Transição do cuidado da pessoa com doença crônica na alta hospitalar: perspectiva de enfermeiros / Transición del cuidado de la persona con enfermedad crónica en el hospital: perspectiva de enfermeros / Transitional care of people with chronic disease at hospital discharge: perspective of nurses

Objetivo: compreender a perspectiva de enfermeiros sobre a transição do cuidado da pessoa com doença crônica não transmissível do hospital para o domicílio. Método: estudo qualitativo, exploratório e descritivo. O cenário do estudo foi um Hospital Universitário no Sul do Brasil. A coleta de dados ocorreu mediante entrevistas semiestruturadas com 28 enfermeiros assistenciais e gestores, entre julho de 2018 a maio de 2019, em que foram feitas as análises pelas temáticas. Resultados: Os enfermeiros apontam algumas estratégias de transição do cuidado, como a inclusão do cuidador nas orientações e o contato telefônico. Indicam, ainda, a necessidade de reconhecimento da rede de saúde pelos profissionais e o desafio da articulação entre diferentes serviços. Considerações finais: a transição do cuidado extrapola a lógica reducionista de simples orientação individualizada para alta hospitalar. O enfermeiro pode protagonizar a mudança e promover a consolidação de práticas seguras e qualificadas, devido sua inserção nos diversos cenários de atenção à saúde.

Objetivo: comprender la perspectiva de enfermeros sobre la transición del cuidado de la persona con enfermedad crónica no transmisible del hospital al domicilio. Método: estudio cualitativo, exploratorio y descriptivo. El escenario del estudio fue un Hospital Universitario en el Sur de Brasil. La recolección de datos se realizó mediante entrevistas semiestructuradas con 28 enfermeros asistenciales y gestores, entre julio de 2018 y mayo de 2019, en las que se realizaron los análisis por las temáticas. Resultados: Los enfermeros apuntan algunas estrategias de transición del cuidado, como la inclusión del cuidador en las orientaciones y el contacto telefónico. Indican, además, la necesidad de reconocimiento de la red de salud por los profesionales y el desafío de la articulación entre diferentes servicios. Consideraciones finales: la transición del cuidado extrapola la lógica reduccionista de simple orientación individualizada para alta hospitalaria. El enfermero puede protagonizar el cambio y promover la consolidación de prácticas seguras y cualificadas, debido a su inserción en los diversos escenarios de atención a la salud.

Objective: to understand the perspective of nurses on the transitional care of the person with chronic non-communicable disease from hospital to home. Method: qualitative, exploratory and descriptive study. The study scenario was a University Hospital in southern Brazil. Data collection occurred through semi-structured interviews with 28 nurses and managers, between July 2018 to May 2019, in which the analyses were made by the themes. Results: The nurses point out some strategies of transition of the care, as the inclusion of the caregiver in the orientations and the telephone contact. They also indicate the need for recognition of the health network by professionals and the challenge of articulation between different services. Final considerations: the transitional care goes beyond the reductionist logic of simple individualized orientation to hospital discharge. The nurse can lead the change and promote the consolidation of safe and qualified practices, due to its insertion in the various scenarios of health care.

A aplicabilidade das pics na assistencia de enfermagem em pacientes com doença crônica: revisão integrativa / The applicability of pics in nursing care for patients with chronic disease: integrative review / La aplicabilidad de la pics en los cuidados de enfermería a pacientes con enfermedades crónicas: revisión integradora

A implementação das PICs no Brasil é uma realidade, dessa forma, compreende-se que o enfermeiro é o profissional que em tese deve possuir habilidades para aplicar as técnicas em pacientes. Com base nisso, o objetivo do trabalho foi descrever a atuação da enfermagem através de Planos de ações por intermédio das PICs em individuos com diminuição da qualidade de vida em razão do desenvolvimento de doenças crônicas degenerativas. Dessa forma, o presente artigo trata-se de uma revisão integrativa de literatura. Os resultados obtidos mostram que a aplicabilidade das PICs, está consolidada, sendo uma prática bastante utilizada na intervenção terapêutica de indivíduos portadores de doenças crônicas degenerativas, na qual as mais utilizadas são: plantas medicinais, reiki, homeopatia, acupuntura e auricuoterapia, entretanto, em relação a assistência de enfermagem, foi observado impasses em relação a capacitação profissional. Logo, concluímos que com base nas produções cientificas existentes a respeito das PICs, a prática infere em diversos benefícios ao indivíduo, estas que se convergem a promoção de maior qualidade de vida ao paciente com doenças crônicas, porém, a falta de capacitação profissional revela um impasse ainda persistente.

The implementation of PICs in Brazil is a reality, therefore, it is understood that the nurse is the professional who, in theory, must have the skills to apply the techniques to patients. Based on this, the objective of the study was to describe the role of nursing through Action Plans through PICs in individuals with reduced quality of life due to the development of chronic degenerative diseases. Thus, this article is an integrative literature review. The results obtained show that the applicability of PICs is consolidated, being a practice widely used in the therapeutic intervention of individuals with chronic degenerative diseases, in which the most used are: medicinal plants, reiki, homeopathy, acupuncture and auricutherapy, however, in regarding nursing care, impasses regarding professional training were observed. Therefore, we conclude that based on the existing scientific productions regarding PICs, the practice infers in several benefits to the individual, these that converge to the promotion of a better quality of life for the patient with chronic diseases, however, the lack of professional training reveals a stalemate still persistent.

