Living With an Intestinal Stoma: A Qualitative Systematic Review.

The main aim of this article is to explore the experiences and life situations of people living with intestinal stomas. Previous studies indicated the need to investigate the concerns of ostomy patients and how these concerns can affect their quality of life and their approaches to the comprehensive conceptualization of the bodily changes. A qualitative systematic review and metasynthesis design was carried out by using the main scientific databases. Original articles from 2002 to 2015 were selected based on their qualitative methodology. Methodological quality was evaluated using the Critical Appraisal Skills Program. The findings were synthesized using the metasynthesis procedure of Sandelowski. The final number of articles included was 95 and 1,982 participants. Regarding the metasummary, the data generated 191 thematic statements that were organized into eight categories. The findings support an explanatory model of the experience of people with ostomy based on three aspects: Acceptance, Adaptation, and Autonomy.

Ostomy patients' perception of the health care received.

AIM: to describe ostomy patient's perception about health care received, as well as their needs and suggestions for healthcare system improvement. METHOD: qualitative phenomenological study was conducted, involving individual and semi-structured interviews on the life experiences of 21 adults who had a digestive stoma. Participants were selected following a purposive sampling approach. The analysis was based on the constant comparison of the data, the progressive incorporation of subjects and triangulation among researchers and stoma therapy nurses. The software Atlas.ti was used. RESULTS: perception of health care received is closely related to the information process, as well as training for caring the stoma from peristomal skin to diet. It is worthy to point out the work performed by stoma care nurses ensuring support during all stages of the process. CONCLUSION: findings contribute to address the main patients' needs (better prepared nurses, shorter waiting lists, information about sexual relation, inclusion of family members all along the process) and recommendations for improving health care to facilitate their adaptation to a new status of having a digestive stoma.

Neutrophil extracellular traps are increased in patients with acute ischemic stroke: prognostic significance.

Neutrophil extracellular traps (NETs) are networks of DNA, histones, and proteolytic enzymes produced by activated neutrophils through different mechanisms. NET formation is promoted by activated platelets and can in turn activate platelets, thus favoring thrombotic processes. NETs have been detected in venous and arterial thrombosis, but data in stroke are scarce. The aim of this study was to evaluate NETs in the plasma of patients with acute ischemic stroke and their potential association with baseline clinical characteristics, stroke severity, and one-year clinical outcomes. The study included 243 patients with acute ischemic stroke. Clinical and demographic data and scores of stroke severity (NIHSS and mRs) at onset and discharge were recorded. Markers of NETs (cell-free DNA, nucleosomes, and citrullinated histone 3 (citH3)), were determined in plasma. Patients were followed-up for 12 months after the ischemic event. NETs were significantly elevated in the plasma of patients with acute ischemic stroke when compared to healthy subjects. NETs were increased in patients who were over 65 years of age and in those with a history of atrial fibrillation (AF), cardioembolic stroke, high glucose levels, and severe stroke scores at admission and discharge. In multivariate analysis, elevated levels of citH3, the most specific marker of NETs, at onset were independently associated with AF and all-cause mortality at one-year follow-up. NETs play a role in the pathophysiology of stroke and are associated with severity and mortality. In conclusion, citH3 may constitute a useful prognostic marker and therapeutic target in patients with acute stroke.

Contributing factors for therapeutic diet adherence in patients receiving haemodialysis treatment: an integrative review.

