Análise do conceito de conforto: contribuições para o diagnóstico de Disposição para Conforto melhorado / Análisis del concepto de confort: contribuciones al diagnóstico de la Disposición para mejorar el confort / Analysis of the concept of comfort: Contributions to the diagnosis of Readiness for enhanced comfort

RESUMO Objetivos Analisar o conceito de conforto à luz do modelo de análise conceitual evolucionista de Rodgers e incorporar elementos da análise conceitual na estrutura do diagnóstico de enfermagem "Disposição para conforto melhorado" (00183). Métodos Estudo de análise de conceito com aplicação das sete etapas do modelo evolucionário de Rodgers, sendo orientado para a condução da fase 1 de validação do diagnóstico de enfermagem. O material para análise foi obtido com a estratégia de revisão integrativa da literatura. Resultados e discussão Apresenta-se perspectiva histórico-desenvolvimental do conceito de quatro períodos temporais. Evidencia atributos, antecedentes, consequentes, termos substitutos e definições conceituais obtidos da decomposição conceitual, utilizando-os para a atualização dos componentes da "Disposição para conforto melhorado" (00183). Conclusão e implicações para a prática A abordagem evolucionária de análise do conceito mostrou ser apropriada para clarificar o conceito de conforto, dela emergindo tanto uma perspectiva orientada para o bem-estar quanto para as alterações do desconforto. A análise do conceito de conforto no método evolucionário contribuiu para a atualização do diagnóstico de enfermagem em tela. Os resultados obtidos fornecem elementos para a realização de futuros estudos de validação diagnóstica por experts e de validação clínica o que impacta positivamente no uso da linguagem diagnóstica.

RESUMEN Objetivos Analizar el concepto de confort a la luz del modelo de análisis conceptual evolutivo de Rodgers e incorporar elementos de análisis conceptual en el marco del diagnóstico enfermero "Disposición para mejorar el confort" (00183). Métodos Estudio de análisis conceptual con aplicación de los siete pasos del modelo evolutivo de Rodgers, orientado a realizar la fase 1 de validación del diagnóstico enfermero. El material para el análisis se obtuvo con la estrategia de revisión integradora de la literatura. Resultados y discusión Se presenta una perspectiva histórica y de desarrollo del concepto de cuatro períodos temporales. Destaca los atributos, antecedentes, consecuencias, términos sustitutos y definiciones conceptuales obtenidas de la descomposición conceptual, usándolos para actualizar los componentes de la " Disposición para mejorar el confort" (00183). Conclusión e implicaciones para la práctica se ha demostrado que el enfoque evolutivo del análisis de conceptos es apropiado para aclarar el concepto de confort desde una perspectiva orientada hacia el bienestar hasta los cambios de la incomodidad. El análisis del concepto de confort en el método evolutivo contribuyó a la actualización del diagnóstico enfermero. Estos resultados proporcionan elementos para futuros estudios de validación diagnóstica por expertos y validación clínica, lo que impacta positivamente el uso del lenguaje diagnóstico.

ABSTRACT Objectives To analyze the concept of comfort in light of Rodgers' conceptual evolutionary analysis model and to incorporate elements of conceptual analysis into the framework of the nursing diagnosis "Readiness for enhanced comfort" (00183). Methods Concept analysis with the application of the seven steps of Rodgers' evolutionary model, oriented to the conduction of phase 1 of the validation of the nursing diagnosis. The material for analysis was obtained through the strategy of integrative review of the literature. Results and discussion A historical-developmental perspective of the concept with four temporal periods is presented. It reveals attributes, antecedents, consequences, substitute terms and conceptual definitions obtained from conceptual decomposition and we used them to update the components of the diagnosis "Readiness for enhanced comfort" (00183). Conclusion and implications for practice The evolutionary approach to concept analysis proved to be appropriate to clarify the concept of comfort, and a well-being perspective and a discomfort perspective emerged from it. An analysis of the concept of comfort in accordance with the evolutionary method contributed to the update of the nursing diagnosis. The results provide elements for future diagnostic validation studies conducted by experts and clinical validation studies, which has a positive impact on the use of diagnostic language.

