. Results: Data on 277 subjects (78% men, age 59 years) was analyzed. There was a significant improvement in: a) walking meters (final / initial difference = 56 meters, p <0.0001), b) physical health score (68 vs 79, p <0.0001), c) emotional health (68 vs 78, p <0.0001) of the SF36. The men walked more meters (p <0.0001). There was a significant association between delta TM6 final-initial and SF36 final-initial only for physical health (p <0.01). For an increase of 10 meters walked in the final TM6, SF36 score for physical health increased 0.38 points in men ad 1.52 in women. Improvement in emotional health was significantly associated only with changes in physical health (p <0.0001). Conclusion: Patients attending a phase II cardiovascular rehabilitation program significantly improve their aerobic capacity, and their perception of physical and emotional health.

Robin Williams' suicide: a case study / O suicídio de Robin Williams: estudo de caso

Abstract Introduction: The world renowned comedian and four-time Oscar nominated actor Robin Williams died on August 11, 2014. From the outset, the news indicated that his death was believed to be a suicide and this was later confirmed to be true by the autopsy reports. Williams had been suffering from severe depression, which is believed to be the leading contributor to his suicide. In this case study, I will highlight the event of the actor's suicide and the main risk factors along with depression leading to his tragic death. As of the end of 2015, no other case study seemed to have addressed or explored the links between the cause (or causes) and events leading to Robin Williams' suicide. Case description: Robin Williams was suffering from relationship problems, financial problems, drug addiction, and major depression. All of these factors led to his suicide. Comments: The chances of committing suicide drastically increase in the presence of any of the key risk factors. Unfortunately, the actor Robin Williams was dealing with four of the major risk factors all together, which put him at a high risk of committing suicide and eventually led to his tragic death.

Resumo Introdução: O ator Robin Williams, comediante reconhecido internacionalmente e quatro vezes indicado ao Oscar, faleceu no dia 11 de agosto de 2014. Desde o início, os noticiários indicavam que sua morte provavelmente resultara de suicídio, e isso foi confirmado posteriormente nos relatórios da autópsia. Williams vinha sofrendo de depressão severa, a qual, acredita-se, foi o fator que mais contribuiu para seu suicídio. Neste estudo de caso, vou discorrer sobre o suicídio do ator e sobre os principais fatores de risco, além da depressão, que levaram à sua morte trágica. Do final de 2015 para cá, nenhum outro estudo de caso parece ter abordado ou explorado as associações entre a causa (ou as causas) e os eventos que levaram ao suicídio do ator Robin Williams. Descrição do caso: Robin Williams vinha sofrendo com problemas de relacionamento, problemas financeiros, abuso de drogas e depressão severa. Todos esses fatores levaram ao seu suicídio. Comentários: As chances de cometer suicídio aumentam drasticamente na presença de qualquer fator de risco chaves. Infelizmente, o ator Robin Williams estava exposto a quatro fatores de risco chaves simultaneamente, colocando-o sob um alto risco de cometer suicídio, o que eventualmente culminou com sua trágica morte.

Development of Brazilian prototypes for short-term psychotherapies / Desenvolvimento de protótipos brasileiros para psicoterapias de curta duração

Abstract Introduction: The Psychotherapy Process Q-Set (PQS) prototype method is used to measure the extent to which ideal processes of different psychotherapies are present in real cases, allowing researchers to examine how adherence to these models relates to or predicts change. Results from studies of short-term psychotherapies suggest that the original psychodynamic prototype is more suitable for studying psychoanalysis and long-term psychodynamic psychotherapy than its time-limited counterparts. Furthermore, culture probably influences how therapies are typically conducted in a given country. Therefore, it seems appropriate to develop Brazilian prototypes on which to base studies of short-term psychodynamic and cognitive-behavioral processes in this country. Objective: To develop prototypes for studying processes of short-term psychotherapies and to examine the degree of adherence of two real psychotherapy cases to these models. Methods: Expert clinicians used the PQS to rate a hypothetical ideal session of either short-term psychodynamic psychotherapy (STPP) or cognitive-behavioral therapy (CBT). Ratings were submitted to Q-type factor analysis to confirm the two groups. Regressive factor scores were rank ordered to describe the prototypes. These ideal models were correlated with ratings of actual therapy processes in two complete psychotherapy cases, one STPP and the other CBT. Results: Agreement levels between expert ratings were high and the two ideal models were confirmed. As expected, the PQS ratings for actual STPP and CBT cases had significant correlations with their respective ideal models, but the STPP case also adhered to the CBT prototype. Conclusion: Overall, the findings reveal the adequacy of the prototypes for time-limited therapies, providing initial support of their validity.

