A complex intervention to support breastfeeding: A feasibility and acceptability study.

AIMS: The aims of this study are to assess the acceptability and feasibility of a multicomponent intervention to support breastfeeding women and their families and explore its effectiveness. METHODS: A pilot study with control and intervention groups was conducted using the complex intervention framework in two primary healthcare centres. Overall, 44 childbearing women, their partners/relatives and 20 healthcare professionals participated in the study. The intervention's feasibility and acceptability were measured. The percentage of exclusive breastfeeding rates and women's self-efficacy were measured at pre-intervention, at 10 days postpartum, and again at 2, 4 and 6 months postpartum. Postpartum depression risk was measured at 2 and 6 months postpartum. Professional self-efficacy was measured at pre-intervention and 3 months later. RESULTS: The intervention was feasible and acceptable. No difference in self-efficacy existed between the intervention and control groups. Preliminary effects of the intervention were found in exclusive breastfeeding percentage and postpartum depression risk in the intervention group. CONCLUSION: The intervention is feasible and acceptable. The results are promising not only for breastfeeding maintenance but also for preventing postpartum depression and recovering exclusive breastfeeding during pandemics. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT03944642.

[The experience of being accompanied by a primary nurse during chemotherapy. A qualitative study]. / Experiencia de vivir el proceso de enfermar de cáncer y recibir quimioterapia, siendo acompañado por una Enfermera de Enlace.

BACKGROUND: The diagnosis of an oncological disease exposes people to a greater state of vulnerability and health care models are not focused on their subjective needs. In this scenario, the primary nurse becomes a professional who contributes to the comprehensive care of people with cancer. AIM: To understand the lived experience of patients with cancer undergoing chemotherapy treatment, when being cared for by a primary nurse. MATERIAL AND METHODS: Qualitative phenomenological study. Nine cancer survivors who were cared for by primary nurses during chemotherapy were interviewed. RESULTS: The analysis revealed two comprehensive categories, namely experiences around becoming ill with cancer, and experiences when navigating the health system, each with subcategories. CONCLUSIONS: This study demonstrates the impact that personalized attention focused on people's needs has on their lives. It also contributes to visualize the work of primary nurses in the care and accompaniment of patients with cancer and their families. The need for specialized professionals such as Advanced Practice Nursing is underlined.

[Advanced practice nursing as a proposal to improve access and coverage in oncology for Latin America]. / Una propuesta para mejorar el acceso y cobertura en oncología para Latinoamérica: enfermería de práctica avanzada.

PAHO/WHO proposes to implement the role of Advanced Practice Nurse (APN) in Latin America, to reduce gaps in coverage and access to health care. For this purpose, it is necessary to train nursing professionals with an expanded role, which allows them to collaborate in the diagnosis, treatment, and monitoring of people with specific diseases, under established protocols and clinical guidelines and within consolidated interdisciplinary health teams in a cost-effective way. One of the areas with the greatest coverage deficit in Latin America is adult oncology, with inequality in care opportunities for these patients. Part of the premature deaths attributable to this disease are due to the lack of access to timely diagnosis and treatment. As a contribution to the reduction of this gap, a training program of Advanced Nursing Practice was developed, addressing the most urgent needs in the field of oncology. The necessary competencies were defined to develop a professional-level master's degree program, considering prevention, early detection, diagnosis, treatment, and monitoring of people with oncological diseases at different levels of care. A program of this kind is an opportunity to reduce the access gap and coverage of health care for people with cancer, improving their quality of life and their survival.

The CRIAA Program complex intervention in primary care to support women and their families in breastfeeding: Study protocol for a pilot trial.

AIM: To report a pilot study protocol to assess the feasibility of a complex intervention, in the primary healthcare context, to support women and their families in breastfeeding. DESIGN: A pilot/feasibility trial with control and intervention groups. METHODS: The study will be conducted in two primary healthcare centres with 40 childbearing women (20 control group; 20 intervention group), with their partner/meaningful person and their respective healthcare professionals. Intervention group participants will receive the intervention: (a) in a breastfeeding workshop during their third trimester of pregnancy; and (b) via virtual breastfeeding support for six months postpartum. Health professionals will be trained to deliver the intervention. The control group will receive standard care in the outpatient clinic. The pilot will help determine the intervention's feasibility. Data collected pre-intervention, 10-days postpartum and two-, four-, and six-months postpartum will provide estimates of the intervention's preliminary effects on self-efficacy and main outcomes. Research Ethics Committee approval was obtained in April 2019. DISCUSSION: Breastfeeding support is a complex reality influenced by multiple factors. Therefore, approaches to breastfeeding are also, requiring interventions that address its multidimensional nature, including all actors involved. The proposed intervention will be applied by an interdisciplinary professional health team, allowing for its incorporation into standard practice and its perpetual maintenance. IMPACT: The study will produce an original, comprehensive, complex intervention addressing contextual, and organizational factors to promote breastfeeding support using an interdisciplinary and family-based approach; breastfeeding self-efficacy is the core concept. The program evaluation and feasibility study will permit exploration of the integration of the intervention's novel aspects into the daily work of professionals and reveal how to better use existing resources in a full-scale clinical trial. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT03944642.