AIMS AND OBJECTIVES: The objective of this integrative review is to identify the factors that contribute to diet adherence in people suffering from kidney disease who are receiving haemodialysis treatment. BACKGROUND: Adherence to the therapeutic regimen determines therapeutic success, quality of life and survival in patients on haemodialysis. Lack of diet adherence ranges from 25%-86% in patients receiving haemodialysis treatment and affects patient morbidity and mortality. DESIGN: An integrative literature review was conducted based on the criteria of Whittemore & Knafl. METHODS: A literature review was performed by two members of the team using twelve databases including PubMed, CUIDEN, CINAHL, The Cochrane Library and ScienceDirect. RESULTS: The main issues identified after analysing the results were as follows: the intrinsic barriers (age, dialysis time, motivation, perceived benefit, distorted perception of adherence) and facilitators (self-efficacy, perception of disease, perception of control), extrinsic barriers (family dysfunction, lack of social support, cultural patterns of consumption of food) and facilitators (social support, relationship with healthcare providers), and interventions to encourage diet adherence, such as the use of motivational interviewing in educational interventions, and the training and education of relevant professionals in communication skills. CONCLUSIONS: Diet nonadherence remains a serious health problem and suffers from a lack of solid criteria to identify this condition. The onset of depression signs and the level of social support available to the patient should be assessed, because these are important factors that determine adherence to treatment. RELEVANCE TO CLINICAL PRACTICE: Professionals should be trained in health education and communication techniques to contribute to the patient's self-management and motivation for diet adherence. Controlled and randomised clinical studies involving predialysis stages should be performed to investigate the impact of the assessment and control of barriers to diet adherence.

Ostomy patients' perception of the health care received / Percepção de pacientes ostomizados sobre os cuidados de saúde recebidos / Percepción de las personas ostomizadas sobre la atención de salud recibida

ABSTRACT Aim: to describe ostomy patient's perception about health care received, as well as their needs and suggestions for healthcare system improvement. Method: qualitative phenomenological study was conducted, involving individual and semi-structured interviews on the life experiences of 21 adults who had a digestive stoma. Participants were selected following a purposive sampling approach. The analysis was based on the constant comparison of the data, the progressive incorporation of subjects and triangulation among researchers and stoma therapy nurses. The software Atlas.ti was used. Results: perception of health care received is closely related to the information process, as well as training for caring the stoma from peristomal skin to diet. It is worthy to point out the work performed by stoma care nurses ensuring support during all stages of the process. Conclusion: findings contribute to address the main patients' needs (better prepared nurses, shorter waiting lists, information about sexual relation, inclusion of family members all along the process) and recommendations for improving health care to facilitate their adaptation to a new status of having a digestive stoma.

RESUMO Objetivo: descrever a percepção dos pacientes ostomizados sobre os cuidados de saúde recebidos, bem como suas necessidades e sugestões para melhorar o sistema de saúde. Método: foi realizado um estudo fenomenológico qualitativo, envolvendo entrevistas individuais e semiestruturadas sobre as experiências de vida de 21 adultos com estoma digestivo. Os participantes foram selecionados seguindo uma abordagem de amostragem proposital. A análise se baseou na comparação constante dos dados, na incorporação progressiva dos sujeitos e na triangulação entre pesquisadores e enfermeiros estomaterapeutas. O software Atlas.ti foi utilizado. Resultados: a percepção sobre os cuidados de saúde recebidos está intimamente relacionada ao processo de informação e à formação para cuidar do estoma, abrangendo desde a pele periestomal até a dieta. O trabalho realizado pelos enfermeiros estomaterapeutas deve ser destacado, garantindo suporte durante todas as etapas do processo. Conclusão: os resultados contribuem para atender às principais necessidades dos pacientes (enfermeiras melhor preparadas, listas de espera mais curtas, informações sobre relações sexuais, inclusão de membros da família ao longo do processo) e recomendações para melhorar os cuidados de saúde para facilitar sua adaptação à nova condição de ostomizado digestivo.

RESUMEN Objetivo: Describir la percepción que los pacientes con estoma tienen sobre los cuidados de salud recibidos así como las necesidades y sugerencias para mejorar el sistema de salud. Método: Estudio cualitativo descriptivo de carácter fenomenológico, realizando entrevistas individuales semi-estructuradas sobre las experiencias de vida de 21 adultos que portaban un estoma digestivo. La selección se hizo mediante un muestreo intencional. El análisis se basó en la comparación constante de datos, la progresiva incorporación de sujetos y triangulación entre investigadores y expertos en estomaterapia. Se usó el software Atlas-ti. Resultados: la percepción de la atención recibida está íntimamente ligada al proceso de información, así como a la formación para el cuidado del estoma desde la piel periestomal hasta la dieta. Se debe resaltar el trabajo de la enfermera estomaterapeuta, garantizando el soporte durante todas las fases del proceso. Conclusiones: los resultados contribuyen a señalar las principales necesidades de los pacientes (enfermeras mejor preparadas, listas de espera más cortas, información sobre relaciones sexuales, inclusión de los familiares a lo largo del proceso) y recomendaciones para mejorar los cuidados y así facilitar su adaptación al nuevo estado de portar un estoma digestivo.

