Medication Adherence and Contraceptive Counseling.

Combined oral contraceptives (COC) are a very popular form of birth control. Incorrect use and lack of adherence to treatment reduce the effectiveness of this method. Having a standard tool to identify poor-adherence profiles quickly and objectively can be helpful for midwives and potentially for COC users. The MMAS-4 adherence scale has been used in various medical fields, but there is little evidence of its potential in contraceptive consultation. This paper presents a piece of multicenter observational research based on a sample of 327 women who had attended contraceptive counselling in Spain and were COC users or had informed the midwife that they want to start to use this method. Two interviews were conducted: at the time of consultation and after one year. In our research, the MMAS-4 identified high-risk behaviors: during the 1-year follow-up period, COC users classified as poorly adherent had a significantly higher risk of missed contraceptive pills, more incidents and problems related to the method of contraception, as well as a lower degree of satisfaction with the contraceptive method. One case of unplanned pregnancy and two cases of emergency contraception were identified, all of them corresponding to poorly adherent women. The use of MMAS-4 in consultation can improve midwives' contraceptive counselling.

'Football and dancing are in our blood': culture promoting sports practice among immigrants in Europe.

The current state of knowledge indicates that regular sports practice helps prevent and treat non-communicable diseases. The promotion of sport is, therefore, an important community health intervention for maintaining and improving the health of individuals and populations. Culture is identified as being associated with sports practice and sedentary behaviour of ethnic and national minorities. This study aims qualitatively to analyse the potential for culture as a basis for the promotion of sport among immigrants in four regions of Mediterranean Europe. Ten focus groups (n = 62) were conducted with immigrants-adults and young people over the age of 11-and people involved in promoting sport. Thematic content analysis was conducted. The results enabled identifying two major issues: sport as a vehicle for cultural expression and synergies between sport and culture. Accordingly, sport serves to express global, local and non-ethno-national cultural belonging. Regarding synergies, culture and sport feed each other positively and contribute to immigrants' health and cultural well-being. Culture as a strategy for promoting sports practice requires an interdisciplinary approach that involves collaboration between healthcare practitioners and social sciences professionals. There is also a need to use the various axes of cultural definition-global, local and non-ethno-national-of those involved, and for them to take part themselves in designing sports activities. Moreover, promoting sport through non-ethno-national axes of cultural definition may help with immigrants' social inclusion, as intercultural relations between migrants and newcomers are promoted.

Lesiones por presión y dermatitis asociada a la incontinencia: evolución de la prevalencia en un hospital de agudos (2014-2017) / Pressure ulcers and Incontinence-Associated Dermatitis: prevalence evolution in an acute hospital (2014-2017)

Objetivos: Analizar la evolución de la prevalencia de las lesiones por presión y la dermatitis asociada a la incontinencia en un hospital de agudos. Metodología: Estudio descriptivo, de prevalencias seriadas, realizado en un hospital de agudos, mediante la explotación de datos del programa informático Gacela Care® durante los años 2014 a 2017. Resultados: De un total de 20 319 pacientes, se registraron 760 lesiones por presión y 8 dermatitis asociadas a la incontinencia, lo que comporta una prevalencia media de lesiones por presión del 3,74% a lo largo del periodo. Las lesiones nosocomiales presentaron una disminución estadísticamente significativa (p = 0,013), pasando del 69,1% en 2014 al 56,4% en 2017. Se observó una diferencia estadísticamente significativa en la prevalencia de estas lesiones, entre las unidades médicas y las quirúrgicas en los dos últimos años del estudio, el 70,8% vs. el 29,2%, respectivamente, en el año 2016 (p = 0,004), y el 74,2% vs. el 25,8% en el año 2017 (p < 0,001). En la prevalencia de las lesiones por presión de categoría III se da un descenso significativo (p = 0,028), del 16,3% en 2014 al 8,3% en 2017, mientras que las de categoría II aumentan no significativamente. Conclusiones: A lo largo del periodo, la prevalencia de ambas lesiones fue inferior a la media nacional. Las lesiones por presión presentaron mayor prevalencia en unidades médicas que en quirúrgicas, siendo más de la mitad nosocomiales. La proporción de las de categoría III sufrió una disminución estadísticamente significativa, mientras que las de categoría II aumentaron, interpretándose como una mejora de las intervenciones de abordaje (AU)

