[How do patients on dialysis experience their disease? A qualitative approach]. / ¿Como viven su enfermedad las personas en diálisis?: una mirada cualitativa a la experiencia del paciente.

BACKGROUND: End-stage chronic kidney disease is a severe public health problem due to the poor quality of life of patients on dialysis and the costs associated with renal replacement treatment. AIM: To understand the social representations of kidney disease of people on dialysis. MATERIAL AND METHODS: In a qualitative study under the post-positivist paradigm, eighteen patients in peritoneal or hemodialysis participated in an in-depth interview. The analysis was performed using content analysis. RESULTS: Eight categories were identified: Friends, Health Care Team, Spirituality and Disease, Family, Health Support System, Physical Consequences, Psychosocial Consequences, Self-Care of Continuous Health-Disease. CONCLUSIONS: Health care of people on dialysis should take into consideration the experience of kidney disease from the perspective of the patient, including his beliefs and feelings and involving the family, community, and the state.

¿Cómo viven su enfermedad las personas en diálisis?: una mirada cualitativa a la experiencia del paciente / How do patients on dialysis experience their disease? A qualitative approach

BACKGROUND: End-stage chronic kidney disease is a severe public health problem due to the poor quality of life of patients on dialysis and the costs associated with renal replacement treatment. Aim: To understand the social representations of kidney disease of people on dialysis. MATERIAL AND METHODS: In a qualitative study under the post-positivist paradigm, eighteen patients in peritoneal or hemodialysis participated in an in-depth interview. The analysis was performed using content analysis. Results: Eight categories were identified: Friends, Health Care Team, Spirituality and Disease, Family, Health Support System, Physical Consequences, Psychosocial Consequences, Self-Care of Continuous Health-Disease. CONCLUSIONS: Health care of people on dialysis should take into consideration the experience of kidney disease from the perspective of the patient, including his beliefs and feelings and involving the family, community, and the state.

Características del proceso enseñanza aprendizaje vinculado al pensamiento crítico desde la mirada de docentes y estudiantes de enfermería / Characteristics of the Teaching-Learning Process Associated to Critical Thinking from the Perspective of Nursing Teachers and Students

Introducción: Enfermería incorpora en su formación de pregrado la competencia genérica y específica de pensamiento crítico y reflexivo, esencial para brindar cuidados holísticos. Objetivo: Describir características del proceso enseñanza aprendizaje vinculado a pensamiento crítico desde la mirada de docentes y estudiantes de la carrera de enfermería. Métodos: Estudio cualitativo descriptivo; realizado en la carrera de enfermería de la Universidad Católica del Norte; Chile, 2017. Las unidades de análisis se conformaron por 8 académicos y 12 estudiantes, seleccionados mediante muestreo por conveniencia, de acuerdo a objetivos, necesidades y alcance metodológico. Se utilizó la técnica de grupo focal. Se realizó análisis de contenido que dieron origen a matrices categoriales que emergen de los discursos. Resultados: El pensamiento crítico para académicos representa un proceso reflexivo complejo, importante para desarrollar habilidades integrales. Desde lo metodológico utilizan estrategias como: aprendizaje basado en problema, estudio de casos, simulaciones de baja y alta fidelidad, trabajo colaborativo, seminarios, clases interactivas, se enfatiza en la indagación; el proceso de evaluación se enmarca en lo oral y escrito, usando pautas y rúbricas. Conclusiones: La enseñanza de pensamiento crítico es compleja, proceso vital en la formación, los docentes y estudiantes construyen una percepción positiva del pensamiento crítico en el desarrollo del proceso enseñanza aprendizaje; emergen categorías: enseñanza del pensamiento crítico, entendida como progreso para favorecer el desarrollo de pensamiento reflexivo, metodologías, para favorecer el aprendizaje consciente de los estudiantes y evaluación del pensamiento crítico-reflexivo, entendido como mecanismos para profundizar logros de aprendizaje(AU)

Introduction: The Nursing major incorporates, in its undergraduate training program, the generic and specific competences of critical and reflective thinking, essential to providing holistic care. Objective: To describe the characteristics of the teaching-learning process associated to critical thinking from the perspective of teachers and students of the Nursing major. Methods: Descriptive and qualitative study carried out, in 2017, in the Nursing major of Universidad Católica del Norte, Chile. The analysis units were made up of eight scholars and twelve students, selected through convenience sampling, according to objectives, needs and methodological scope. The focus group technique was used. Content analysis was carried out, which gave rise to categorical matrices that emerge from the discourses. Results: Critical thinking for scholars represents a complex reflective process, important to developing comprehensive skills. From the methodological point of view, they use strategies such as problem-based learning, case studies, low and high fidelity simulations, collaborative work, seminars and interactive classes, while emphasis is placed on inquiry. The evaluation process is framed within oral and written activities, using guidelines and headings. Conclusions: The teaching of critical thinking is complex, a vital process in training. Teachers and students build a positive perception of critical thinking in the development of the teaching-learning process. Several categories emerge, such as teaching critical thinking, understood as progress to promote the development of reflective thinking; methodologies, to promote the conscious learning of students; and assessment of critical-reflective thinking, understood as mechanisms to deepen learning achievements(AU)

