Psicologia e diabetes no Brasil: um mapeamento de profissionais e de suas ações / Psychology and diabetes in Brazil: the mapping of professionals and their practices / Psicología y diabetes en Brasil: un mapeo de los profesionales y sus acciones

Pouco se sabe sobre a atuação do psicólogo no Brasil junto a pessoas com Diabetes Mellitus. O objetivo desta pesquisa foi identificar os psicólogos brasileiros que trabalham com essa população e suas ações. Foram convidados a responder a um questionário online psicólogos que atuam ou atuaram junto a pessoas com diabetes. Participaram 79 psicólogos, principalmente da região Sudeste (59,5%). Todos declararam que haviam cursado pósgraduação. Na amostra, predominou o gênero feminino (89,9%), com idade entre 26 e 40 anos (46,8%). A maioria dos que atuam com diabetes declarou-se autônoma ou voluntária, e quase metade trabalhava menos do que 10 horas semanais. Entre aqueles que deixaram de trabalhar com diabetes, apenas uma minoria tinha vínculo empregatício. Além do trabalho com pessoas com diabetes, a maior parte declarou exercer outras atividades profissionais, como atendimentos clínicos em consultórios particulares, sugerindo que esta não é a atividade principal. Majoritariamente, os respondentes declararam não ter conhecimentos suficientes para o atendimento específico às pessoas com diabetes. Discute-se a qualidade da formação profissional dos psicólogos no Brasil, a necessidade de aprimoramento em relação à atuação com pessoas com diabetes e as condições de trabalho.(AU)

Little is known about the practice of psychologists in Brazil caring for people with Diabetes Mellitus. The aim of this research was to identify the Brazilian psychologists who work with this population and describe their actions. Psychologists who work or have worked with people diagnosed with diabetes were invited to answer an online questionnaire. The 79 participants lived mainly in the Southeast Region (59.5%). All of them declared to have a graduate degree, most were female (89.9%), aged 26 to 40 years (46.8%). Most of those working with diabetes declared to be autonomous or voluntary, and almost half had a workload of less than 10 hours a week. Among those who stopped working with diabetes, only a minority had a formal employment contract. In addition, most of them stated that they had other professional activities related to clinical care in private offices, suggesting that working with diabetes is not their main activity. Mostly, respondents stated that they did not have enough knowledge to care for people with diabetes. The quality of professional education of psychologists in Brazil, the need for specific improvement in labor relations and conditions were discussed.(AU)

Son escasas las informaciones del trabajo de los psicólogos en Brasil con las personas con Diabetes Mellitus. El objetivo de este estudio fue identificar los psicólogos brasileños que trabajan con esta población y describir sus acciones. Se invitó a psicólogos que trabajan o hayan trabajado con personas con diabetes a responder un cuestionario en línea. Participaron 79 psicólogos, principalmente de la región Sureste de Brasil (59,5%). Todos declararon tener posgrado. En la muestra hubo una mayor prevalencia del género femenino (89,9%), de edades de entre 26 y 40 años (46,8%). La mayoría de los que trabajan con personas con diabetes se declararon autónomos o voluntarios, y casi la mitad trabajaba menos de 10 horas a la semana. Entre los que dejaron de trabajar con las personas con diabetes, solo una minoría tenía una relación laboral. Además de trabajar con personas con diabetes, la mayoría afirmó tener otras actividades profesionales, como la atención clínica en consultorios privados, lo que sugiere que esta no es su actividad principal. La mayoría de los encuestados afirmaron que no tenían los conocimientos suficientes para atender específicamente a las personas con diabetes. Se discuten la calidad de la formación profesional de los psicólogos en Brasil, la necesidad de mejora en relación con el trabajo con personas con diabetes y las condiciones laborales.(AU)

Construction of a non-contact community treatment centre for asymptomatic and mildly symptomatic COVID-19 patients during the COVID-19 pandemic.

The explosive outbreak of COVID-19 led to a shortage of medical resources, including isolation rooms in hospitals, healthcare workers (HCWs) and personal protective equipment. Here, we constructed a new model, non-contact community treatment centres to monitor and quarantine asymptomatic and mildly symptomatic COVID-19 patients who recorded their own vital signs using a smartphone application. This new model in Korea is useful to overcome shortages of medical resources and to minimise the risk of infection transmission to HCWs.

Levels of type 1 diabetes care in children and adolescents for countries at varying resource levels.

