Theory of Inpatient Circadian Care (TICC): A Proposal for a Middle-Range Theory.

The circadian system controls the daily rhythms of a variety of physiological processes. Most organisms show physiological, metabolic and behavioral rhythms that are coupled to environmental signals. In humans, the main synchronizer is the light/dark cycle, although non-photic cues such as food availability, noise, and work schedules are also involved. In a continuously operating hospital, the lack of rhythmicity in these elements can alter the patient's biological rhythms and resilience. This paper presents a Theory of Inpatient Circadian Care (TICC) grounded in circadian principles. We conducted a literature search on biological rhythms, chronobiology, nursing care, and middle-range theories in the databases PubMed, SciELO Public Health, and Google Scholar. The search was performed considering a period of 6 decades from 1950 to 2013. Information was analyzed to look for links between chronobiology concepts and characteristics of inpatient care. TICC aims to integrate multidisciplinary knowledge of biomedical sciences and apply it to clinical practice in a formal way. The conceptual points of this theory are supported by abundant literature related to disease and altered biological rhythms. Our theory will be able to enrich current and future professional practice.

Diversidad cultural de sanadores tradicionales afrocolombianos: preservación y conciliación de saberes / Cultural Diversity of Afro-Colombian Traditional Healers: Preservation and Conciliation of Knowledge / Diversidade cultural dos curandeiros tradicionais afro-colombianos: preservação e conciliação de saberes

La diversidad afrocolombiana entreteje prácticas culturales en salud específicas. Los sanadores tradicionales son poseedores de una costumbre milenaria en el cuidado de la salud. Gozan del reconocimiento, la confianza y el respeto de sus comunidades, pero son desconocidos o ignorados en las instituciones de salud y en el mundo profesional. Objetivo: describir las prácticas de cuidado realizadas por los sanadores tradicionales (remedieros y parteras) en una comunidad afrocolombiana en Guapi, Cauca, Colombia. Método: el estudio etnográfico utiliza observación participante y entrevistas en profundidad con tres remedieros y tres parteras. El análisis se realizó de forma inductiva e interpretativa. Resultados: los hallazgos evidencian diversos métodos de curación relacionados con el uso de hierbas, maniobras, fórmulas especiales y rezos, entre otros. Esta diversidad de métodos implica que las personas sean vistas de manera holística adoptándose diferentes maneras de sanar y cuidar la salud. Conclusiones: la importancia de conocer y preservar estos conocimientos es una forma de expresar el compromiso por proteger, rescatar y favorecer el diálogo entre los saberes profesional y popular. Es una invitación a conocer y reconocer el papel que pueden jugar los sanadores tradicionales en los sistemas de salud.

Afro-Colombian diversity is interwoven with specific cultural health-care practices. Traditional healers possess a thousand-year-old tradition regarding health care. They enjoy the recognition, trust and respect of their communities, but are unknown to health institutions and the professional world, or ignored by them. Objective: The study describes health-care practices performed by traditional healers; specifically, remedieros (non-professional apothecaries) and parteras (midwives) in an Afro-Colombian community in Guapi, a town located in the Cauca region of Colombia. Methodology: This ethnographic study relied on participant observation and in-depth interviews with three remedieros and three parteras. The analysis was conducted in an inductive and interpretative way. Results: The results demonstrate different healing methods associated with the use of herbs, maneuvers, special formulas and prayers, among other elements. This diversity of methods implies the person is viewed in a holistic manner that is conducive to the adoption of diverse ways to heal and protect health. Conclusions: The importance of being aware of this knowledge and preserving it is a way to express a commitment to protecting, rescuing and favoring dialogue between professional and traditional healers. It also is an invitation to understand and acknowledge the role traditional healers can play in health care systems.

A diversidade afro-colombiana entretece práticas culturais específicas em saúde. Os curandeiros tradicionais são possuidores de um costume milenar no cuidado da saúde. Desfrutam do reconhecimento, da confiança e do respeito de suas comunidades, mas são desconhecidos ou ignorados nas instituições de saúde e no mundo profissional. Objetivo: o estudo descreve as práticas de cuidado realizadas pelos curandeiros tradicionais ("ervateiro" e parteiras) em uma comunidade afro-colombiana em Guapi, Cauca, Colômbia. Método: o estudo etnográfico utiliza observação participante e entrevistas em profundidade com três "ervateiros" e três parteiras. A análise se realizou de forma indutiva e interpretativa. Resultados: os resultados encontrados evidenciam diversos métodos de cura relacionados com o uso de ervas, manipulações, fórmulas especiais e rezas, entre outros. Essa diversidade de métodos implica que as pessoas sejam vistas de maneira holística, adotando diferentes maneiras de curar e cuidar a saúde. Conclusões: a importância de conhecer e preservar esses conhecimentos é uma forma de expressar o compromisso por proteger, resgatar e favorecer o diálogo entre os saberes profissional e popular. É um convite a conhecer e reconhecer o papel que os curandeiros tradicionais podem ter nos sistemas de saúde.

Tejido de significados en la adversidad: discapacidad, pobreza y vejez / A web of meanings in adversity: disability, poverty and old age / Tecido de significados na adversidade: deficientes fisicos, pobreça e velhice

Objetivo: describir los significados en torno a la discapacidad, pobreza y vejez de las personas ancianas del municipio de Guapi (Cauca, Colombia, 2009). Método: estudio de tipo etnográfico con observación participante y quince entrevistas en profundidad. El análisis de datos se realizó de manera inductiva e interpretativa. Resultados: los significados en discapacidad se enmarcan en las deficiencias físicas, limitaciones para realizar actividades y en la falta de acceso a los ámbitos de participación social. La pobreza está relacionada con aspectos espirituales y materiales. La vejez se sitúa en una polarización de significados entre la aceptación y el sufrimiento ante las enfermedades y limitaciones. Conclusiones: la comprensión de los significados culturales en las dimensiones de discapacidad, pobreza y vejez puede llevar a respuestas intersectoriales y profesionales más eficientes y eficaces para mejorar las condiciones de vida y de salud de las personas ancianas en situaciones de adversidad.

Objective: to describe the meanings about disability, poverty and old age of elderly people in the municipality of Guapi (Cauca, Colombia, 2009). Method: ethnographic study with participant observation and fifteen in-depth interviews. The analysis of the data was carried out in an inductive and interpretative manner. Results: the meanings in disability are framed in physical failure, limitations to perform activities, and lack of access to social participation spheres. Poverty is related to spiritual and material aspects. Old age is located in a polarization of meanings between acceptance and suffering when facing diseases and limitations. Conclusions: the understanding of cultural meanings in the dimensions of disability, poverty and old age may trigger in the future more efficient and effective cross-sectorial and professional responses to improve life and health conditions of elderly in situations of adversity.

Objetivo: descrever os significados em torno aos deficientes, pobreza e velhice das pessoas anciãos do município de Guapi (Cauca, Colombia, 2009). Método: pesquisa de tipo etnográfica com observação participante e quinze entrevistas em profundidade. O analise de dados se realizou de maneira indutiva e interpretativa. Resultados: Os significados em deficientes físicos, as limitações para realizar atividades e na falta de aceso aos âmbitos de participação social. A pobreza está relacionada com aspectos espirituais e materiais. A velhice situa se em uma politização de significados entre a aceitação e o sofrimento antes as doenças e limitações. Conclusões: A compreensão dos significados culturais nas dimensões de deficientes físicos, pobreza, e velhice pode levar a respostas inter-sociais e profissionais, mas eficientes e eficazes para melhorar as condições de vida e de saúde das pessoas anciãos em situação de adversidade.

[The effect of an elderly people caregivers' educational program: a cultural perspective]. / Efecto de un programa educativo para cuidadores de personas ancianas: una perspectiva cultural.

OBJECTIVE: Determining the effect of implementing a culturally-based educational program for caregivers working with the elderly in conditions of disability and poverty in a sector of Bogota, Colombia; perceived health, family functioning, caregiver burden and depression were the variables of interest. METHODS: This was a quasi-experimental study, involving using pre-test and post-test;56 family caregivers participated: 37 in the experimental group and 19 in the control group. The educational program consisted of six group sessions with a 30-day interval. Each session had five phases: sensitization, culturally-appropriate information, decision-making, commitment to action and closure. These were led by a nurse who was an expert in gerontology-geriatrics and transcultural nursing. Several scales were applied: self-perception of health, family Apgar, caregiver burden and depression scale. RESULTS: The culturally-based educational program had statistically significant effects on the variables being considered: family functioning (T=2.506; p=0.015) and caregiver burden (p=-2.149 T=0.036). Self-perception of health and depression revealed no statistically significant differences. DISCUSSION: Health education activities addressed from a cultural approach may lead to co-creating therapeutic diversity arising from dialogue and mediation between popular and professional knowledge. It could be a key against the lack of success in users' adherence to health facilities and treatment.

Efecto de un programa educativo para cuidadores de personas ancianas: una perspectiva cultural / The effect of an educational program for elderly people's caregivers: a cultural perspective

Objetivo Determinar el efecto de la aplicación de un programa educativo con perspectiva cultural para cuidadores de personas ancianas en situación de discapacidad y pobreza en un sector de Bogotá - Colombia, sobre las variables: auto percepción de salud, funcionalidad familiar, carga del cuidador y depresión. Métodos Estudio cuasiexperimental con pre-prueba y pos-prueba. Participaron 56 cuidadores familiares, 37 en el grupo experimental (ge) y 19 en el grupo control (gc).El programa educativo aplicado al grupo experimental constaba de seis sesiones grupales con intervalo de 30 días. Cada sesión tiene cinco fases: sensibilización, información culturalmente adaptada, toma de decisiones, compromisos de acción y cierre. Fue aplicado por una enfermera experta en geronto-geriatría y enfermería transcultural. Se aplicaron las escalas de Autopercepción de Salud, Apgar familiar, Carga del cuidador y Escala de Depresión. Resultados El programa educativo con enfoque cultural tuvo efectos significativos, sobre las variables: funcionalidad familiar (T=2,506; p=0,015) y carga del cuidador (T=-2,149; p=0,036). La autopercepción en salud y depresión no presentaron diferencias significativas. Discusión Las acciones en educación en salud abordadas desde la perspectiva cultural abren una puerta a co-crear diversidad de terapéuticas derivadas del diálogo y la mediación entre los saberes populares y profesionales. Podría ser una clave frente al escaso éxito en la adherencia de los usuarios a las instituciones de salud y a los tratamientos.

Objective Determining the effect of implementing an educational programme using a cultural approach for caregivers looking after elderly disabled and poor people living in a sector of Bogota, Colombia regarding the following variables: perceived health, family functioning, caregiver burden and depression. Methods This was a quasi-experimental study involving pre-test and post-test. 56 family caregivers participated in the study, 37 in the experimental group and 19 in the control group. The educational program being applied consisted of six group sessions with a 30-day interval. Each session had five phases: awareness-raising, culturally-appropriate information, making decisions, commitments for action and closure. They were led by a nurse specializing in gerontology-geriatrics and transcultural nursing. Several scales were applied: self-perception of health, family APGAR, caregiver burden, and a depression scale. Results The educational program involving a cultural approach had statistically significant effects on family functioning (T=2.506; p=0.015) and caregiver burden (p=-2.149 T=0.036). Self-perception of health and depression revealed no statistically significant differences. Discussion Health education activities addressed from a cultural approach opens the way forward for creating therapeutic diversity arising from dialogue and mediation between popular and professional knowledge. It could be a key against the lack of success in users' adherence to health facilities and treatment.

Efecto de un programa educativo para cuidadores de personas ancianas: una perspectiva cultural / The effect of an elderly people caregivers' educational program: a cultural perspective

Objetivo Determinar el efecto de la aplicación de un programa educativo con perspectiva cultural para cuidadores de personas ancianas en situación de discapacidad y pobreza en un sector de Bogotá-Colombia, sobre las variables: autopercepción de salud, funcionalidad familiar, carga del cuidador y depresión. Métodos Estudio cuasi experimental con pre-prueba y pos-prueba. Participaron 56 cuidadores familiares, 37 en el grupo experimental y 19 en el grupo control. El programa educativo aplicado al grupo experimental constaba de seis sesiones grupales con intervalo de 30 días. Cada sesión tiene cinco fases: sensibilización, información culturalmente adaptada, toma de decisiones, compromisos de acción y cierre. Fue aplicado por una enfermera experta en geronto-geriatría y enfermería transcultural. Se aplicaron las escalas de Autopercepción de Salud, Apgar familiar, Carga del cuidador y Escala de Depresión. Resultados El programa educativo con enfoque cultural tuvo efectos significativos, sobre las variables: funcionalidad familiar (T=2,506; p=0,015) y carga del cuidador (T=-2,149; p=0,036). La autopercepción en salud y depresión no presentaron diferencias significativas. Discusión Las acciones en educación en salud abordadas desde la perspectiva cultural abren una puerta a co-crear diversidad de terapéuticas derivadas del diálogo y la mediación entre los saberes populares y profesionales. Podría ser una clave frente al escaso éxito en la adherencia de los usuarios a las instituciones de salud y a los tratamientos.

Objective Determining the effect of implementing a culturally-based educational program for caregivers working with the elderly in conditions of disability and poverty in a sector of Bogota, Colombia; perceived health, family functioning, caregiver burden and depression were the variables of interest. Methods This was a quasi-experimental study, involving using pre-test and post-test;56 family caregivers participated: 37 in the experimental group and 19 in the control group. The educational program consisted of six group sessions with a 30-day interval. Each session had five phases: sensitization, culturally-appropriate information, decision-making, commitment to action and closure. These were led by a nurse who was an expert in gerontology-geriatrics and transcultural nursing. Several scales were applied: self-perception of health, family Apgar, caregiver burden and depression scale. Results The culturally-based educational program had statistically significant effects on the variables being considered: family functioning (T=2.506; p=0.015) and caregiver burden (p=-2.149 T=0.036). Self-perception of health and depression revealed no statistically significant differences. Discussion Health education activities addressed from a cultural approach may lead to co-creating therapeutic diversity arising from dialogue and mediation between popular and professional knowledge. It could be a key against the lack of success in users' adherence to health facilities and treatment.