Resumo Introdução: O método dos protótipos derivados do Psychotherapy Process Q-Set (PQS) mensura em que medida processos de diferentes psicoterapias estão presentes em casos reais, permitindo pesquisadores examinarem como a adesão a esses modelos se relaciona com ou prediz a mudança. Resultados de estudos com psicoterapias breves sugerem que o protótipo psicodinâmico original é mais adequado para estudar psicanálise e psicoterapia psicodinâmica de longo prazo do que suas variantes de tempo limitado. Além disso, a cultura provavelmente influencia o modo como as psicoterapias são tipicamente conduzidas em determinado país. Portanto, parece apropriado o desenvolvimento de protótipos brasileiros para subsidiar estudos de processos psicodinâmicos e cognitivo-comportamentais de curto prazo neste país. Objetivo: Desenvolver protótipos para o estudo dos processos de psicoterapias de curta duração e examinar o grau de adesão de dois casos reais de psicoterapia a esses modelos. Métodos: Especialistas brasileiros usaram o PQS para avaliar uma sessão hipotética ideal de psicoterapia psicodinâmica breve (PPB) ou de terapia cognitivo-comportamental (TCC). A análise fatorial do tipo Q foi realizada para confirmar os dois fatores. Os escores fatoriais regressivos foram ordenados para descrever os protótipos. Os protótipos foram correlacionados com as avaliações de processos reais de terapia em dois casos completos, um de PPB e outro de TCC. Resultados: Houve alta concordância entre especialistas, e os dois modelos ideais foram confirmados. Como esperado, os escores do PQS para os casos reais de PPB e TCC apresentaram correção significativa com seus respectivos modelos ideais, mas o caso de PPB aderiu também ao protótipo TCC. Conclusões: No geral, os resultados revelam a adequação dos protótipos para terapias com tempo limitado, fornecendo suporte inicial de sua validade.

Aspectos emocionais do paciente cardíaco cirúrgico no período pré-operatório / Emotional aspects of the cardiac surgical patient during the preoperative period

As doenças cardiovasculares são a principal causa de óbitos no Brasil. A intervenção cardíaca traz consigo grande carga emocional e anseios característicos naquele que se submeterá a ela, o que pode ser minimizado através do apoio psicológico nesta situação de crise. Para tanto, faz-se necessário investigar como se caracterizam os aspectos emocionais de tal paciente, sendo esse o objetivo dessa pesquisa qualitativa. O estudo contou com a participação de quatro pacientes cardíacos cirúrgicos, no período pré-operatório, de um hospital geral de Porto Alegre - RS. Na avaliação desses pacientes foram utilizadas uma entrevista e duas escalas, uma de ansiedade e outra de depressão. Os dados foram tratados por análise de conteúdo e descritivas. Os resultados indicaram que a metade dos pacientes apresentava um nível de ansiedade grave. Algumas emoções verbalizadas foram: dificuldade de aceitação, medo da ineficácia cirúrgica, de sentir dor, de ficar incapacitado para o trabalho e de morrer

Cardiovascular diseases are the leading cause of death in Brazil. Cardiac intervention brings great emotional burden and characteristic anxities in the person who will be submitted to it, which can be minimized through psychological support in this crisis situation. Therefore, it is necessary to investigate how to characterize the emotional aspects of such a patient, which is the purpose of this qualitative research. The study involved the participation of four cardiac surgical patients in the preoperative period in a general hospital in Porto Alegre-RS. An interview and two scales were used in the evaluation of these patients: one for anxiety and another for depression. The data were analyzed through content and descriptive analysis. The results indicated that half of the patients had a severe anxiety level. Some verbalized emotions were: difficulty of acceptance, fear of surgery ineffectiveness, of experiencing pain, of being unable to work and of dying