Experiences and coping with the altered body image in digestive stoma patients.

Objective: to describe the coping of stoma patients with the news about the ostomy, as well as to analyze the meaning and the experience of their new bodily reality. Method: qualitative phenomenological study undertaken through semistructured interviews with 21 stoma patients. The analysis was based on the constant comparison of the data, the progressive incorporation of subjects and triangulation among researchers and stomal therapy nurses. The software Atlas.ti was used. Results: two main categories emerge: "Coping with the news about receiving a stoma" and "Meaning and experience of the new bodily reality". The informants' answer varies, showing situations that range from the natural acceptance of the process to resignation and rejection. The previous experiences of other family members, the possible reconstruction of the stoma or the type of illness act as conditioning factors. Conclusions: the coping with the news about the stoma is conditioned by the type of illness, although the normalization of the process is the trend observed in most informants. Nursing plays a fundamental role in the implementation of cognitive-behavioral interventions and other resources to promote the patients' autonomy in everything related to care for the stoma.

Metaestudio cualitativo sobre vivencias y gestión del cotidiano en adultos mayores que padecen enfermedades crónicas / Meta-estudo qualitativo sobre as experiências e gestão diárias em idosos com doenças crônicas / Qualitative meta-study on daily experiences and management in older adults with chronic diseases

Objetivo: Describir la experiencia cultural, interpersonal y personal de los adultos mayores con enfermedades crónicas e identificar las estrategias y redes de apoyo que utilizan en su entorno cotidiano para gestionar la enfermedad. Método: Se desarrolló un metaestudio tipo metaanálisis cualitativo. La estrategia metodológica constó de cuatro etapas: Búsqueda bibliográfica, Categorización de los estudios, Evaluación de la calidad metodológica y Análisis de resultados. Resultados: Se obtuvo una muestra bibliográfica de 22 estudios de naturaleza cualitativa. Los hallazgos se organizaron en 4 categorías: Compresión del padecimiento, Autogestión en el cotidiano, Percepción de los Servicios de Salud y Cotidiano del cuidador. Conclusiones: El esfuerzo de los adultos mayores por alcanzar un nuevo equilibrio social y personal se articula en las estrategias de autogestión que utilizan en su día a día para afrontar sus padecimientos. Las interrelaciones con los servicios de salud, familia y redes de apoyo son fundamentales para gestionar la cronicidad (AU)

Aims: To describe the cultural, interpersonal and personal experience of older adults with chronic diseases and to identify the strategies and support networks used by them in their daily environment for managing the disease. Methods: A qualitative meta-analitic study was developed in four stages: literature search, studies categorization, methodological quality assessment and results analysis. Results: A sample of 22 qualitative studies was obtained. The findings were organized into 4 categories: Compression of the condition, daily self-management, perception of health services and the caregiver´s daily life. Conclusions: The effort of older adults to achieve a new social and personal balance is articulated in self-management strategies that they use to face their sufferings. Interrelationships with health services, family and support networks are essential for chronicity management (AU)

Objetivo: Descreva a experiência cultural, interpessoal e pessoal dos idosos com doenças crônicas e identificar estratégias e redes de apoio que eles usam em seu ambiente todos os dias para controlar a doença. Método: Um tipo qualitativo meta-meta foi desenvolvido. A estratégia metodológica consistiu em quatro etapas: pesquisa bibliográfica, categorização dos estudos, avaliação da qualidade metodológica e análise dos resultados. Resultados: Uma amostra bibliográfica de 22 estudos qualitativos foi obtido. Os resultados foram organizados em quatro categorias: condição de compressão, a auto-gestão no cotidiano, Percepção dos Serviços de Saúde e cuidador Daily. Conclusões: O esforço de adultos mais velhos para alcançar um novo equilíbrio social e pessoal é dividido em estratégias de auto-gestão que eles usam no seu dia a cumprir as suas condições. Inter-relações com os serviços de saúde, redes de apoio à família são essenciais para a gestão crônica (AU)

