"I didn't know anything, but I learned over time": The process of nurses attaining autonomy in Intensive Care Units / "No sabía nada, con el tiempo lo aprendí": El proceso de los enfermeros de alcanzar la Autonomía en Unidades de Cuidado Intensivos / "Não sabia nada, com o tempo aprendi": O processo de autonomia do enfermeiro em Unidade de Terapia Intensiva

Objective. Understand the social processes experienced by nursing professionals and the meanings underlying autonomy in adult Intensive Care Units in the city of Cartagena (Colombia). Methods. A qualitative study with a grounded theory approach was conducted. Fifteen semi-structured interviews were carried out with nursing professionals, and the analysis was based on the coding technique proposed by Strauss & Corbin. Results. Of the respondents, fourteen were female and one was male, with ages ranging from 23 to 57 years. Experience in intensive care units ranged from 1 to 28 years, and none had postgraduate studies. After thematic analysis, the central category was obtained from four categories: adaptation process, applicability of autonomy exercise, building autonomous competence, and limitations to the exercise of autonomy. Conclusion. Nursing professionals achieve their autonomy through a social process, based on different stages of learning when facing the environment of the units. It is grounded in decision-making and the power to act freely. However, barriers continue to hinder it, including limitations imposed by institutions, protocol-based interventions, social status, and individual differences among professionals.

Objetivo. Comprender el proceso social que viven los profesionales de enfermería y los significados que subyacen a la autonomía en las Unidades de Cuidados Intensivos adultos en la ciudad de Cartagena (Colombia). Métodos. Estudio cualitativo con enfoque de la teoría fundamentada, se realizaron quince entrevistas semiestructuradas en profesionales de enfermería, el análisis se realizó basado en la técnica de codificación propuesta por Strauss y Corbin. Resultados. Los entrevistados eran catorce de sexo femenino y uno de sexo masculino, con edades entre los 23 y 57 años, la experiencia en unidades de cuidados intensivos oscilo entre 1 y 28 años y ninguno conto con estudios de posgrados. Tras el análisis temático se obtuvo la categoría central "Cuando yo entré no sabía, con el tiempo lo aprendí" a partir de cuatro categorías: proceso de adaptación; aplicabilidad ejercicio de la autonomía; construyendo la competencia autónoma; y limitaciones para el ejercicio de la autonomía. Conclusión. El profesional de enfermería logra su autonomía a través de un proceso social, basado en diferentes etapas de aprendizaje al enfrentarse al ambiente de las unidades, se sustenta en la toma de decisiones y el poder de hacer las cosas de forma libre. Sin embargo, existen barreras que la siguen obstaculizando, entre ellas las limitaciones dadas por las instituciones, intervenciones basadas en protocolos, el estatus social y la individualidad entre los profesionales.

Objetivo. Compreender o processo social vivenciado pelos profissionais de enfermagem e os significados subjacentes à autonomia nas Unidades de Terapia Intensiva adulto da cidade de Cartagena (Colômbia). Métodos. Estudo qualitativo com abordagem da teoria fundamentada, foram realizadas quinze entrevistas semiestruturadas com profissionais de enfermagem, a análise foi realizada com base na técnica de codificação proposta por Strauss y Corbin. Resultados. Os entrevistados foram quatorze mulheres e um homem, com idade entre 23 e 57 anos, a experiência em unidades de terapia intensiva variou entre 1 e 28 anos e nenhum possuía pós-graduação. Após a análise temática, obteve-se a categoria central "Quando entrei não sabia, aprendi com o tempo" a partir de quatro categorias: processo de adaptação; aplicabilidade exercício de autonomia; construção de competência autônoma; e limitações para o exercício da autonomia. Conclusão. O profissional de enfermagem conquista sua autonomia por meio de um processo social, baseado em diferentes etapas de aprendizagem diante do ambiente das unidades, baseado na tomada de decisão e no poder de fazer livremente. No entanto, existem barreiras que continuam a dificultá-lo, incluindo limitações dadas pelas instituições, intervenções baseadas em protocolos, status social e individualidade entre os profissionais.

"I didn't know anything, but I learned over time": The process of nurses attaining autonomy in Intensive Care Units.

