CUIDADO PALIATIVO CERCANO, ADAPTACIÓN DEL CUIDADO DE ENFERMERÍA BRINDADO EN TIEMPO DE PANDEMIA / CLOSE PALLIATIVE CARE, ADEQUACY OF NURSING CARE PROVIDED IN TIMES OF PANDEMIC

INTRODUCCIÓN: La pandemia a nivel mundial afectó gravemente los servicios de prevención y tratamiento de las Enfermedades No Transmisibles, viéndose las personas con cáncer afectadas por su tamizaje, tratamiento y acompañamiento a fin de vida. En este contexto, el cuidado brindado por enfermería se hizo complejo, generando impotencia y frustración frente al aislamiento y la mortalidad. OBJETIVO: Explorar la percepción de las enfermeras respecto al cuidado otorgado a personas en cuidados paliativos oncológicos en el contexto de la pandemia por COVID-19, en la Región Metropolitana de Chile. MÉTODOS: Estudio cualitativo exploratorio descriptivo en base al análisis de contenido temático de Krippendorff. Contó con una muestra intencionada de 6 enfermeras de unidades de cuidados paliativos. La recolección de datos fue con entrevistas semiestructuradas audio grabadas por video conexión, tras dar el consentimiento, entre septiembre del 2020 y abril del 2021. Las entrevistas trascritas fueron analizadas por cada uno de los investigadores por separado, para luego triangular los hallazgos y develar las categorías, logrando la saturación de datos. RESULTADOS: Las enfermeras de CP que participaron en esta investigación se vieron enfrentadas a desafíos generados por la pandemia, sin embargo, reconocen haber logrado un cuidado paliativo cercano en base a las adaptaciones en la gestión del cuidado, la cual estuvo mediada por factores facilitadores en el proceso. Esta experiencia las llevó a dar sentido al cuidado brindado, valorando las adecuaciones realizadas y el compromiso asumido en pos de mantener un cuidado humanizado a pesar de los obstáculos que se fueron presentando. CONCLUSIÓN: El afrontar la pandemia permitió a las enfermeras de cuidados paliativos adaptarse a través de una gestión del cuidado oportuna, segura, innovadora y humanizada, lo que dio sentido a dicho cuidado, relevando el desarrollo de los programas de cuidados paliativos en personas con limitación de la vida.

INTRODUCTION: The worldwide pandemic severely affected services related to the prevention and treatment of Non-Communicable Diseases, especially in people with cancer who require screening, treatment, and accompaniment at the end of life. In this context, the care provided by nurses became complex, creating feelings of impotence and frustration in the face of isolation and mortality. OBJECTIVE: To explore nurses' perceptions of the oncologic palliative care provided during the COVID-19 pandemic in the Metropolitan Region of Chile. METHODS: Descriptive exploratory qualitative study based on Krippendorff thematic content analysis. The study had an intentional sample of 6 nurses from palliative care units. Data was collected between September 2020 and April 2021, using semi-structured video interviews which were audio-recorded after obtaining consent. The transcribed interviews were analyzed by each of the researchers separately to triangulate the findings and reveal the categories that characterized the nurses' perceptions. RESULTS: While the PC nurses who participated in this research were faced with challenges generated by the pandemic, they were able to provide close palliative care based on adaptations in care management, adaptations facilitated by factors in the process. This experience enabled them to give meaning to the care provided, value the adjustments and the commitment made to maintain humanized care despite the obstacles. CONCLUSION: Facing the pandemic prompted palliative care nurses to adapt through timely, safe, innovative, and humanized care management, giving meaning to such care and highlighting the importance of palliative care programs in people with life limitations.

Conformational Changes of Poly(Maleic Anhydride-alt-styrene) Modified with Amino Acids in an Aqueous Medium and Their Effect on Cytocompatibility and Hemolytic Response.