Optimal care for children and adolescents with type 1 diabetes is well described in guidelines, such as those of the International Society for Pediatric and Adolescent Diabetes. High-income countries can usually provide this, but the cost of this care is generally prohibitive for lower-income countries. Indeed, in most of these countries, very little care is provided by government health systems, resulting in high mortality, and high complications rates in those who do survive. As lower-income countries work toward establishing guidelines-based care, it is helpful to describe the levels of care that are potentially affordable, cost-effective, and result in substantially improved clinical outcomes. We have developed a levels of care concept with three tiers: "minimal care," "intermediate care," and "comprehensive (guidelines-based) care." Each tier contains levels, which describe insulin and blood glucose monitoring regimens, requirements for hemoglobin A1c (HbA1c) testing, complications screening, diabetes education, and multidisciplinary care. The literature provides various examples at each tier, including from countries where the life for a child and the changing diabetes in children programs have assisted local diabetes centres to introduce intermediate care. Intra-clinic mean HbA1c levels range from 12.0% to 14.0% (108-130 mmol/mol) for the most basic level of minimal care, 8.0% to 9.5% (64-80 mmol/mol) for intermediate care, and 6.9% to 8.5% (52-69 mmol/mol) for comprehensive care. Countries with sufficient resources should provide comprehensive care, working to ensure that it is accessible by all in need, and that resulting HbA1c levels correspond with international recommendations. All other countries should provide Intermediate care, while working toward the provision of comprehensive care.

Effect of a mobile health, sensor-driven asthma management platform on asthma control.

BACKGROUND: Asthma inflicts a significant health and economic burden in the United States. Self-management approaches to monitoring and treatment can be burdensome for patients. OBJECTIVE: To assess the effect of a digital health management program on asthma outcomes. METHODS: Residents of Louisville, Kentucky, with asthma were enrolled in a single-arm pilot study. Participants received electronic inhaler sensors that tracked the time, frequency, and location of short-acting ß-agonist (SABA) use. After a 30-day baseline period during which reference medication use was recorded by the sensors, participants received access to a digital health intervention designed to enhance self-management. Changes in outcomes, including mean daily SABA use, symptom-free days, and asthma control status, were compared among the initial 30-day baseline period and all subsequent months of the intervention using mixed-model logistic regressions and χ2 tests. RESULTS: The mean number of SABA events per participant per day was 0.44 during the control period and 0.27 after the first month of the intervention, a 39% reduction. The percentage of symptom-free days was 77% during the baseline period and 86% after the first month, a 12% improvement. Improvement was observed throughout the study; each intervention month demonstrated significantly lower SABA use and higher symptom-free days than the baseline month (P < .001). Sixty-nine percent had well-controlled asthma during the baseline period, 67% during the first month of the intervention. Each intervention month demonstrated significantly higher percentages than the baseline month (P < .001), except for month 1 (P = .80). CONCLUSION: A digital health asthma management intervention demonstrated significant reductions in SABA use, increased number of symptom-free days, and improvements in asthma control. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02162576.

Sociodrama: estratégia para autorreflexão de enfermeiros sobre a cegueira / Sociodrama: strategy for nurses’ self-reflection on blindness

Investigar as auto expressões de mestrandas acerca dos sentimentos, dificuldades e desafios decorrentes da participação em sociodrama “como se” fossem cegas. Métodos: estudo qualitativo. Participaram oito mestrandas em enfermagem. Utilizaram-se sociodrama, uma filmadora e Análise de Conteúdo. Na execução do sociodrama, foram seguidas as etapas de aquecimento, dramatização, comentários e processamento teórico.Resultados: emergiram as categorias temáticas: O papel de cega desencadeando limitação, bloqueio e medo; O papel de cega desencadeando uma noção confusa do próprio corpo; A espontaneidade-criatividade manifestada pelas mestrandas. Conclusão: as mestrandas expressaram o sentimento de medo ao se mobilizarem em ambiente com o qual já estavam familiarizadas, tiveram dificuldade para se alimentar devido à noção confusa do próprio corpo, e puderam refletir acerca do desafio que é cuidar da pessoa cega, pois perceberam que,profissionalmente, estavam despreparadas para cuidar destes indivíduos.

Objective: to investigate the master students’ expressions about feelings, difficulties and challenges arising from participation in sociodrama “as if” they were blind. Methods: qualitative study. Participants were eight Master students in nursing. They used sociodrama, a video recorder and the Content Analysis technique. In implementing the sociodrama, the steps were followed were warm-up, drama, comments and theoretical processing. Results: the following thematic categories emerged: the role as blind person triggering limitation, blocking and fear; the role as blind person triggering a confused notion of one’s own body; spontaneity and creativity expressed by Master students. Conclusion: the Master students expressed the feeling of fear to walking in an environment with which they were already familiar, had difficulty in eating because of the confused notion of their own body, and could reflect on the challenge of caring for the blind person, because they realized that they were professionally unprepared to take care of these individuals.