[ effect of spiritual care based on GHALBE SALIM model on spiritual experience in patients with coronary artery disease]

Patients, who have experienced a heart attack, indicate the dominant role of spirituality in passing this stressful and dangerous event. The purpose of this study was to assess the effect of spiritual care based on GHALBE SALIM model on spiritual experience in patients with coronary artery disease. This is a clinical-trial study that done on 60 CAD patients in Baqyatallah hospital coronary care unit in 2013. Samples were chosen with base on target method sampling and had been studied randomly in two intervention and control groups. Spiritual care program based on GHALBE SALIM model performed from hospitalization until discharge in unit for intervention group. Daily spiritual experiences scale, before and two months later was completed in both groups. Data of research with descriptive statistics [mean, standard deviation, and frequency] and inferential statistics [chi-square, paired and independent t] and using with SPSS software version 18 were analyzed. Findings showed that total score of spiritual experiences after the intervention groups compared with the control group did differ significantly [p<0.001]. Spiritual care based on GHALBE SALIM model, enhanced the spiritual experience of patients. As a result, the achievement of peace and freedom from stress and psychological adjustment to the disease and indirectly helps to treatment status and health

Preferencias de los pacientes sobre la información de su enfermedad / Patients' preferences for information in health care decision-making

Se realizó una encuesta a pacientes que concurrían a servicios de cardiología para conocer cómo preferían ser informados sobre su estado de salud, y las características sociodemográficas asociadas con estas preferencias, considerando los siguientes ítems: conocimiento sobre la enfermedad, información sobre opciones terapéuticas y toma de decisiones. De 770 encuestados, 738 (95.8%) respondieron completamente el formulario. Se observó una tendencia a confiar sólo en el médico para obtener información (81.7%), a querer conocer las opciones de tratamiento y poder opinar (85.9%) y en menor medida, a la participación de la familia en las decisiones (63.2%). El 9.6% deseaba recibir la información mínima necesaria o "no saber nada" sobre una presunta enfermedad grave. Los varones fueron menos proclives a solicitar opciones y dar opinión (OR: 0.64), dando menos libertad a la participación familiar (OR: 1.31). Los de menor nivel socioeconómico reclamaron menos opciones (OR: 0.48) y dieron menor participación familiar (OR: 1.79). Los provenientes de otros países de Sudamérica tuvieron una menor tendencia a reclamar opciones y manifestar opinión (OR: 0.60); y los de menor nivel educativo confiaron menos en el conocimiento del médico (OR: 1.81), exigieron menos opciones (OR: 0.45) y prefirieron no conocer la gravedad de la enfermedad (OR: 0.56). El análisis de las variables demográficas permitió definir distintas preferencias de información asociadas a la edad, sexo, procedencia, educación, religión y estado de salud. Se concluye que, aunque es imperativo promover la autonomía del paciente, se deben conocer las preferencias individuales antes de informar y comprometer al paciente en el proceso de toma de decisiones sobre su enfermedad.

A survey was carried out among patients who concurred to cardiologic services to know how patients preferred to be informed about their health status, and the demographic characteristics associated to these preferences, considering the following items: knowledge about the disease, information about different therapeutic options and decision-making. From 770 people surveyed, 738 (95.8%) answered the form completely. A trend to trust only in the doctor's knowledge to obtain information (81.7%), in wanting to know the options of treatment and express one's point of view (85.9%), and to involve the family in the decisions (63.2%) was observed. 9.6% preferred to receive the minimum necessary information or "to know nothing" about an alleged serious disease. Males tended less to request options and give opinion on the subject (OR: 0.64), giving less freedom to family involvement (OR: 1.31). People with a lower social and economical level claim fewer options (OR: 0.48) and gave less family participation (OR = 1.79). Natives from other South American countries had a minor tendency to demand for options and express their thoughts (OR: 0.60); and the ones with lower education level trusted less in the doctor's knowledge (OR: 1.81), demanded fewer options (OR: 0.45) and chose not to know the severity of the disease (OR: 0.56). The analysis of the demographical variables allowed to define preferences associated to age, sex, origin, education, religion and health status. In conclusion, although it is imperative to promote the patient's autonomy, individual preferences must be taken into account before informing and compromising the patient in decision-making about his disease.