Objectives: To assess prevalence evolution for pressure ulcers and Incontinence-Associated Dermatitis, at an acute care hospital. Method: Descriptive study analysing the prevalence in a series, conducted at an acute care hospital through Gacela Care software programme data use, during the years 2014 to 2017. Result: From a total of 20,319 patients, 760 pressure ulcers and 8 incontinence associated dermatitis were registered. The mean pressure ulcer prevalence was 3.74% throughout the study. Nosocomial lesions showed a statistically significant decrease (p=0.013), from 69.1% in 2014, to 56.4% in 2017. A statistically significant difference was observed in the prevalence of these lesions among medical units and surgical units in the last two years of the study, 70.8% vs. 29.2% respectively in 2016 (p = 0.004) and 74.2% vs. 25.8% in 2017 (p<0,001). Category III pressure ulcers prevalence showed a significant decrease (p=0.028), from 16.3% in 2014 to 8.3% in 2017. Category II pressure ulcers do increase not significantly. Conclusion: For the period studied, both pressure ulcers and incontinence associated dermatitis prevalence is lower regarding the national average. Pressure ulcers prevalence seems to be larger in medical units than in surgical ones, and more than half of the ones registered happen to be nosocomial. Category III pressure ulcers proportion suffers a statistically significative decrease during the period studied, whereas those classified as category II, increase, understanding this fact as an improvement on the wounds approach, from nurse professionals (AU)

Contraceptive counselling experiences in Spain in the process of creating a web-based contraceptive decision support tool: a qualitative study.

BACKGROUND: The choice of contraceptive method is a complex decision, and professionals should offer counselling based on the preferences, values and personal situation of the user(s). Some users are unsatisfied with the counselling received, which may, among other consequences, adversely affect method use adherence. In view of this situation, we propose exploring the experiences and needs of users and professionals for contraceptive counselling, in the context of creating a web-based contraceptive decision support tool. METHODS/DESIGN: Qualitative research was conducted through focus group discussions (64 users split into eight groups, and 19 professionals in two groups, in Tarragona, Spain) to explore the subjects' experiences and needs. The data were categorized and the categories were defined and classified based on the three-step protocol or framework for Quality on Contraceptive Counseling (QCC), created by experts, which reviews the quality of interactions between user and professional during the counselling process. RESULTS: In counselling, users demand more information about the different methods, in an environment of erroneous knowledge and misinformation, which lead to false beliefs and myths in the population that are not contrasted by the professional in counselling. They complain that the method is imposed on them and that their views regarding the decision are not considered. Professionals are concerned that their lack of training leads to counselling directed towards the methods they know best. They acknowledge that a paternalistic paradigm persists in the healthcare they provide, and decision support tools may help to improve the situation. CONCLUSIONS: Users feel unsatisfied and/or demand more information and a warmer, more caring approach. Professionals are reluctant to assume a process of shared decision-making. The use of a contraception DST website may solve some shortcomings in counselling detected in our environment.

Kennedy terminal ulcer and other skin wounds at the end of life: An integrative review.