[Effect of a multidimensional intervention for prevention of falls in the eldery]. / Efecto de una intervención multidimensional en personas mayores autovalentes para el manejo del riesgo de caídas.

OBJECTIVE: To evaluate the effect of a multidimensional intervention on the perception and management of risk factors and frequency of falls in independent elderly people living in the community. DESIGN: Randomised clinical trial. SETTING: Family health centre, primary care. PARTICIPANTS: Independent elderly people living in the community. INTERVENTION: For intervention group (IG) a multidimensional intervention, consisting of home visits and telephone follow-up was carried out for 5 months (n=77), and those assigned to the control group (CG, n=77) received usual care in the family health centre. MAIN MEASUREMENTS: Perception of risk of falls, number of risk factors and number of falls in the study period. RESULTS: In both groups there were increases in the perception of risk factors for falling associated with walking (IG: P<.001 and CG: P<.001). Belonging to the IG was significantly associated with a decrease in the risk factors associated with surfaces (r=0.25) and shoes (r=0.24), as well as an increase in the perception of risk of falls associated with walking (r=0.21) and the presence of objects or furniture (r=0.36). In the IG, 5 participants (7.9%) suffered at least one fall in the 5-month period and 18 (27.7%) patients in the CG (P=.004). CONCLUSIONS: The multidimensional intervention was effective in reducing the frequency of falls and in the management of extrinsic risk factors associated with surfaces, lighting, and support devices.

[I want to breastfeed my baby: Unvealing the experiences of women who lived process difficulties in their breastfeeding]. / “Yo quiero amamantar a mi hijo”: Develando la experiencia de mujeres que enfrentaron dificultades en su proceso de lactancia.

Breastfeeding is the most beneficial feeding practice for infants. However, it is not always the first choice for mothers and their encouragement and support from health professionals is variable. OBJECTIVE: To understand the experience of mothers who had difficulties with their breastfeeding process. PATIENTS AND METHOD: A phenomenological study was conducted in a University Health center. Twelve breastfeeding women were included. Data collection technique was in depth interviews, taped recorded with participants’ consent. Phenomenological analysis of data followed Streubert´s method. The rigor of the study was guarded by criteria for qualitative research and the research process. Ethical aspects were sheltered through the informed consent process, confidentiality and methodological rigor. RESULTS: The experience of living difficulties in the breastfeeding process is revealed in five comprehensive categories: recognizing the difficulties with breastfeeding; emotional impact when unable to breastfeed; motivation to overcome the difficulty and ask for help; support for breastfeeding recovery; and transition process from stress and anxiety to peace, gratification and empowerment. CONCLUSION: The understanding of this experience is qualitative evidence that contributes to a comprehensive understanding of the situation of each mother and child, allowing to improve support care interventions in health.

[Meaning of becoming mother and son/daughter through massage]. / Significado de ser madre e hijo/a por medio del masaje.

OBJECTIVE: Revealing the experience of mothers when massaging their children to know the phenomenon in the context of a mother-child healthy development. METHOD: This is a qualitative study with a phenomenological approach carried out with 11 women who massaged their children and answered the guiding question: What did the experience of massaging your child mean to you? RESULTS: The experience of massaging their children meant the development of their being a mother and of being a son/daughter, in addition to developing the attachment relationship between them. The massage can operationalize this integrality, become a tool of communication, stimulation and promotion of secure attachment, by promoting the loving interaction between mother and child. CONCLUSION: This practice should be considered as an option in the programs that promote the comprehensive health of the mother and child.

Advanced Practice Nursing Titles and Roles in Cancer Care: A Scoping Review.

OBJECTIVES: Advanced practice nursing roles in cancer care are diverse and exist across the cancer care continuum. However, the titles used and the scope of practice differ across countries. This diversity is likely to be misleading to patients and influence nurses' contribution to health care. An understanding of the current state of advanced practice nursing roles in cancer care internationally is needed to inform opportunities for future role development and enhance cancer nursing career pathways. METHODS: This scoping review included a systematic search of four databases: MEDLINE, CINAHL, PsycINFO, and Academic Search Complete. Independent screening for papers meeting the review's inclusion criteria was undertaken using online screening software. Data extraction, coding, and mapping were undertaken in NVivo 12. RESULTS: Of the 13,409 records identified, 108 met the review's inclusion criteria. A variety of roles in cancer care settings were described. The United States and the United Kingdom had the most titles for advanced practice nursing roles. Tumor-specific roles were described and integrated into different phases of the cancer care continuum. Trends in continuing professional development for advanced practice nurses in cancer care included the rise in Fellowship programs in the United States and practice-based education in the United Kingdom. CONCLUSIONS: The differences in advanced practice nursing roles in cancer care allow regional and institutional variation to meet the needs of patient populations and health care system demands. However, a lack of clarity surrounding titles and roles results in confusion and underutilization of these nurses' highly specialized skill sets. IMPLICATIONS FOR NURSING PRACTICE: Incongruence in titles and scope of practice internationally will ultimately result in a merging of roles. There is a need for international agreement on education requirements for advanced practice nursing roles to promote career pathways.