Objective: Understand the social processes experienced by nursing professionals and the meanings underlying autonomy in adult Intensive Care Units in the city of Cartagena (Colombia). Methods: A qualitative study with a grounded theory approach was conducted. Fifteen semi-structured interviews were carried out with nursing professionals, and the analysis was based on the coding technique proposed by Strauss & Corbin. Results: Of the respondents, fourteen were female and one was male, with ages ranging from 23 to 57 years. Experience in intensive care units ranged from 1 to 28 years, and none had postgraduate studies. After thematic analysis, the central category was obtained from four categories: adaptation process, applicability of autonomy exercise, building autonomous competence, and limitations to the exercise of autonomy. Conclusion: Nursing professionals achieve their autonomy through a social process, based on different stages of learning when facing the environment of the units. It is grounded in decision-making and the power to act freely. However, barriers continue to hinder it, including limitations imposed by institutions, protocol-based interventions, social status, and individual differences among professionals.

Respuesta inflamatoria en pacientes con un primer ataque cerebrovascular isquémico: evaluación por género / Inflammatory response in a first ischemic stroke: differences by gender

Introducción. Se han descrito diferencias por género en la incidencia, la severidad y mortalidad asociadas al ataque cerebrovascular isquémico. Objetivo. Describir el comportamiento de la respuesta inflamatoria en hombres y mujeres con un primer episodio de ACV isquémico. Material y Métodos. Se incluyeron 50 mujeres postmenopáusicas mayores de 45 años y 50 hombres mayores de 45 años con un primer episodio de ataque cerebrovascular isquémico. Se evaluaron y analizaron diferencias en la presentación de síntomas, antecedentes, severidad, respuesta inflamatoria y mortalidad entre ambos géneros. Resultados. Las mujeres tuvieron un promedio de edad mayor al momento de presentar un primer ataque cerebrovascular isquémico (72,9 ± 9,8 años vs. 69,7 ± 9,03 años; p= 0,09), sin diferencias en la severidad del evento (mediana NIHSS 10,4 ± 7,61 en mujeres vs. 10,46 ± 4,96 en hombres), con mayores niveles de colesterol total (216,39 ± 50,61 vs. 188,76 ± 49,56; p=0,007), LDL (140,40 ± 39,57 vs. 121,3 ± 45,36; p=0,032), HDL (44,69 ± 15,52 vs. 37,67 ± 12,23; p= 0,013), triglicéridos (158,03 ± 74,65 vs. 144,05 ± 55,64; p=0,291) y glicemia (142,77 ± 71,60 vs. 138,16 ± 115,75; p=0,826), menor respuesta inflamatoria evaluada por PCR ultrasensible, IL-6 y TNFα, y mortalidad hospitalaria que los hombres (6,52% vs. 14%; p=0,231). Conclusión. Se propone que las diferencias por género en el comportamiento del ACV isquémico observadas en este estudio podrían ser explicadas por la protección cardiovascular hormonal extendida o la existencia de factores inherentes en las mujeres que les confieren un estado de protección ante un ACV isquémico.

Introduction. Controversy persists regarding gender differences in the incidence, severity and mortality associated with ischemic stroke. Objective. To describe the inflematory response in patients with a first ischemic stroke behavior in women and men over 45 year-old. Materials and Methods. 50 postmenopausal women and 50 men, over 45 years old with a first-ever ischemic stroke were included. Differences in symptoms, medical history, severity, inflammatory response and mortality were evaluated and analyzed among both genders. Results: Postmenopausal women were older at the first-ever ischemic stroke (72,9 + 9,8 years vs. 69,7 + 9,03 years, p=0,09), with no differences in stroke severity (NIHSS median score 10,4 + 7,61 in women vs. 10,46 + 4,96 in men), with higher levels of total cholesterol (216,39 + 50,61 vs. 188,76 + 49,56; p=0,007), LDL cholesterol (140,40 + 39,57 vs. 121,3 + 45,36; p=0,032), HDL cholesterol (44,69 + 15,52 vs. 37,67 + 12,23; p= 0,013), triglycerides (158,03 + 74,65 vs. 144,05 + 55,64; p=0,291) and blood glucose (142,77 + 71,60 vs. 138,16 + 115,75; p=0,826); less inflammatory response assessed by CRP, IL-6 and TNF-α, and hospital mortality than men (6,52% vs. 14%, p=0,231). Conclusion. Gender differences in ischemic stroke behavior observed in this study could be explained by the cardiovascular protection of premenopausal hormonal factors or inherent factors in women that confers a protection state against ischemic stroke.