Experiencia de un espacio de reflexión en una unidad de cuidados paliativos / Experience of a reflection space in a palliative care unit

OBJETIVO: Valorar la experiencia, después de un año de funcionamiento, de las sesiones mensuales de reflexión y aprendizaje realizadas en la unidad de cuidados paliativos de un hospital sociosanitario de Barcelona. MATERIAL Y MÉTODOS: Mediante un enfoque metodológico cualitativo-fenomenológico se realizaron tres entrevistas individuales y un grupo focal en el que participaron 11 profesionales de la unidad. Se registraron magnetofónicamente las entrevistas y la sesión del grupo focal. Los datos se analizaron con el apoyo del programa Atlas. ti versión 5.0. Posteriormente se procedió a la triangulación de las técnicas empleadas, entrevistas y grupo focal. RESULTADOS: A través del proceso de análisis de las aportaciones recogidas en la presente investigación emergieron dos vectores cualitativos: aspectos favorables y desfavorables de la experiencia. Las categorías correspondientes a los aspectos favorables fueron: espacio necesario e imprescindible; útil para compartir experiencias y ayuda a expresar emociones. En cuanto a los aspectos desfavorables, las categorías resultantes fueron: falta de madurez del grupo y metodología de trabajo inadecuada. CONCLUSIONES: Los profesionales de la unidad de cuidados paliativos que fueron entrevistados y participaron en el grupo focal consideran el espacio de reflexión como un logro que se debe mantener en el funcionamiento de la unidad aunque deben incorporarse cambios más dirigidos a incrementar la madurez del equipo

OBJECTIVE: To assess the experience, after a year of running monthly sessions of reflection and learning in the palliative care unit of a geriatric hospital in Barcelona. MATERIAL AND METHODS: Through a qualitative-phenomenological methodological approach, three individual interviews and a focus group involving 11 professionals from the unit were assessed. Interviews and focus group session was audio recorded. Data were analyzed with the support of Atlas. ti software version 5.0. A triangulation was performed on the techniques used, as well as on the interviews and focus group. RESULTS: Through the process of analysis of the contributions collected in this study, two qualitative vectors emerged: positive aspects and unfavourable aspects of the experience. The following categories were positive aspects: necessary and essential space; useful for sharing experiences, and helps to express emotions. As for the unfavourable aspects, the resulting categories were: lack of maturity of group and poor working METHODOLOGY: CONCLUSIONS: The professional of the palliative care units interviewed and participated in the focus group considered the space for reflection as an achievement that must be maintained in the operation of the unit, but new methodology should be incorporated in order to increase the maturity of the team

Towards the implementation of OSCE in undergraduate nursing curriculum: A qualitative study.

BACKGROUND: Despite the fact that Objective Structured Clinical Examination is considered to be an efficient assessment method, their implementation in the undergraduate nursing curriculum encounters difficulties. However, the initiative of the European Higher Education Area to promote competency-based assessment may represent an opportunity to introduce this instrument in undergraduate nursing curriculum. OBJECTIVE: To explore the perception of nursing faculty members regarding the implementation of the OSCE as an assessment tool in Catalan Nursing Schools. DESIGN/PARTICIPANTS/SETTING: In this qualitative study, fifteen teachers participated in semi-structured interviews in eight Catalan Nursing Schools. METHODS: Semi-structured interviews were conducted. A thematic content analysis was used to identify major themes in the interview data and collaborative analysis was undertaken to ensure rigorous results. RESULTS: The relevant aspects that are emphasized by teachers included the consideration of the dual purpose of the OSCE via its formative and evaluative facets by enhancing the feedback received by students about their performance on the OSCE. The OSCE should be administered towards the end of the degree program and should complement other methods of assessment. Despite its high cost, the OSCE was deemed to be efficient as it enables student competencies to be assessed with objective criteria, which is a difficult task with other instruments. OSCE implementation is feasible with the institutional support of and collaborative work between schools. CONCLUSIONS: The implementation of the OSCE in the Catalan undergraduate nursing degree programs is feasible if the project receives the support of all involved parties and if creative strategies are determined to reduce economic costs and optimize resources. With adequate feedback, the OSCE is an assessment tool that can provide high-impact training to students.

A comparison of medical students', residents' and tutors' attitudes towards communication skills learning.