Experiences and coping with the altered body image in digestive stoma patients / Vivências e enfrentamento diante da alteração da imagem corporal em pessoas com estomas digestivos / Vivencias y afrontamiento ante el cambio de imagen corporal en personas con estomas digestivos

ABSTRACT Objective: to describe the coping of stoma patients with the news about the ostomy, as well as to analyze the meaning and the experience of their new bodily reality. Method: qualitative phenomenological study undertaken through semistructured interviews with 21 stoma patients. The analysis was based on the constant comparison of the data, the progressive incorporation of subjects and triangulation among researchers and stomal therapy nurses. The software Atlas.ti was used. Results: two main categories emerge: "Coping with the news about receiving a stoma" and "Meaning and experience of the new bodily reality". The informants' answer varies, showing situations that range from the natural acceptance of the process to resignation and rejection. The previous experiences of other family members, the possible reconstruction of the stoma or the type of illness act as conditioning factors. Conclusions: the coping with the news about the stoma is conditioned by the type of illness, although the normalization of the process is the trend observed in most informants. Nursing plays a fundamental role in the implementation of cognitive-behavioral interventions and other resources to promote the patients' autonomy in everything related to care for the stoma.

RESUMO Objetivo: descrever o enfrentamento de pessoas ostomizadas diante da notícia da realização do estoma, assim como analisar o significado e a vivência diante de sua nova realizada corporal. Método: estudo qualitativo fenomenológico mediante entrevistas semiestruturadas com 21 personas ostomizadas. Foi desenvolvido através da comparação constante de dados, incorporação progressiva de sujeitos e triangulação entre investigadores e enfermeiras especialistas em estomaterapia. Foi utilizado o software Atlas.ti. Resultados: emergiram duas categorias centrais: "Enfrentamento diante da notícia de que serão ostomizados" e "Significado e vivência da nova realidade corporal". A resposta dos informantes é variável, revelando situações que vão desde a aceitação natural do seu processo até a resignação e a rejeição. As experiências prévias de outros familiares, a possibilidade de reconstrução do estoma ou o tipo de doença são fatores condicionantes. Conclusões: o enfrentamento diante da notícia do estoma está condicionado pelo tipo de doença. Apesar disso, observa-se que a maioria dos informantes tende a normalizar o processo. A enfermagem tem papel fundamental na implementação de intervenções cognitivas-comportamentais e outros recursos destinados à promoção da autonomia dos pacientes em tudo relacionado ao cuidado do estoma.

RESUMEN Objetivo: describir el afrontamiento de personas ostomizadas ante la noticia de la realización de la ostomía, así como analizar el significado y la vivencia ante su nueva realidad corporal. Método: estudio cualitativo fenomenológico mediante entrevistas semiestructuradas a 21 personas ostomizadas. Se realizó análisis mediante comparación constante de datos, incorporación progresiva de sujetos y triangulación entre investigadores y enfermeras expertas en estomaterapia. Se empleó el programa Atlas.ti. Resultados: emergen dos categorías centrales: "Afrontamiento ante la noticia de que van a ser ostomizados" y "Significado y vivencia de la nueva realidad corporal". La respuesta de los informantes es variable, percibiéndose situaciones que van desde la aceptación natural de su proceso hasta la resignación y el rechazo. Las experiencias previas de otros familiares, la posibilidad de reconstrucción del estoma o el tipo de enfermedad, son factores condicionantes. Conclusiones: el afrontamiento ante la noticia del estoma está condicionado por el tipo de enfermedad, aunque la normalización del proceso es la tendencia observada en la mayoría de los informantes. Enfermería tiene un papel fundamental en la puesta en marcha de intervenciones cognitivos-conductuales y otros recursos destinados a la promoción de la autonomía de los pacientes en todo lo relacionado con el cuidado del estoma.