AIMS: To undertake an integrative literature review to identify, analyse and synthesize current literature on the Kennedy terminal ulcer (KTU) and other unavoidable skin injuries that appear at the end of life regardless of the healthcare context in which they occur. METHODS: Integrative review following the Whittemore and Knafl methodology. The search was carried out in PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Scopus. It was limited to articles in English, French, Portuguese and Spanish. As there is little scientific production on the subject, no restrictions were applied regarding publication date. RESULTS: Only 17 articles met the inclusion criteria. These articles were reviewed and analysed. Four relevant issues emerged: Skin failure, SCALE, Kennedy Terminal Ulcer, Trombley-Brennan: different names for the same problem; the defining characteristics and physiopathology of KTU; the differences between KTU and other injuries; and the care approach for KTU and other unavoidable injuries at the end of life. CONCLUSIONS: We identified gaps regarding the physiopathology of KTU since the current knowledge is based only on hypotheses. There is also a large gap in the knowledge about care approaches, perhaps because care plans are not recorded. Despite this, it is clear that the main objective in this situation at the end of life would be to prioritize patient comfort and quality of life.

Meanings and practices of the physical activity engaged in by Moroccan women in an Islamic urban environment: A quasi-ethnography.

AIM: To understand the meanings and practices of the physical activity (PA) engaged in by Moroccan women in an Islamic urban environment. DESIGN: Quasi-ethnographical study. METHODS: 13 semi-structured interviews and 15 observation sessions of the PA engaged in by women. RESULTS: The concept of PA fits into the holistic approach of Islam. The social and cultural conditions of those who regularly practise PA are diverse. The community collaborates to overcome difficulties involved with this practice. The flexibility of issues such as gender segregation and clothing, Islam as a stimulus for PA, health as a value, the promotion of a rights and duty-based model for health care user, the community co-creation of the PA offer, and the power of organized civil society could inspire new strategies for the promotion of PA among Muslim women in other contexts.

Nurses' Perspective of Treating Patients With an Amputation Due to Diabetic Foot Syndrome.

BACKGROUND: Expert nurses must provide both physical and emotional care to patients with diabetic foot syndrome (DFS) who require an amputation. This includes helping patients and families to cope with this situation, while ensuring the maximum level of comfort. PURPOSE: The aim of this study was to explore the perspective of expert nurses on the needs and hospital care of people requiring an amputation due to DFS. METHOD: This was a qualitative multicenter study involving 8 hospitals in Spain and Portugal. In-depth interviews with expert nurses were transcribed verbatim to enable content analysis. RESULTS: Twenty-four expert nurses were interviewed about their knowledge and experience of treating patients with diabetic foot disease. Two themes emerged from the qualitative analysis: (1) poor self-care and the disease trajectory, and (2) effective hospital care. CONCLUSIONS: The results of this study highlight the key role that expert nurses play in the care of patients with DFS. Expert nurses considered that amputation leaves the individual physically and psychologically vulnerable, especially upon discharge from hospital. It is therefore essential to provide these patients with comprehensive and multidisciplinary care that includes emotional support.

The effectiveness of a digital shared decision-making tool in hormonal contraception during clinical assessment: study protocol of a randomized controlled trial in Spain.

BACKGROUND: Decision-making tools represent a paradigm shift in the relationship between the clinician and the user/patient. Some of their advantages include patient commitment, the promotion of preferences and values, and increased treatment adherence. This study protocol aims to assess the effectiveness of a decision-making tool in contraception (SHARECONTRACEPT) concerning: a) Improvement in counselling on hormonal contraception at the medical consultation, measured in terms of decreasing decisional conflict and improving knowledge of available contraceptive options; b) Improvement in adherence to treatment measured in terms of: persistence in the chosen treatment, compliance with dose or procedure of use, and ability to deal with incidents related to the use of the contraceptive method; and decreasing unwanted pregnancies and voluntary interruption of pregnancy. The SHARECONTRACEPT tool, developed by previous phases of this project, is available at: http://decisionscompartides.gencat.cat/en/decidir-sobre/anticoncepcio_hormonal/ METHODS/DESIGN: A longitudinal, prospective-type, randomized, controlled community clinical trial, carried out in the clinical contraceptive counselling units of 6 autonomous regions in Spain, with an experimental group and a control group. Description of the intervention: The health professionals participating will be randomly assigned to one of the two groups. Clinicians assigned to the experimental group will perform contraceptive counselling assisted by SHARECONTRACEPT, and those of the control group will follow the conventional contraceptive counselling provided in their clinical unit. It is planned to study 1708 users (control group n = 854 and intervention group n = 854), recruited from women who attend the consultations of the health professionals. The selected users will be followed up for one year. The data will be collected through ad-hoc questionnaires, and validated instruments for measuring decisional conflict and adherence to treatment. DISCUSSION: The results of this study protocol will offer evidence of the effectiveness of a shared decision-making tool, SHARECONTRACEPT, which may prove a useful tool for users and professionals to promote adherence to contraceptive methods. TRIAL REGISTRATION: Clinical Register number ISRCTN5827994 . Date: 15/04/2019 (Retrospectively registered).