Validación de apariencia, contenido y consistencia interna de la Escala de Apreciación de Agencia de Autocuidado (ASA) para Costa Rica, segunda versión en español / Validation of appearance, content and internal consistency of the scale Appraisal of Self-care Agency (ASA) to Costa Rica, second versión in Spanish

Resumen:Introducción:Este artículo presenta los resultados obtenidos del proceso de validación de apariencia, contenido y consistencia interna al que fue sometida la segunda versión en español de la escala ASA aplicada a población costarricense.Método:Este estudio es descriptivo, transversal, con un enfoque cuantitativo, con un diseño no experimental y psicométrico, realizado con una muestra de 211 personas en la etapa de la adultez temprana, intermedia y tardía, según su condición de salud conocidas como sanas o con diagnóstico de enfermedad crónica.Resultados:La investigación determinó que el análisis factorial con la aplicación de métodos estadísticos, la prueba de Kaiser-Meyer-Olkin (KMO) con resultado de 0,79, evidenció la viabilidad de la escala, en la que las variables miden factores comunes con una varianza total del 64,14%.Conclusión:El análisis factorial arrojó siete ejes factoriales y obtuvo valores adecuados que demuestran su validez.

Abstract:Introduction:This paper presents the results of the validation process of appearance, content and internal consistency that was submitted the second versión in Spanish of the ASA scale Costa Rican population.Method:It is a descriptive, cross-sectional non-experimental and psychometric study with a quantitative approach, design, conducted with a sample of 211 people at the stage of early, middle and late adulthood, according to your health condition and healthy known or diagnosed disease chronic.Results:The investigation determined that the factor analysis with the application of statistical methods, testing Kaiser-Meyer-Olkin (KMO) resulting in 0.79, showed the feasibility of the scale, which measured variables with a common variance factors Total 64.14%.Conclusion:Factor analysis showed seven factorial axes, appropriate values obtained demonstrate the validity of the same reflecting that is able to measure what it claims.

Using Nursing Activities Score to Assess Nursing Workload on a Medium Care Unit.

BACKGROUND: The medium care unit (MCU) or "stepdown" unit is an increasingly important, but understudied care environment. With an aging population and more patients with complex multiple diseases, many patients often require a higher level of inpatient care even when full intensive care is not indicated. However, the nurse-to-patient ratio required on a MCU is neither well defined nor clear whether this ratio should be adjusted per shift. The Nursing Activities Score (NAS) is an effective instrument for measuring nursing workload in the intensive care unit (ICU) but has not been used in an MCU. The aim of this study was to measure the nursing workload per 8-hour shift on an MCU using the NAS and compare it with the NAS from an ICU in the same hospital. We also compared the NAS between groups of patients with different admission sources. METHODS: The NAS was prospectively measured per patient per shift for 2 months in a 9-bed tertiary referral university hospital MCU and during a similar period in an ICU in the same hospital. RESULTS: The mean NAS per patient did not differ between day (7:30 AM to 4:00 PM) and evening (3:00 PM to 11:30 PM) shifts, but the NAS was significantly lower during the night shift (11:00 PM to 8:00 AM) than during the day (P < 0.0001) and evening (P < 0.0001) shifts. The mean NASs in the ICU for day and night shifts were significantly lower than the scores in the MCU (P = 0.0056 and P < 0.0001, respectively), but NAS during the evening shift did not differ between the ICU and the MCU. The mean NAS for patients admitted to the MCU from the accident and emergency department was significantly higher than for those admitted from the ICU (P = 0.002), recovery (P = 0.002), and general ward (P < 0.0001). Patients on the MCU had a NAS comparable with that of ICU patients. CONCLUSIONS: In our university hospital, NAS was higher during the day and evening hours and lower at night. We also found that patients from accident and emergency had a higher NAS than those admitted to the MCU from other locations. NAS in the MCU was not lower than the NAS in the ICU. Because of its ability to discriminate between day and evening workloads and between patients from different sources, the NAS may assist MCU managers in assessing staffing needs.

Patient self-medication--a change in hospital practice.