La implementación de los PICs en Brasil es una realidad, por lo tanto, se entiende que la enfermera es el profesional que, en teoría, debe tener las habilidades para aplicar las técnicas a los pacientes. Con base en esto, el objetivo del estudio fue describir el papel de la enfermería a través de Planes de Acción por medio de PICs en individuos con calidad de vida reducida debido al desarrollo de enfermedades crónico degenerativas. Así, este artículo es una revisión bibliográfica integradora. Los resultados obtenidos muestran que la aplicabilidad de los PICs está consolidada, siendo una práctica ampliamente utilizada en la intervención terapéutica de individuos con enfermedades crónicas degenerativas, en la que las más utilizadas son: plantas medicinales, reiki, homeopatía, acupuntura y auricuterapia, sin embargo, en lo que respecta a los cuidados de enfermería, se observaron impasses en cuanto a la formación profesional. Por lo tanto, concluimos que con base en las producciones científicas existentes en relación a las PICs, la práctica infiere en varios beneficios al individuo, estos que convergen a la promoción de una mejor calidad de vida para el paciente con enfermedades crónicas, sin embargo, la falta de formación profesional revela un impasse aún persistente.

Transitando desde las fases de cambio de comportamiento hacia el automanejo de personas con condiciones crónicas / Transiting from phases of behavior change to the self-management of people with chronic conditions

Introducción: A nivel mundial existe una constante preocupación debido a que cada día proliferan más personas con enfermedades crónicas. Para su abordaje, se han propuesto una serie de medidas que enfatizan el rol preponderante que tiene la persona en el logro del automanejo de su salud y enfermedad. El objetivo de este trabajo fue reflexionar acerca de elementos que favorecen el avance desde las etapas de cambio hacia el automanejo de personas con condiciones crónicas. Desarrollo: Para lograr el automanejo, resulta trascendental considerar en la atención a la persona con enfermedades crónicas, entre otros aspectos, el proceso de cambio de comportamiento y el grado de autoeficacia percibida. Asimismo, el personal profesional de la atención primaria de salud y enfermería requieren desarrollar habilidades específicas y de alta idoneidad para una atención integral, oportuna y continuada. Todos estos aspectos se interrelacionan para converger juntos en un plan de atención de salud colaborativo, consensuado y centrado en la persona. Conclusión: Para favorecer el avance del automanejo existen elementos tanto de la persona con enfermedad crónica como de la profesional que se articulan. Entre estas personas se dan relaciones de bidireccionalidad, que han de ser vistas como un proceso funcional continuo y no como elementos discretos en el cuidado en salud.

Introdução: Em todo o mundo existe uma preocupação constante, pois a cada dia proliferam mais pessoas com doenças crônicas. Para sua abordagem, foi proposta uma série de medidas que enfatizam o papel preponderante que a pessoa tem na realização do autogerenciamento de sua saúde e doença. O objetivo deste trabalho foi refletir sobre elementos que favorecem a passagem das etapas de mudança para a autogestão de pessoas com condições crônicas. Desenvolvimento: A fim de alcançar a autogestão, é crucial considerar, entre outros aspectos, o processo de mudança de comportamento e o grau de auto-eficácia percebido no cuidado da pessoa cronicamente doente. Do mesmo modo, os profissionais de cuidados de saúde primários e de enfermagem precisam desenvolver competências específicas e altamente qualificadas para cuidados abrangentes, atempados e contínuos. Todos estes aspectos se inter-relacionam para convergir em um plano de cuidados de saúde colaborativo, consensual e centrado na pessoa. Conclusão: Para favorecer o avanço da autogestão, há elementos tanto da pessoa quanto do profissional que se articulam, existindo relações bidirecionais entre eles, que devem ser vistos como um processo funcional contínuo e não como elementos discretos no cuidado à saúde.

Introduction: There is worldwide constant concern because of the increasing number of people with chronic diseases every day. When it comes to approaching this situation, a series of measures have been proposed to emphasize the preponderant role that the people have has in achieving the self-management of their health and disease. The objective of this work was to reflect on the elements that favor progress from the stages of change towards self-management in people with chronic conditions. Development: To achieve self-management, it is essential to consider - among other aspects - the process of behavioral change and the degree of perceived self-efficacy in the care of chronically ill people. Likewise, primary healthcare and nursing professionals need to develop specific and highly suitable skills for comprehensive, timely, and continuous care. All these aspects interrelate to converge together in a collaborative, consensual, and person-centered healthcare plan. Conclusion: To favor the advancement of self-management, there are elements that both the person and the professional need to articulate, for instance, the existing bidirectional relationships between them must be seen as a continuous functional process and not as discrete elements in healthcare.

Práticas do enfermeiro no monitoramento das Doenças Crônicas Não Transmissíveis na Atenção Primária à Saúde / Prácticas del enfermero en el seguimiento de las Enfermedades Crónicas No Transmisibles en la Atención Primaria de Salud / Practices of nurses in monitoring Chronic Non-communicable Diseases in Primary Health Care

Resumo Objetivo analisar as práticas do enfermeiro da Atenção Primária à Saúde para o monitoramento das quatro principais Doenças Crônicas Não Transmissíveis (doenças do aparelho circulatório, câncer, diabetes e doenças respiratórias crônicas) em um município do interior do Estado de Santa Catarina. Método estudo de caso único, de abordagem qualitativa. Os dados foram coletados por meio de triangulação de técnicas: entrevistas focadas, análise documental e banco de dados on-line, de janeiro a julho de 2019. As técnicas de análise deram-se por meio de proposições teóricas e da construção da explicação relativas às práticas dos enfermeiros. Resultados as práticas do enfermeiro para o monitoramento das doenças crônicas identificadas foram: Grupo HiperDia; educação em saúde; telemonitoramento; acolhimento; visita domiciliar; consulta de Enfermagem; plano de cuidados; automonitoramento e protocolos. Conclusão e implicações para a prática os enfermeiros do contexto estudado realizam práticas diversas para o monitoramento das doenças crônicas, contribuindo para a efetividade das políticas para esta condição e, possivelmente, com a queda no indicador de mortalidade por essas causas.