Incidencia de lesiones relacionadas con la dependencia en una población de pacientes críticos / Incidence of dependence-related lesions in a population of critical patients

OBJETIVO: Determinar la incidencia de los distintos tipos de lesiones relacionadas con la dependencia (LRD) en una población de pacientes críticos. MÉTODO: Estudio descriptivo, longitudinal y prospectivo realizado en una Unidad de Cuidados Intensivos desde enero de 2014 a enero de 2015. Incluidos los pacientes mayores de edad que no presentaban LRD al ingreso. Excluidos aquellos con muerte encefálica y/o estancia en la unidad superior a dos días. Permanecieron en estudio hasta que desarrollaron LRD, fueron exitus, dados de alta o su estancia superior a 14 días. Cada paciente fue evaluado diariamente hasta desarrollar LRD o salida de estudio. En el caso de presentar LRD esta se fotografiaba y se anotaban los datos relacionados. La comparación entre variables cuantitativas de distribución normal se realizó mediante la t de Student, y se utilizó la U de Mann-Whitney en el resto. Entre variables cualitativas se utilizó el test chi cuadrado de Pearson considerándose en ambos casos significativa una p menos o igual a 0,05. RESULTADOS: Incluidos 295 pacientes, el 27,45% de los cuales desarrollaron LRD. La densidad de incidencia fue de 41 LRD/1.000 días en riesgo. El 50,62% de las LRD se catalogaron como UPP, el 17,28% fueron lesiones por humedad, el 13,58% lo fueron por fricción y el resto resultaron lesiones combinadas. El riesgo según las escalas EMINA y Braden fue significativamente superior en el grupo de pacientes con lesiones respecto al grupo sin ellas. CONCLUSIONES: No todas las lesiones fueron causadas por la presión. Se requieren estrategias preventivas específicas en función de los distintos mecanismos causales

AIM: To determine the incidence of various types of dependence-related lesions (DRL) on a population of critically ill patients. METHOD: Descriptive, longitudinal and prospective study in an Intensive Care Unit from January 2014 to January 2015. Adult patients who did not present DRL at the moment of admission were included. Those with brain death and/or stay at the unit for more than two days were excluded. Patients were studied till they developed DRL, were exitus, discharged or stayed for more than 14 days. Each patient was evaluated daily till DRL did develop or was excluded from the study. If DRL did develop it was photographed and related data were recorded. The comparison between quantitative variables of normal distribution was done with the t de Student. The Mann-Whitney U was used to compare the other variables. Qualitative variables were compared through Pearson's chi square. In both cases p less than or equal to 05 was considered significant. RESULTS: 295 patients were included, 27.45% of them developed DRL. The density of incidence was 41 DRL/1,000 days at risk.50.62% of DRL were categorized as PU.17.28% were moisture injuries, 13.58% were due to friction and the rest were combined injuries. The risk according to EMINA and Braden scale was significantly different in the group of patients with lesions compared to the group without them. CONCLUSIONS: Not all injuries were caused by pressure. Specific prevention strategies based on different causal mechanisms are required

[Incidence of dependence-related lesions in a population of critical patients]. / Incidencia de lesiones relacionadas con la dependencia en una población de pacientes críticos.

