Relatos sobre COVID-19 de profesionales de la salud en un hospital / Stories about covid-19 from health professionals in a hospital

Introducción: la pandemia de COVID-19 impone a los profesionales de la salud: altas exigencias y modificaciones en el modo de vincularse con pacientes, pares y familiares. Estos cambios implican consecuencias emocionales tales como el incremento del nivel de estrés y síntomas de ansiedad y de depresión. Objetivo: describir un proyecto interdisciplinario creado bajo el modelo de la Medicina Narrativa dirigido a habilitar el relato de la experiencia de profesionales de la salud pertenecientes a un hospital general privado de alta complejidad de la ciudad de Buenos Aires durante la pandemia de COVID-19. Metodología: se creó una lista de correo y se convocó a profesionales del hospital a realizar una producción escrita, oral o gráfica que represente su experiencia durante la pandemia. Luego, el material recibido se envió a la misma lista de distribución con frecuencia semanal. En cada correo se renovó la invitación a narrar lo vivido o comentar los relatos de otros. Resultados: en el transcurso de siete semanas se recibieron diez producciones individuales: ocho textos, un audio y un gráfico. Los principales temas tratados pudieron agruparse en tres ejes: sala COVID, comunidad y telemedicina. Los autores fueron profesionales de Medicina, Enfermería, Psicología y de Puericultura. Conclusión: desarrollamos un proyecto bajo el modelo de la Medicina Narrativa que permitió a profesionales narrar su experiencia durante la pandemia de COVID-19, habilitando la posibilidad de poner en palabras lo vivido, reflexionar sobre modelos de actuación y elaborar el desgaste emocional generado por el contacto permanente con el dolor y el sufrimiento. (AU)

Introduction: the COVID-19 pandemic imposes high demands on health professionals and changes in the way they relate to patients, peers and family members. These changes involve emotional consequences such as increased stress levels, symptoms of anxiety and depression. Objective: to describe an interdisciplinary project created under the Narrative Medicine model aimed at enabling the reporting of the experience of health professionals belonging to a highly complex private general hospital in the city of Buenos Aires during the COVID-19 pandemic. Methodology: a mailing list was created and hospital professionals were invited to make a written, oral or graphic production that represents their experience during the pandemic. Then, the received material was sent to the same distribution list on a weekly basis. In each email, the invitation to narrate what was experienced or to comment on the stories of others was renewed. Results: over the course of seven weeks, ten individual productions were received: eight texts, one audio and one graphic. The main topics discussed could be grouped into three axes: COVID room, community and telemedicine. The authors were professionals from Medicine, Nursing, Psychology and Childcare. Conclusion: we developed a project under the Narrative Medicine model that allowed professionals to tell their experience during the covid 19 pandemic, enabling the possibility of putting into words what was experienced, reflecting on models of action and elaborating on the emotional exhaustion generated by permanent contact with pain and suffering. (AU)

[A training diary as a strategy for reflection about practice during initial and continuous training of Mental Health specialists]. / El diario de formación como estrategia para la reflexión sobre la práctica en la formación inicial y continua de los especialistas en Salud Mental.

This article presents a Training Diary as a strategy for professional training under the framework of a thoughtful practice. As such, it is a tool that allows access to knowledge through narrative thinking, favoring the organization of experience by integrating cognitive, affective, and practical aspects. This work proposes a necessary dialogue between narrative and logical-scientific thinking, while exposing the theoretical foundations of the Diary as well as some suggestions for its implementation.

Using high-intensity care management to integrate acute and long-term care services: substitute for large scale system reform?

This study evaluates a demonstration that used high intensity care management to improve integration between the acute and long-term care service systems. The demonstration intervention included the use of clinical nurse care manager, supervised by a geriatrician, to supplement an existing in-home care management system. Chronically disabled home care clients age 60 and over were randomly assigned (N = 308) to receive enhanced clinical services plus traditional care management, or to the control group, to receive the normal care management services provided. Treatment group members were expected to experience lower use of hospitals and nursing homes and lower overall health and long-term care costs. Research subjects were followed for up to 18 months using Medicare records and mortality data. A subsample (N = 150) also received in-person interviews to cover a range of health and social outcomes anticipated as a result of the intervention. Although there was some variation in health use and cost across treatment and control groups over the 18 month time period, the overall conclusion is that there were no differences between groups on any of the outcome variables examined. Efforts to integrate the acute and long-term care systems have proven to be difficult. This intervention, which attempted to create integration through high intensity care managers, but without financial or regulatory incentives, was simply unable to create enough change in the care system to produce significant change for the clients served.