Influência do perfil clínico e sociodemográfico na qualidade de vida de cardiopatas submetidos à reabilitação cardíaca / Influence of socio-demographic and clinical profiles in quality of life of cardiac patients undergoing cardiac rehabilitation

Introdução: Programas de reabilitação cardiovascular são fundamentais para garantir uma melhor qualidade de vida (QV) em pacientes cardiopatas. Objetivos: Avaliar a QV de pacientes submetidos à reabilitação cardíaca (RC) e investigar se aspectos sociodemográficos, tipo de diagnóstico e tempo de tratamento são variáveis que influenciam a QV desses pacientes. Métodos: Realizou-se um estudo transversal com 82 pacientes, 64,52 ± 9,04 anos, que responderam dois questionários, para avaliação da QV (questionário SF-36) e para classificação do nível socioeconômico, e tiveram seu nível sociodemográfico determinado. Resultados: Maiores valores dos escores do questionário SF-36 que avaliam aspectos emocionais foram observados em todas as associações realizadas. Os aspectos do perfil da amostra abordados neste estudo não repercutiram de forma representativa na QV. Conclusão: Pacientes cardiopatas submetidos à RC apresentaram maiores valores em escores de qualidade de vida que avaliam aspectos emocionais. Os fatores estudados não influenciaram a QV desses participantes.

Introduction: Cardiovascular rehabilitation programs are fundamental to ensure a better quality of life (QL) in cardiac patients. Objective: Evaluate the QL of patients undergoing cardiac rehabilitation (CR) and investigate if demographic aspects, diagnosis and treatment time are variables that influence on these patients QL. Methods: It was conducted a cross-sectional study with 82 patients, 64,52 ± 9,04 years old, who answered two questionnaires, for QL assessment (questionnaire SF-36) and for socioeconomic level classification, and their socio-demographie profile determined. Results: Higher values of scores of SF-36 questionnaire that assess emotional aspects were observed in all associations held. The sample profile aspects addressed in this study did not represent echo in QL. Conclusion: Cardiac patients submitted to RC showed greater benefits on emotional aspects and factors studied did not influence on these patients QL.

Elaboración y validación de una escala de calidad de vida para pacientes con cardiopatía / Elaboration and validation of a life quality scale for patients with cardiovascular diseases

El presente es un estudio no experimental de elaboración y validación estadística de un instrumento diagnóstico que evalúa la calidad de vida en personas con algún tipo de enfermedad cardiovascular. Método: Se elaboró un instrumento que incluye datos sociodemográficos y datos clínicos 32 reactivos que conforman la escala de calidad de vida. Se aplicó a 75 personas con cardiopatía y a 137 pertenecientes a la población general, utilizando como criterio externo el Cuestionario General de Salud en su versión de doce reactivos (CGS-12), esperando encontrar consistencia en los resultados obtenidos en los dos instrumentos. Resultados: La escala de calidad de vida para pacientes con cardiopatía posee un Alpha de Cronbach de .816, lo cual indica que es un instrumento confiable. El análisis factorial con rotación Varimax demostró que la mayoría de los reactivos poseen un peso factorial superior a 0.40. Se revisarán los reactivos que no entraron en el análisis.

The present is a non experimental study consisting of constructing and validating a diagnostic instrument which evaluates quality of life in people with any kind of cardiovascular disease. Method: The instrument constructed includes sociodemographic and clinical data along with 32 items which constitute the quality of life scale. It was applied to 75 people with a cardiopathy and to 137 members of the general population, using the General Health Questionnaire in its 12 item version as an external criteria, hoping to find consistency among the results thrown by both of the instruments. Results: The quality of life scale for patients with cardiopathy obtained .816 in the analysis of Cronbach’s Alpha, which indicates it is a reliable instrument. The data reduction analysis with varimax rotation proved that most of the items have a factorial weight above 0.40. The rest of the items will be reviewed.