AIM: To determine the incidence of various types of dependence-related lesions (DRL) on a population of critically ill patients. METHOD: Descriptive, longitudinal and prospective study in an Intensive Care Unit from January 2014 to January 2015. Adult patients who did not present DRL at the moment of admission were included. Those with brain death and/or stay at the unit for more than two days were excluded. Patients were studied till they developed DRL, were exitus, discharged or stayed for more than 14 days. Each patient was evaluated daily till DRL did develop or was excluded from the study. If DRL did develop it was photographed and related data were recorded. The comparison between quantitative variables of normal distribution was done with the t de Student. The Mann-Whitney U was used to compare the other variables. Qualitative variables were compared through Pearson's chi square. In both cases p≤.05 was considered significant. RESULTS: 295 patients were included, 27.45% of them developed DRL. The density of incidence was 41 DRL/1,000 days at risk. 50.62% of DRL were categorized as PU. 17.28% were moisture injuries, 13.58% were due to friction and the rest were combined injuries. The risk according to EMINA and Braden scale was significantly different in the group of patients with lesions compared to the group without them. CONCLUSIONS: Not all injuries were caused by pressure. Specific prevention strategies based on different causal mechanisms are required.

Perceived discrimination among Maghrebi users of health services in Tarragona (Spain).

BACKGROUND: Discrimination in health services for reasons of nationality or ethnicity is not a rare occurrence. This work aims to qualitatively analyse the perceived discrimination among Maghrebi community in Tarragona (Spain) with regard to the healthcare services they receive. METHODS: A qualitative study was carried by means of 12 semi-structured interviews and 10 focus groups with Maghrebi adults living in Tarragona. The scope of the study was public health services in the area. A content analysis was performed using open coding. RESULTS: Our results show that perceived discrimination is greater than actual discrimination because the deficiencies of the healthcare system are often interpreted as unfairness. However, our subjects also recounted incidents of clear discrimination against Maghrebi users of the healthcare system. The tendency to feel discriminated against is the culmination of an interaction between the group's low self-esteem and locals' often negative sentiments towards the group. CONCLUSIONS: We suggest addressing the shortcomings of the healthcare system in order to reduce this level of perceived discrimination and thus improve patient satisfaction. To improve this group's self-esteem and change how they are perceived, public policies should be put into effect which promote social inclusion and the respect for Maghrebis' rights as people, with actions taken on both fronts: in the host society and within the Maghrebi community itself. Furthermore, an active role for the patient with regard to his or her rights should be encouraged in order to minimize abuse from professionals and to facilitate institutional control of individual actions.

Identificación y clasificación de las lesiones relacionadas con la dependencia: de la teoría a la práctica clínica / Identification and classification of the injuries related to the dependence: from theory to clinical practice

Objetivo: clasificar y categorizar las lesiones relacionadas con la dependencia según la teoría de García-Fernández y cols. Metodología: estudio descriptivo y longitudinal realizado en una unidad de cuidados intensivos en el que se incluyó a todos los pacientes ingresados sin lesiones previas. Cada paciente fue evaluado diariamente hasta desarrollar una lesión relacionada con la dependencia o salida de estudio. Resultados: El 27,9% de los pacientes (n = 136) desarrollaron lesiones relacionadas con la dependencia, sin diferencias estadísticamente significativas entre pacientes que las desarrollaron y aquellos que no lo hicieron salvo para EMINA primer día (p = 0,035). Solo el 46,4% de las lesiones relacionadas con la dependencia se catalogaron como úlceras por presión. El 36,8% se relacionaron con dispositivos terapéuticos. Conclusiones: los resultados apoyan el cambio de paradigma propuesto por los autores, lo que permite diferenciar entre úlceras por presión y otro tipo de lesiones

