Percepción de las fuentes de apoyo que facilitan la adherencia a los tratamientos / Perception of sources of support that facilitate adherence to the treatments

Introducción: La falta de adherencia a los tratamientos aumenta la probabilidad de fracaso terapéutico y complicaciones innecesarias. Objetivo: Explorar las fuentes de apoyo percibidas por los pacientes con enfermedades crónicas que les facilitan la adherencia a los tratamientos. Método: Estudio cualitativo descriptivo con enfoque fenomenológico, en el que se reclutaron ocho pacientes crónicos complejos, sin distinción de género, ni edad, residentes en Barcelona, y que tras evaluar la adherencia farmacológica con los test de Morisky-Green y el test de Batalla diera como resultado ser adherente al régimen terapéutico. Tras lo cual se efectuaron dos preguntas abiertas que fueron grabadas en un dispositivo de audio y transcritas textualmente. Para el análisis de los datos, se utilizó el método Colaizzi. Resultados: Surgieron tres grupos temáticos: 1) Tener el apoyo familiar; 2) Comprensión de la enfermedad y estrategias que facilitan la adhesión a los tratamientos; y 3) Relación con los profesionales de referencia. Conclusiones: La fuente más importante de apoyo percibida por los participantes, es la familia, coincidiendo con otros autores. El hallazgo de este estudio, es que se evidencia a medicina y enfermería como instigadores que fomentan su empoderamiento y como fuente de influencia reconocida que ha permitido su asimilación y capacitación para adoptar medidas que les ayudan a seguir las pautas farmacoterapéuticas. (AU)

Introduction: Non-adherence to treatments increases the probability of therapeutic failure and unnecessary complications. Objective: To explore the sources of support perceived by patients with chronic diseases that facilitate adherence to treatment. Method: Qualitative descriptive study with a phenomenological approach, in which eight complex chronic patients were recruited, without distinction of gender or age, residents of Barcelona, and who, after evaluating pharmacological adherence with the Morisky-Green test and the test of Batalla resulted in being adherent to the therapeutic regimen.After which, two open questions were asked that were recorded on an audio device and transcribed verbatim. For data analysis, the method Colaizzi was used. Results: Three thematic groups emerged: 1) Having family support; 2) Understanding of the disease and strategies that facilitate adherence to treatments; and 3) Relationship with reference professionals. Conclusions: The most important source of support perceived by the participants is the family, coinciding with other authors. The finding of this study is that shows medicine and nursing are evidenced as instigators that promote their empowerment and as a recognized source of influence that has allowed their assimilation and training to adopt measures that help them follow the pharmacotherapeutic guidelines. (AU)

Moral sensitivity of nursing students. Adaptation and validation of the moral sensitivity questionnaire in Spain.

Ethical sensitivity is a requirement for people care as well as for decision-making in everyday practice. The aim is to present an adaptation and transcultural validation -in Spanish- of the Moral Sensitivity Questionnaire by Lützén et al. in Spain. In addition to that, we provide a practical implementation analysing the degree of moral sensitivity of nursing students. The data used for data collection were moral Sensitivity Questionnaire, socio-demographic data and a self-report questionnaire. The psychometric properties of the questionnaire were assessed, including validity and reliability. Fit indices of the overall model were computed. The fit indices of the Confirmatory Factor Analysis (CFA) indicate a poor fit, although the Exploratory Factor Analysis (EFA) revealed two dimensions that show a better fit of its indices. Women and those women with more experience in the clinical setting have a higher mean score, as well as those who study in centers where the strategic lines are the humanization of care. Female nursing students with more experience in the clinical setting and with more educational training present higher sensitivity indexes, as well as those who study in centers where the strategic lines are the humanization of care. The findings confirm that the Lützén et al. questionnaire is multidimensional. In the Spanish sample, it was necessary to group the three initial factors into two: sense of moral burden and moral strength-grouping the moral responsibility items into the above items to make the instrument more resilient.

Emotions and feelings in critical and emergency caring situations: a qualitative study.

BACKGROUND: Moral emotions are a key element of our human morals. Emotions play an important role in the caring process. Decision-making and assessment in emergency situations are complex and they frequently result in different emotions and feelings among health-care professionals. METHODS: The study had qualitative deductive design based on content analysis. Individual interviews and focus groups were conducted with sixteen participants. RESULTS: The emerging category "emotions and feelings in caring" has been analysed according to Haidt, considering that moral emotions include the subcategories of "Condemning emotions", "Self-conscious emotions", "Suffering emotions" and "Praising emotions". Within these subcategories, we found that the feelings that nurses experienced when ethical conflicts arose in emergency situations were related to caring and decisions associated with it, even when they had experienced situations in which they believed they could have helped the patient differently, but the conditions at the time did not permit it and they felt that the ethical conflicts in clinical practice created a large degree of anxiety and moral stress. The nurses felt that caring, as seen from a nursing perspective, has a sensitive dimension that goes beyond the patient's own healing and, when this dimension is in conflict with the environment, it has a dehumanising effect. Positive feelings and satisfaction are created when nurses feel that care has met its objectives and that there has been an appropriate response to the needs. CONCLUSIONS: Moral emotions can help nurses to recognise situations that allow them to promote changes in the care of patients in extreme situations. They can also be the starting point for personal and professional growth and an evolution towards person-centred care.

The emotion: A crucial component in the care of critically ill patients.

BACKGROUND: The acquisition of experience is a major concern for nurses in intensive care units. Although the emotional component of the clinical practice of these nurses has been widely studied, greater examination is required to determine how this component influences their learning and practical experience. OBJECTIVE: To discover the relationships between emotion, memory and learning and the impacts on nursing clinical practice. RESEARCH DESIGN: This is a qualitative phenomenological study. The data were collected from open, in-depth interviews. A total of 22 intensive care unit nurses participated in this research between January 2012 and December 2014. Ethical considerations: The School of Nursing Ethics Committee approved the study, which complied with ethical principles and required informed consent. FINDINGS: We found a clear relationship between emotion, memory and the acquisition of experience. This relationship grouped three dimensions: (1) satisfaction, to relieve the patient's pain or discomfort, give confidence and a sense of security to the patient, enable the presence of family members into the intensive care unit and provide family members with a realistic view of the patient's situation; (2) error experience, which nurses feel when a patient dies, when they fail to accompany a patient in his or her decision to abandon the struggle to live or when they fail to lend support to the patient's family; and (3) the feel bad-feel good paradox, which occurs when a mistake in the patient's care or handling of his or her family is repaired. CONCLUSION: Emotion is a capacity that impacts on nurses' experience and influences improvements in clinical practice. Recalling stories of satisfaction helps to reinforce good practice, while recalling stories of errors helps to identify difficulties in the profession and recognise new forms of action. The articulation of emotional competencies may support the development of nursing ethics in the intensive care unit to protect and defend their patients and improve their relationships with families in order to maximise the potential for patient care.