AIMS AND OBJECTIVES: The purpose of this study was to evaluate the effectiveness of a self-medication programme (SMP) for inpatients of the Nursing Convalescent Unit, a 26-bed unit with medical and surgical patients. BACKGROUND: Self-medication is an important part of self-management of chronic illness. Self-medication is a way of allowing patients to give themselves their medications in hospital after receiving education instead of the usual practice of medications administered by a Registered Nurse (RN). DESIGN: The pilot study was undertaken over a six-month period to examine the relationship between a programme of self-medication and patient knowledge and adherence to medication regimens, number of medication errors, efficiency in relation to the number of nursing hours associated with the SMP, patient and nursing satisfaction. METHODS: A total of 220 patients participated in the study. The SMP included three levels of patient self-administration of medications: level one, medications administered by a RN; level two, self-medication directly supervised by a RN and level three, self-medication indirectly supervised by a RN. Outcome measures included staff and patient satisfaction, number of medication errors, time taken by nurses to undertake activities related to the SMP and the number of patients who achieved levels two and three. RESULTS: Study findings showed that 45% of patients remained on level one, 26% achieved level two and 29% achieved level three. There were no patient initiated medication errors during the study period. Efficiencies were identified in staff workload associated with patient discharge procedures. Overall, nurses perceived that the SMP increased their knowledge of medications and contributed to effective patient education. CONCLUSIONS: In selected patients, the SMP was an effective aid for improving adherence to medication regimens. Collaboration between nurses, medical staff, pharmacists, patients and carers is integral to the success of in hospital SMP.

Competency in shaping one's life: autonomy of people with type 2 diabetes mellitus in a nurse-led, shared-care setting; a qualitative study.

BACKGROUND: In the Netherlands diabetes specialist nurses play an important role in specialized, long-term care for the chronically ill. One of the goals of nurse-led, shared care is to encourage chronically ill people to participate actively in selecting the organisation and interventions of care. This paper reports the findings of a study to determine which concepts of autonomy people with type 2 diabetes use in a nurse-led, shared-care setting. OBJECTIVES: The aim of this article was to portray how people with type 2 diabetes mellitus who are being cared for by diabetes specialist nurses in a shared-care unit view autonomy. DESIGN AND SETTING: This qualitative study used in-depth interviews and was carried out in a nurse-led, shared-care unit in the Netherlands. PARTICIPANTS: The study population consisted of 15 people who were enrolled for at least 1 year at the nurse-led, shared-care unit and who lived independently at home. METHOD: Data were analysed with a grounded-theory-like method. RESULT: The core category, 'competency in shaping one's life', described how people with diabetes exercise their autonomy. Seven categories that emerged were considered dimensions of autonomy. The dimensions were: identification, self-management, welcomed paternalism, self-determination, shared decision-making, planned surveillance, and responsive relationship. CONCLUSION: Autonomy is a multi-dimensional, dynamic and complex construct. Further research is needed to investigate which decision-making processes patients with type 2 diabetes use in a nurse-led, shared-care setting.

Doing it by yourself.

The DoH (1999) describes how it 'needs leaders who are motivated, self aware, socially skilled and able to work together with others across professional and organisational boundaries'. Self-medication incorporates all professional groups and divisions within Calderdale and Huddersfield NHS Trust; we work in partnership with the pharmacy departments. The main purpose of any organisation in the health and social sector is to ensure that a high quality service is delivered to service users (Martin 2001), so self-medication is now being given the attention it deserves. Assessment will be integral to every service user's stay and will continue throughout their stay, including transfer from secondary to primary care. It is expected that following its introduction, quality will improve; patients will receive their medication on time and it is anticipated that discharge delays will reduce. We acknowledge however that this will be difficult to demonstrate, as often medical conditions are cited as reasons for admission, not non-compliance with medication regimes. We see ourselves as being competent in the roles of change agents and our styles have changed throughout the process. We have worked together as equals and focused on one outcome. It will call on all our professional and educational skills to mould staff so that they are ready to embrace the change. Perhaps the lesson that has been learned so far is that, despite meticulous planning, the actions of others for whom we are not responsible can seriously disrupt the plan. The opportunity to manage change through experiential learning, reflection and the transfer of knowledge has been challenging while enhancing our personal growth and self-awareness. The project has been extended until March 2004 because of the merger and the associated increased workload. Becoming a project manager, leader and change agent has proved to be an exciting, interesting and challenging experience, although at times we felt isolated. The project has now entered a phase that involves intense staff training and phase one of introduction.

The Cooperative Care model: an innovative approach to deliver blood and marrow stem cell transplant care.