Discursos sobre la precariedad: consecuencias en la identidad y en la obra del artista / Discourses about precariousness: consequences on artists' work and identity

La precariedad es un fenómeno laboral que afecta a muchos Individuos de las sociedades actuales. Se ha convertido ya en un problema crónico que tiene incidencia en el bienestar psicológico en distintos colectivos, entre ellos el de los y las artistas, dando lugar a cuadros de fatiga crónica, depresión, ansiedad, insomnio, nerviosismo, vulnerabilidad y bloqueo artístico. El objetivo de este trabajo reside en analizar los discursos que circulan por diarios y periódicos alrededor de la figura del/la artista y cómo ellos mismos comunican la precariedad y sus consecuencias. La metodología seguida se ha centrado en la identificación de los repertorios interpretativos sobre dicha precariedad en los contextos discursivos que la sociedad vehicula en referencia a la producción del arte y su consumo. Entre los resultados hallados podemos destacar la presencia de tres repertorios interpretativos en los que los propios artistas dan cuenta de lo que es vivir en precario y las consecuencias psicológicas que se observan en su identidad y propio bienestar

Precariousness is a work condition that affects many individuals in today's societies. It has already become a chronic problem that has a psychological impact on the well-being of many groups, such as artists, resulting in chronic fatigue, depression, anxiety, insomnia, nervousness, vulnerability, or artist's block. The objective of this research study is to analyze the discourses that circulate in newspapers and online news around the figure of the artist and how artists themselves communicate about precariousness and its consequences. The methodology followed has focused on the identification of interpretative repertoires as to how people communicate about precariousness in the discursive contexts that society conveys in reference to the production of art and its consumption. Among the results found, we can highlight the presence of three interpretative repertoires in which artists themselves give an account of what it is like to live in precariousness and its psychological consequences in their identity and well-being

Teaching Nurses From a Holistic Comfort Perspective.

Nursing students in various degree programs experience an array of stressful and demanding circumstances. As such, nursing faculty have a unique opportunity to provide student-centered teaching from a holistic comfort perspective. Holistic comfort is a concept supported by evidence symbolizing more than just the relief of pain. It involves caring for the whole person. The majority of research surrounding holistic comfort has been focused on patients-but, what about students in nursing? In this article, the authors aim to explain and expand upon the role of teaching from a holistic comfort perspective. Holistic comfort has been well documented in the literature and it is delivered in one (or more) of 4 different contexts: the physical, psychospiritual, sociocultural, and/or environmental context. Implementing a program of teaching focused on comforting students has implications for nursing education, organizational policy, and nursing practice.

End-of-Life Travel: A Bucket List Desire for Patients With Life-Limiting Illnesses.

Patients at end of life often express a desire to travel, and many have requests that go unfulfilled. Studies show that a majority of patients have a desire to return to their place of birth to die when presented with the option, yet goals-of-care conversations do not routinely include travel desires for numerous reasons. Patients faced with a life-limiting illness are at greater risk of depression, withdrawal, denial, anger, and feelings of helplessness. When palliative care teams assist patients with end-of-life travel, they empower them with a greater sense of control over the dying process. Improving goals-of-care conversations regarding medical travel begins with well-developed communication skills and a knowledge of available options. This article primarily focuses on the recommendation of medical travel as a goals-of-care comfort measure for the palliative care patient.