BACKGROUND: The consensus about the importance of communication skills in patient-care does not guarantee that students and faculty perceive the usefulness of these skills. This study evaluated and compared medical students', residents' and tutors' attitudes towards learning communication skills, and examined the association with gender and year of residency. METHODS: We conducted a cross-sectional survey with 492 participants (282 second-year students, 131 residents and 79 tutors). They completed the Communication Skills Attitude Scale (CSAS) and demographic/educational information. RESULTS: In general, participants showed positive attitudes towards learning communication skills. Medical students, residents and tutors did not differ on the Positive Attitudes Scale (CSAS-PAS). Residents scored higher than medical students on the Negative Attitudes Scale (CSAS-NAS) (P < 0.01). Females showed higher scores on the CSAS-PAS (P < 0.05) and lower scores on the CSAS-NAS (P < 0.01) than males in all subsamples. The effect sizes were medium. There were no significant differences according to year of residency. DISCUSSION: Medical students, residents and tutors consider training in communication skills an essential component for clinical practice and they agree about the need to learn these communication skills. Attention should be paid to measuring attitudes at all three levels of medical education in the design of communication skills courses.

Aproximación a la experiencia del paciente y sus cuidadores en la oxigenoterapia domiciliaria / Defining Patient and Caregivers’ Experience of Home Oxygen Therapy

Introducción: Las terapias respiratorias a domicilio suponen un gran impacto en la vida del paciente y de sus familiares. El objetivo de este estudio reside en conocer las opiniones, percepciones y actitudes de los pacientes y sus cuidadores sobre la oxigenoterapia domiciliaria. Método: Estudio cualitativo-fenomenológico de una muestra de 57 personas: 18 familiares y 39 pacientes que reciben oxigenoterapia domiciliaria en núcleos urbanos relevantes. Se realizaron 5 grupos focales entre marzo y julio de 2014 en centros hospitalarios de Barcelona, Madrid y Alicante. El material de análisis constó de las grabaciones en audio de las entrevistas en los grupos focales, la trascripción de las mismas y las notas de campo registradas. El análisis de los datos se realizó a partir del método de las comparaciones constantes. Resultados: Los datos se analizaron en 2 niveles. En un primer nivel de análisis se obtuvieron 21 categorías que, posteriormente, en un segundo nivel de análisis, se integraron en 6 metacategorías: atención facilitada por los profesionales sanitarios, impacto psicológico, atención facilitada por las casas comerciales, impacto en la vida cotidiana, inconvenientes y satisfacción. Conclusiones: La oxigenoterapia domiciliaria tiene un gran impacto psicológico y en la vida diaria tanto de los pacientes como de sus familiares. Por otro lado, sería conveniente mejorar la coordinación entre los diferentes niveles asistenciales y las empresas suministradoras de oxigenoterapia para facilitar información coherente y estrategias útiles para los pacientes y familiares

Introduction: Home oxygen therapy has a great impact on the lives of patients and their families. The aim of this study is to define the opinions, perceptions and attitudes of patients and their caregivers regarding home oxygen. Method: Qualitative, phenomenological study of a sample of 57 subjects, consisting of 18 family members and/or caregivers and 39 patients receiving home oxygen in urban centers. Five focus groups were formed between March and July 2014 in hospitals in Barcelona, Madrid and Alicante. Prior informed consent was obtained from patients and families. The study material consisted of audio recordings of all focus group interviews, transcription of selected materials and field notes. Data analysis was performed using constant comparison method, establishing 2 levels of analysis. Results: Data from the focus groups were analyzed on 2 levels. A first level of analysis gave 21 categories. In a second level of analysis, these were integrated into 6 meta-categories: care provided by health professionals, psychological impact, care provided by commercial companies, impact on daily life, problems and satisfaction. Conclusions: Home oxygen has a major psychological impact on the daily lives of both patients and their families, and can cause social isolation. Although the results show that healthcare professionals are highly appreciated, better coordination is needed between different levels of care and companies supplying oxygen in order to provide patients and families with consistent information and useful strategies

Defining Patient and Caregivers' Experience of Home Oxygen Therapy.