Aim: Descriptive to clasified and categorize the dependence related lesions on the theory García-Fernández y cols. Metodology: Descriptive and longitudinal study in intensive care unit in which all patients admitted. We included patients without previous pressure ulcers. Each patient was assessed daily to develop dependence related lesions or output study. Results: 27.9% of patients (n = 136) developed dependence related lesions. No statistically significant differences between patients who developed dependence related lesions and those who did not save for EMINA first day (p = 0.035). Only 46.4% of dependence related lesions were classified as pressure ulcers. 36.8% were related to medical devices. Conclusions: Our results support the paradigm shift proposed by these authors allowing differentiation between pressure ulcers and other lesions

Fiabilidad interobservador de las escalas EMINA y EVARUCI en una unidad de cuidados intensivos / Interobserver reliability in EVARUCI and EMINA scales for intensive care unit

El objetivo de este estudio fue valorar la fiabilidad interobservador de las escalas EMINA y EVARUCI en una unidad de cuidados intensivos. Para ello, dos observadores valoraron diariamente el riesgo de desarrollar úlceras por presión mediante ambas escalas. La concordancia entre observadores para la puntuación total de las escalas se midió mediante el coeficiente de correlación intraclase (CCI) y la concordancia entre subescalas con el índice de Kappa. La fiabilidad total interobservador fue muy buena para EMINA, (CCI = 0,92) y para EVARUCI (CCI = 0, 99). En la escala EMINA el ítem nutrición presentó concordancia pobre (k = 0,137), mientras que las subescalas restantes presentaron concordancia buena. En la escala EVARUCI todas las subescalas mostraron buena concordancia

The aim of this study was to evaluate the interobserver reliability of the scales EMINA and EVARUCI in Intensive Care Unit. To this day two observers assessed the risk of developing pressure ulcers by EMINA and EVARUCI scales in all patients admitted. The interobserver agreement for the total score EVARUCI and EMINA was measured by intraclass correlation coefficient (ICC). The agreement between the subscales was measured by Kappa. The overallinter observer reliability was very good for EMINA scale (ICC =0.92) and EVARUCI (ICC = 0.99). In item scale Nutrition EMINA presented poor agreement (k = 0.137) while the remaining subscales showed good agreement. On the scale EVARUCI all subscales showed very good agreement

Maghrebi minors as translators in health services in Tarragona (Spain): a qualitative study of the discourse of the Maghrebi adults.

BACKGROUND: In the province of Tarragona (Spain), 24% of immigrants come from countries in the Maghreb. 40% of Maghrebis residing in Spain say their linguistic command of Spanish is inadequate, which could hinder their relationship with healthcare professionals. The use of minors as translators by health services is a fairly common practice. The suitability of using children as translators has been questioned, although there has been little specific research on the subject and most has been from the perspective of professionals. The aim of this study was to qualitatively analyze the discourse of Maghrebi adults to the use of Maghrebi minors as translators in the health services. METHODS: A qualitative study using 12 in-depth interviews and 10 focus groups with Maghrebi adults living in Tarragona. The scope of the study was primary healthcare and hospital services in the area. A content analysis was performed using open coding. RESULTS: The practice studied is attributed to a lack of funding for translation resources, and prioritization of adults' work over children's education. It is seen as a convenient solution to the community's communication problems, although it is considered unreliable and detrimental to the rights of the child. The attitudes of healthcare professionals to the phenomenon studied varies from acceptance without any ethical concerns to concern about its effects on the child. The solutions proposed are the organization of translation resources with a proactive approach which are adapted to real needs, and a change in the focus of language training activities for the adults in the community. CONCLUSIONS: It is necessary to reconcile access to healthcare for Maghrebi adults with the rights of children who act as translators in the healthcare context. This requires coordination between health and educational institutions, changes in the organization and provision of translation resources, and a guarantee that immigrants have employment rights under the same conditions as Spanish nationals.