The conformational changes of poly(maleic anhydride-alt-styrene) (PSMA) modified with different amino acids (PSMA-Aa) were studied in an aqueous medium as a function of ionic strength and pH. The specific viscosity of PSMA-Aa decreased with increasing salt concentration due to a more compact conformation. There was a decrease in surface tension with increasing concentrations of the modified polyelectrolyte having a greater effect for the PSMA modified with l-phenylalanine at pH 7.0, demonstrating a greater surface-active character. The conformational changes were also confirmed by molecular dynamics studies, indicating that PSMA-Aa exhibits a compact structure at pH 4.0 and a more extended structure at pH 7.0. On the other hand, the conformational changes of PSMA-Aa were related to its biological response, where the higher surface-active character of the PSMA modified with l-phenylalanine correlates very well with the higher hemolytic activity observed in red blood cells, in which the surface-active capacity supports lytic potency in erythrocytes. The cytocompatibility assays indicated that there were no significant cytotoxic effects of the PSMA-Aa. Additionally, in solvent-accessible surface area studies, it was shown that the carboxylate groups of the PSMA modified with l-phenylalanine are more exposed to the solvent at pH 7.0 and high salt concentrations, which correlates with lower fluorescence intensity, reflecting a loss of mitochondrial membrane potential. It is concluded that the study of the conformational changes in PE modified with amino acids is essential for their use as biomaterials and relevant to understanding the possible effects of PE modified with amino acids in biological systems.

Proceso iterativo con sentido para el cuidado de la persona con cáncer en pandemia / Meaningful iterative process for the care of the person with cancer in pandemic

Objetivo: Comprender la experiencia de los cuidados prestados por enfermeras a personas con cáncer en el contexto de pandemia. Método: Estudio cualitativo constructivista con diseño descriptivo, realizado a enfermeras hospitalarias de la Región Metropolitana de Santiago de Chile, entre septiembre del 2020 y marzo del 2021. Se realizaron quince entrevistas semiestructuradas, las que luego de su transcripción fueron sometidas a un análisis de contenido según Krippendorff. Principales resultados: La pandemia se convirtió en un desafío para las enfermeras de oncología y cuidados paliativos, quienes debieron enfrentar esta crisis sanitaria reorganizando los cuidados a través de un proceso iterativo, lo que permitió dar sentido a la atención brindada. Conclusiones: Las enfermeras de oncología y cuidados paliativos afrontaron la pandemia con un liderazgo resiliente que las llevó a reorganizar los cuidados centrados en la persona en un marco de integralidad, aprendizaje significativo, innovación, compromiso y cohesión.(AU)

Objective: To understand the experience of care provided by nurses to people with cancer in the context of a pandemic. Method: Constructivist qualitative study with descriptive design, conducted with hospital nurses in the Metropolitan Region of Chile between September 2020 and March 2021. Fifteen semi-structured interviews were conducted, which after transcription were subjected to content analysis according to Krippendorff. Findings: The pandemic became a challenge for oncology and palliative care nurses, who had to face this health crisis by reorganizing care through an iterative process, which made it possible to give meaning to the care provided. Conclusions: Oncology and palliative care nurses faced the pandemic with resilient leadership that led them to reorganize person-centered care within a framework of comprehensiveness, meaningful learning, innovation, engagement, and cohesion.(AU)

New Hybrid Nanocomposites with Catalytic Properties Obtained by In Situ Preparation of Gold Nanoparticles on Poly (Ionic Liquid)/Poly (4-Vinylpyridine) Nanofibers.

In this work, we report the obtaining of new hybrid nanocomposites with catalytic activity formed by nanofibers of polymer blends and gold nanoparticles. The nanofibers were obtained by electrospinning blends of a poly (ionic liquid) (PIL) and its precursor polymer, poly (4-vinyl pyridine) (P4VPy). The characteristics of the nanofibers obtained proved to be dependent on the proportion of polymer in the blends. The nanofibers obtained were used to synthesize, in situ, gold nanoparticles on their surface by two-step procedure. Firstly, the adsorption of precursor ions on the nanofibers and then their reduction with sodium borohydride to generate gold nanoparticles. The results indicated a significant improvement in the performance of PIL-containing nanofibers over pure P4VPy NFs during ion adsorption, reaching a 20% increase in the amount of adsorbed ions and a 6-fold increase in the respective adsorption constant. The catalytic performance of the obtained hybrid systems in the reduction reaction of 4-nitrophenol to 4-aminophenol was studied. Higher catalytic conversions were obtained using the hybrid nanofibers containing PIL and gold nanoparticles achieving a maximum conversion rate of 98%. Remarkably, the highest value of kinetic constant was obtained for the nanofibers with the highest PIL content.