Mediation pattern of proactive coping and social support on well-being and depression

Proactive coping is a multidimensional and future-looking quality of life strategy that can predict positive outcomes and regulate distress. Recently, social support has been seen as an essential resource for effective coping with stressors. On this basis, a cross-sectional study examining a theoretical model was investigated using a path analysis. It was hypothesized that social support would be associated with proactive coping in the synergistic relationship and in relation to the positive psychological variable of well-being. Moreover, direct relationships between well-being and feelings of depression were expected. In a sample of 482 full-time university students attending public university, the results showed that social support and comparable proactive coping directly contributed to an increase in well-being. Furthermore, well-being was directly related to depression. Besides direct effects, an indirect pathway from social support to well-being was tested confirming the hypothesis that proactive coping functions as a partial mediator between social support and well-being. Generalizability of the findings was tested across gender and age performing multi-group analyses. Furthermore, practical implications, study limitations, and future research are discussed

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Incidence of the initiation of comfort care immediately following emergent neurosurgical and endovascular procedures.

OBJECTIVE: It is unknown what proportion of patients who undergo emergent neurosurgical procedures initiate comfort care (CC) measures shortly after the operation. The purpose of the present study was to analyze the proportion and predictive factors of patients who initiated CC measures within the same hospital admission after undergoing emergent neurosurgery. METHODS: This retrospective cohort study included all adult patients who underwent emergent neurosurgical and endovascular procedures at a single center between 2009 and 2014. Primary and secondary outcomes were initiation of CC measures during the initial hospitalization and determination of predictive factors, respectively. RESULTS: Of the 1295 operations, comfort care was initiated in 111 (8.6%) during the initial admission. On average, CC was initiated 9.3 ± 10.0 days postoperatively. One-third of the patients switched to CC within 3 days. In multivariate analysis, patients > 70 years of age were significantly more likely to undergo CC than those < 50 years (70-79 years, p = 0.004; > 80 years, p = 0.0001). Two-thirds of CC patients had been admitted with a cerebrovascular pathology (p < 0.001). Admission diagnosis of cerebrovascular pathology was a significant predictor of initiating CC (p < 0.0001). A high Hunt and Hess grade of IV or V in patients with subarachnoid hemorrhage was significantly associated with initiation of CC compared to a low grade (27.1% vs 2.9%, p < 0.001). Surgery starting between 15:01 and 06:59 hours had a 1.70 times greater odds of initiating CC compared to surgery between 07:00 and 15:00. CONCLUSIONS: Initiation of CC after emergent neurosurgical and endovascular procedures is relatively common, particularly when an elderly patient presents with a cerebrovascular pathology after typical operating hours.

Calidad de vida con órtesis de compresión frente a apósito en el postoperatorio de pacientes con cirugía conservadora de cáncer de mama / Quality of life in patients with compression orthoses compared with those with compressive bandage during the postoperative period after conservative surgery for breast cancer

Objetivos. Comparar el efecto producido por el uso de una órtesis de compresión controlada (sujetador de compresión) frente al apósito compresivo clásico, sobre la calidad de vida y otras características que también pueden incidir en esta como el bienestar, la satisfacción estética, la facilidad de uso y el dolor de pacientes intervenidas de cirugía conservadora de cáncer de mama. Método. Estudio prospectivo aleatorizado sobre 198 casos distribuidos en 2 grupos: apósito (n=88) y órtesis (n=99), recogiendo variables relacionadas con la calidad de vida, facilidad de uso, bienestar, satisfacción estética y dolor. Se realizó un estudio comparativo y de la evolución temporal de las variables durante el primer mes postoperatorio utilizándose para la valoración de la calidad de vida el cuestionario de salud general SF-12 cuyo objetivo es evaluar el grado de bienestar y capacidad funcional de las pacientes. Para la valoración del grado de facilidad de uso, bienestar y satisfacción estética se emplearon escalas de Likert. En cuanto a la intensidad del dolor fue valorado con una escala visual-analógica graduada numéricamente (0 a 10). Resultados. Se encontraron diferencias significativas en la calidad de vida a favor del uso de la órtesis (p<0,0005). En cuanto a la valoración de la facilidad de uso, bienestar y la satisfacción estética también existen diferencias significativas (p<0,0005) entre los grupos, y en cada uno de los momentos de tiempo del postoperatorio. La intensidad del dolor mejoró también significativamente en el grupo experimental a los 7 (p=0,002) y a los 15 días (p=0,012). Conclusiones. La calidad de vida en el postoperatorio de las pacientes tratadas con órtesis es superior a la de las pacientes tratadas con apósito, mejorando también la facilidad de uso, bienestar, satisfacción estética y la intensidad del dolor, constituyendo por tanto una alternativa válida en la recuperación postoperatoria de las pacientes intervenidas de cirugía conservadora de cáncer de mama