Living with digestive stomas: strategies to cope with the new bodily reality.

OBJECTIVE: the objective in this study was to describe the strategies developed by digestive stoma patients to cope with their situation. METHOD: a qualitative and descriptive study was undertaken, involving 21 stoma patients living in the provinces of Málaga and Granada (Spain). The informants were selected in accordance with criteria of appropriateness and diversity, through intentional sampling. The data were collected by means of semistructured interviews. RESULTS: the content analysis revealed three categories around which the distinct strategies were developed: Self-care, Adaptation to the bodily change and Self-help. CONCLUSION: the strategies developed are focusing on achieving the effective management of the stoma and are closely linked with the achievement of autonomy. Discovering the strategies applied is fundamental for the nursing professionals to offer high-quality care, centered on people and their process.

Living with digestive stomas: strategies to cope with the new bodily reality / Convivendo com estomas digestivos: estratégias de enfrentamento da nova realidade física / Conviviendo con estomas digestivos: estrategias de afrontamiento de la nueva realidad corporal

OBJECTIVE: the objective in this study was to describe the strategies developed by digestive stoma patients to cope with their situation. METHOD: a qualitative and descriptive study was undertaken, involving 21 stoma patients living in the provinces of Málaga and Granada (Spain). The informants were selected in accordance with criteria of appropriateness and diversity, through intentional sampling. The data were collected by means of semistructured interviews. RESULTS: the content analysis revealed three categories around which the distinct strategies were developed: Self-care, Adaptation to the bodily change and Self-help. CONCLUSION: the strategies developed are focusing on achieving the effective management of the stoma and are closely linked with the achievement of autonomy. Discovering the strategies applied is fundamental for the nursing professionals to offer high-quality care, centered on people and their process. .

OBJETIVO: o objetivo deste estudo foi descrever as estratégias desenvolvidas pelas pessoas portadoras de estomas digestivos para enfrentar a sua situação. MÉTODO: foi realizado estudo qualitativo, de caráter descritivo, com 21 pessoas ostomizadas, residentes nas províncias de Málaga e Granada (Espanha). A seleção dos participantes foi feita seguindo-se os critérios de adequação e diversidade de uma amostragem intencional. A coleta de dados foi realizada através de entrevistas semiestruturadas. RESULTADOS: através da análise do conteúdo foram obtidas três categorias, em torno das quais foram desenvolvidas as diferentes estratégias: autocuidados, adaptação à mudança corporal e autoajuda. CONCLUSÃO: as estratégias desenvolvidas estão focadas para assegurar manejo eficaz do estômato, estando intimamente vinculadas à conquista da autonomia. Conhecer quais são as estratégias a serem implementadas é indispensável para oferecer, como profissionais de enfermagem, atendimento de qualidade com foco nas pessoas e sua carreira. .

OBJETIVO: el objetivo del estudio fue describir las estrategias desarrolladas por personas portadoras de estomas digestivos para hacer frente a su situación. MÉTODO: se realizó un estudio cualitativo de carácter descriptivo con 21 personas ostomizadas residentes en las provincias de Málaga y Granada (España). La selección de los informantes se hizo siguiendo los criterios de adecuación y diversidad mediante un muestreo intencional. La recogida de datos se realizó a través de entrevistas semiestructuradas. RESULTADOS: tras el análisis del contenido se obtuvieron tres categorías en torno a las cuales se desarrollaban las distintas estrategias: Autocuidados, Adaptación al cambio corporal y Autoayuda. CONCLUSIÓN: las estrategias desarrolladas están enfocadas a conseguir un manejo efectivo del estoma, quedando vinculadas estrechamente a la consecución de la autonomía. Conocer cuáles son las estrategias puestas en marcha se hace indispensable para ofrecer como profesionales de enfermería unos cuidados de calidad centrados en las personas y su proceso. .