Resumen Objetivo analizar las prácticas de los enfermeros en la Atención Primaria de Salud para el seguimiento de las cuatro principales Enfermedades Crónicas No Transmisibles (enfermedades del aparato circulatorio, cáncer, diabetes y enfermedades respiratorias crónicas) en un municipio del interior del Estado de Santa Catarina. Método estudio de caso único, con abordaje cualitativo. Los datos fueron recolectados a través de triangulación de técnicas: entrevistas focalizadas, análisis de documentos y base de datos en línea, de enero a julio de 2019. Las técnicas de análisis ocurrieron a través de proposiciones teóricas y la construcción de la explicación relacionadas con las prácticas de los enfermeros. Resultados las prácticas de enfermería para el acompañamiento de las enfermedades crónicas identificadas fueron: Grupo HiperDia; educación para la salud; televigilancia; recepción; visita a casa; consulta de Enfermería; plan de cuidados; autocontrol y protocolos. Conclusión e implicaciones para la práctica los enfermeros en el contexto estudiado realizan diferentes prácticas de seguimiento de enfermedades crónicas, contribuyendo para la efectividad de las políticas para esta condición y, posiblemente, con una caída en el indicador de mortalidad por esas causas.

Abstract Objective to analyze the Primary Health Care nurses' practices for monitoring the four main Chronic Non-communicable Diseases (circulatory system diseases, cancer, diabetes, and chronic respiratory diseases) in a city in the interior of Santa Catarina State. Method single case study, qualitative approach. Data was collected through triangulation of techniques: focused interviews, document analysis, and online database, from January to July 2019. The analysis techniques were given by means of theoretical propositions and the construction of explanation regarding the nurses' practices. Results the nurse's practices for monitoring chronic diseases identified were: HiperDia Group; health education; tele-monitoring; welcoming; home visits; nursing consultation; care plan; self-monitoring and protocols. Conclusion and implications for the practice the nurses in the studied context perform several practices for the monitoring of chronic diseases, contributing to the effectiveness of policies for this condition and, possibly, with the drop in the mortality indicator for these causes.

Visão de familiares sobre o cuidado compartilhado da criança com condição crônica hospitalizada / Visión familiar sobre el cuidado compartido de niños con condición crónica hospitalizada / Family view on the shared care of hospitalized children with chronic condition

Objetivo: compreender a visão dos familiares de criança com condição crônica hospitalizada sobre o cuidado compartilhado com a equipe de enfermagem. Método: estudo transversal, realizado com 231 universitários da área da saúde entre os meses de setembro e outubro de 2020. Aplicou-se o Maslach Burnout Inventory/ Student Survey para avaliar a Síndrome de Burnout e associou-se um questionário para levantamento das variáveis sociodemográficas e acadêmicas. A associação entre variáveis categóricas foi avaliada por meio dos testes Qui-quadrado e Exato de Fisher. Considerou-se nível de significância de 5%. Resultados: identificou-se quatro categorias: Buscando uma definição para cuidado compartilhado; Ajudando e aprendendo durante a hospitalização; Exemplificando as formas de realizar cuidado compartilhado no ambiente hospitalar; Sensações vivenciadas pelos cuidados compartilhados. Considerações Finais: na visão dos cuidadores de crianças em condição crônica, o compartilhamento do cuidado nas hospitalizações é percebido como ajuda dos acompanhantes aos profissionais, e não como parte do cuidado. Foram identificados momentos de troca e aprendizado, porém o cuidado pareceu ser mais compartimentado do que compartilhado.

Objetivo: comprender la visión de los familiares de niños con enfermedades crónicas hospitalizadas sobre la atención compartida con el equipo de enfermería. Método: estudio cualitativo, exploratorio y descriptivo, realizado con diez familiares de niños con enfermedades crónicas hospitalizados en las salas intensivas clínicas, quirúrgicas y pediátricas de un Hospital Universitario de Río de Janeiro, Brasil. La recolección de datos se produjo mediante la aplicación de entrevistas semiestructuradas. Los datos fueron analizados por análisis de contenido. Resultados: se identificaron cuatro categorías: Búsqueda de una definición de atención compartida; Ayudar y aprender durante la hospitalización; Ejemplificar las formas de realizar la atención compartida en el ámbito hospitalario; Sensaciones experimentadas por el cuidado compartido. Consideraciones finales: en opinión de los cuidadores de niños en condiciones crónicas, el reparto de cuidados en las hospitalizaciones se percibe como la ayuda de los acompañantes a los profesionales, y no como parte de los cuidados. Se identificaron momentos de intercambio y aprendizaje, pero el cuidado parecía estar más compartimentado que compartido.

