Contraste de perspectivas y experiencias sobre compasión de enfermeras colombianas con 14 países / Contrast of perspectives and experiences on compassion of Colombian nurses with 14 countries

Se exploraron puntos de vista y experiencias sobre compasión en la práctica de enfermeras colombianas que contrastan con los otros 14 países participantes del estudio internacional online. El estudio transversal exploratorio con survey internacional online con 10 preguntas (abiertas y cerradas) contó con 1323 enfermeras; 103 fueron de Colombia. Los datos cuantitativos colombianos fueron analizados en Excel y los cualitativos, en el programa Nvivo con análisis temático y consenso entre investigadores. La muestra colombiana contó con 83,5% docentes, y eligieron la definición de compasión como la "conciencia profunda de sufrimiento de los otros y el deseo de aliviar ese sufrimiento" (84,3%). Piensan que la compasión puede ser enseñada (64,1%) pero no es impartida (45,1%) y es influenciada por la experiencia personal (38,2%) y los valores culturales (37,3%). Los relatos de Colombia revelan barreras sociopolíticas, organizacionales y educativas para la atención compasiva. Perciben compasión de sus pacientes (84,7%), escasa compasión entre colegas (14,3%) y casi nula compasión por parte de los gerentes (1%). Sin embargo, emerge la naturaleza consciente e intencional de la compasión y el esfuerzo de enfermería por desarrollarla en cinco componentes: particularizar, invertir tiempo, estar presente, ir más allá y la defensa/abogacia. Se hacen evidentes algunas variaciones culturales de la compasión y formas de promoverla en un ejercicio profesional cada vez más transcultural.

Points of view and experiences about compassion were explored in the practice of Colombian nurses and a contrast was made with the other 14 participating countries of the international online study. The cross-sectional exploratory study with an online international survey with 10 questions (open and closed), had 1323 nurses, 103 were from Colombia. Colombian quantitative data were analyzed in Excel and qualitative data in Nvivo with thematic analysis and consensus among researchers. The Colombian sample counted with 83.5% teachers and they chose the definition of compassion as the "deep awareness of the suffering of others and the desire to alleviate that suffering" (84.3%) in contrast to 59.5% of the online international study. Although, there are statistically significant differences between the countries of the international online study in the definition of compassion and some experiences, there are also similarities in several qualitative findings. The sociopolitical, organizational and educational barriers for compassionate care are evident. However, there is a conscious and intentional nature of the compassion and nursing effort to develop it. Some cultural variations of compassion and ways of promoting it in an increasingly transcultural professional exercise are evident.

La telaraña del cuidado familiar para el adulto mayor en situación de discapacidad y pobreza / The spiderweb of family care for the elderly in situation of disabily and poverty

Resumen Objetivo: Explorar la trayectoria de cuidado popular y la dinámica familiar de familias con adulto mayor en situación de discapacidad y pobreza de tres grupos culturalmente diversos de Colombia. Método: Estudio cualitativo de datos secundarios guiado por Johnston de estudios etnográficos de 2007 hasta 2016. Los datos fueron organizados en el programa N-Vivo y el análisis guiado por Leininger. Resultados: El tema cultural "La telaraña del cuidado familiar: fortaleza y fragilidad" revela cómo la trayectoria de cuidado parte del compromiso filial y del sufrimiento por la triple condición de vejez, discapacidad y pobreza. Las decisiones y acciones son derivadas del conocimiento popular, los exiguos recursos externos y las funestas experiencias con los servicios de salud. La familia logra cierto control adaptándose con ingenio, manteniendo el optimismo ante la pobreza, la desprotección social y política, pero es evidente la vulnerabilidad para el sistema familiar. Conclusiones: El sistema cultural del grupo familiar es determinante en las trayectorias y dinámicas familiares que se tejen en torno al cuidado; en un mundo lleno de adversidades, los sentimientos, la familia y los recursos propios son los amortiguadores para salir adelante. La familia demanda diversos soportes para cuidar y no sucumbir en el intento.