Meaning and social participation of man when become a father for the first time. / Significado y participación social del hombre al transformarse en padre por primera vez.

OBJECTIVE: To analyze the meanings attributed to fatherhood by first-time fathers. PARTICIPANTS AND METHOD: Qualitative research of Hermeneutic-Dialectic design. Data collection was carried out through in-depth interviews with fathers and mothers (10 of each) of children older than 12 months. The analysis of the data was carried out through the participants' discourse analysis and their articu lation with the historical-social context and the theoretical references of the research. RESULTS: The meaning and social participation of men when they became a first-time father were grouped in five categories: meaning of the fatherhood experience; meaning of fatherhood from a gender perspective; meaning of the experience in the father-child relationship; meaning of the parenting experience in the couple relationship; and exercising fatherhood and its relationship with the health system. Con clusions: It is necessary to implement strategies to include the father in the upbringing and care of the children, favoring his participation, and thus, the growth and comprehensive development of the child conceived in the different types of families.

Experiências de estudantes do curso de licenciatura em enfermagem sobre supervisão clínica em uma universidade de Moçambique

Objetivo: Descrever as experiências dos estudantes do último ano do Curso de Enfermagem da Universidade Católica de Moçambique sobre a supervisão clínica prestada pelos técnicos de enfermagem. Método: Estudo qualitativo-fenomenológico, realizado com estudantes do último ano do Curso de Enfermagem da Universidade Católica de Moçambique. A entrevista em profundidade foi a técnica utilizada para recolha de dados, analisados através da análise de conteúdo. Resultados: Os resultados foram divididos em quatro categorias principais que emergiram da análise das entrevistas e dizem respeito 1) à percepção dos alunos sobre o supervisor acadêmico, destacada pela presença e ausência de docentes no ambiente clínico; 2) ao supervisor clínico explicitado pelos supervisores técnicos de enfermagem, com subcategorias sobre o aluno de nível superior como ameaça ao enfermeiro técnico, tensão na relação entre supervisores clínicos e alunos, disposição e reação dos supervisores clínicos; 3) ao contexto, representado pela falta de recursos materiais e humanos, diversidade cultural e pandemia de COVID-19; e 4) à percepção de si mesmos como alunos, dividida em falta de orientação no ambiente clínico, vivência da prática clínica como um pesadelo e esperança durante a experiência. Também são apresentadas algumas propostas de melhorias. Conclusão: Os resultados deste estudo permitiram descrever o fenômeno em estudo, revelando a percepção dos estudantes sobre a supervisão clínica e o efeito do contexto em que esta relação se desenvolve. Estes resultados servirão para avaliar a forma de melhorar a supervisão clínica através da identificação de um modelo inovador a seguir. Esta medida é essencial para o desenvolvimento profissional dos estudantes de enfermagem.

Objetivo: Describir las experiencias de los estudiantes de último año de enfermería de la Universidad Católica de Mozambique en relación con la supervisión clínica realizada por los técnicos de enfermería. Método: Estudio cualitativo-fenomenológico realizado con estudiantes de último año de enfermería de la Universidad Católica de Mozambique. La entrevista en profundidad fue la técnica utilizada para la recolección de datos, que fueron analizados a través del análisis de contenido. Resultados: Los resultados se dividieron en cuatro categorías principales que surgieron del análisis de las entrevistas y están relacionadas con 1) la percepción de los estudiantes sobre el supervisor académico, destacada por la presencia y ausencia de personal docente en el entorno clínico; 2) el supervisor clínico explicitado por los supervisores técnicos de enfermería, con subcategorías sobre el estudiante de nivel superior como amenaza para el enfermero técnico, tensión en la relación entre supervisores clínicos y estudiantes, disposición y reacción de los supervisores clínicos; 3) al contexto, representado por la falta de recursos materiales y humanos, la diversidad cultural y la pandemia COVID-19; y 4) a la percepción sobre ellos mismos como estudiantes, dividido en la falta de orientación en el entorno clínico, el vivir las prácticas clínicas como una pesadilla y la esperanza durante la experiencia. También se presentan algunas propuestas de mejora. Conclusión: Los resultados de este estudio han permitido describir el fenómeno estudiado, revelando la percepción de los estudiantes sobre la supervisión clínica y el efecto del contexto en el que se desarrolla esta relación. Estos resultados servirán para evaluar cómo mejorar la supervisión clínica, identificando un modelo innovador a seguir. Esta medida es esencial para el desarrollo profesional de los estudiantes de enfermería.