Comprensión de la gestión de la política pública de protección integral de la infancia en Chile / Understanding the Children Integral Protection Public Policy Management in Chile / Compreensão da gestão da política pública de proteção integral da meninice no Chile

Resumen La desigualdad social afecta desfavorablemente el desarrollo infantil, por esto fue relevante comprender las experiencias vividas por los profesionales en la gestión de procesos del Sistema de Protección Integral de la Infancia en una comuna de la Región Metropolitana, Chile. Método: investigación descriptiva, cualitativa. Fueron entrevistados doce profesionales con cargos y funciones en un centro de salud familiar público. Se utilizó la entrevista en profundidad y para la interpretación de los datos el método fenomenológico desde la perspectiva de Schütz. Hallazgos: se develó el rol relevante que se atribuyeron en la implementación del sistema y resaltaron la complejidad y las dificultades en la gestión sistémica que requiere la política. Emergieron vivencias sobre la resistencia al cambio, la fragmentación de la gestión, la hegemonía del paradigma biomédico y la importancia de la participación ciudadana. La información reportada justifica el desarrollo de competencias para instalar una nueva gestión sanitaria sistémica en la red intersectorial del territorio local.

Abstract Social inequality adversely affects children development, which is the reason why it was relevant to understand the experiences of the process management professionals of the Children Integral Protection System in a commune of the Metropolitan Region in Chile. Method: qualitative descriptive research. We interviewed twelve professionals with certain position and functions in a public family health center. We used an in-depth interview, and, for data interpreting, we used the phenomenological method from Schütz's perspective. Findings: we uncovered the relevant role they attributed to themselves in the implementation of the system and they highlighted the complexity and difficulties in the systemic management required by the policy. Experiences related to resistance to change were brought up, and also related to management fragmentation, the hegemony of the biomedical paradigm, and the importance of citizen participation. The information reported justifies the development of competencies to set in pace a new systemic health management in the cross-sectional network of the local territory.

Resumo A desigualdade social afeta desfavoravelmente o desenvolvimento infantil, por isso é que foi relevante compreender as experiências vividas pelos profissionais na gestão de processos do Sistema de Proteção Integral da Meninice em uma comuna da Região Metropolitana do Chile. Método: pesquisa descritiva, qualitativa. Foram entrevistados doze profissionais com posições e funções em um centro de saúde familiar público. Entrevista em profundidade foi utilizada e para a interpretação dos dados o método fenomenológico desde a perspectiva de Schütz. Achados: o papel relevante que se atribuíram na implementação do sistema foi desvendado e ressaltaram-se a complexidade e dificuldades na gestão sistémica que a política requer. Emergiram vivências sobre resistência às mudanças, fragmentação da gestão, hegemonia do paradigma biomédico e a importância da participação cidadã. A informação relatada justifica o desenvolvimento de competências para instalar uma nova gestão sanitária sistémica na rede intersetorial do território local.

La gestión clínica de la política pública de protección social en la atención primaria de salud / Clinic management of public social protection policy in primary health care

OBJETIVO: Conocer la efectividad de la gestión clínica de los profesionales de atención primaria de salud en el ámbito del Sistema de Protección Integral de la Infancia «Chile Crece Contigo» y la Red Protege. MÉTODO: Estudio observacional, descriptivo, con información disponible desde fuentes secundarias del Sistema Chile Crece Contigo, realizado en la comuna de Pudahuel, Santiago de Chile. La población fue de 1.656 mujeres embarazadas adscritas el año 2009 al Sistema Chile Crece Contigo. La vulnerabilidad social se midió con la ficha de protección social. Se seleccionaron variables sociodemográficas y de prestaciones del Sistema Chile Crece Contigo. Se contó con una base de datos bruta y depurada. El procesamiento y análisis de los datos se realizó por medio del programa estadístico Statistical Package Social Sciences y Excel. Se calcularon estadísticos descriptivos de frecuencia, posición y dispersión. Se contó con la certificación del Comité de Ética Científico de la Facultad de Enfermería. RESULTADOS: Se observó un 91,4% de vulnerabilidad social detectada por tamizaje institucional (ficha de protección social). El riesgo psicosocial fue mayor en mujeres con vulnerabilidad social (42,0 vs.28,2%) reconociéndose como más frecuente el insuficiente apoyo familiar, los síntomas depresivos, violencia de género, abuso de sustancias y conflictos con la maternidad. En las prestaciones universales, específicas e integradas no se cumplió con el 100% del acceso a las mismas. CONCLUSIONES: La invisibilidad de la vulnerabilidad social y la baja efectividad de la transferencia de beneficios a mujeres/niños-as socialmente vulnerables merece el desarrollo de competencias de gestión clínica contextualizada e integrada en los profesionales de atención primaria de salud