Estrategias del equipo de salud para afrontar la muerte de niños y adolescentes con cáncer / Strategies by the Health Team for Coping with the Death of Children and Adolescents with Cancer

Introducción: La muerte en niños y adolescentes por cáncer suele ser difícil de afrontar por los profesionales de salud. Si no cuentan con modos adecuados para transitar estos duelos, pueden generarse problemas psicológicos, emocionales y físicos, exponiéndose a Burnout. Objetivo: Develar las estrategias utilizadas por profesionales y técnicos de salud de hospitales públicos chilenos para afrontar la muerte de infantes con cáncer. Métodos: Investigación cualitativa fenomenológica, realizada en cinco hospitales públicos en Santiago de Chile, entre mayo-septiembre del 2017. Población de 37 profesionales y técnicos de salud que vivenciaron morir niños y adolescentes con cáncer. Se efectuaron entrevistas en profundidad, guiadas por la pregunta "¿Cómo ha afrontado usted la muerte de los pacientes en su unidad?" Las narrativas se transcribieron y analizaron según las etapas de Streubert, se triangularon los datos hasta alcanzar la saturación. Resultados: Las principales estrategias fueron participar de ritos de despedida ante la muerte, realizar actividades recreativas con miembros del equipo fuera de la jornada laboral, hacer cambios en la rutina de trabajo, separar aspectos personales y profesionales. Al percibir un bajo apoyo de la institución, propusieron facilitar la asistencia al funeral, desarrollar intervenciones formales de apoyo en duelo, realizar intervenciones de autocuidado e incorporar el tema de la muerte en las inducciones laborales. Conclusión: Los profesionales y técnicos cuentan con estrategias para afrontar sus duelos. Sin embargo, requieren de apoyo formal de la institución, junto con capacitación continua en la temática. Es fundamental que la institución se implique en esta problemática(AU)

Introduction: Cancer deaths among children and adolescents are often difficult for health professionals to cope with. If they do not have adequate ways to deal with this grief, psychological, emotional and physical problems may arise, exposing them to burnout or the so called burned-out worker syndrome. Objective: To reveal the strategies used by health professionals and technicians in Chilean public hospitals to cope with the death of children with cancer. Methods: Qualitative and phenomenological research carried out in five public hospitals in Santiago, Chile, between May and September 2017. The population was made up of 37 health professionals and technicians who experienced the death of children and adolescents with cancer. In-depth interviews were conducted, guided by the following question: How have you coped with the death of patients in your unit? The narratives were transcribed and analyzed according to the stages described by Streubert. In addition, the data were triangulated until saturation was reached. Results: The main strategies were to participate in farewell rites in the face of death, to carry out recreational activities with team members outside the workday, to make changes in the work routine, as well as to separate personal and professional aspects. When perceiving low support from the institution, they proposed facilitating attendance at the funeral, developing formal bereavement support interventions, carrying out self-care, and incorporating the matter of death into work inductions. Conclusion: Professionals and technicians have strategies to cope with their bereavement. However, they need formal support from the institution, together with continuous training on the matter. It is essential for the institution to become involved in this issue(AU)

Trascender la muerte del niño con cáncer: Experiencias profesionales de la salud

Objetivo: Develar la percepción del apoyo en duelo de los profesionales de las unidades de oncología pediátrica, tras el fallecimiento de los pacientes. Método: Estudio fenomenológico cualitativo. Se realizaron 22 entrevistas en profundidad a profesionales de 5 unidades de oncología pediátrica de hospitales públicos de Santiago de Chile. Una vez transcritas las narraciones, se realizó el análisis comprensivo y posteriormente la triangulación de los datos, hasta lograr su saturación. Resultados: Los profesionales se perciben apoyados en su duelo al poder experimentar las pérdidas en un ambiente protegido y sentirse apoyados por su entorno. Reconocen la existencia de factores externos e internos que facilitan el proceso de duelo. Sin embargo, este apoyo se percibe como insuficiente, ya que falta un apoyo formal por parte de la institución, así como un periodo de duelo protegido, o el apoyo de los profesionales de la salud mental a los equipos. Todas las experiencias de muerte permiten a los profesionales trascender su dolor a partir del aprendizaje permanente y dar sentido a su trabajo. Conclusión: El apoyo en duelo que sienten los profesionales se genera a partir de sus propias iniciativas de reencuentro dentro de los equipos, lo cual es insuficiente. Por ello, es necesaria la formación en el afrontamiento de la muerte desde el pregrado, lo que permitiría una mayor cohesión en el afrontamiento y un mayor autocuidado dentro de los equipos.