Seguridad cultural: la interculturalidad y la salud en un entorno globalizado / Cultural safety: interculturality and health in a globalized setting

El presente ensayo reflexiona sobre la importancia de valorarla interculturalidad aplicada a la salud en la realidad global del siglo XXI y propone una nueva manera de cuidar y atenderla diversidad en salud: la seguridad cultural. El concepto se enraiza en las bases filosóficas que lo sustentan y es propuesto como útil para pensar la interculturalidad y la salud en un entorno globalizado. La seguridad cultural concibe la investigación y la práctica enfermera como un saber que va más allá del estricto conocimiento de las costumbres culturales de los colectivos para identificar y actuar sobre las causas históricas, sociales, culturales, políticas y económicas de las desigualdades en salud. Asimismo, reflexiona sobre las múltiples dimensiones con que se expresa la diversidad cultural. El intercambio,las relaciones entre culturas y el trato entre personas deberían darse en condiciones de igualdad y justicia. La reflexión sobre el ejercicio del poder en la gestión de la salud,el reconocimiento del prejuicio hacia la diferencia y la voluntad de dar voz a los que hasta ahora no la han tenido, para valorar sus saberes y escuchar sus necesidades, abre una nueva perspectiva en la investigación intercultural que deja atrás la consideración esencialista de las culturas, que reconoce un nuevo espacio de formación de la identidad y que va más lejos del hecho estrictamente cultural para adentrarse en la responsabilidad social y en la reparación de los agravios (AU)

This study makes a reflection on the importance of given sufficient value to the interculturality applied to health in the global reality of the XXI century and proposes a new way ofcaring for and provide for such health diversity: cultural safety.The concept is rooted in the philosophical basis that supports it and is proposed as a useful tool to think about interculturality and health in a globalised setting. Cultural safety understands research and nursing practice as a “know how”that goes beyond the strict knowledge of cultural customs of collective groups, identifying and acting upon the historical, social, cultural, political and economic causes of inequality in health. Moreover, it also makes a reflection on the multipledimensions in which cultural diversity is manifested. The exchange,cultural relations among cultures and the way peopletreat each other should take place in levelled conditions ofequality and justice. The reflection on the exercise of power inhealth management, the recognition of prejudice towards indifference,and the willingness to give voice to those that have not had the privilege of being heard before to value their duties and knowledge and listen to their needs, opens a new perspective in intercultural research that leaves behind the essentialist consideration of cultures, that recognises a newspace for the development of identity and which goes beyond the purely cultural fact to reach further into social responsibility and in the repair of offences and personal da (AU)

[Interdisciplinary relationships and humanization in intensive care units]. / Relaciones interdisciplinarias y humanización en las unidades de cuidados intensivos.

OBJECTIVE: To analyze those aspects of the relationship between the health care team of an ICU that may be decisive in the construction of humanized care. DESIGN: phenomenology: descriptive and exploratory. ANALYSIS and observation unit: Polyvalent 23-bed adult ICU. DATA COLLECTION: nine extensive interviews. POPULATION: healthcare professionals in interaction in the ICU that is being studied. ANALYSIS: assigning of data to emergent categories. Contrasting with existing theories. RESULTS: Identification of guideline values circumspect to the humanistic paradigm. The value of professional role is accepted as emergency factor of certain attitudes. All the professional groups detect lack of independence situations, which are not always attributable to hierarchical reasons. Systematic interdisciplinary communication is evaluated positively. Humanization requires time, resources, and intergroup relationships and explicit commitment by the institution. CONCLUSIONS: Relief of great suffering situations is the main reason for interdisciplinary disagreement. Construction of a tolerant setting and institutional recognition as factors favoring humanized care. Lack of time and resources as obstacles to the humanization of care.