INTRODUCTION: Home oxygen therapy has a great impact on the lives of patients and their families. The aim of this study is to define the opinions, perceptions and attitudes of patients and their caregivers regarding home oxygen. METHOD: Qualitative, phenomenological study of a sample of 57 subjects, consisting of 18 family members and/or caregivers and 39 patients receiving home oxygen in urban centers. Five focus groups were formed between March and July 2014 in hospitals in Barcelona, Madrid and Alicante. Prior informed consent was obtained from patients and families. The study material consisted of audio recordings of all focus group interviews, transcription of selected materials and field notes. Data analysis was performed using constant comparison method, establishing 2 levels of analysis. RESULTS: Data from the focus groups were analyzed on 2 levels. A first level of analysis gave 21 categories. In a second level of analysis, these were integrated into 6 meta-categories: care provided by health professionals, psychological impact, care provided by commercial companies, impact on daily life, problems and satisfaction. CONCLUSIONS: Home oxygen has a major psychological impact on the daily lives of both patients and their families, and can cause social isolation. Although the results show that healthcare professionals are highly appreciated, better coordination is needed between different levels of care and companies supplying oxygen in order to provide patients and families with consistent information and useful strategies.

Competencias transversales de los profesionales que facilitan atención domiciliaria a pacientes crónicos / Transferable skills of healthcare professionals in providing homecare in chronically ill patients

OBJETIVO: Determinar, a partir de los análisis de los profesionales de atención domiciliaria, el grado de relevancia de las competencias no técnicas de esos profesionales dedicados a la atención de pacientes con enfermedades crónicas. DISEÑO: Investigación cuanti-cualitativa realizada en 2 fases: la 1. a entre noviembre de 2010 y marzo de 2011 y la 2. a entre diciembre de 2012 y agosto de 2013. Emplazamiento: Región Sanitaria de Barcelona ciudad. PARTICIPANTES: En la primera fase, 30 profesionales pertenecientes a 6 equipos de atención domiciliaria (3 del ámbito de la atención primaria y 3 del ámbito hospitalario). En la 2. a fase, 218 profesionales pertenecientes a 50 equipos de atención primaria (EAP) y a 7 programas deatención domiciliaria y equipos de apoyo sanitario y social (PADES). MÉTODO: Muestreo intencional en la 1. a fase y aleatorio en la 2. a. Se emplearon escalas tipo Likert y grupos focales. RESULTADOS: A partir de la identificación de 19 categorías competenciales en la 1. a fase del estudio, se establecieron, en la 2. a fase, 3 metacategorías competenciales: atención integral centrada en el paciente, organización interprofesional y entre niveles asistenciales y competencia relacional. CONCLUSIONES: Es necesario favorecer y garantizar las relaciones profesionales entre niveles asistenciales, la continuidad asistencial, la concepción biopsicosocial y la atención holística al paciente y a su entorno, contemplando emociones, expectativas, sentimientos, creencias y valores de pacientes y familiares. Es imprescindible el diseño e implementación de formación en competencias transversales en el ámbito de cada centro, a través de metodologías didácticas activas y participativas

AIM: To determine the relevance level of non-technical skills of those professionals dedicated to the healthcare of patients with chronic diseases, from an analysis of home care professionals. DESIGN: Quantitative and qualitative research conducted in 2 phases: 1. st from November 2010 to March 2011 and 2. nd from December 2012 to August 2013. SETTING: Health Region of Barcelona city. PARTICIPANTS: During the 1. st phase, 30 professionals from homecare teams (3 from Primary Care and 3 from Hospitals). In 2. nd phase, 218 professionals from 50 Primary Healthcare Centres and 7 home care programmes. Method: Purposive sampling in was used in the1st phase, and randomized sampling in the 2. nd phase. Likert scales and focus group were used. RESULTS: A total of 19 skill categories were identified in the 1. st phase. In the 2. nd phase 3 metacategories were established: comprehensive patient-centered care, interprofessional organization, and inter-health care fields and interpersonal skills. CONCLUSIONS: It is necessary to improve and secure the professionals relationships between levels of healthcare, continuity of healthcare, biopsychosocial model and holistic attention to patients and relatives, looking at emotions, expectations, feelings, beliefs and values. It is essential to design and implement continuing training in transferable skills in every healthcare centre, through active methodologies

[Transferable skills of healthcare professionals in providing homecare in chronically ill patients]. / Competencias transversales de los profesionales que facilitan atención domiciliaria a pacientes crónicos.