Objective: to understand the view of family members of children with chronic hospitalized conditions about shared care with the nursing team. Method: qualitative, exploratory and descriptive study, conducted with ten relatives of children with chronic conditions hospitalized in the clinical, surgical and pediatric intensive wards of a University Hospital in Rio de Janeiro, Brazil. Data collection occurred through the application of semi-structured interviews. The data were analyzed by content analysis. Results: four categories were identified: Seeking a definition for shared care; Helping and learning during hospitalization; Exemplifying the ways to perform shared care in the hospital environment; Sensations experienced by shared care. Final considerations: in the view of caregivers of children in chronic conditions, the sharing of care in hospitalizations is perceived as the help of companions to professionals, and not as part of care. Moments of exchange and learning were identified, but care seemed to be more compartmentalized than shared.

Latent Class Analysis of Symptom Burden Among Seriously Ill Adults at the End of Life.

BACKGROUND: Serious illness is characterized by high symptom burden that negatively affects quality of life (QOL). Although palliative care research has highlighted symptom burden in seriously ill adults with cancer, symptom burden among those with noncancer serious illness and multiple chronic conditions has been understudied. Latent class analysis is a statistical method that can be used to better understand the relationship between severity of symptom burden and covariates, such as the presence of multiple chronic conditions. Although latent class analysis has been used to highlight subgroups of seriously ill adults with cancer based on symptom clusters, none have incorporated multiple chronic conditions. OBJECTIVES: The objectives of this study were to (a) describe the demographic and baseline characteristics of seriously ill adults at the end of life in a palliative care cohort, (b) identify latent subgroups of seriously ill individuals based on severity of symptom burden, and (c) examine variables associated with latent subgroup membership, such as QOL, functional status, and the presence of multiple chronic conditions. METHODS: A secondary data analysis of a palliative care clinical trial was conducted. The latent class analysis was based on the Edmonton Symptom Assessment System, which measures nine symptoms on a scale of 0-10 (e.g., pain, fatigue, nausea, depression, anxiousness, drowsiness, appetite, well-being, and shortness of breath). Clinically significant cut-points for symptom severity were used to categorize each symptom item in addition to a categorized total score. RESULTS: Three latent subgroups were identified (e.g., low, moderate, and high symptom burden). Lower overall QOL was associated with membership in the moderate and high symptom burden subgroups. Multiple chronic conditions were associated with statistically significant membership in the high symptom burden latent subgroup. Older adults between 65 and 74 years had a lower likelihood of moderate or high symptom burden subgroup membership compared to the low symptom burden class. DISCUSSION: Lower QOL was associated with high symptom burden. Multiple chronic conditions were associated with high symptom burden, which underlines the clinical complexity of serious illness. Palliative care at the end of life for seriously ill adults with high symptom burden must account for the presence of multiple chronic conditions.

Indicadores de saúde em usuários de uma unidade básica de saúde da cidade de Santarém, Pará, Brasil / Health indicators in users of a basic health unit in the city of Santarém, Pará, Brazil

Introdução: Usuários do sistema de saúde com doenças crônicas não transmissíveis devem estar em acompanhamento constante para evitar complicações em seu estado de saúde. Objetivo: Analisar os indicadores laboratoriais de saúde em usuários de uma Unidade Básica de Saúde com e sem o diagnóstico para a diabetes e hipertensão. Métodos: A amostra foi de 231 usuários de uma unidade básica de saúde da cidade de Santarém-PA, maiores de idade, que foram agrupados em pacientes com DM/HAS (DM/HAS; n=144), e sem o diagnóstico para DM/HAS (AUS; n=87). As coletas envolveram informações socioeconômicas, clínicas e laboratoriais. Os dados foram tratados com estatística descritiva e inferencial, adotando-se p<0.05. Resultados: Tanto no DM/HAS como no AUS predominou o sexo feminino, estado civil casado, com vínculo empregatício, cor de pele parda, com 4-7 anos de estudo, renda de 1-2 salários, não tabagistas, não etilista e faixa etária de 38-77 anos. A HAS foi a doença mais presente de forma geral, bem como por sexo. Identificou-se no DM/HAS valores menores para a taxa de filtração glomerular (TFG) e maiores valores para a glicemia, triglicerídeos, colesterol total, LDL-c e não HDL-c. Conclusão: De acordo com a proposta desenvolvida, destaca-se que os usuários com DM/HAS apresentam associação positiva para valores alterados de glicemia, colesterol total, não HDL-c, triglicerídeos, TFG e para a presença da síndrome metabólica e risco cardiovascular moderado/alto.

Introduction: Users of the health system with chronic non-communicable diseases must be constantly monitored to avoid complications in their health status. Objective: Analyze laboratory health indicators in users of a Basic Health Unit with and without a diagnosis for diabetes and hypertension. Methods: The sample consisted of 231 users of a basic health unit in the city of Santarém-PA, all of them of age, grouped into patients with DM/SAH (DM/SAH; n=144), and without the diagnosis for DM/SAH (ABS; n=87). The collections involved socioeconomic, clinical, and laboratory information. The data were treated with descriptive and inferential statistics, adopting p <0.05. Results: In both DM/SAH and ABS groups, there was a predominance of female individuals, married status, employed, brown skin color, with 4-7 years of study, income of 1-2 salaries, non-smokers, non-alcoholic drinkers, and aged between 38-77 years. SAH was the most common disease in general, as well as when analyzing by gender. Lower values for the glomerular filtration rate (GFR) were identified in the DM/SAH and higher values for the glycemia, triglycerides, total cholesterol, LDL-c, and non-HDL-c. Conclusion: According to the proposal of this paper, it is noteworthy that users with DM/SAH have a positive association for altered values of blood glucose, total cholesterol, non-HDL-c, triglycerides, GFR, and for the presence of metabolic syndrome and moderate/high cardiovascular risk.