Relaciones interdisciplinarias y humanización en las unidades de cuidados intensivos / Interdisciplinary relationships and humanization in intensive care units

Objetivo. Analizar los aspectos de la relación entre el equipo asistencial de una unidad de cuidados intensivos (UCI) que puedan ser decisivos en la construcción de una atención humanizada. Método. Diseño: fenomenológico; descriptivo y exploratorio. Unidad de análisis y observación: UCI polivalente de adultos de 23 camas. Recogida de datos: 9 entrevistas a fondo. Población: profesionales sanitarios en interacción en la UCI objeto de estudio. Análisis: asignación de datos a categorías emergentes. Contrastación con teorías existentes. Resultados. Identificación de valores guía circunscritos al paradigma humanista. Valores asociados a características personales más que profesionales. Se acepta el valor del rol profesional como factor de emergencia de determinadas actitudes. Todos los grupos profesionales detectan situaciones de falta de autonomía, no siempre atribuibles a causa jerárquica. Se valora positivamente la comunicación interdisciplinaria sistemática. La humanización requiere tiempo, recursos, buena relación intergrupal y el compromiso explícito de la institución. Conclusiones. El alivio de situaciones de gran sufrimiento, principal motivo de desacuerdo interdisciplinario. La construcción de un entorno tolerante y el reconocimiento institucional como factores favorecedores de la atención humanizada. La falta de tiempo y recursos como obstáculos a la humanización de la atención

Objective. To analyze those aspects of the relationship between the health care team of an ICU that may be decisive in the construction of humanized care. Method. Design: phenomenology: descriptive and exploratory. Analysis and observation unit: Polyvalent 23-bed adult ICU. Data collection: nine extensive interviews. Population: healthcare professionals in interaction in the ICU that is being studied. Analysis: assigning of data to emergent categories. Contrasting with existing theories. Results. Identification of guideline values circumspect to the humanistic paradigm. The value of professional role is accepted as emergency factor of certain attitudes. All the professional groups detect lack of independence situations, which are not always attributable to hierarchical reasons. Systematic interdisciplinary communication is evaluated positively. Humanization requires time, resources, and intergroup relationships and explicit commitment by the institution. Conclusions. Relief of great suffering situations is the main reason for interdisciplinary disagreement. Construction of a tolerant setting and institutional recognition as factors favoring humanized care. Lack of time and resources as obstacles to the humanization of care

Humanización del cuidado: de la jerarquía a la colaboración / The care humanise: from hierarchy to collaboration

La humanización de la atención a la salud se ha estudiado preferentemente desde la experienciade la persona receptora de cuidados, desde la visión de la familia o desde la aportaciónaislada de los diferentes profesionales. Ahora bien, en un entorno profesional interdisciplinar,no puede obviarse la contribución que el carácter relacional del trabajo en equipo aportaa la configuración de la atención. El presente artículo muestra un recorrido por la evoluciónde la relación interdisciplinar en el medio sanitario y su influencia en la humanización dela atención. El tránsito de un modelo de relación basado en la jerarquía hacia un modelo decolaboración, añade valores humanistas al paradigma biomédico y contribuye, con ello, ahumanizar el cuidado

The humanisation of healthcare has been preferably studied from the perspective of the experienceof the person receiving the care, from the perspective of the family or from the isolatedcontribution of the different professionals. Now, in an interdisciplinary professional setting,we cannot obviate the contribution that the relational nature of team work provides to theconfiguration of care. This paper shows the path followed by the evolution of this interdisciplinaryrelationship in the healthcare setting and its influence on the humanisation of care.The transit from one relational model based on hierarchy towards a collaboration model, addshumanistic values to the biomedical paradigm and contributes, with it, to humanise care

Intervención enfermera en la persona en coma y su familia / The nurse's role when treating a person in coma and that patient's family

Se presenta el plan de cuidados estándar para personas adultas en coma en las primeras semanas, después de la fase aguda, como una guía práctica que clarifica la orientación de los cuidados a seguir en este proceso. En primer lugar se delimita el proceso que se va a realizar. En segundo lugar se normalizan las características que definen a las personas en estos procesos. Se resalta como parte fundamental trabajar desde las situaciones de cuidados que la persona y familia tendrán que afrontar, lo cual proporciona al estándar un carácter preventivo de tratamiento de los problemas. Los diagnósticos enfermeros son vistos como prevalentes. Las situaciones de cuidados y los diagnósticos se enmarcan en el modelo de V. Henderson (AU)