Objective: To describe the experiences of final year nursing students at the Catholic University of Mozambique regarding the clinical supervision done by nursing technicians. Method: A qualitative-phenomenological study carried out with final year nursing students at the Catholic University of Mozambique. The in-depth interview was the technique used to collect data, which was analyzed using Content Analysis. Results: The results were divided into four main categories that emerged from the analysis of the interviews and are related to 1) the students' perception of the academic supervisor, highlighted by the presence and absence of teaching staff in the clinical setting; 2) the clinical supervisor made explicit by the nursing technical supervisors, with subcategories on the higher level student as a threat to the technical nurse, tension in the relationship between clinical supervisors and students, disposition and reaction of clinical supervisors; 3) the context, represented by the lack of material and human resources, cultural diversity and the COVID-19 pandemic; and 4) the perception about themselves as students, divided into lack of orientation in the clinical setting, living the clinical practice as a nightmare and hope during the experience. Some proposals for improvement are also presented. Conclusion: The results of this study have helped to describe the phenomenon studied, revealing the students' perception about clinical supervision and the effect of the context that this relationship develops. These results will help to evaluate how to improve clinical supervision by identifying an innovative model to follow. This action is essential for the professional development of nursing students.

Care during Breastfeeding: Perceptions of Mothers and Health Professionals.

OBJECTIVES: To know the perceptions of mothers and health professionals in relation to the care provided and received during breastfeeding at primary health care level. METHODS: A qualitative exploratory study was conducted with breastfeeding mothers (10) and primary health care professionals (24). Data was gathered through in-depth interviews and focus groups. Data analysis was performed through thematic content analysis. The rigor of the study was ensured by the Guba and Lincoln criteria for qualitative research. Ethical aspects were addressed through the informed consent process, confidentiality, and methodological rigor. RESULTS: The experience of providing/receiving breastfeeding support was revealed as a dynamic, multidimensional care and support process, through three central themes: 1. Influence of previous care and support experiences during the breastfeeding process; 2. Importance of the context within which care is framed; and 3. Addressing emotions to establish trust between professionals and mothers. CONCLUSIONS: The study findings contribute to further understanding a complex phenomenon, such as breastfeeding support and care for mothers/families, from the experience of the actors involved, deepening the experiences of both in integrated manner. In addition, the relational, organizational, and contextual dimensions that influence support, and that should guide care, are also highlighted.

The lived experience of undergraduate student parents: roles compatibility challenge.

OBJECTIVES: To reveal the meanings attributed by university students to their experience of becoming a mother/father during their studies. METHODS: A phenomenological study was conducted with students at a private Chilean University. Sixteen students from different undergraduate careers (eight women and eight men) participated in in-depth interviews, which were recorded. A phenomenological analysis of the data that followed the Streubert method was carried out, ensuring rigor by the criteria established by Guba and Lincoln during the research process. The ethical aspects were addressed through the process of informed consent, confidentiality and methodological rigor. RESULTS: The phenomenon of becoming a mother/father during the university studies was revealed through four central themes: Emotions in conflict; Internal mobilization to address the situation; Position oneself in a new role; and Need for support. The central contribution of the study is the revelation of the transformation process towards the integrated role of father/mother-student. CONCLUSIONS: This study provides qualitative evidence that contributes to a comprehensive understanding of the experience of becoming a mother/father during the university studies; concluding that this life experience is presented as a process of role compatibility, which is necessary to support. For this, it is necessary to make visible the role of parents/students in university policies, with the aim of providing concrete support during this process of parallel transition in the lives of young people.

Facilitadores y barreras para la implementación de un programa de enfermería de práctica avanzada en Chile / Facilitators and barriers in the implementation of advanced practice in nursing program

INTRODUCCIÓN: El desarrollo de la Enfermería de Práctica Avanzada se ha transformado en una tendencia global en las últimas décadas. Desde que esta formación de posgrado emergió en Estados Unidos ha trascendido a otros continentes y países. Si bien en la región de las Américas estos programas aún tienen un carácter incipiente, la Organización Panamericana de la Salud ha realizado esfuerzos constantes para relevar su aporte al logro del acceso universal de salud y al fortalecimiento de la atención primaria de salud y a la fuerza laboral de Enfermería. OBJETIVO: Este artículo presenta una reflexión acerca de la implementación de un programa de Práctica Avanzada en Chile, analizando facilitadores y desafíos del proceso. DESARROLLO: En respuesta a las necesidades del país y al contexto, la Escuela de Enfermería UC abrió su primer programa en 2021, específicamente en el área de la oncología, enfocado a abordar las brechas de acceso y cobertura en el área. Se plantean facilitadores y desafíos de la implementación que coinciden con lo que ocurre a nivel internacional CONCLUSIONES: Las fortalezas como los desafíos identificados proporciona una clara orientación para avanzar en la implementación y permiten proyectar estrategias basadas en evidencia y con pertinencia contextual, que consideren e integren las iniciativas exitosas publicadas y los logros obtenidos.