Objetivo: Desvelar a percepção do apoio ao luto dos profissionais das unidades de oncologia pediátrica, após o óbito dos pacientes. Método: Estudo fenomenológico qualitativo. Foram realizadas vinte e duas entrevistas aprofundadas com profissionais de cinco unidades de oncologia pediátrica de hospitais públicos de Santiago. Uma vez transcritas as narrativas, realizou-se à análise compreensiva e posteriormente à triangulação dos dados, alcançando a saturação destes. Resultados: Os profissionais percebem-se amparados em seu luto, pois podem vivenciar perdas em um ambiente protegido e sentir-se amparados por seu ambiente. Eles reconhecem a existência de fatores externos e internos que facilitam o processo de luto. Contudo, este apoio é percebido como insuficiente, visto que falta um apoio formal da instituição, bem como um período de luto protegido, ou o apoio dos profissionais de saúde mental para as equipes. Todas as experiências de morte permitem aos profissionais transcender sua dor por meio da aprendizagem ao longo da vida e dar sentido ao seu trabalho. Conclusão: O apoio no luto, sentido pelos profissionais, é gerado a partir das suas próprias iniciativas de reencontro com as equipes, o que é insuficiente. Portanto, o treinamento no enfrentamento da morte desde a graduação faz-se necessário, o que possibilitaria maior coesão no enfrentamento e maior autocuidado dentro das equipes.

Objective: To reveal the perception of grief support of professionals in pediatric oncology units, after the death of the patients. Method: Qualitative phenomenological study. 22 in-depth interviews were conducted with professionals from 5 pediatric oncology units of public hospitals in Santiago. Once the narratives were transcribed, the comprehensive analysis and subsequent triangulation of the data was performed, achieving saturation. Results: Professionals perceive themselves supported in their grief by being able to experience the losses in a protected environment and feeling supported by their surroundings. They recognized the existence of external and internal factors that facilitated the process of grief. However, this support is perceived as insufficient, as there is a lack of formal support from the institution, as well as a protected grief period, or support from mental health professionals to the teams. All death experiences allow professionals to transcend their pain based on lifelong learning and to give meaning to their work. Conclusion: Grief support felt by the professionals is generated from their own initiatives of re-encounter within the teams, which is insufficient. Therefore, training in coping with death is necessary from undergraduate level, which would allow greater cohesiveness in coping and greater self-care within the teams.

Perception of support in professional's and technician's grief of pediatric intensive care units in public hospitals. / Percepción de apoyo en duelo por profesionales y técnicos de cuidados intensivos pediátricos de hospitales públicos.

INTRODUCTION: Death in childhood is a reality faced by health professionals, especially in highly com plex units such as intensive care ones. This leads to feelings of helplessness and frustration in health professionals, compromising their physical, emotional, and mental health, which is worsened by the feeling of low social support and poor preparation for coping with death and support for the patient's family. OBJECTIVE: To expose the perception of sorrow support of professionals and techni cians in pediatric intensive care units of public hospitals, after the death of the patients. SUBJECTS AND METHOD: Qualitative study with a phenomenological approach. 16 in-depth interviews were conduc ted with pediatric intensive care professionals and technicians from five public hospitals in Santiago, Chile. Inclusion criteria considered working for more than a year in the Unit, having experienced the death of patients, and recognizing that they have gone through a professional sorrow. The in terview focused on the following question: How have you experienced the sorrow support received after the death of patients in your unit? Once the narratives were transcribed, the phenomenological analysis and subsequent data triangulation were carried out, achieving saturation. RESULTS: It was observed that the participants feel little supported in their sorrows after the death of the patients, where there are obstacles to face the situation. Although facing death is something complex for the participants, they recognize that they can generate protection strategies and also feel supported by the people around them. Despite the complexity of this experience, the participants consider that there are lessons learned in facing death which leads them to give meaning to their professional work. CONCLUSION: Professionals need the recognition of deaths in the workplace and, therefore, formal and continuous support from their work team and institution.