Competition among healthcare institutions, the need to improve outcomes, and the desire to decrease costs have motivated blood and marrow stem cell transplant centers to develop innovative care models. In an effort to meet these challenges, a major midwestern medical center adapted the transplant process to the outpatient setting. This transition created greater educational and care demands for patients and families. To address these demands and provide improved accommodations and amenities for patients and families, the center adopted an innovative model of care, Cooperative Care, for transplant recipients. Cooperative Care embraces patients and families as key members of the healthcare team. A family member serves as a primary caregiver for the patient during the acute inpatient phase of the transplant. Care becomes more personal and individualized, cost is reduced, the rate of rehospitalization potentially is decreased, and patients ultimately become more confident and competent in caring for themselves. The healthcare team shifted its care philosophy to incorporate a care partner, increase patient control and independence, and create greater emphasis on education. Outcomes, including patient satisfaction, have demonstrated success and motivated expansion of this model to other patient populations.

Self-administered cardiac medication program evaluation.

For patients to manage their medication regimens at home, adequate preparation is required prior to hospital discharge. Self-administered medication programs are a strategy for improving medication knowledge and regimen adherence. The purpose of this study was to evaluate the effectiveness of a self-administered cardiac medication program on patients knowledge of and adherence to their medication regimen. Patient and nurse satisfaction with the self-administered medication program were assessed. A comparison group, repeated measures design was used in which patients received nurse-administered medications (n = 172) or self-administered medications (n = 178). Data were collected at admission, discharge, and 2, 6, and 16 weeks post-discharge. Outcome variables were medication knowledge, medication adherence, and program satisfaction. Patients in the self-administered medication group had significantly higher medication knowledge scores over time compared to those in the nurse-administered medication group. There was no statistically significant difference between groups on medication adherence. The self-administered medication group reported significantly higher levels of satisfaction and had significantly fewer medication errors and medication-related problems compared to the nurse-administered medication group.

Guía metodológica de organización y funcionamiento de los clubes de pacientes con enfermedades crónica no transmisibles / Guide metodologic of organization and operation of the clubs of patients with chronic illnesses not transmissible

Presenta a través del Ministerio de Salud (MINSA) manual "Guía Metodológica de Organización y Funcionamiento de los Clubes de Pacientes con Enfermedades Crónicas No Transmisibles". Proporciona a los miembros los pasos para organisarse y las funciones a fin de que los enfermeno crónicos tengan los elementos para el autocuidado de su salud y poder participar activamente en la prevención de sus complicaciones y control de sus enfermedades. Incluye concepto básicos deun club, las orientaciones generales de cómo se orgniza, hasta quiénes constituyen la Junta Directiva, estructura y funciones de los mismos

Trajectory, transition and vulnerability in adult medical-surgical patients: a framework for understanding in-hospital convalescence.

Relatively recent changes in health care have seen shorter hospital stays and a considerable increase in day-only admissions, anticipated to involve 60% of all patients admitted for surgery and/or investigations within the next couple of years. Surprisingly little is known about the experiences of the approximately 40% of patients who will begin to convalesce in hospital following illness, trauma or surgery. Findings from a qualitative study, briefly reported here, identified a sense of vulnerability in transition as a significant discomfort. By examining assumptions underlying the care of patients recovering in hospital, the nexus between system-determined care trajectories transition, and patient vulnerability can be identified and problems suitably addressed.

Searching for sustainable change.

Change in nursing practice has been dogged by factors which have been perceived to be outside the autonomy of nurses. Consequently, projects have been initiated which have then faltered or even ceased altogether This paper reports on an action research study that was carried out in Newcastle from 1997 to 1999 and used the process within a focus group setting to rekindle and sustain an innovative change. The aim of the study was to look at staff perceptions surrounding development of the practice of self-administration of medication for patients. The findings support the view that all disciplines need to be involved in health service change. Health service employees should have a knowledge of the theory associated with the change process and be open about their views of proposed alterations in practice. They also need to have a sense of dissatisfaction with the present, a clear outline of what the problem is and the direction which they intend to take. Change involves many complex issues. It should be worked through from a bottom-up approach and consist of repeated evaluation exercises which are akin to a cyclical strategy and include a reflective process.

Eu - o cuidador / I - The Caregiver

O texto faz uma análise reflexiva sobre aspectos do ser cuidador, lembrando da mudança paradigmática que acontece hoje, na área de saúde, e de seu papel (identificação/missão) nesse contexto. Revê a importância do autocuidado e da atenção à sua própria saúde, da consciência dos seus limites e fragilidades