INTRODUCTION: The development of Advanced Practice Nursing has become a global trend in recent decades. Since this postgraduate training emerged in the United States, it has spread to other continents and countries. Although in the region of the Americas these programs are still incipient, the Pan American Health Organization has made constant efforts to highlight their contribution to the achievement of universal health access and to the strengthening of primary health care and the nursing workforce. OBJECTIVE: This article presents a reflection on the implementation of an Advanced Practice program in Chile, analyzing facilitators and challenges of the process. DEVELOPMENT: In response to the needs of the country and the context, the UC School of Nursing opened its first program in 2021, specifically in oncology, focused on addressing the gaps in access and coverage in the area. Facilitators and challenges of implementation are raised that coincide with what is happening internationally CONCLUSIONS: The strengths as well as the challenges identified provide clear guidance to advance implementation and allow projecting strategies based on evidence and with contextual relevance, which consider and integrate the successful initiatives published and the achievements obtained.

Experiencia de vivir el proceso de enfermar de cáncer y recibir quimioterapia, siendo acompañado por una Enfermera de Enlace / The experience of being accompanied by a primary nurse during chemotherapy. A qualitative study

BACKGROUND: The diagnosis of an oncological disease exposes people to a greater state of vulnerability and health care models are not focused on their subjective needs. In this scenario, the primary nurse becomes a professional who contributes to the comprehensive care of people with cancer. AIM: To understand the lived experience of patients with cancer undergoing chemotherapy treatment, when being cared for by a primary nurse. MATERIAL AND METHODS: Qualitative phenomenological study. Nine cancer survivors who were cared for by primary nurses during chemotherapy were interviewed. RESULTS: The analysis revealed two comprehensive categories, namely experiences around becoming ill with cancer, and experiences when navigating the health system, each with subcategories. CONCLUSIONS: This study demonstrates the impact that personalized attention focused on people's needs has on their lives. It also contributes to visualize the work of primary nurses in the care and accompaniment of patients with cancer and their families. The need for specialized professionals such as Advanced Practice Nursing is underlined.

Acompañando la lactancia materna con eHealth: revisión integrativa

Resumen: Introducción: La Organización Mundial de la Salud recomienda la lactancia materna exclusiva durante los primeros 6 meses de vida, así como continuar complementada con alimentos apropiados hasta los 2 años y más. Es por esto, que se observa la necesidad del apoyo profesional en torno a esta, para las madres durante el embarazo y una vez iniciado el amamantamiento. La Asamblea Mundial de la Salud, reconoció el potencial de las tecnologías digitales para la mejora de la salud pública, destacando que el uso de eHealth ha transformado la salud, permitiendo la entrega de cuidados en los hogares de las personas de manera remota. Objetivo: Determinar si el apoyo profesional por medio de eHealth es una estrategia que favorece el acompañamiento a las madres que viven el proceso de amamantamiento y mejora sus resultados en la lactancia materna. Metodología: Se realizó una revisión integrativa buscando la comprensión del fenómeno o tema de interés desde diversas perspectivas. Para llevarla a cabo en junio de 2020 se consultaron las bases de datos Pubmed, Scopus, CINAHL, ProQuest, ClinicalKey y Science Direct. Resultados: Se organizaron en dos grupos: estrategias de acompañamiento profesional a través de eHealth a las madres en proceso de amamantamiento y resultados de eHealth como herramienta para el acompañamiento profesional a las madres en proceso de amamantamiento. Conclusión: La eHealth es una herramienta efectiva para brindar apoyo a mujeres embarazadas o en proceso de amamantamiento.

Resumo: Introdução: A A Organização Mundial da Saúde recomenda o aleitamento materno exclusivo durante os primeiros 6 meses de vida, e também que seja complementado com alimentos apropriados até os 2 anos ou mais. É por isso que se faz necessário o apoio profissional às mães neste processo, desde a gestação até o início da amamentação. A Assembléia Mundial da Saúde reconheceu os benefícios das tecnologias digitais para o aprimoramento da saúde pública, destacando a ferramenta eHealth, cuja utilização transformou a saúde e permitiu um atendimento especializado nos lares das pessoas, de maneira remota. Objetivo: Determinar se o apoio profissional por meio da eHealth é uma estratégia que favorece o acompanhamento às mães que estão atravessando o processo de amamentação e melhora seus resultados do aleitamento. Metodologia: Foi realizada uma revisão integrativa, procurando compreender o fenômeno ou tópico de interesse a partir de diferentes perspectivas. Para implementá-la em junho de 2020 foram consultadas as bases de dados Pubmed Scopus, CINAHL, ProQuest, ClinicalKey e Science Direct. Resultados: Eles foram organizados em dois grupos: estratégias de apoio profissional por meio da eHealth para mães em processo de amamentação e resultados da eHealth como ferramenta de apoio profissional para mães em processo de amamentação. Conclusão: A eHealth é uma ferramenta efetiva oferecem um suporte significativo às gestantes e às mães durante o aleitamento.

