La Calidad de Vida de las Cuidadoras Informales Principales en tiempos de COVID-19 y su Relación con la Enfermería de Atención Primaria / The quality of life of informal primary caregivers in times of covid-19 and its relation to primary care nursing

Objetivo: determinar la calidad de vida, la sobrecarga del rol del cuidador y el apoyo social percibido de las cuidado ras principales de pacientes pertenecien tes a la Cartera de Servicios de la Aten ción Domiciliaria de tres Centros de Sa lud del Área de Salud de Gran Canaria. Método: estudio descriptivo-transversal, con un muestreo aleatorio simple de cui dadoras. Participaron 89 cuidadoras, las cuáles realizaban 4 cuestionarios: uno de elaboración propia, Zarit (sobrecar ga), Duke (apoyo social percibido) y Coop-Wonca (calidad de vida). Este proyecto permite conocer la realidad psico social de las cuidadoras principales y con ello visibilizar su situación (AU)

Objective: to determine the quality of life, caregiver role overload and per ceived social support of the main caregi vers of patients belonging to the Home Care Service Portfolio of three Health Centres in the Health Area of Gran Cana ria. Method: descriptive-cross-sectional study, with simple random sampling of caregivers. Eighty-nine carers took part, completing four questionnaires: one self completed questionnaire , Zarit (overload), Duke (perceived social support) and Coop-Wonca (quality of life). This project allows us to know the psychosocial reality of the main carers and thus to make their situation more visible (AU)

Palliative Care in Colombia: home care services, access barriers, and progress in the implementation of these programs during the COVID-19 pandemic

Palliative care aims to comprehensively alleviate the suffering of patients with chronic, degenerative and terminal diseases, and thus improve their quality of life by including physical, psychosocial, and spiritual aspects in the care process. In Colombia, the provision of palliative care services is regulated by Law 1733 of 2014, but access to them is limited since the health care centers where these services are provided are concentrated in the large capitals of the country. Furthermore, the general population is unaware of the existence of this type of care. The fear of contagion during the COVID-19 pandemic created additional barriers, hindering even more the access to palliative care. For example, the access of health personnel in charge of these services to patients' homes was restricted and it was observed that people avoided attending their appointments at health centers. Similarly, isolation and social distancing measures further worsened the psychosocial suffering of both inpatients and their families, as the support and presence of their loved ones was extremely limited during the end-of-life period, making, in turn, the grieving process more difficult when these patients passed away. Bearing this in mind, the objectives of this reflection were to explore the current situation of palliative care services in Colombia and analyze the impact that the COVID-19 pandemic has had on their provision at home.

Los cuidados paliativos buscan aliviar de manera integral el sufrimiento de los pacientes con enfermedades crónicas, degenerativas y terminales, y, de esta forma, mejorar su calidad de vida al incluir aspectos físicos, psicosociales y espirituales en la atención. En Colombia, la prestación de los servicios de cuidados paliativos está regulada por la Ley 1733 de 2014; sin embargo, el acceso a los mismos es limitado, ya que los centros de atención donde se prestan estos servicios se concentran en las capitales departamentales; además, la población general desconoce la existencia de este tipo de atención. El temor al contagio durante la pandemia por COVID-19 ha creado barreras adicionales que dificultan aún más el acceso a los cuidados paliativos; por ejemplo, se ha restringido el acceso del personal de salud encargado de estos servicios a los domicilios de los pacientes y se ha evidenciado que las personas evitan asistir a sus consultas a los centros de salud. De igual forma, las medidas de aislamiento y distanciamiento social han empeorado aún más el sufrimiento psicosocial de los pacientes hospitalizados, así como el de sus familias, ya que el apoyo y la presencia de los seres queridos se han limitado seriamente durante el periodo de fin de la vida, lo que a su vez ha hecho más difícil el proceso de duelo cuando estos pacientes fallecen. Con esto en mente, los objetivos de la presente reflexión fueron explorar la situación actual de los servicios de cuidados paliativos en Colombia y analizar el impacto que ha tenido la pandemia por COVID-19 en la prestación domiciliaria de este tipo de cuidados.