Surfaces based on amino acid functionalized polyelectrolyte films towards active surfaces for enzyme immobilization.

Surface based on polyelectrolytes functionalized with amino acids onto amino-terminated solid surfaces of silicon wafers was prepared, with the purpose of evaluate the chemical functionality of the polyelectrolyte films in adsorption and catalytic activity of an enzyme. In this work, the adsorption of the enzyme glucose 6-phosphate dehydrogenase from Leuconostoc mesenteroides (LmG6PD) was studied as model. The polyelectrolytes were obtained from poly (maleic anhydride-alt-vinylpyrrolidone) [poly(MA-alt-VP)] and functionalized with amino acids of different hydropathy index: glutamine (Gln), tyrosine (Tyr) and methionine (Met). The polyelectrolytes were adsorbed onto the amino-terminated silicon wafer at pH 3.5 and 4.5 and at low and high ionic strength. At low ionic strength and pH 3.5, the largest quantity of adsorbed polyelectrolyte was on the films containing glutamine moiety as the most hydrophilic amino acid in the side chain of polymer chain (5.88 mg/m2), whereas at high ionic strength and pH 4.5, the lowest quantity was in films containing tyrosine moiety in the side chain (1.88 mg/m2). The films were characterized by ellipsometry, contact angle measurements and atomic force microscopy (AFM). The polyelectrolyte films showed a moderate degree of hydrophobicity, the methionine derivative being the most hydrophobic film. With the aim of evaluate the effect of the amino acid moieties on the ability of the surface to adsorb enzymes, we study the activity of the enzyme on these surfaces. We observed that the polarity of the side chain of the amino acid in the polyelectrolyte affected the quantity of LmG6PD adsorbed, as well as its specific activity, showing that films prepared from poly(MA-alt-VP) functionalized with Met provide the best enzymatic performance. The results obtained demonstrated that the surfaces prepared from polyelectrolytes functionalized with amino acids could be an attractive and simple platform for the immobilization of enzymes, which could be of interest for biocatalysis applications.

Percepción de apoyo en duelo por profesionales y técnicos de cuidados intensivos pediátricos de hospitales públicos / Perception of support in professional's and technician's grief of pediatric intensive care units in public hospitals

INTRODUCCIÓN: La muerte en la infancia es una realidad a la que se ven enfrentados los profesionales de salud, especialmente en unidades de alta complejidad como son los cuidados intensivos. Esto genera en los profesionales impotencia y frustración, comprometiendo su salud física, emocional y mental, agravada por la sensación de bajo soporte social y deficiente preparación para el afrontamiento de la muerte y el apoyo a los familiares de sus pacientes. OBJETIVO: Develar la percepción de apoyo en duelo de profesionales y técnicos en unidades de cuidado intensivo pediátrico de hospitales públicos, tras la muerte de los pacientes. SUJETOS Y MÉTODO: Estudio cualitativo con enfoque fenomenológico. Se realizaron 16 entrevistas en profundidad a profesionales y técnicos de cuidados intensivos pediátricos de cinco hospitales públicos de Santiago. Como criterios de inclusión se consideraron el trabajar por más de un año en la unidad, haber vivenciado la muerte de pacientes, y reconocer que ha cursado un duelo profesional. La entrevista fue guiada por la siguiente pregunta: ¿Cómo ha vivenciado usted el apoyo en duelo recibido, tras la muerte de pacientes en su unidad? Una vez trascritas las narrativas se realizó el análisis fenomenológico y posterior triangulación de los datos, logrando la saturación. RESULTADOS: Se develó que los participantes se sienten poco apoyados en sus duelos tras la muerte de los pacientes, existiendo obstáculos para su afrontamiento. Aunque enfrentar la muerte es algo complejo para ellos, reconocen que son capaces de generar estrategias de protección y además se sienten apoyados por personas de su entorno. A pesar de lo complejo de esta experiencia, ellos consideran que existen aprendizajes al enfrentar la muerte que los lleva a dar sentido a su labor profesional. CONCLUSIÓN: Los profesionales requieren que las pérdidas en el ámbito laboral sean reconocidas, y por ello, contar con un apoyo formal y continuo de su equipo de trabajo e institución.