Abstract: Introduction: The World Health Organization recommends exclusive breastfeeding during the first 6 months of life, as well as continuing it supplemented with appropriate foods up, to 2 years and more. Therefore, the need of professional support around it is observed for mothers during pregnancy and once breastfeeding has begun. The World Health Assembly recognized the potential of digital technologies to improve public health, highlighting that the use of eHealth has transformed health, allowing the delivery of care in people's homes remotely. Objective: To determine if professional support through eHealth is a strategy that favors the support to mothers who are going through the breastfeeding process and improves their breastfeeding results. Methodology: A integrative review was carried out seeking to understand the phenomenon or topic of interest from different perspectives. To carry it out in June 2020, the databases Pubmed, Scopus, CINAHL, ProQuest, ClinicalKey and Science Direct were consulted. Results: They were organized into two groups: professional support strategies through eHealth to mothers in breastfeeding process and results of eHealth as a tool for professional support to mothers in breastfeeding process. Conclusion: eHealth is an effective tool to provide meaningful support to pregnant or breastfeeding women.

Significado de la experiencia materna en torno al apoyo durante su proceso de amamantamiento

Introducción: Se ha descrito la existencia de experiencias de la vida de las personas que tienen la capacidad de modular el sistema nervioso, lo que influye directamente en el desarrollo humano. Intervenir oportunamente en la primera infancia tiene el potencial de impactar positivamente en su desarrollo. En esta lógica, la lactancia materna cobra especial protagonismo, ya que aumenta la probabilidad de sobrevivir, brinda una nutrición y estimulación adecuada, favorece un entorno seguro, además de ser un inmenso aporte en el fortalecimiento de los lazos sociales, entre otros beneficios. El apoyo que reciba la madre durante el proceso es fundamental para lograr un amamantamiento exitoso. Objetivo: Develar el significado de la experiencia materna en torno al apoyo en el proceso de amamantamiento. Metodología: Estudio de diseño fenomenológico en el cual se realizó un análisis con datos secundarios, según la perspectiva de Edmund Husserl. Para asegurar el rigor metodológico de esta investigación se aplicaron los criterios de Guba y Lincoln. Los aspectos éticos de la investigación fueron abordados desde los siete requisitos éticos de Ezekiel Emanuel. Resultados: El significado de la experiencia materna en torno al apoyo en el proceso de amamantamiento se develó en cuatro categorías comprensivas: la experiencia materna de amamantamiento, experiencia de apoyo de los profesionales de la salud, experiencia de apoyo de la pareja y experiencia de apoyo de otros familiares. Conclusiones: Las tres fuentes de apoyo identificadas nutren y modulan la experiencia de amamantamiento de manera complementaria, por lo que la indivisibilidad de las influencias ejercidas por ellas es una característica constitutiva para que el apoyo sea percibido por las madres como comprensivo y contenedor.

Introdução: Descreveu-se a existência de experiências de vida de pessoas que têm a capacidade de moldar o sistema nervoso, o que influencia diretamente no desenvolvimento humano. Intervir oportunamente na primeira infância tem o potencial de impactar positivamente no seu desenvolvimento. Seguindo esta lógica, o aleitamento materno ganha um protagonismo especial, já que aumenta a probabilidade de sobrevivência, oferece nutrição e estimulacão adequadas, favorece um ambiente seguro, além de ser uma imensa contribuição no fortalecimento de laços sociais, entre outros benefícios. O apoio que a mãe recebe durante o processo é fundamental para conseguir uma amamentação de sucesso. Objetivo: Revelar o significado da experiência materna ao redor do apoio no processo do aleitamento materno. Metodologia: Estudo do desenho fenomenológico, para o qual se realizou a análise com dados secundários, conforme a perspectiva de Edmund Husserl. Para garantir o rigor metodológico desta investigação foram aplicados os critérios de Guba e Lincoln. Os aspectos éticos da investigação foram abordados desde os sete requisitos éticos de Ezekiel Emanuel. Resultados: O significado da experiência materna ao redor do apoio no processo da amamentação foi dividido em quatro categorias compreensivas: a experiência materna do aleitamento, a experiência do apoio dos profissionais da saúde, a experiência do apoio do parceiro e a experiência do apoio de outros familiares. Conclusões: As três fontes de apoio identificadas nutrem e moldam a experiência do aleitamento de forma complementária. Por tanto, a indivisibilidade das influências que cada um destes atores exercem é uma característica constitutiva para que o apoio seja percebido pelas mães como compreensivo e acolhedor.