AIM: To determine the relevance level of non-technical skills of those professionals dedicated to the healthcare of patients with chronic diseases, from an analysis of home care professionals. DESIGN: Quantitative and qualitative research conducted in 2 phases: 1.st from November 2010 to March 2011 and 2.nd from December 2012 to August 2013. SETTING: Health Region of Barcelona city. PARTICIPANTS: During the 1.st phase, 30 professionals from homecare teams (3 from Primary Care and 3 from Hospitals). In 2.nd phase, 218 professionals from 50 Primary Healthcare Centres and 7 home care programmes. METHOD: Purposive sampling in was used in the1st phase, and randomized sampling in the 2.nd phase. Likert scales and focus group were used. RESULTS: A total of 19 skill categories were identified in the 1.st phase. In the 2.nd phase 3 metacategories were established: comprehensive patient-centered care, interprofessional organization, and inter-health care fields and interpersonal skills. CONCLUSIONS: It is necessary to improve and secure the professionals relationships between levels of healthcare, continuity of healthcare, biopsychosocial model and holistic attention to patients and relatives, looking at emotions, expectations, feelings, beliefs and values. It is essential to design and implement continuing training in transferable skills in every healthcare centre, through active methodologies.

Formación en habilidades comunicativas desde la perspectiva de residentes y tutores en medicina / Training in communication skills according to residents' and tutors' perspective in medicine

Introducción: En las últimas décadas se ha producido un cambio sustancial respecto a la consideración de las habilidades comunicativas en el currículo de medicina. Actualmente, se considera una competencia nuclear del profesional sanitario, susceptible de entrenamiento y mejora. Objetivo: Identificar el nivel de formación y las necesidades percibidas de médicos especialistas en formación (MEF) y tutores respecto al aprendizaje de habilidades comunicativas, como primer paso para diseñar programas efectivos adaptados al contexto actual. Sujetos y métodos: Participaron 131 residentes y 79 tutores, de 12 centros hospitalarios de Cataluña, que cumplimentaron vía online un cuestionario autoadministrado. Resultados: Un 74% de residentes y un 67% de los tutores habían recibido formación en habilidades comunicativas. Residentes y tutores coincidieron en la valoración del área en la que la formación es adecuada (entrevista clínica) y en las áreas susceptibles de mejora (manejo de emociones, gestión de situaciones difíciles y comunicación con familiares y cuidadores) durante el programa de MEF. Ambos manifestaron una alta predisposición a participar en futuros programas de formación. Conclusiones: Existen deficiencias en la formación en habilidades comunicativas de residentes y tutores de medicina. Uno de los retos es asegurar que los residentes, independientemente de la especialidad, adquieran un nivel óptimo de competencias comunicativas una vez finalizado el periodo de formación

Introduction: During last decades there has been a substantial change from the consideration of communication skills in the curriculum of medicine. Currently, it is considered a core competency of health professionals; it can be trained and improved. Aim: To identify the level of training and the perceived needs of residents and tutors about the learning of communication skills as a first step in designing effective programs adapted to the current context. Subjects and methods: Participants were 131 residents and 79 tutors, from 12 hospitals in Catalonia, who completed a self administered questionnaire via online. Results: 74% of residents and 67% of the tutors had received training in communication skills. Residents and tutors agreed on the valuation of the area in which the training was appropriate (clinical interview) and in areas for improvement (managing emotions, managing difficult situations, and communication with family and caregivers) during the training system of health care professionals. Both showed a high willingness to participate in future training programs. Conclusions: There are deficiencies in communication skills training of residents and tutors of Medicine. One of the challenges is to ensure that residents, regardless of specialty, acquire an optimal level of communicative competence upon completion of the training period

Proceso de Bolonia (VI): aprendiendo comunicación para la salud en el Grado de Medicina / Bologna Process (VI): learning health communication in medical undergraduate

La comunicación forma parte de la actividad clínica y en ocasiones determina el éxito o fracaso del proceso asistencial. Sin embargo, no ha sido reconocida en los planes de estudio del Estado español hasta muy recientemente, sobre todo con el impulso del llamado 'Plan Bolonia'. En el año 2009 se aprobó en la Facultad de Medicina de la Universitat de Barcelona un nuevo plan docente que proponía incorporar la enseñanza de la comunicación en las materias clínicas y preclínicas, contabilizando entre 3 y 6 créditos europeos (ECTS), como competencia transversal. El presente artículo aborda el diseño de esta competencia, los pros y contras, cómo se inserta en diferentes asignaturas y cómo puede evaluarse (AU)