Psicopatología y personalidad de pacientes cardiópatas / Psychopathology and personality of patients with heart disease

PURPOSE: To know the psychological aspects involved in cardiac ailments and whether there was a distinctive personality profile of each disorder. METHODS: We evaluated 137 patients with congenital heart, acute myocardial infarction (AMI) or awaiting a heart transplant who came to the National Institute of Cardiology Ignacio Chavez. We used multiphase Personality Inventory, which provides information on personality traits and psychopathology. RESULTS: There were significant differences between some cardiac sufferings and the scales that the inventory measures, as well as the existence of differences between sexes. CONCLUSIONS: The diseases associated with the heart involve not only some physical and psychological consequences, but also significant psychological consequences depending on the type of heart disease. Those with a congenital heart had better conditions than other emotional heart diseases studied. For their part, those who have suffered IAM are showing higher depressive Levels (being higher in males), while those more concerned about their health in this study were patients awaiting heart transplantation. That is why it is important to take into account the psychological aspects in the cardiac conditions to achieve a better multidisciplinary management.

Psychiatric disorders in cardiac patients

Psychiatric disorders and coronary heart disease are not uncommonly seen together in the same patient especially in association with myocardial infarction these disorders vary from simple anxiety, depression, posttraumatic stress disorder, adjustment disorder. Studying the depressive disorders in the Iraqi cardiac patients and its prevalence after April 2003 and trying to ascertain any mispractice in management of such patients by ignoring the psychiatric cause. 260 patients admitted to Baghdad teaching hospital medical departments over the period December 2005- October 2007. Those patients were having either stable angina unstable angina and myocardial infraction. A uniform questionnaire was used for all patients to find out the prevalence any psychiatric disorders. This study showed the presence of depression during the pre and post cardiac events in 70 cases [27%] anxiety was also a very common problem in about 60 cases [23%], however the percentage of patients whom were had psychiatric disorders after an acute events due to unsettled security in the country since 2003 were as follow depression [21% cases 8%] from the total number of cases respectively. Psychiatric disorders are becoming a common problem in many Iraqi cardiac patients because of the difficulties of their daily life since 2003 and it represents about 50% of the cases of psychiatrics disorders. This may make it an important issue to use antidepressant drugs in many of those patients

Experiência da doença cardíaca entre adultos submetidos à revascularização do miocárdio / Experiencia de enfermedad cardiaca entre adultos sometidos a revascularización del miocárdio / Heart disease experience of adults undergoing coronary artery bypass grafting surgery

OBJETIVO:Analisar os significados da experiência da enfermidade cardíaca e de seu tratamento entre indivíduos em processo de reabilitação da cirurgia de revascularização do miocárdio. MÉTODOS:Estudo etnográfico realizado entre 2003 e 2005, em Goiânia, GO. Foram realizadas observação direta e entrevistas em profundidade com 11 indivíduos em reabilitação de cirurgia de revascularização do miocárdio. Com base na antropologia interpretativa, os dados foram reunidos em dossiês narrativos e analisados por meio da elaboração de unidades de significados e núcleos temáticos. RESULTADOS:Os sentidos atribuídos à enfermidade relacionaram-se a: descoberta da doença cardíaca, sentimentos desencadeados, explicações formuladas, aceitação da cirurgia e vida pós-cirurgia. A experiência foi interpretada como ruptura biográfica, situação entre a vida e a morte, invalidez, perda de autonomia e incapacidade de trabalhar. Os significados remeteram a uma lógica que articula senso comum, religião e fragmentos do discurso médico na compreensão da doença e da cirurgia cardíaca. CONCLUSÕES:Os resultados revelam que as experiências da doença e da cirurgia cardíacas marcam uma ruptura no modo de viver, trabalhar e compreender o processo saúde-doença. A abordagem da experiência da doença cardíaca contribui para extrapolar os limites de um modelo centrado na doença, seus sintomas e causas, característico do entendimento biomédico do processo saúde-doença, cujo foco é o mau funcionamento do processo biológico e/ou psicológico.