Management of care to chronic conditions in the rural under the coordination of nurses / Gestión de la atención a condiciones crónicas en rural bajo la coordinación de enfermeras / Gestão do cuidado às condições crônicas no rural sob a coordenação de enfermeiras

ABSTRACT Objective To analyze the perspective of Nurses Coordinators of Family Health Teams on the management of care for people with chronic illness in rural areas. Method Qualitative approach exploratory study, carried out in a Health Region of Rio Grande do Sul, together with the Nurses in charge of the Units, between 2014 and 2015. The sample included seven participants. Data analysis was driven by thematic categorization and using NVIVO software. Results The thematic categories identified were: The administrative political organization of health care; The pluralities of rural impose specifics on care management and Strategies for management of care in the rural areas. Final considerations We pointed out elements of care management that are related not only to individual care, but also elements related to broader dimensions of health care, such as the social and political relationships that tension over the territories and that have implications to clinical practice.

RESUMEN Objetivo Analizar la perspectiva de las Enfermeras Coordinadoras de los Equipos de Salud de la Familia sobre la gestión de la atención a las personas con enfermedades crónicas en el rural. Método Estudio exploratorio de abordaje cualitativo, realizado en una Región de Salud de Rio Grande do Sul junto a las Enfermeras en cargo de Coordinación de las Unidades de Salud de la Familia, entre 2014 y 2015, la muestra consistió en siete participantes. El análisis de datos se realizó mediante análisis de contenido temático, con soporte del software NVIVO. Resultados Categorías temáticas identificadas: La organización política administrativa de la atención en salud; Las pluralidades del rural imponiendo especificidades a la gestión del cuidado y Estrategias para la gestión del cuidado en el campo. Consideraciones finales Se apuntan elementos de la gestión del cuidado que están relacionados no sólo a la atención individual, sino también elementos vinculados a dimensiones más amplias de la atención en salud.

RESUMO Objetivo Analisar a perspectiva de Enfermeiras Coordenadoras de Equipes de Saúde da Família sobre a gestão do cuidado às pessoas em adoecimento crônico no rural. Método Estudo exploratório de abordagem qualitativa, realizado em uma Região de Saúde do Rio Grande do Sul, junto às Enfermeiras em cargo de Coordenação das Unidades de Saúde da Família, entre 2014 e 2015. A amostra foi constituída por sete participantes. A análise dos dados se deu por análise de conteúdo do tipo temática, com apoio do software NVIVO. Resultados Categorias temáticas identificadas: A organização político-administrativa da atenção em saúde; As pluralidades do Rural impondo Especificidades à Gestão do Cuidado e Estratégias para a gestão do cuidado no rural. Considerações finais Apontam-se elementos da gestão do cuidado que estão relacionados não só ao atendimento individual, mas também elementos ligados a dimensões mais amplas da atenção em saúde, como as relações sociais e políticas que tensionam os territórios e que têm implicações à prática clínica.

Characteristics for a tool for timely identification of palliative needs in heart failure: The views of Dutch patients, their families and healthcare professionals.

BACKGROUND: Palliative care can improve outcomes for patients with advanced chronic heart failure and their families, but timely recognition of palliative care needs remains challenging. AIM: The aim of this study was to identify characteristics of a tool to assess palliative care needs in chronic heart failure that are needed for successful implementation, according to patients, their family and healthcare professionals in The Netherlands. METHODS: Explorative qualitative study, part of the project 'Identification of patients with HeARt failure with PC needs' (I-HARP), focus groups and individual interviews were held with healthcare professionals, patients with chronic heart failure, and family members. Data were analysed using the Consolidated Framework for Implementation Research. RESULTS: A total of 13 patients, 10 family members and 26 healthcare professionals participated. Direct-content analysis revealed desired tool characteristics for successful implementation in four constructs: relative advantage, adaptability, complexity, and design quality and packaging. Healthcare professionals indicated that a tool should increase awareness, understanding and knowledge concerning palliative care needs. A tool needs to: be adaptable to different disease stages, facilitate early identification of palliative care needs and ease open conversations about palliative care. The complexity of chronic heart failure should be considered in a personalized approach. CONCLUSIONS: The current study revealed the characteristics of a tool for timely identification of palliative care needs in chronic heart failure needed for successful implementation. The next steps will be to define the content of the tool, followed by development of a preliminary version and iterative testing of this version by the different stakeholders.

Characteristics of People with Dementia vs Other Conditions on Admission to Inpatient Palliative Care.