Viviendo con un estoma digestivo: la importancia del apoyo familiar / Living with a digestive stoma: the importance of family support

Objetivo principal: Describir la relación y participación de la familia percibida por personas con estomas digestivos. Metodología: Estudio cualitativo descriptivo con 21 personas con estomas digestivos de las provincias de Málaga y Granada (España). La selección se hizo siguiendo los criterios de adecuación y diversidad mediante un muestreo intencional. La recogida de datos se realizó a través de entrevistas semiestructuradas. Se realizó un análisis del contenido, obteniéndose como categoría central el apoyo familiar. Resultados principales: Para las personas ostomizadas la familia se convierte en un recurso terapéutico esencial a lo largo de todo el proceso. Que el entorno familiar acepte esta nueva situación es fundamental para favorecer el reencuentro de la persona con su nueva realidad corporal. La implicación familiar en el proceso de aprendizaje de los cuidados desde el inicio es fundamental para la consecución de la autonomía. Contar con la aceptación y el apoyo de la pareja influye positivamente en el restablecimiento de las relaciones sexuales. Conclusión principal: La familia se convierte en un recurso terapéutico esencial a lo largo de todo el proceso, desde la toma de decisión acerca de la realización de la ostomía y durante el proceso de aceptación y adaptación del estoma (AU)

Objective: The aim of this study was to describe the family participation through the illness of people with digestive stomas. Methods: A descriptive qualitative study was carried out with 21 people with a digestive stoma living in the provinces of Malaga and Granada (Spain). The selection of informants was done through an intentional sampling, accordingly to the criteria of suitability and diversity. Data were collected by semi-structured interviews. The content analysis yielded a main category: family support. Results: For ostomized people the family turns into a key therapeutic resource along the whole process. The fact of families" acceptance of this new situation is essential for the process of patient"s reconciliation with his/her own corporal reality. The family implication in the process of care learning from the beginning is very important for achieving autonomy. The couple"s acceptance and support has a positive influence for recovering sexual relations (AU)

Effect of the Act on Promotion of Personal Autonomy and Care for dependent persons on their family caregivers.

BACKGROUND: The need of home care services is becoming an increasingly common scenario. These cares are mainly provided by the dependents' relatives specifically, by the women part of the family. This situation might take years, decreasing the physical and psychological health of the caregiver. In Spain, the Act of Promotion of Personal Autonomy and Care for dependent persons, guarantees those dependent persons and their caregivers to have access to social services or to financial grants. The aim of this study is to Know the possible effects of the benefits provided by this Act in regards to the mental health, the quality of life and use of health services by the family caregivers assisting their relatives in situation of dependency. METHODS AND DESIGN: A longitudinal descriptive study following-up a cohort of patients and caregivers. The study shall be carried out in Andalusia. It shall include the baseline assessment of the variables in those caregivers free from the exposure factor (reception of assistance pursuant to the Act). Following, once the benefits have been received, this cohort shall be followed-up.The study shall take three years, and the starting date for its development as well as its funding is January 2011. DISCUSSION: The longitudinal assessment of the rate of change of the variables studied shall allow us to know the implications which might be potentially generated as well as the natural evolution of those.

Understanding the suffering of a patient with an illness: signs, context and strategies.

The aim of this study is to understand the suffering of a patient with an illness, by using a secondary research method, that is, a qualitative meta-study. The primary data source of the meta-study includes "biographical reports". This project is based on a case study, in which the first-hand experiences of a patient with an illness were collected. The findings of the reports were compiled using the Archivos de la Memoria collection of the Index Foundation (Granada, Spain) and journals specialized in editing these materials. A selection of 20 biographical reports was targeted. The results of the meta-study show that suffering is a multidimensional process within a framework of ambiguous feelings. The suffering involves family and social network participation. Patients develop a range of strategies to overcome the illness. One of the effects is the fear of illness relapse or worsening.