Abstract Objective: Explore the trajectory of popular care and the family dynamics of families with elderly members in situations of disability and poverty in three culturally diverse groups in Colombia. Method: Qualitative study of secondary data guided by Johnston, of ethnographic studies from 2007 through 2016. Data was organized in the N-Vivo program and the analysis guided by Leininger. Results: The cultural topic "The cobweb of family care: strength and fragility" reveals how the trajectory of care starts from filial commitment and the suffering caused by old age, disability and poverty. Decisions and actions are derived from popular knowledge, meager external resources, and dismal experiences with health services. The family achieves some control to adapt with ingenuity, maintaining optimism despite poverty, lack of social and political of protection, but the vulnerability of the family system is evident. Conclusions: The cultural system of the family group are decisive in the family trajectories and dynamics that are woven around the care. In a world full of adversity, feelings, the family and owning resources are the buffers to get ahead. The family demands different supports to care for itself and not succumb in the attempt.

Dolor en personas ancianas con dependencia: programa de visita domiciliaria adaptado culturalmente a población rural / Pain in dependent elderly people: home visit program culturally adapted to a rural population

RESUMEN Objetivo Evaluar los efectos de un programa de visita domiciliaria culturalmente adaptado sobre la intensidad del dolor de personas ancianas en situación de discapacidad y pobreza en la población rural de Cáqueza-Cundinamarca. Método Estudio cuasi-experimental con pre-prueba y post-prueba. Participaron 34 mayores de 60 años con deficiencia física o visual y dependencia total o parcial. El programa de visita domiciliaria constó de siete visitas con un promedio de dos horas de duración y un intervalo de 13 a 15 días. Para el manejo del dolor se propuso un sincretismo entre medicamentos, plantas medicinales y remedios caseros. El dolor se evaluó con la escala verbal del dolor y en diario de campo fueron registrados los datos cualitativos. Se aplicó la prueba de rangos asignados de Wilcoxon. Resultados En la pre-prueba el 100 % tenían un tipo de dolor y en la post-prueba hubo efectos favorables y significativos (p.valor <0.001) en la disminución del dolor. Cualitativamente son atribuidos los cambios en parte al desarrollo del programa y otras explicaciones corresponden a los valores y creencias del grupo. Conclusiones El programa de visita domiciliaria adaptado culturalmente deja evidencia cómo ofrecer una respuesta donde se dialoga entre el saber popular y profesional logrando una práctica segura y adaptada al universo cultural de las personas. Latinoamerica requiere de profesionales culturalmente sensibles a las expresiones y percepciones de dolor con curiosidad para explorar en la evidencia las posibilidades terapéuticas de las propuestas provenientes del saber popular.(AU)

ABSTRACT Objective To assess the effects of a culturally adapted home visit program on pain intensity in elderly people with disability and poverty conditions in the rural population of Cáqueza-Cundinamarca, Colombia. Method Quasi-experimental study with pre-test and post-test. The study included 34 people over 60 years of age with physical or visual impairment and total or partial dependence. The home visit program consisted of seven visits paid for an average of two hours and an interval of 13 to 15 days. A syncretism of drugs, medicinal plants and home remedies was proposed for pain management. Pain was assessed using the verbal pain scale and qualitative data were recorded in the field diary. Wilcoxon signed-rank test was applied. Results During the pre-test, 100 % of the participants presented with a type of pain, while favorable and significant effects were observed in the post-test (p value <0.001) in relation to pain reduction. Changes are qualitatively attributed, partly, to the development of the program and other explanations include values and beliefs of the group. Conclusions The culturally adapted home visits program shows that it is possible to act in contexts where dialogues occur between popular and professional knowledge, achieving a safe practice adapted to the cultural universe of people. Latin America requires professionals culturally sensitive to expressions and perceptions of pain, who are curious to explore, based on evidence, the therapeutic possibilities proposed by popular knowledge.(AU)

[Pain in dependent elderly people: home visit program culturally adapted to a rural population]. / Dolor en personas ancianas con dependencia: programa de visita domiciliaria adaptado culturalmente a población rural.