OBJECTIVES: Our aim was to (1) describe the clinical characteristics and symptoms of people diagnosed with dementia at the time of admission to inpatient palliative care; and (2) compare the nature and severity of these palliative care-related problems to patients with other chronic diseases. DESIGN: Descriptive study using assessment data on point of care outcomes (January 1, 2013, to December 31, 2018). SETTING: A total of 129 inpatient palliative care services participating in the Australian Palliative Care Outcomes Collaboration. PARTICIPANTS: A total of 29,971 patients with a primary diagnosis of dementia (n = 1,872), lung cancer (n = 19,499), cardiovascular disease (CVD, n = 5,079), stroke (n = 2,659), or motor neuron disease (MND, n = 862). MEASUREMENTS: This study reported the data collected at the time of admission to inpatient palliative care services including patients' self-rated levels of distress from seven common physical symptoms, clinician-rated symptom severity, functional dependency, and performance status. Other data analyzed included number of admissions, length of inpatient stay, and palliative care phases. RESULTS: At the time of admission to inpatient palliative care services, relative to patients with lung cancer, CVD, and MND, people with dementia presented with lower levels of distress from most symptoms (odds ratios [ORs] range from .15 to .80; P < .05 for all) but higher levels of functional impairment (ORs range from 3.02 to 8.62; P < .001 for all), and they needed more assistance with basic activities of daily living (ORs range from 3.83 to 12.24; P < .001 for all). The trends were mostly the opposite direction when compared with stroke patients. Patients with dementia tended to receive inpatient palliative care later than those with lung cancer and MND. CONCLUSION: The unique pattern of palliative care problems experienced by people with dementia, as well as the skills of the relevant health services, need to be considered when deciding on the best location of care for each individual. Access to appropriately trained palliative care clinicians is important for people with high levels of physical or psychological concerns, irrespective of the care setting or diagnosis. J Am Geriatr Soc 68:1825-1833, 2020.

A enfermeira gestora de casos na Espanha: enfrentando o desafio da cronicidade por meio de uma prática integral / Case management nurse in Spain: facing the challenge of chronicity through a comprehensive practice

Resumo Em fins da década de 1990, instituiu-se um novo tipo de atuação para a enfermeira no sistema de saúde espanhol, denominada atualmente de enfermeira gestora de casos, com vistas à garantia do acesso aos recursos necessários para o enfrentamento das condições de cronicidade e atendimento integral no domicílio. O objetivo do artigo é o de apresentar essa figura e discutir aspectos de sua atuação. A metodologia baseou-se em revisão bibliográfica de artigos e publicações normativas e entrevistas com enfermeiras de Atenção Primária de Saúde, docentes de enfermagem e enfermeiras gestoras de casos. Apresenta-se um breve histórico de implantação da enfermeira gestora de casos e as bases conceituais e operacionais de sua prática em três comunidades autônomas espanholas: Andaluzia, Comunidade Valenciana e País Basco, discutindo potencialidades e questões a respeito dessa atuação dentro de um sistema de saúde de características universais. Nas conclusões, são tecidas algumas considerações a respeito das possibilidades para a implantação da figura da enfermeira gestora de casos no sistema brasileiro de saúde.

Abstract A new type of nurse role was established in the Spanish health care system in the late 1990s, currently called case manager nurse, to ensure access to resources needed to cope with chronic conditions and comprehensive home care. This paper aims to present this figure and discuss aspects of its work. The methodology was based on the bibliographic review of papers and normative publications and interviews with primary health care nurses, nursing faculty, and case management nurses. We present a brief history of the implementation of the case manager nurse role and the conceptual and operational bases of her practice in three autonomous Spanish communities: Andalusia, Valencian Community, and Basque Country, discussing potentialities and issues concerning this practice. In the conclusions, we make some considerations on the possible implementation of the case manager nurse in the Brazilian health system.

Nurse as an integrator in healthcare management of children with chronic condition / Enfermero como integrador en la gestión del cuidado al niño con condición crónica / Enfermeiro como integrador na gestão do cuidado à criança com condição crônica

ABSTRACT Objectives: to understand the practice of the nurse in healthcare management of children with chronic condition in the hospital setting. Methods: analytical study of qualitative approach with theoretical and methodological reference of institutional ethnography. Developed in the pediatric unit of a university hospital, in a municipality in Northeastern Brazil. Data collections techniques were: participant observation, documentary analysis and semi-structured interview. Participants of the study totaled twenty professionals, including nurses, social workers, psychologists, pharmacists, nutritionists, physiotherapists, and doctors. For data analysis, it was used the Bardin's Content Analysis with interface of the Atlas.ti software. Results: categories of analysis were "Nurse as mediator of healthcare management"; "Nursing process as a mechanism of healthcare management". Final considerations: the nurse proved to be essential for healthcare management of the child with chronic condition, acting as mediator of the relationship between the doctor, the members of the health team, the user and their family.

RESUMEN Objetivos: comprender la práctica del enfermero en la gestión del cuidado al niño con condición crónica en el contexto hospitalário. Métodos: estudio analítico de abordaje cualitativo, con referencial teórico y metodológico de la etnografía institucional. Desarrollado en la unidad pediátrica de un hospital universitario, en un municipio del Nordeste brasileño. Se utilizaron técnicas de recolección de datos, como observación participante, análisis documental y entrevista semiestructurada. Participaron del estudio un total de veinte profesionales, siendo ellos enfermeros, asistentes sociales, psicólogos, farmacéuticos, nutricionistas, fisioterapeutas y médicos. Para el análisis de los datos, se utilizó el Análisis de Contenido de Bardin con interfaz del software Atlas.ti Resultados: las categorías de análisis fueron "enfermero como mediador de la gestión del cuidado"; "Proceso de enfermería como mecanismo de gestión del cuidado". Consideraciones finales: el enfermero se reveló fundamental para la gestión del cuidado al niño con condición crónica, actuando como mediador de la relación entre el médico, los integrantes del equipo de salud, el usuario y su família.