OBJECTIVE: Knowing the effectiveness of clinical management of primary care health in the field of Integral Protection System for Children "Chile Crece Contigo" and "Red Protege". Method: Observational, descriptive, with information available from secondary sources of Chile Crece Contigo system in the district of Pudahuel, Santiago de Chile. The population was 1,656 pregnant women assigned to Chile Crece Contigo system in 2009. Social vulnerability was measured with the Social Protection Record. Sociodemographic and Chile Crece Contigo system performance variables were selected. It featured a raw and refined database. Processing and analysis of data was performed using the statistical program Statistical Package for Social Sciences and Excel. Descriptive statistics for frequency, position and dispersion were calculated. Certification of Scientific Ethics Committee of the School of Nursing was granted. RESULTS: A 91.4% of institutional social vulnerability detected by screening social protection record was observed. Psychosocial risk was higher in women with social vulnerability (42.0 vs.28.2%) more often recognized as inadequate family support, depressive symptoms, domestic violence, substance abuse and conflicts with motherhood. In the universal, specific and integrated performance it was not met with 100% access to benefits. CONCLUSIONS: The invisibility of the social vulnerability and low effectiveness of the transfer of benefits to socially vulnerable women/children deserves skills development of contextualized and integrated clinical management professionals in primary health care

[Clinic management of public social protection policy in primary health care]. / La gestión clínica de la política pública de protección social en la atención primaria de salud.

OBJECTIVE: Knowing the effectiveness of clinical management of primary care health in the field of Integral Protection System for Children "Chile Crece Contigo" and "Red Protege". METHOD: Observational, descriptive, with information available from secondary sources of Chile Crece Contigo system in the district of Pudahuel, Santiago de Chile. The population was 1,656 pregnant women assigned to Chile Crece Contigo system in 2009. Social vulnerability was measured with the Social Protection Record. Sociodemographic and Chile Crece Contigo system performance variables were selected. It featured a raw and refined database. Processing and analysis of data was performed using the statistical program Statistical Package for Social Sciences and Excel. Descriptive statistics for frequency, position and dispersion were calculated. Certification of Scientific Ethics Committee of the School of Nursing was granted. RESULTS: A 91.4% of institutional social vulnerability detected by screening social protection record was observed. Psychosocial risk was higher in women with social vulnerability (42.0 vs. 28.2%) more often recognized as inadequate family support, depressive symptoms, domestic violence, substance abuse and conflicts with motherhood. In the universal, specific and integrated performance it was not met with 100% access to benefits. CONCLUSIONS: The invisibility of the social vulnerability and low effectiveness of the transfer of benefits to socially vulnerable women/children deserves skills development of contextualized and integrated clinical management professionals in primary health care.

Imaginative construction of care: the nursing professional experience in a remote care service.

The direction of care delivery goes from the action to the being; a process built from professional experience, which gains special characteristics when the service is delivered by telephone. The goal of this research was to understand the interaction between professionals and users in a remote care service; to do so, a research is presented, using Grounded Theory and Symbolic Interactionism as theoretical references. Data were collected through eight interviews with professionals who deliver care by telephone. The theoretical understanding permitted the creation of the theoretical model of the Imaginative Construction of Care, which shows the interaction processes the professional experiences when delivering care by telephone. In this model, individual and social facts are added, showing the link between the concepts, with special emphasis on uncertainty, sensitivity and professional responsibility, as essential components of this experience.