Buurtzorg Nederland: una propuesta de atención domiciliaria dirigida por enfermeras / Buurtzorg Nederland, a proposal for nurse-led home care

Buurtzorg Nederland es una organización holandesa de atención sanitaria en la que equipos de enfermeras prestan atención domiciliaria en todas las competencias de su profesión. En este artículo se plantean algunas cuestiones relativas a aspectos internos de la organización, con base en 3dimensiones. La primera, la dimensión organizativa, según la cual los equipos están estructurados con base en 8 roles, sin jerarquías y apoyados en la filosofía del coaching. La segunda, la dimensión enfermera, en la que destaca que las enfermeras despliegan todas las competencias de su profesión, desde el cuidado básico hasta el cuidado más complejo, con el objetivo de desfragmentar la atención. Y la tercera, la dimensión económica, según la cual la sostenibilidad de la organización está en ser un sistema sin directivos, de equipos pequeños que trabajan en áreas geográficas pequeñas, con un sistema informático que da soporte a todos los asuntos organizativos, asistenciales y económicos.Las principales características de Buurtzorg Nederland son la autogestión de los equipos y la atención desfragmentada, que satisfacen tanto a la enfermera como al paciente. Sin embargo, esta desfragmentación se ha conseguido en cuanto al cuidado del paciente, al atender el mismo equipo todas las necesidades de cuidados básicos y complejos en el domicilio, pero en otros ámbitos asistenciales no se ha conseguido, y el paciente debe visitar a otros proveedores, por lo que la atención de salud en otros niveles sigue estando fragmentada.(AU)

Buurtzorg Nederland is a Dutch healthcare organization in which nursing teams provide home care in all the skills that affect their profession. This article raises some questions regarding more internal aspects of the organization based on 3dimensions. The first, the organizational dimension, in which the teams are structured based on 8 roles, without hierarchies and supported by the coaching system. The second, the nursing dimension, in which it is highlighted that nurses deal with all the competences that affect their profession, from basic care to more complex care, with the aim of defragmenting care. And the third, the economic dimension, in which it stands out that the sustainability of the organization is in being a system without managers, of small teams that work in small geographic areas, with a computer system that supports all organizational matters, healthcare and financial.The main characteristics of Buurtzorg Nederland are the self-management of the teams and the defragmented care that both the nurse and the patient satisfy. However, this defragmentation has been achieved in terms of patient care, with the same team attending to all basic and complex care needs at home, but at other levels of care it has not been achieved, and the patient must visit other providers, therefore, health care at other levels continues to be fragmented.(AU)

Buurtzorg Nederland, a proposal for nurse-led home care.

Buurtzorg Nederland is a Dutch healthcare organization in which nursing teams provide home care in all the skills that affect their profession. This article raises some questions regarding more internal aspects of the organization based on three dimensions. The first, the organizational dimension, in which the teams are structured based on 8 roles, without hierarchies and supported by the coaching system. The second, the nursing dimension, in which it is highlighted that nurses deal with all the competences that affect their profession, from basic care to more complex care, with the aim of defragmenting care. And the third, the economic dimension, in which it stands out that the sustainability of the organization is in being a system without managers, of small teams that work in small geographic areas, with a computer system that supports all organizational matters, healthcare and financial. The main characteristics of Buurtzorg Nederland are the self-management of the teams and the defragmented care that both the nurse and the patient satisfy. However, this defragmentation has been achieved in terms of patient care, with the same team attending to all basic and complex care needs at home, but at other levels of care it has not been achieved, and the patient must visit other providers, therefore, health care at other levels continues to be fragmented.

Buurtzorg Nederland, a proposal for nurse-led home care. / Buurtzorg Nederland: una propuesta de atención domiciliaria dirigida por enfermeras.

Buurtzorg Nederland is a Dutch healthcare organization in which nursing teams provide home care in all the skills that affect their profession. This article raises some questions regarding more internal aspects of the organization based on 3dimensions. The first, the organizational dimension, in which the teams are structured based on 8 roles, without hierarchies and supported by the coaching system. The second, the nursing dimension, in which it is highlighted that nurses deal with all the competences that affect their profession, from basic care to more complex care, with the aim of defragmenting care. And the third, the economic dimension, in which it stands out that the sustainability of the organization is in being a system without managers, of small teams that work in small geographic areas, with a computer system that supports all organizational matters, healthcare and financial. The main characteristics of Buurtzorg Nederland are the self-management of the teams and the defragmented care that both the nurse and the patient satisfy. However, this defragmentation has been achieved in terms of patient care, with the same team attending to all basic and complex care needs at home, but at other levels of care it has not been achieved, and the patient must visit other providers, therefore, health care at other levels continues to be fragmented.