Communication is part of the clinical activity and sometimes determines the healthcare success or failure. However it has not been recognized in the Spanish curricula until recently, in the context of the so called Plan Bologna. In 2009 a new teaching plan was approved at Medical School of Barcelona University which intended to incorporate communication in clinical and preclinical areas (3-6 ECTS). In this article we explain pros and cons to introduce communication not as a subject, but as a competency, how can be integrated in different subjects and how can be evaluated (AU)

Formar en comunicación a los estudiantes de medicina. A propósito de un seminario para profesores universitarios / Teaching communication to medical undergraduated. About a seminar for university teachers

Las expectativas de los ciudadanos y la evidencia que existe sobre la incidencia de la comunicación en los resultados clínicos determinan, entre otros aspectos, la necesidad de que la dimensión comunicacional se integre en la enseñanza del pregrado de medicina. En este sentido, se realizó en el Instituto d’Estudis de la Salut un Seminario para profesores de la Facultat de Medicina de la Universitat Autònoma de Barcelona. Según la opinión de los participantes la experiencia fue exitosa; cabe advertir de las dificultades que puede suponerla implementación de los aspectos comunicacionales en el currículo de las facultades de medicinase espera que el inicio de esta actividad formativa favorezca el desarrollo de una dinámica positiva hacia la introducción y consolidación de este tipo de habilidades en la enseñanza del pregrado de medicina, habida cuenta de la poca tradición de las universidades de nuestro entorno en abordarlas habilidades de comunicación y de relación como un contenido de la misma importancia competencial que las esferas técnica y clínica (AU)

Citizens’ expectations and scientific finds about the effects of communication on clinical outcomes determine the need to integrate communication dimension on undergraduate medical education. In order to achieve this, a Seminar was carried out at the Institut d’Estudis de la Salut for Medicine teachers from the Universitat Autònoma de Barcelona. According to participant’s opinion, the experience was successful. It is necessary to identify difficulties about the implementation of communicational skills at the undergraduate curriculum. We hope that this kind of activities can improve communication skills on undergraduate medical education. The medical schools in Spain lack the tradition to consider communication as a core professional skill (AU)

[Scientific evidence in medicine: the only alternative?]. / Evidencia científica en medicina: única alternativa?

The present article aims to reflect on the current situation of medical sciences by incorporating a critical discussion of knowledge atomization, which can be a consequence of the pragmatism of scientific evidence. The article proposes to integrate the contributions of quantitative and qualitative methodologies in health sciences, paying attention to qualitative and quantitative designs that take into account the complexity of human beings and their axiological, social, and cultural referents.The authors defend and argue for the need for health research to contemplate five useful dimensions for decision-making, approaching the object of the study and without eliminating the subject and his/her polyhedral and complex circumstances. Medicine must unavoidably consider technological and technical knowledge, but this training must not elude the necessary relational and communicative competences. Scientific and medical updating implies a constant close association between technical rigor and improved links among the individuals involved (health professionals and the public), with a careful and respectful attitude. Community activity and the gradual establishment of complicities are put forward as the basis for an integrative health model, with biopsychosocial roots, both at a theoretical and a practical level.

Hacia el aprendizaje de emociones y sistemas motivacionales en la relación asistencial / Towards learning emotions and motivational systems in clinical practice

Las emociones, la motivación y los sistemas motivacionales se hallan presentes en cualquier encuentro establecido entre un profesional de la salud y la persona que consulta; la habilidad en el enfoque de tales aspectos influirá en la calidad final del trabajo asistencial. El presente artículo pretende señalar la importancia de favorecer el aprendizaje de la gestión emocional en la relación asistencial desde una visión posmoderna o constructivista (nueva perspectiva para abordar las relaciones humanas), en respuesta a los antiguos paradigmas modernistas o positivistas vigentes desde el siglo XIX. Desde esta visión propuesta y a partir de la experiencia asistencial, los autores exponen diferentes tipos de interrelaciones que los profesionales de la salud pueden establecer en la práctica asistencial y la necesidad de reflexionar sobre el significado de ser un profesional de la salud. El material que sigue ha servido a los autores para diseñar un seminario formativo (AU)