RESUMO Objetivos: compreender a prática do enfermeiro na gestão do cuidado à criança com condição crônica no contexto hospitalar. Métodos: estudo analítico de abordagem qualitativa, com referencial teórico e metodológico da etnografia institucional. Desenvolvido na unidade pediátrica de um hospital universitário, em um município do Nordeste brasileiro. Foram utilizadas técnicas de coleta de dados, como observação participante, análise documental e entrevista semiestruturada. Participaram do estudo vinte profissionais, sendo eles enfermeiros, assistentes sociais, psicólogos, farmacêuticos, nutricionistas, fisioterapeutas e médicos. Para análise dos dados, utilizou-se a Análise de Conteúdo de Bardin com interface do software Atlas.ti. Resultados: categorias de análise, bem como "Enfermeiro como mediador da gestão do cuidado"; "Processo de enfermagem como mecanismo de gestão do cuidado". Considerações finais: o enfermeiro revelou-se fundamental para gestão do cuidado à criança com condição crônica, atuando como mediador da relação entre o médico, os integrantes da equipe de saúde, o usuário e sua família.

Prevalence of Chronic Health Conditions in Australian Adults with Depression and/or Anxiety.

The association between psychotic illness and poor physical health is now clearly articulated in the literature. By contrast the impact of depression and/or anxiety on physical health is considerably less understood, despite depression being the leading cause of disability worldwide and is associated with significantly higher prevalence of physical comorbidities than found in the general population. An Australia national cross-sectional population-based survey was conducted to ascertain the prevalence of chronic physical health conditions in persons with, and without depression and/or anxiety, allowing for demographic characteristics and lifestyle factors. The telephone-based survey was conducted using trained interviewers. Survey questions included those eliciting information about demographics, health status, and health behaviours. Independent t-tests and chi square tests showed demographic, health behaviours, and physical illness differed between those with and without depression and/or anxiety. Heart disease, high blood pressure, stroke, cancer, arthritis, chronic neck and/or back pain, and asthma were significantly higher in participants diagnosed with depression and/or anxiety. Binary logistic regression showed the strongest predictor of chronic illness was having a diagnosis of depression and/or anxiety. Depression and anxiety present major health problems impacting a considerable proportion of the population. A greater understanding of the associated physical health issues should provide impetus to broaden the physical health and mental illness research agenda to include these diagnoses.

Socioeconomic Status and Health Services Utilization for Children With Complex Chronic Conditions Liable to Receive Nurse-Led Services: A Cross-Sectional Study.

AIM: To analyze the use of health services for children with severe chronic diseases, seeking to identify patterns of use according to sociodemographic and clinical conditions, and to identify unmet needs of care coordination that could benefit from nursing case management services. DESIGN: Cross-sectional study. METHODS: Children treated in ambulatory and hospital care in Granada, Spain, with complex chronic diseases in 2016 were analyzed to determine their use of healthcare resources. Socioeconomic variables were evaluated, along with clinical status and duration of their conditions. RESULTS: In total, 265 children were analyzed (mean age 7.3 years, SD 4.63; 56.6% male). The average duration of the disease was 63.26 months (SD 54.09). The most common types of disease were neurological (35.80%), congenital (23.90%), and oncological (18.90%). Multivariate analysis showed that children in need of advanced care (ß = 0.71), with a relatively recent diagnosis (ß = -0.11), with criteria for palliative care 1 (ß = -0.26), and whose mothers were older (ß = 0.36) and had a higher educational level (ß = 0.19) made greater use of healthcare resources during the preceding 12 months, whether urgent or scheduled (r2 = 78.0%, p < .001). CONCLUSIONS: Children with higher needs for advanced care have a heterogeneous use of healthcare resources depending on certain clinical and sociodemographic determinants. This finding highlights the importance of the identification of profiles of children and families for care coordination. The presence of sociodemographic determinants may need individualized approaches to assure a timely health care utilization. CLINICAL RELEVANCE: A significant proportion of the children used multiple health services, being treated at several centers simultaneously, and producing up to 139 total yearly contacts with the health system. Policymakers, healthcare providers, and patients' families should engage in a redesign of healthcare services for these children, providing comprehensive and coordinated systems of care for this population.

Meta-Analysis of Anxiety in Parents of Young People with Chronic Health Conditions.

OBJECTIVE: Chronic health conditions are often associated with uncertainty and threats which may cause anxiety in the family members. The present meta-analysis analyzed whether parents of children with chronic physical diseases and/or sensory/physical disabilities show higher anxiety levels than parents of healthy/nondisabled children or test norms. METHODS: The databases PSYCINFO, MEDLINE, Google Scholar, CINAHL, and PSYNDEX were searched for relevant studies. In total, 486 studies were identified that fulfilled the inclusion criteria. RESULTS: We found moderate elevations of anxiety symptoms in parents of young people with chronic conditions (g = .54 standard deviation units). About 16% of the parents fulfilled the criteria for an anxiety disorder. Parents of young people with neuromuscular disorders, HIV-infection/AIDS, and cancer during active treatment showed large elevations of anxiety symptoms. Elevations of anxiety symptoms were smaller in the cases of longer lasting chronic conditions, longer time since the end of active treatment, in families of older children, in samples with lower percentages of mothers, and in studies from economically developed countries compared to less developed countries. CONCLUSION: Measures for preventing and reducing anxiety symptoms in parents of young people with neuromuscular disorders, HIV-infection/AIDS, and those undergoing cancer treatments are particularly needed.

Community Care For High-Need Patients.