Objectives. To compare the effects of controlled compression orthoses (compression bra) with those of traditional compressive bandage after conservative surgery for breast cancer. The analysed effects focussed on patients’ quality of life, convenience, aesthetic satisfaction, user-friendliness and pain after breast-conserving surgery. Method. A randomised prospective study was carried out in 198 patients distributed in 2 groups: bandage (n=88) and orthoses (n=99). The following variables were collected: quality of life, user-friendliness, convenience, aesthetic satisfaction and pain. This comparative study also analysed the temporal evolution of the variables during the first postoperative month. To assess quality of life, the SF-12 general health questionnaire was used, which aims to evaluate patients’ degree of well-being and functional capacity. To assess the degree of user-friendliness, convenience and aesthetic satisfaction, Likert scales were used. Pain intensity was assessed by using a numerically numbered (0 to 10) visual-analogue scale. Results. Significant differences were found in relation to quality of life favouring the use of orthoses (P<.0005). There were also differences (P<.0005) in the assessment of user-friendliness, convenience and aesthetic satisfaction between the two groups and throughout the postoperative period. Pain intensity also improved significantly in the experiment group after 7 (P=.002) and 15 days (P=.012). Conclusions. Quality of life during the postoperative period was higher among patients treated with orthoses than among those treated with bandages. User-friendliness, convenience, aesthetic satisfaction and pain intensity also improved. Therefore, the use of orthoses is a valid alternative for postoperative recovery in patients undergoing breast-conserving surgery

Confort neonatal del recién nacido pre-término / Neonatal comfort of preterm infant

Justificación: la clarificación de conceptos es un elemento primordial en el desarrollo científico, estos son explicativos y permiten caracterizar los fenómenos de interés disciplinar. Propósito: clarificar el significado de confort neonatal, para desarrollar una definición operacional que permita comprender mejor las necesidades de los recién nacidos pre-término. Metodología: se realizó un análisis de concepto bajo la metodología de Walker y Avant. Resultado: una definición teórica actual y operacional para su uso en intervenciones de enfermería del cuidado neonatal. Conclusión: el introducir nuevos conceptos en la disciplina, permite al profesional de enfermería desarrollar habilidades para resolver problemas propios de la práctica diaria

Justification: clarification of concepts is a key factor in scientific development; they are explanatory and enable the characterization of disciplinary interest phenomena. Objective: to clarify the meaning of neonatal comfort, in order to develop an operational definition that enables a better understanding of the needs of preterm infants. Method: a concept analysis under Walker and Avant's methodology was performed. Results: a current theoretical and operational definition for its use in nursing interventions of neonatal care. Conclusions: introducing new concepts to the discipline enables the nursing professionals to develop skills to solve problems related to everyday practice

El estudiante de medicina ante el síndrome de Down. Cuidados a las personas / No disponible

El cuidado a las personas con síndrome de Down parte de un principio fundamental: La esencia se asienta en que es un ser humano; lo accesorio es que tiene síndrome de Down. El cuidado a la persona exige contemplarla como tal: con sus necesidades y sus capacidades. Función indispensable de los médicos es el atender a la problemática médica mediante la aplicación de específicos programas de salud. El bienestar físico le ayudará a alcanzar el mayor bienestar psico-social. El taller analizará este programa, expondrá las modernas tareas educativas y psico-sociales, y dará oportunidad para que personas adultas con síndrome de Down muestren su realidad y experiencias