OBJECTIVE: To assess the effects of a culturally adapted home visit program on pain intensity in elderly people with disability and poverty conditions in the rural population of Cáqueza-Cundinamarca, Colombia. METHOD: Quasi-experimental study with pre-test and post-test. The study included 34 people over 60 years of age with physical or visual impairment and total or partial dependence. The home visit program consisted of seven visits paid for an average of two hours and an interval of 13 to 15 days. A syncretism of drugs, medicinal plants and home remedies was proposed for pain management. Pain was assessed using the verbal pain scale and qualitative data were recorded in the field diary. Wilcoxon signed-rank test was applied. RESULTS: During the pre-test, 100 % of the participants presented with a type of pain, while favorable and significant effects were observed in the post-test (p value <0.001) in relation to pain reduction. Changes are qualitatively attributed, partly, to the development of the program and other explanations include values and beliefs of the group. CONCLUSIONS: The culturally adapted home visits program shows that it is possible to act in contexts where dialogues occur between popular and professional knowledge, achieving a safe practice adapted to the cultural universe of people. Latin America requires professionals culturally sensitive to expressions and perceptions of pain, who are curious to explore, based on evidence, the therapeutic possibilities proposed by popular knowledge.

OBJETIVO: Evaluar los efectos de un programa de visita domiciliaria culturalmente adaptado sobre la intensidad del dolor de personas ancianas en situación de discapacidad y pobreza en la población rural de Cáqueza-Cundinamarca. MÉTODO: Estudio cuasi-experimental con pre-prueba y post-prueba. Participaron 34 mayores de 60 años con deficiencia física o visual y dependencia total o parcial. El programa de visita domiciliaria constó de siete visitas con un promedio de dos horas de duración y un intervalo de 13 a 15 días. Para el manejo del dolor se propuso un sincretismo entre medicamentos, plantas medicinales y remedios caseros. El dolor se evaluó con la escala verbal del dolor y en diario de campo fueron registrados los datos cualitativos. Se aplicó la prueba de rangos asignados de Wilcoxon. RESULTADOS: En la pre-prueba el 100 % tenían un tipo de dolor y en la post-prueba hubo efectos favorables y significativos (p.valor <0.001) en la disminución del dolor. Cualitativamente son atribuidos los cambios en parte al desarrollo del programa y otras explicaciones corresponden a los valores y creencias del grupo. CONCLUSIONES: El programa de visita domiciliaria adaptado culturalmente deja evidencia cómo ofrecer una respuesta donde se dialoga entre el saber popular y profesional logrando una práctica segura y adaptada al universo cultural de las personas. Latinoamerica requiere de profesionales culturalmente sensibles a las expresiones y percepciones de dolor con curiosidad para explorar en la evidencia las posibilidades terapéuticas de las propuestas provenientes del saber popular.

Diversidad cultural de sanadores tradicionales afrocolombianos: preservación y conciliación de saberes / Cultural Diversity of Afro-Colombian Traditional Healers: Preservation and Conciliation of Knowledge / Diversidade cultural dos curandeiros tradicionais afro-colombianos: preservação e conciliação de saberes

La diversidad afrocolombiana entreteje prácticas culturales en salud específicas. Los sanadores tradicionales son poseedores de una costumbre milenaria en el cuidado de la salud. Gozan del reconocimiento, la confianza y el respeto de sus comunidades, pero son desconocidos o ignorados en las instituciones de salud y en el mundo profesional. Objetivo: describir las prácticas de cuidado realizadas por los sanadores tradicionales (remedieros y parteras) en una comunidad afrocolombiana en Guapi, Cauca, Colombia. Método: el estudio etnográfico utiliza observación participante y entrevistas en profundidad con tres remedieros y tres parteras. El análisis se realizó de forma inductiva e interpretativa. Resultados: los hallazgos evidencian diversos métodos de curación relacionados con el uso de hierbas, maniobras, fórmulas especiales y rezos, entre otros. Esta diversidad de métodos implica que las personas sean vistas de manera holística adoptándose diferentes maneras de sanar y cuidar la salud. Conclusiones: la importancia de conocer y preservar estos conocimientos es una forma de expresar el compromiso por proteger, rescatar y favorecer el diálogo entre los saberes profesional y popular. Es una invitación a conocer y reconocer el papel que pueden jugar los sanadores tradicionales en los sistemas de salud.