Perfil de funcionamento do SAD, Serviço de Apoio Domiciliário-caso de Braga, Portugal / Operating profile of SAD, Home Support Service, in the case of Braga, Portugal / Perfil operativo de SAD, Servicio de asistencia domiciliaria, en el caso de Braga, Portugal

O SAD português carateriza-se por um perfil tradicional. Reúne como principais caraterísticas funcionar de segunda a sexta-feira, com uma intensidade considerada baixa, com a prestação de cuidados voltadapara as AVD ́S, Atividades de vida diária dos idosos.Objetivos desteestudo: (i)identificar a oferta da estrutura de cuidados existentes,prestada pelo SAD, nas InstituiçõesParticulares de Solidariedade Social (IPSS)especificamentedo distrito de Braga (Portugal);e (ii) analisar seu perfil de funcionamento,com base nos comportamentos de gestãoe na existência ou não dos planos de cuidados no SAD.A metodologia utilizada foi a quantitativa, recorrendo-seà aplicação de inquéritos por questionário, por meiodo instrumento de avaliação,Protocolo de Serviço de Apoio Domiciliário, versão 2. A amostra foipor conveniência,composta pelos20 diretores técnicos das IPSS deBraga,Portugal.Como conclusões, oestudo aponta para um SAD tradicional, rural, com função assistencial, visando asatisfazer as AVD ́S, com declínio funcional, muito idosos,ou com idade inferior aos 65 anos,havendoa necessidade de completar a avaliação multidimensional realizada,e distribuir as tarefas executadas ainda centralizadas na figura do diretor técnico. São apontadas três prioridades:pensar numa boa gestão e rentabilização de recursos humanos; trabalhar os planos de cuidados com a área da saúde e a retaguarda familiar como principal enfoque;e uniformizar os critérios de exclusão e inclusão de acesso ao SAD,ostão importantes critérios de elegibilidade, dando lugar à implementação de um modelo de SAD que se baseienos cuidados pessoais individualizadoscom base na classificação do Rai Home Care.

The Portuguese SAD is characterized by a traditional profile. Its maincharacteristics are to operate from Monday to Friday, with a low intensity, with theprovision of care for ADLs, activities of daily living of the elderly. Objectives of this study:(i) to identify the provision of the existing care structure provided by SAD in the PrivateSocialSolidarity Institutions (IPSS) specifically in thedistrict of Braga (Portugal); and (ii) analyze itsoperating profile, based on managementbehaviors and the existence or otherwise ofcare plans in the DSS. The methodology usedwas quantitative, using surveys by means ofthe assessment instrument, Protocol of HomeSupport Service, version 2. The sample wasfor convenience, composed by the 20technical directors of Braga IPSS, Portugal. As conclusions, the study points to atraditional, rural DSS, with care function,aiming to satisfy the ADLs, with functionaldecline, very elderly, or under 65 years old,with the need to complete themultidimensional assessment performed, anddistribute the tasks performed still centered onthe technical director. Three priorities arepointed out: think about good managementand profitability of human resources; work withhealth care and family care plans as the mainfocus; and standardize the exclusion andinclusion criteria for access to SAD, the all-important eligibility criteria, leading to theimplementation of a model of SAD that isbased on individualized personal care basedon the Rai Home Care classification.

El SAD portugués se caracteriza por un perfil tradicional. Suscaracterísticas principales son operar de lunes a viernes, de baja intensidad, con laprestación de atención para las AVD, actividades de la vida cotidiana de los ancianos. Objetivos de este estudio: (i) identificar la provisión de la estructura de atención existenteproporcionada por SAD en las Instituciones Privadas de Solidaridad Social (IPSS)específicamente en el distrito de Braga (Portugal); y (ii) analizar su perfil operativo, enfunción de los comportamientos de gestión y la existencia o no de planes de atención en el DSS. La metodología utilizada fue cuantitativa, utilizando encuestas por medio delinstrumento de evaluación, Protocolo de Servicio de Apoyo a Domicilio, versión 2. La muestra fue por conveniencia, compuesta por los 20 directores técnicos de Braga IPSS,Portugal Como conclusiones, el estudio apunta a un DSS rural tradicional, con función asistencial, con el objetivo de satisfacer las AVD, con deterioro funcional, muy ancianoso menores de 65 años, con la necesidad de completar la evaluación multidimensionalrealizada, y distribuir las tareas aún en marcha centralizados en la figura del director técnico. Se identifican tres prioridades: pensar en una buena gestión y uso de los recursoshumanos; planes de trabajo de cuidar la salud y antecedentes familiares como el foco principal; y estandarizar los criterios de exclusión e inclusión para el acceso a SAD, loscriterios de elegibilidad más importantes, que conducen a la implementación de un modelo de SAD que se basa en el cuidado personal individualizado basado en laclasificación Rai Home Care.