Introduction: It has been described that there are experiences in people's lives that have the capacity to modulate the nervous system, which directly influences human development. Timely intervention in early childhood has the potential to have a positive impact on their development. In this logic, breastfeeding takes on special importance, since it increases the probability of survival, provides adequate nutrition and stimulation, favors a safe environment, and is an immense contribution to the strengthening of social ties, among other benefits. The support the mother receives during the process is fundamental for successful breastfeeding. Objective: To unveil the meaning of the maternal experience on support during the breastfeeding process. Methodology: A phenomenological design study in which an analysis was carried out with secondary data, according to Edmund Husserl's perspective. To ensure the methodological rigor of this research, the criteria of Guba and Lincoln were applied. The ethical aspects of the research were approached from Ezekiel Emanuel's seven ethical requirements. Results: The meaning of the maternal experience of support during the breastfeeding process was unveiled in four comprehensive categories: maternal experience of breastfeeding, experience of support from health professionals, experience of support from partners, and experience of support from other family members. Conclusions: The three sources of support identified nurture and modulate the breastfeeding experience in a complementary manner, so that the indivisibility of the influences exerted by them is a constitutive characteristic for the support to be perceived by the mothers as comprehensive and supportive.

Viviendo la experiencia de cuidar a un familiar mayor y ser empleado: roles en conflicto / Living the experience of caring for an elderly relative and being employed: roles in conflict

Objetivo: Develar la experiencia vivida de personas que realizan el doble rol de cuidar a un familiar mayor dependiente y trabajar remuneradamente. Metodología: investigación cualitativa fenomenológica. Participaron 14 personas que asistieron a un programa de apoyo al trabajador-cuidador familiar, y que eran cuidadores de una persona mayor dependiente, de quienes se recogió la experiencia a través de una entrevista semiestructurada. Se entrevistó hasta alcanzar la saturación de significados. El análisis se realizó a través del método propuesto por Streubert. Resultados: el fenómeno se develó en la categoría comprensiva multiplicidad de roles compuesta por las subcategorías angustia/agobio y culpa. Conclusiones: resulta urgente visibilizar las consecuencias de la multiplicidad de roles y desarrollar políticas públicas para la conciliación de ellos (AU)

Objective: To reveal the lived experience of people who perform the double role of caring for a dependent elderly relative and working remuneratively. Methodology: qualitative phenomenological research of 14 people who participated in a family worker-caregiver support program, and were caregivers of a dependent elderly person, from whom the experience was collected through a semi-structured interview. It was interviewed until a saturation of meanings was reached. The analysis was performed through the method proposed by Streubert. Results: the phenomenon was revealed in the comprehensive multiplicity of roles category composed of the subcategories distress/burden and guilt. Conclusions: it is urgent to make visible the consequences of the multiplicity of roles and develop public policies for their reconciliation (AU)

Una propuesta para mejorar el acceso y cobertura en oncología para Latinoamérica: enfermería de práctica avanzada / Advanced practice nursing as a proposal to improve access and coverage in oncology for Latin America

PAHO/WHO proposes to implement the role of Advanced Practice Nurse (APN) in Latin America, to reduce gaps in coverage and access to health care. For this purpose, it is necessary to train nursing professionals with an expanded role, which allows them to collaborate in the diagnosis, treatment, and monitoring of people with specific diseases, under established protocols and clinical guidelines and within consolidated interdisciplinary health teams in a cost-effective way. One of the areas with the greatest coverage deficit in Latin America is adult oncology, with inequality in care opportunities for these patients. Part of the premature deaths attributable to this disease are due to the lack of access to timely diagnosis and treatment. As a contribution to the reduction of this gap, a training program of Advanced Nursing Practice was developed, addressing the most urgent needs in the field of oncology. The necessary competencies were defined to develop a professional-level master's degree program, considering prevention, early detection, diagnosis, treatment, and monitoring of people with oncological diseases at different levels of care. A program of this kind is an opportunity to reduce the access gap and coverage of health care for people with cancer, improving their quality of life and their survival.

Efecto de una intervención multidimensional en personas mayores autovalentes para el manejo del riesgo de caídas / Effect of a multidimensional intervention for prevention of falls in the eldery