El cuidado y la cultura: Génesis, lazos y referentes teóricos en enfermería / The care and culture: Origin, connections and theories in nursing

Vivimos inmersos en una sociedad multicultural. La cultura da forma a la manera en la que la persona vive la salud y la enfermedad. Este hecho nos insta a que como profesionales dispongamos no solo del conocimiento necesario acerca de otras culturas y la propia, sino también de las actitudes y habilidades culturales necesarias para llevar a cabo unos cuidados culturalmente competentes en un contexto concreto. En este artículo se hace un recorrido por los conceptos de cultura y cuidados, sus conexiones y las principales corrientes y referentes teóricos con los que contamos en el campo de los cuidados culturales. Se trata de ofrecer alternativas que huyendo de una visión reduccionista de la persona defienden la importancia de atender las necesidades desde la perspectiva de la competencia cultural (AU)

We live immersed in a multicultural society. Culture determines the way in which a person lives in both health and illness. We need to have, as professionals, the necessary knowledge, not only about other cultures and their own, but also cultural attitudes, and have the skills needed to conduct culturally competent care in any given situation. This article discusses culture and care concepts, their connections and the current theories in the field of cultural care. The aims are to offer alternatives that defend the importance of seeing the needs of the patient from the perspective of cultural competence and to leave behind the reductionist view of the person (AU)

Understanding the suffering of a patient with an illness: signs, context and strategies / Compreendendo o sofrimento humano frente à doença: manifestações, contexto e estratégias / Comprendiendo el padecimiento humano ante la enfermedad: manifestaciones, contexto y estrategias

The aim of this study is to understand the suffering of a patient with an illness, by using a secondary research method, that is, a qualitative meta-study. The primary data source of the meta-study includes "biographical reports". This project is based on a case study, in which the first-hand experiences of a patient with an illness were collected. The findings of the reports were compiled using the Archivos de la Memoria collection of the Index Foundation (Granada, Spain) and journals specialized in editing these materials. A selection of 20 biographical reports was targeted. The results of the meta-study show that suffering is a multidimensional process within a framework of ambiguous feelings. The suffering involves family and social network participation. Patients develop a range of strategies to overcome the illness. One of the effects is the fear of illness relapse or worsening.

O objetivo deste estudo foi compreender a experiência do sofrimento frente à doença, utilizando um método de pesquisa secundário, metaestudo qualitativo. A principal fonte de dados foi o relato biográfico, baseado em estudo de caso que reflete a experiência narrada em primeira pessoa, nesse caso, frente à doença. A localização dos relatos foi feita através de pesquisa nos Arquivos de Memória da Fundação Index e em revistas especializadas na publicação desses materiais. Foram selecionados 20 relatos biográficos. Os resultados do estudo mostram que o sofrimento é um processo multidimensional, caracterizado pela ambiguidade de sentimentos. É fenômeno que envolve a família e a rede social. Os indivíduos doentes desenvolvem diferentes estratégias de enfrentamento e é evidente o medo de recaída ou deterioração.

El propósito de este trabajo es comprender la experiencia del padecimiento ante la enfermedad mediante la utilización de un método de investigación secundaria, un meta estudio cualitativo. La fuente de datos primarios ha sido el relato biográfico, un diseño basado en el estudio de caso que recoge la experiencia en primera persona, en este caso, ante la enfermedad; la localización de relatos se ha hecho a través del fondo Archivos de la Memoria de la Fundación Index y de revistas especializadas en la edición de estos materiales. Se seleccionaron 20 relatos biográficos. Los resultados del meta estudio muestran que el padecimiento es un proceso multidimensional, caracterizado por la ambigüedad de sentimientos. Es un fenómeno que comparte la familia y la red social. Las personas enfermas desarrollan diferentes estrategias de afrontamiento y es manifiesto el miedo a la recaída o el empeoramiento.