People living with serious illness, including multiple chronic conditions and conditions that limit the ability to perform everyday activities, prefer to receive care in their home or their community rather than in an institutional health care setting. This month's DataGraphic highlights the workforce that cares for these people in the home and community, including the characteristics of this workforce and the costs of such care.

Pediatric palliative care in the medical neighborhood for children with medical complexity.

Children with medical complexity (CMC) are a medically fragile pediatric population that experience severe chronic illnesses resulting in significant health care needs, functional limitations, and health care utilization, and are at the highest risk for morbidity and mortality among all children. Furthermore, families and parents of CMC experience significant caregiver hardships and diminished quality of life. The field of pediatric palliative care has grown in recent years, in part to address the physical and psychosocial issues inherent to the care of these chronically ill children. However, as the prevalence and long-term survival of CMC increases with medical advancements, the demand for pediatric palliative care will likely exceed the capacity of current and future pediatric palliative care specialists. Therefore, alternative strategies to ensure access to essential aspects of palliative care must be considered. This article focuses on why and how high-quality palliative care should be integrated into the patient- and family-centered medical home, the ideal care delivery model for CMC and their families. We first discuss how palliative care principles naturally align with and complement the goals of the CMC medical home. Next, we detail what actions pediatric palliative care specialists can take to best support the CMC medical home as "medical neighbors." Lastly, we describe the fundamental aspects of pediatric palliative care that all clinicians caring for CMC should be able to provide, referred to as "primary pediatric palliative care." (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The social network of adolescents who need special health care / La red social de los adolescentes que necesitan una atención especial a la salud / Rede social de adolescentes que necessitam de atenção especial à saúde

ABSTRACT Objective: To describe the social network of adolescents who need special health care. Method: A qualitative, descriptive and exploratory study conducted between 2016 and 2017 in the pediatric outpatient clinic of a teaching hospital in southern Brazil. Thirty-five semi-structured interviews were conducted with adolescents between 12 and 18 years of age, followed by the construction of genograms and ecomaps. After transcription, the enunciations were subjected to Pêcheux's method of discourse analysis. Results: The institutional network consists of health services, schools and religious entities, as well as adolescents' families and friends. In the family network, women family members—such as mothers, grandmothers and aunts—have a special role. Final Consideration: The adolescents' social network is composed of institutional and family circles. In the view of adolescents, the tertiary service is more capable of solving their problems, and for this reason used the most. In order to ensure these adolescents access to and continuity of care, the articulation between health policies and health services is suggested.

RESUMEN Objetivo: Describir la red social de los adolescentes que necesitan una atención especial a la salud. Método: Estudio cualitativo, descriptivo y exploratorio, realizado entre 2016 y 2017 en la clínica pediátrica de un hospital escuela en la región sur de Brasil. Se realizaron 35 entrevistas semiestructuradas con adolescentes de 12 a 18 años de edad, y después se elaboraron genogramas y ecomapas. Después de la doble transcripción, se sometieron los relatos a análisis de discurso pecheutiano. Resultados: En la red institucional constan de servicios de salud, escuelas y organismos religiosos, así como de familiares y amigos de los adolescentes. En la red de la familia, se elogian a las mujeres, representadas por las madres, las abuelas y las tías. Consideraciones Finales: La red social de los adolescentes se compone de círculos institucionales y familiares. En la perspectiva de los adolescentes, el servicio terciario es más resolutivo, por lo tanto, es lo más utilizado. Se recomienda articular las políticas con los servicios de salud para que se oferte a estos adolescentes el acceso a la salud y la continuidad del cuidado.

RESUMO Objetivo: Descrever a rede social de adolescentes que necessitam de atenção especial à saúde. Método: Estudo qualitativo, descritivo e exploratório realizado entre 2016 e 2017 no ambulatório pediátrico de um hospital de ensino no sul do Brasil. Foram realizadas 35 entrevistas semiestruturadas com adolescentes entre 12 a 18 anos de idade, seguidas pela construção de genogramas e ecomapas. Após a dupla transcrição, as enunciações foram submetidas à análise de discurso pechetiana. Resultados: A rede institucional é composta por serviços de saúde, escolas e entidades religiosas, além de familiares e amigos dos adolescentes. Na rede familiar, as mulheres são enaltecidas, representadas pelas mães, avós e tias. Considerações Finais: A rede social dos adolescentes é composta pelos círculos institucional e familiar. Na ótica dos adolescentes, o serviço terciário é mais resolutivo e por isso é o mais utilizado. Sugere-se articular as políticas e os serviços de saúde para o acesso e continuidade do cuidado desses adolescentes.

Advance care planning for patients and their relatives.

BACKGROUND: Advance care planning (ACP) has been suggested to improve the quality of life (QoL) and mental wellbeing in severely ill patients and their relatives. AIM: To investigate the effects of ACP among patients with lung, heart and cancer diseases with an estimated life-span of up to 12 months. METHODS: Patients and relatives were randomised into two groups: one receiving usual care and one receiving ACP and usual care. Themes from the ACP discussion were documented in patients' electronic medical file. Participants completed self-reported questionnaires four to five weeks after randomisation. FINDINGS: In total, 141 patients and 127 relatives participated. No significant differences were found according to outcomes. However, patients with non-malignant diseases had the highest level of anxiety and depression; these patients seemed to benefit the most from ACP, though not showing statistically significant results. CONCLUSION: No significant effects of ACP among patients with lung, heart, and cancer diseases and their relatives regarding HRQoL, anxiety, depression, and satisfaction with healthcare were found.