OBJETIVO: Evaluar el efecto de una intervención multidimensional en la percepción y el manejo de factores de riesgo intrínsecos y extrínsecos de caídas y en la frecuencia de caídas en personas mayores autovalentes que viven en la comunidad. DISEÑO: Ensayo clínico aleatorizado controlado. Emplazamiento: Centro público de salud familiar, nivel primario de atención. PARTICIPANTES: Personas mayores autovalentes que viven en la comunidad. Intervención: Intervención educativa multidimensional de visita domiciliaria y seguimiento telefónico mensual por 5 meses para el grupo intervenido (GI, n = 77) y los asignados al grupo control (GC, n = 77) atención habitual en su centro de salud. Mediciones principales: Percepción de riesgo de caídas, número de factores de riesgo caídas y número de caídas en el periodo. RESULTADOS: En ambos grupos aumenta la percepción de los factores de riesgo de caídas asociadas con la deambulación (GI: p ≤ 0,001 y GC: p ≤ 0,001). Pertenecer al GI se asocia significativamente con una disminución en los factores de riesgo asociados con las superficies (r = 0,25) y los zapatos (r = 0,24); un aumento en la percepción de riesgo de caídas asociadas a la deambulación (r = 0,21) y la presencia de objetos o muebles (r = 0,36). En GI, 5 participantes (7,9%) sufrieron al menos una caída en el periodo de 5 meses y en el GC 18 (27,7%) (p = 0,004). CONCLUSIONES: La intervención multidimensional fue efectiva para reducir la frecuencia de caídas y para el manejo de factores de riesgo extrínsecos asociados con las superficies, la iluminación y los dispositivos de apoyo

OBJECTIVE: To evaluate the effect of a multidimensional intervention on the perception and management of risk factors and frequency of falls in independent elderly people living in the community. DESIGN: Randomised clinical trial. SETTING: Family health centre, primary care. PARTICIPANTS: Independent elderly people living in the community. INTERVENTION: For intervention group (IG) a multidimensional intervention, consisting of home visits and telephone follow-up was carried out for 5 months (n = 77), and those assigned to the control group (CG, n = 77) received usual care in the family health centre. MAIN MEASUREMENTS: Perception of risk of falls, number of risk factors and number of falls in the study period. RESULTS: In both groups there were increases in the perception of risk factors for falling associated with walking (IG: P < .001 and CG: P < .001). Belonging to the IG was significantly associated with a decrease in the risk factors associated with surfaces (r = 0.25) and shoes (r = 0.24), as well as an increase in the perception of risk of falls associated with walking (r = 0.21) and the presence of objects or furniture (r = 0.36). In the IG, 5 participants (7.9%) suffered at least one fall in the 5-month period and 18 (27.7%) patients in the CG (P = .004). CONCLUSIONS: The Multidimensional intervention was effective in reducing the frequency of falls and in the management of extrinsic risk factors associated with surfaces, lighting, and support devices

Acompañando en el último viaje: vivencia de personas mayores institucionalizadas / Accompanying in the last trip: experience of institutionalized elderly people

El envejecimiento trae consigo pérdidas en diferentes aspectos de la vida, y el proceso de muerte es uno de los más relevantes debido a su mayor proximidad. Un contexto especial que considerar son los establecimientos de larga estancia (ELEAM), lugar en el que viven de manera recurrente el duelo de compañeros, temática que se encuentra escasamente estudiada a nivel mundial. OBJETIVO: Comprender los significados de la experiencia vivida por personas mayores institucionalizadas ante el fallecimiento de un compañero residente. METODOLOGÍA: Se utilizó un diseño cualitativo fenomenológico. RESULTADOS: Se entrevistó a 13 personas mayores institucionalizadas. El fenómeno fue dividido en ocho categorías interrelacionadas: día a día y recambio; sentimientos ante el sufrimiento y fallecimiento de un compañero/a; rituales de despedida; muerte como proceso natural y de autorreflexión; soledad; adaptación a la perdida junto a compañeros; rol de las cuidadoras; profesionales, y escasa percepción de apoyo. CONCLUSIÓN: Los relatos permiten comprender el proceso que viven las personas mayores al experimentar el fallecimiento de un compañero/a, cómo expresan sus sentimientos y cómo los despiden. Esto les permite reflexionar sobre su propia muerte y sus redes de apoyo. Este conocimiento puede aportar a la comprensión del fenómeno y a la propuesta de cuidados de enfermería basados en las necesidades de cada residente ante el fallecimiento de compañeros

Aging is accompanied with losses in differents aspects of life and one of the greater impact is about death, because of its proximity. A important context to consider is (LSE) Long Stay Establishments, place that patients live with frecuency peers bereavement. OBJECTIVE: Understand the meanings of the experience lived by institutionalized elderly people due to the death of a partner. METHODOLOGY: For this study it used a qualitative phenomenological design. RESULTS:13 elderly people interviewed who established in a institution. The phenomenon was separated in 8 categories connected: day by day and replacement; feelings about suffering and peer's death; farewell rituals; death as a natural process and self-reflection; loneliness, adaptation to the loss with their peers; caregiver's role; professionals and poor perception of support. CONCLUSION: Their experiences allow to comprehend the process that elder people lives in nursing home to experiment death's peer, their perceptions about their feelings and how they said goodbye to them. This situation makes that elder people reflect about their own death and support networks. This knowledge can contribute to the understanding of the phenomenon and can be useful as guide to make nursing care based on resident's needs when they have to deal with peers death