Imaginative construction of care: the nursing professional experience in a remote care service / A construção imaginativa de cuidados: a experiência de profissionais de enfermagem em um serviço de assistência remota / La construcción imaginativa del cuidado: la experiencia del profesional de enfermería en un servicio de asistencia remota

The direction of care delivery goes from the action to the being; a process built from professional experience, which gains special characteristics when the service is delivered by telephone. The goal of this research was to understand the interaction between professionals and users in a remote care service; to do so, a research is presented, using Grounded Theory and Symbolic Interactionism as theoretical references. Data were collected through eight interviews with professionals who deliver care by telephone. The theoretical understanding permitted the creation of the theoretical model of the Imaginative Construction of Care, which shows the interaction processes the professional experiences when delivering care by telephone. In this model, individual and social facts are added, showing the link between the concepts, with special emphasis on uncertainty, sensitivity and professional responsibility, as essential components of this experience.

Prestar cuidados em saúde é questão que transcorre desde a ação até o ser; é um processo construído na experiência profissional e contém características especiais, ao ser realizado por meio de telefone. O objetivo deste estudo foi compreender a experiência de interação entre profissionais de um serviço de assistência remota, por telefone, com os usuários. Foi conduzido segundo a Teoria Fundamentada, tendo o Interacionismo Simbólico como referencial teórico. A coleta de dados foi realizada por meio de entrevistas com oito profissionais de enfermagem que prestam cuidados pelo telefone. A compreensão teórica resultante da análise interpretativa permitiu a construção do modelo teórico da Construção Imaginativa do Cuidado, que reflete os processos interacionais que o profissional vivencia quando presta cuidados por meio do telefone. O modelo incorpora fenômenos individuais e sociais, demonstrando a vinculação entre conceitos e destacando a incerteza, a sensibilidade e a responsabilidade do profissional como componentes essenciais da experiência.

Brindar cuidados es una cuestión que transcurre desde la acción hasta el ser; un proceso construido desde la experiencia profesional, que cobra características especiales al ser brindado a través del teléfono. El objetivo de este estudio fue comprender la experiencia de interacción de los profesionales y los usuarios en un servicio de asistencia remota; para ello, se presenta una investigación utilizando la metodología de la Teoría Fundamentada y el Interaccionismo Simbólico como referente teórico. La recolección de datos se realizó mediante ocho entrevistas a profesionales que brindan atención telefónica. La comprensión teórica permitió la construcción del modelo teórico de la Construcción Imaginativa del Cuidado, el cual refleja los procesos interaccionales que experiencia el profesional cuando brinda cuidados a través del teléfono. En el modelo se incorporan los fenómenos individuales y sociales, demostrando la vinculación entre sus conceptos y destacando la incertidumbre, la sensibilidad y la responsabilidad del profesional como componentes esenciales de la experiencia.

La experiencia de familiares cuidadores de pacientes que sufren Alzheimer y competencias del profesional de enfermería / contributions of family caretakers of Alzheimer's patients and nursing competence

El propósito de este artículo es examinar la dimensión existencial de la experiencia de los familiares responsables de pacientes que sufren la enfermedad de Alzheimer y, de acuerdo con los hallazgos, presentar algunos aspectos del rol que le compete al profesional de enfermería, con especial énfasis en el área de la enfermería familiar. El método utilizado fue la investigación cualitativa de trayectoria fenomenológica, descrita por Martins y Bicudo1.Se describe la difícil relación interpersonal que se crea entre el cuidador familiar y el paciente a medida que surgen las diferentes dimensiones del fenómeno, que develan la agobiante experiencia que sufre el cuidador por la evolución de la enfermedad e incapacidades del paciente.Los profesionales de enfermería pueden contribuir a mejorar la calidad de vida de los pacientes por medio de su saber sobre cuidado, al educar y asistir a los familiares cuidadores.El estudio se presenta iniciando con una breve descripción de la trayectoria en el tema, para continuar con la metodología utilizada, la descripción de las dimensiones del fenómeno y, por último, las pertinentes competencias del profesional de enfermería.

La enfermedad vino a quedarse / The desease came to stay

El objetivo de esta investigación fue conocer la experiencia del cliente diabético que vivencia el fenómeno salud-enfermedad en el ambulatorio de un Hospital-Escuela en Sao Paulo, Brasil. Se procuró, con ello, comprender sus maneras de pensar y de sentir, además de sus prácticas a lo largo del período de tratamiento. En este estudio fue adoptado el método etnográfico de SPRADLEY (1979-1980) como también el interaccionismo Símbólico para aprehender la cosmovisión de los clientes. Se constató que el tema central fue: "La enfermedad vino para quedarse". En este universo cultural se develaron las metáforas de las enfermedad, como peligrosa, imposible, exasperante, que ataca y se queda, provocando sentimientos de miedo, tristeza, dolor y finitud. El conocimiento émico obtenido es importante como base epistemológica y ontológica de la enfermería y su práctica