OBJECTIVE:To evaluate the meanings of heart disease experience in patients undergoing rehabilitation post-coronary artery bypass grafting surgery. METHODS:Ethnographic study carried out between 2003 and 2005 in the city Goiânia, Central-West Brazil. Direct observation and in-depth interviews were conducted in 11 patients undergoing rehabilitation post- coronary artery bypass grafting surgery. Using an interpretative anthropology approach, data were gathered in narrative documents and analyzed through the identification of units of meanings and thematic groups. RESULTS:Disease-related meanings included heart disease realization, triggered feelings, formulated explanations, surgery acceptance and post-surgery life. Heart disease experience was understood as a biographic rupture, a situation between life and death, disability, loss of autonomy, inability to work. The meanings, analytically constructed, followed a logic that articulated common sense, religion and fragments of medical discourse for the understanding of disease and surgery. CONCLUSIONS: The study results showed that heart disease and surgery experience mark a rupture in the patient's lifestyle, work and their understanding of the health-disease process. The disease experience approach contributes to transcend the limits of a medical model based on disease, its symptoms and causes, and characterized by a biomedical understanding of the health-disease process focused on biological and/or psychological malfunctioning.

OBJETIVO: Analizar los significados de la experiencia de la enfermedad cardiaca y de su tratamiento entre individuos en proceso de rehabilitación de la cirugía de revascularizacion del miocárdio. MÉTODOS:Estudio etnográfico realizado entre 2003 e 2005, en Goiania (Centro-Oeste de Brasil). Fueron realizadas observación directa y entrevistas en profundidad con 11 individuos en rehabilitación de cirugía de revascularizacion del miocárdio. Con base en antropología interpretativa, los datos fueron reunidos en informes narrativos y analizados por medio de la a elaboración de unidades de significados y núcleos temáticos. RESULTADOS:Los sentidos atribuidos a la enfermedad se relacionaron a: descubierta de la enfermedad cardiaca, sentimientos desencadenados, explicaciones formuladas, aceptación de la cirugía y vida pos-cirurgica. La experiencia fue interpretada como ruptura biográfica, situación entre la vida y la muerte, invalidez, perdida de autonomía e incapacidad de trabajar. Los significados se remitieron a una lógica que articula sentido común, religión y fragmentos del discurso médico en la comprensión de la enfermedad y de la cirugía cardiaca. CONCLUSIONES: Los resultados rebelan que las experiencias de la enfermedad y de la cirugía cardíaca marcan una ruptura en el modo de vivir, trabajar y comprender el proceso salud-enfermedad. La abordaje de la experiencia de la enfermedad cardiaca contribuye para extrapolar los límites de un modelo centrado en la enfermedad, sus síntomas y causas, característico del entendimiento biomédico del proceso salud-enfermedad, cuyo foco es el mal funcionamiento del proceso biológico y/o psicológico.

Reações psicológicas do idoso cardiopata uma pesquisa feita com pacientes do Instituto de Cardiologia do Instituto Dante Pazzanese / Psychological reactions of the aged cardiopatic: one research with patients of the Institute of Cardiology Dante Pazzaneze

Este estudo busca levantar reações psicológicas de idosos cardiopatas e especificamente a presença de quadros depressivos nesta clientela, assim como investigar a relação entre a ocorrência da cardiopatia e a intensificação das angústias mobilizadas pelo processo de envelhecimento. Após análise qualitativa dos dados, observou-se que a maioria da população pesquisada não apresentava um quadro depressivo nos moldes psiquiátricos, mas pode ser identificada a presença de características melancólicas advindas de mudanças significativas referentes à idade e doenças, as quais tendem a constituir-se em depressão nos pacientes que vivenciaram perdas sucessivas e precoces ao longo da vida ou que desenvolveram recursos precários para o enfrentamento das situações de crise. A presença de uma cardiopatia no conjunto das perdas experimentadas pelo envelhecimento tende a acentuar a angústia diante das mesmas, mas não se caracterizou como fator determinante para o desenvolvimento de um quadro depressivo.Concluiu-se pela importância de pensar a velhice a partir de uma perspectiva interdisciplinar, que encare o fenômeno do envelhecer do ponto de vista biológico, psicológico e sociológico, visto que a forma como se dará o enfrentamento das crises mobilizadas pelo envelhecimento não pode ser compreendida unicamente pela consideração de um ou outro destes fatores.