Afro-Colombian diversity is interwoven with specific cultural health-care practices. Traditional healers possess a thousand-year-old tradition regarding health care. They enjoy the recognition, trust and respect of their communities, but are unknown to health institutions and the professional world, or ignored by them. Objective: The study describes health-care practices performed by traditional healers; specifically, remedieros (non-professional apothecaries) and parteras (midwives) in an Afro-Colombian community in Guapi, a town located in the Cauca region of Colombia. Methodology: This ethnographic study relied on participant observation and in-depth interviews with three remedieros and three parteras. The analysis was conducted in an inductive and interpretative way. Results: The results demonstrate different healing methods associated with the use of herbs, maneuvers, special formulas and prayers, among other elements. This diversity of methods implies the person is viewed in a holistic manner that is conducive to the adoption of diverse ways to heal and protect health. Conclusions: The importance of being aware of this knowledge and preserving it is a way to express a commitment to protecting, rescuing and favoring dialogue between professional and traditional healers. It also is an invitation to understand and acknowledge the role traditional healers can play in health care systems.

A diversidade afro-colombiana entretece práticas culturais específicas em saúde. Os curandeiros tradicionais são possuidores de um costume milenar no cuidado da saúde. Desfrutam do reconhecimento, da confiança e do respeito de suas comunidades, mas são desconhecidos ou ignorados nas instituições de saúde e no mundo profissional. Objetivo: o estudo descreve as práticas de cuidado realizadas pelos curandeiros tradicionais ("ervateiro" e parteiras) em uma comunidade afro-colombiana em Guapi, Cauca, Colômbia. Método: o estudo etnográfico utiliza observação participante e entrevistas em profundidade com três "ervateiros" e três parteiras. A análise se realizou de forma indutiva e interpretativa. Resultados: os resultados encontrados evidenciam diversos métodos de cura relacionados com o uso de ervas, manipulações, fórmulas especiais e rezas, entre outros. Essa diversidade de métodos implica que as pessoas sejam vistas de maneira holística, adotando diferentes maneiras de curar e cuidar a saúde. Conclusões: a importância de conhecer e preservar esses conhecimentos é uma forma de expressar o compromisso por proteger, resgatar e favorecer o diálogo entre os saberes profissional e popular. É um convite a conhecer e reconhecer o papel que os curandeiros tradicionais podem ter nos sistemas de saúde.

[The effect of an elderly people caregivers' educational program: a cultural perspective]. / Efecto de un programa educativo para cuidadores de personas ancianas: una perspectiva cultural.

OBJECTIVE: Determining the effect of implementing a culturally-based educational program for caregivers working with the elderly in conditions of disability and poverty in a sector of Bogota, Colombia; perceived health, family functioning, caregiver burden and depression were the variables of interest. METHODS: This was a quasi-experimental study, involving using pre-test and post-test;56 family caregivers participated: 37 in the experimental group and 19 in the control group. The educational program consisted of six group sessions with a 30-day interval. Each session had five phases: sensitization, culturally-appropriate information, decision-making, commitment to action and closure. These were led by a nurse who was an expert in gerontology-geriatrics and transcultural nursing. Several scales were applied: self-perception of health, family Apgar, caregiver burden and depression scale. RESULTS: The culturally-based educational program had statistically significant effects on the variables being considered: family functioning (T=2.506; p=0.015) and caregiver burden (p=-2.149 T=0.036). Self-perception of health and depression revealed no statistically significant differences. DISCUSSION: Health education activities addressed from a cultural approach may lead to co-creating therapeutic diversity arising from dialogue and mediation between popular and professional knowledge. It could be a key against the lack of success in users' adherence to health facilities and treatment.

Efecto de un programa educativo para cuidadores de personas ancianas: una perspectiva cultural / The effect of an educational program for elderly people's caregivers: a cultural perspective

Objetivo Determinar el efecto de la aplicación de un programa educativo con perspectiva cultural para cuidadores de personas ancianas en situación de discapacidad y pobreza en un sector de Bogotá - