Cuidado de enfermería transpersonal con base en la teoría del caring a una mujer con cáncer de mama / Transpersonal nursing care based on the caring theory for a woman with breast cancer

Resumen:

Introducción: el pensamiento de Jean Watson se basa en dos perspectivas: la filosofía de cuidados y la teoría de cuidados transpersonales. Watson basa su teoría en siete supuestos y 10 factores caritativos de cuidados, que después denomina proceso caritas de cuidados; en la práctica se incorpora el concepto de sufrimiento espiritual como parte del proceso y plan de cuidados de enfermería, con un enfoque primordial hacia la comprensión de la experiencia, el significado y el propósito de la vida. Objetivo: implementar un proceso de enfermería transpersonal con base en los 10 procesos de cuidado del caring a una mujer con cáncer de mama.

Metodología: para la valoración se utilizó un mapa de cuidados con base en el estudio fenomenología) de la persona; se determinaron siete diagnósticos con la taxonomía NANDA Internacional, Inc.; los planes de cuidado se formularon con las taxonomías NOC y NIC; la guía para la definición de intervenciones de enfermería estuvo constituida por los 10 procesos de cuidado y para describir la experiencia en la aplicación de esos 10 procesos del caring se utilizó la narrativa. Resultados: la empatía fue un valor que se puso en práctica para el cuidado de la mujer con cáncer de mama, lo que permitió valorar la dimensión espiritual de la persona y el reconocimiento de las fortalezas y debilidades para afrontar las situaciones que vivimos día a día.

Conclusiones: la incorporación de los 10 procesos de cuidado del caring en el plan de cuidado de enfermería transpersonal de la mujer con cáncer de mama implica que el profesional de enfermería desarrolle valores humanos esenciales y se reconozca como ser espiritual y de ayuda.

Abstract:

Introduction: Jean Watson's thought is based on two fundamental perspectives: philosophy of care and transpersonal care theory. She bases her theory in seven assumptions and 10 caritative care factors, named after Watson's Caritas Process (CP); in practice, the concept of spiritual suffering is incorporated as part of the process and nursing care plan, with primary focus on understanding the experience, the meaning and purpose of life.

Objective: To implement a transpersonal nursing process based on the 10 processes of the caring theory for a woman with breast cancer.

Methods: For the valuation, a care map was used based on the phenomenological study of the individual; seven diagnoses using NANDA International, Inc. taxonomy were determined; care plans were formulated with NIC and NOC taxonomies; the guidance for nursing interventions were the 10 care (carative) processes; and narrative was used to describe the experience of implementing those 10 processes.

Results: Empathy was a value implemented for women with breast cancer's care, allowing to assess the spiritual dimension of the person in its own unique personality and recognizing the strengths and weaknesses for dealing with situations that humans live everyday.

Conclusions: The addition of the 10 processes in Caring's care plan of transpersonal nursing care to women with breast cancer implies that the nurse develops essential human values and recognizes herself as a spiritual being of help.

Functional and quality-of-life results of displaced and nondisplaced proximal humeral fractures treated conservatively.

OBJECTIVES: Functional and quality-of-life outcomes of conservatively treated proximal humeral fractures. DESIGN: Prospective study. SETTING: University orthopedic department at a hospital. PATIENTS/PARTICIPANTS: Seventy consecutive patients between the ages of 60 and 85 years. INTERVENTION: Conservative treatment. MAIN OUTCOME MEASUREMENTS: Functional outcome measured according to the Constant score, quality of life assessed using EuroQol-5D, and fracture pattern analyzed with x-ray and computed tomography scan. RESULTS: : All fractures consolidated uneventfully with no loss of reduction in either group. Four-part fractures obtained the worst functional results (33.66) followed by three-part fractures (54.64) and finally two-part fractures (65.88 and 71). Mild pain was expected in three- and four-part fractures, whereas two-part fractures achieved near complete pain relief. Nondisplaced fractures obtained a final Constant score of 73.58 and displaced fractures a score of 59.41 with significant differences in all Constant score items with the exception of external rotation. Although patients older than 75 years scored lower (54.63) than those younger than 75 years (70.83), there was no difference in the quality-of-life perception. CONCLUSION: Conservative treatment of proximal humeral fractures in those patients older than age 75 years provides good pain relief with limited functional outcome. Despite limited functional outcome, this appears to have no effect on the quality-of-life perception in the population studied. Four-part fractures present the worst results and treatment options may need to be discussed with the patient to adjust treatment to patient expectations.

Morphology of the scapula relative to the reverse shoulder prosthesis.

PURPOSE: To analyse the morphology of the scapula relative to the reverse shoulder prosthesis. METHODS: Scapulas of 46 women and 27 men aged 16 to 84 (mean, 53) years with proximal humeral fractures (n=52) or recurrent antero-inferior instability (n=21) were assessed using 3-dimensional computed tomography (CT). For comparison, 108 cadaveric scapulas with unknown epidemiology were assessed using a goniometer and a caliper. The length of the glenoid neck, the angle between the glenoid surface and the upper posterior column of the scapula, and the angles between the major craneocaudal glenoid axis and (1) the base of the coracoid process and (2) the upper posterior column of the scapula were assessed. RESULTS: The length of the glenoid neck was classified into short and long. In the respective CT and cadaveric groups, the anterior glenoid neck was short in 42% and 18% of scapulas and long in 58% and 82%, whereas the posterior glenoid neck was short in 34% and 60% of scapulas and long in 66% and 40%. The angle between the glenoid surface and the upper posterior column of the scapula was classified into types I (50-52 degrees) and II (62-64 degrees). In the respective CT and cadaveric groups, 61% and 71% of scapulas were type I and 39% and 29% were type II. All differences between groups were significant. The mean angles between the major craneocaudal glenoid axis and (1) the base of the coracoid process and (2) the upper posterior column of the scapula were 18 and 8 degrees, respectively. CONCLUSION: Because of variations in scapular morphology, individualised adjustment is needed for reverse shoulder prostheses. Three-dimensional CT is valuable in preoperative planning.

Computer-assisted surgery can reduce blood loss after total knee arthroplasty.

The aim of this study was to compare blood loss and transfusion requirements in patients undergoing computer-assisted total knee arthroplasty (TKA) and patients operated with conventional instrumentation with intra-medullar guides. A prospective randomized study of 87 patients undergoing a TKA assigned to conventional technique (n = 44) or computer-assisted surgery (n = 43) was conducted. All patients were operated by the same surgeon and in all cases a cemented arthroplasty and deep recovery drainage were used. Both groups were comparable in all variables except for duration of ischemia, which was 13.7 min higher in the computer-assisted group. Blood loss due to drainage was higher in the conventional technique group (613 vs. 447 ml), as was the number of patients in which blood from the blood recovery system was reinfused (53 vs. 23%). Those patients undergoing computer-assisted surgery experienced less bleeding than those operated with the conventional technique. However, hemoglobin drop and allogenic transfusion rate were not statistically different in both groups.

Cadaveric and three-dimensional computed tomography study of the morphology of the scapula with reference to reversed shoulder prosthesis.

PURPOSE: The purpose of this study is to analyze the morphology of the scapula with reference to the glenoid component implantation in reversed shoulder prosthesis, in order to improve primary fixation of the component. METHODS: Seventy-three 3-dimensional computed tomography of the scapula and 108 scapular dry specimens were analyzed to determine the anterior and posterior length of the glenoid neck, the angle between the glenoid surface and the upper posterior column of the scapula and the angle between the major craneo-caudal glenoid axis and the base of the coracoid process and the upper posterior column. RESULTS: The anterior and posterior length of glenoid neck was classified into two groups named "short-neck" and "long-neck" with significant differences between them. The angle between the glenoid surface and the upper posterior column of the scapula was also classified into two different types: type I (mean 50 degrees-52 degrees ) and type II (mean 62.50 degrees-64 degrees ), with significant differences between them (p < 0.001). The angle between the major craneo-caudal glenoid axis and the base of the coracoid process averaged 18,25 degrees while the angle with the upper posterior column of the scapula averaged 8 degrees . CONCLUSION: Scapular morphological variability advices for individual adjustments of glenoid component implantation in reversed total shoulder prosthesis. Three-dimensional computed tomography of the scapula constitutes an important tool when planning reversed prostheses implantation.

The pectoralis major tendon as a reference for restoring humeral length and retroversion with hemiarthroplasty for fracture.

The success of anatomic reattachment of the tuberosities in proximal humeral fractures, treated with hemiarthroplasty, correlates with functional results. The purpose of this study was to determine the value of the upper edge of the pectoralis major insertion (PMI) as a landmark to establish the proper height and version of hemiarthroplasty implanted for proximal humeral fractures. Twenty cadaveric humeri were studied by CT scan to analyze the relationship between the PMI and humeral height and retroversion. The mean distance from the PMI to the tangent to the humeral head was 5.64 cm. The mean distance of the PMI to the posterior fin of the prosthesis was 1.06 cm. The mean angle between the PMI and the posterior fin of the prosthesis was 24.65 degrees. The upper edge of the pectoralis major insertion constitutes a reproducible reference point to restore proper humeral height and retroversion in hemiarthroplasty for proximal humeral fracture.

Factors affecting meniscal extrusion: correlation with MRI, clinical, and arthroscopic findings.

The existence of meniscal extrusion is well known in the natural history of the osteoarthritic knee. However, extruded menisci are also seen in non-pathologic knees. To ascertain the prevalence of meniscal extrusion in non-arthritic patients, the MRIs of 100 knees were prospectively studied. The data were correlated both with clinical and operative arthroscopic findings. The results showed 68.5% of the medial menisci to have some degree of extrusion, averaging at 28% of the meniscal size. While the lateral meniscus were extruded in 18.8% of cases at an average of 15% of the meniscal size. Furthermore, a relationship between the anterior insertion variant of the anterior medial meniscus and meniscal extrusion was found (P=0.001) in this series. The results suggest meniscal extrusion to be much more common in non-arthritic knees than previously estimated. The results also suggest that when the anterior horn of the medial meniscus inserts anteriorly in the tibial plateau, the meniscus tends to be extruded. It must be kept in mind that one of the limitations of this work is that the MRIs are taken in a non-weightbearing position.