Cómo escribir un caso clínico en Enfermería utilizando Taxonomía NANDA, NOC, NIC / How to write Clinical Case Studies in Nursing using the NANDA, NOC, NIC taxonomies

Los profesionales de enfermería cuentan como herramienta de trabajo con el proceso enfermero y los lenguajes estandarizados, lo que ha posibilitado en éstos un aumento considerable en la publicación de casos clínicos en revistas científicas. A partir de esta situación, el presente trabajo tiene el objetivo de proponer un conjunto de sugerencias que contribuyan a la labor de redactar y fijar una estructura determinada en un caso clínico en el que se gestionen cuidados basados en el uso de las taxonomías enfermeras, contemplando cada uno de los apartados que debería de contener: desde el título, resumen, introducción, valoración, plan de cuidados (fase de diagnóstico, planificación, ejecución, evaluación), gestión del caso, discusión, hasta la bibliografía, quedando recogidas todas las fases del proceso enfermero, con la ayuda de la taxonomías antes mencionadas (AU)

Nursing professionals use the nursing process as well as standard languages as working tools. As a result of this, the number of case studies published in scientific publications has increased considerably. The aim of this paper is to suggest a number of proposals which might facilitate the writing process, as well as the development of a certain structure for clinical case studies based on Nursing taxonomies. Furthermore all sections that should be included in such a study are reviewed - title, abstract, introduction, assessment, care plan (diagnosis, planning, execution, evaluation), case management and discussion, as well as bibliography-so that all phases in the nursing process are recorded with the above mentioned taxonomies (AU)

El empleo del humor como estrategia de mejora de los cuidados / The use os humour as a strategy to improve the nursing care

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Las dos caras de la enfermedad. Experiencia de una persona ostomizada / The two faces of the illness: Experience of a person with an ostomy

El relato biográfico es un tipo de investigación cualitativa que nos permite conocer y comprender las vivencias de una persona expresada con sus propias palabras. El protagonista del relato que se presenta a continuación se llama Antonio, tiene 63 años y en 2005 le diagnosticaron cáncer de colon. Fue intervenido y tuvo una rápida recuperación, volviendo a su vida normal. Sin embargo al año y medio le volvieron a detectar un pólipo maligno. Tuvo que ser intervenido de nuevo y finalmente, en una tercera intervención, le realizaron una ileostomía de urgencia. A lo largo del relato Antonio nos cuenta como vivió el proceso desde que le diagnosticaron hasta el día de hoy, poniendo de relieve la indefensión y el vacío de información con el que se encontró al ser dado de alta, hasta conocer a su enfermera estomaterapeuta

The biographical report is a kind of qualitative research which allows us to know and understand the experience of a person in his own words. The protagonist of the report is called Antonio, he is 63 years old and in 2005 he was diagnosed from colon cancer. He was operated and he had a speedy recovery, returning to his everyday life. Nevertheless, one year and a half later, he was detected again of a malignant polyp. He had to be operated again and finally, in a third operation, the physician had to make an emergency ileostomy. Antonio tells us, through the report, how he lived the process from the diagnosis to nowadays, underlining the helpless and the lack of information that he faced after been discharged from the hospital, until he meet the stomatherapist nurse

La importancia de las habilidades comunicativas en la humanización de los cuidados / The importance of communication skills in the humanization of patients' cares

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[Design and validation of a home care satisfaction questionnaire: SATISFAD]. / Diseño y validación de instrumento de evaluación de la satisfacción con los servicios de atención domiciliaria: SATISFAD.

OBJECTIVES: To design and validate an instrument to assess satisfaction with home care services, in both self-administered and telephone versions. METHODS: We performed a cross-sectional observational study of the population using home care services in the health districts of Malaga, Costa del Sol, Almeria and Granada (Spain). A questionnaire was designed by an expert panel using a Deplhi technique. Reliability between the self-administered and telephone versions was analyzed. Finally, internal consistency and construct validity were assessed. RESULTS: Reliability between the self-administered and telephone versions was high (intraclass correlation coefficient = 0.876; 95% CI, 0.726-0.941; p = 0.0001). Internal consistency was adequate (Cronbach's alpha: 0.853 and 0.799 for both versions, with or without caregiver, respectively). The factorial analysis explained 66.80% and 67.81% of the observed variance for the two versions (with or without caregiver, respectively). Two factors were isolated and related to interpersonal relationships, the role of the carer, and decision making. CONCLUSION: Assessment of satisfaction with home care can be performed with the dimensions routinely used in satisfaction studies, but these should be evaluated with instruments designed ad hoc. Accessibility, communication and interpersonal relationships have a high explanatory value in satisfaction among this population.