The care to individuals with Down syndrome should be based upon an essential principle: the person is a human being. Having Down syndrome is just an accidental element. Coping the care requires addressing the entire person, including both limitations and the abilities. The main function of the medical profession is to care for the physical health through the use of good health programs. The physical quality of life will help to secure the best psychosocial well-being. This workshop will offer and summarize, first, the health program; second, it will explain the current educational and psychosocial practices; third, it will give the opportunity to a lady with Down syndrome to show the highlights and experiences of her life

Percepción de enfermeras y familiares de pacientes sobre conductas de cuidado importantes / Perception of nurses and families of patients regarding important care behaviors

RESUMEN Objetivo: Determinar si existen diferencias entre las enfermeras de pacientes hospitalizados y sus familiares, respecto de la percepción de cuáles conductas de cuidado son importantes. Material y método: Estudio descrip tivo, transversal, cuya muestra, estratificada por servicio, estuvo constituida por 54 enfermeras y 96 familiares de un hospital general. Para medir la variable respuesta se empleó el Caring Assessment Instrument (Care- Q) de Patricia Larson, que consta de 50 preguntas dividas en 6 subescalas que miden el comportamiento del pro fesional de enfermería en la entrega de cuidado: a) es accesible, b) explica y facilita, c) conforta, d) se anticipa, e) mantiene relación de confianza y f) monitorea y hace seguimiento. Resultados: La priorización de la primera conducta, representada por la subescala "monitorea y hace seguimiento", coincide en ambos grupos. En rela ción a la importancia asignada al resto de las conductas de cuidado y sus subescalas, se observan diferencias en ambos grupos. Conclusión: La priorización de las categorías y conductas de cuidado entre las enfermeras y los familiares de los pacientes son diferentes y como primera selección se enfocan hacia conductas del tipo técnicas, más que al desarrollo de habilidades sociales.

ABSTRACT Objective: To determine whether there are differences between nurses of hospitalized patients and their relatives, regarding the perception they have of what care behaviors are important. Material and method: A cross-sectional descriptive study whose sample, stratified by service, consisted of 54 nurses and 96 relatives of a general hospital. To measure the response variable, the Caring Assessment Instrument (Care- Q) by Patricia Larson was used, which consists of 50 questions divided into 6 sub-scales that measure the behavior of the nursing professional in the delivery of care: a) it is accessible, b) explains and facilitates, c) comforts, d) anticipates, e) maintains a relationship of trust and f) monitors and follows up. Results: The prioritization of the first behav ior, represented by the subscale "monitors and follows-up", coincides in both groups. Regarding the importance assigned to the rest of the care behaviors and their subscales, differences are observed in both groups. Conclu sion: The prioritization of care categories and behaviors between nurses and patients' relatives are different and, as a first choice, it focuses on technical type behavior rather than the development of social skills.

Palliative Care in Lung Cancer.

Lung cancer is the most common cancer worldwide and is the leading cause of cancer death for both men and women in the USA. Symptom burden in patients with advanced lung cancer is very high and has a negative impact on their quality of life (QOL). Palliative care with its focus on the management of symptoms and addressing physical, psychosocial, spiritual, and existential suffering, as well as medically appropriate goal setting and open communication with patients and families, significantly adds to the quality of care received by advanced lung cancer patients. The Provisional Clinical Opinion (PCO) of American Society of Clinical Oncology (ASCO) as well as the National Cancer Care Network's (NCCN) clinical practice guidelines recommends early integration of palliative care into routine cancer care. In this chapter, we will provide an overview of palliative care in lung cancer and will examine the evidence and recommendations with regard to a comprehensive and interdisciplinary approach to symptom management, as well as discussions of goals of care, advance care planning, and care preferences.