INTRODUCTION: Death in childhood is a reality faced by health professionals, especially in highly com plex units such as intensive care ones. This leads to feelings of helplessness and frustration in health professionals, compromising their physical, emotional, and mental health, which is worsened by the feeling of low social support and poor preparation for coping with death and support for the patient's family. OBJECTIVE: To expose the perception of sorrow support of professionals and techni cians in pediatric intensive care units of public hospitals, after the death of the patients. SUBJECTS AND METHOD: Qualitative study with a phenomenological approach. 16 in-depth interviews were conducted with pediatric intensive care professionals and technicians from five public hospitals in Santiago, Chile. Inclusion criteria considered working for more than a year in the Unit, having experienced the death of patients, and recognizing that they have gone through a professional sorrow. The in terview focused on the following question: How have you experienced the sorrow support received after the death of patients in your unit? Once the narratives were transcribed, the phenomenological analysis and subsequent data triangulation were carried out, achieving saturation. RESULTS: It was observed that the participants feel little supported in their sorrows after the death of the patients, where there are obstacles to face the situation. Although facing death is something complex for the participants, they recognize that they can generate protection strategies and also feel supported by the people around them. Despite the complexity of this experience, the participants consider that there are lessons learned in facing death which leads them to give meaning to their professional work. CONCLUSION: Professionals need the recognition of deaths in the workplace and, therefore, formal and continuous support from their work team and institution.

Spontaneous adsorption of gold nanoparticles by polyelectrolyte thin films.

Nanocomposed films constituted by gold nanoparticles immobilized onto polyelectrolytes were obtained and studied. To obtain the films, amino terminated silicon wafer surfaces were put in contact with aqueous solution of polyelectrolytes derived from Poly(maleic anhydride-alt-styrene) containing aryl and amine-alkyl groups in the side chains, in this condition the adsorption of macromolecules was achieved. The effects of the chemical nature of the side chains and ionic strength on the amounts of adsorbed polyelectrolytes were studied by ellipsometry. The adsorption of polyelectrolytes increases with increasing ionic strength in agreement with the screening-enhanced adsorption regime; the results are discussed considering the steric hindrance of the side chains and flexibility of the polymers. A spontaneous adsorption process of nanoparticles onto polyelectrolyte films took place when these last were immersed in a gold nanoparticles suspension. The adsorption amounts were qualitatively evaluated by SEM and AFM and these showed to be dependent on chemical structure of polyelectrolytes.

Adsorption behavior of hydrophobically modified polyelectrolytes onto amino- or methyl-terminated surfaces.

The adsorption of hydrophobically modified polyelectrolytes derived from poly(maleic anhydride-alt-styrene) (P(MA-alt-St)) containing in their side chain aryl-alkyl groups onto amino- or methyl-terminated silicon wafers was investigated. The effect of the spacer group, the chemical nature of the side chain, molecular weight of polyelectrolyte, and ionic strength of solution on the polyelectrolyte adsorbed amount was studied by null ellipsometry. The adsorbed amount of polyelectrolyte increased with increasing ionic strength, in agreement with the screening-enhanced adsorption regime, indicating that hydrophobic interactions with the surface play an important role in the adsorption process. At constant ionic strength, the adsorbed amount was slightly higher for polyelectrolytes with larger alkyl side chain and decreased with the hydrophobicity of aryl group. The adsorption behavior is discussed in terms of the side chain flexibility of the polymer. Characteristics of the adsorbed layer were studied by atomic force microscopy (AFM) and contact angle measurements. AFM images show the presence of aggregates and closed globular structure of polyelectrolyte onto the amino- or methyl-terminated surface, which agrees with a 3D and 2D growth mechanism, respectively. Fluorescence measurements showed that the aggregation of polyelectrolyte containing the hydrophobic naphthyl group occurs already in the solution. However, the aggregation of polyelectrolytes containing the phenyl group in its side chain is not observed in solution but is induced by the amino-terminated surface. This difference can be explained in terms of the higher flexibility of side chain bearing the phenyl group. The polyelectrolyte films showed a high chemical heterogeneity and moderate hydrophobicity.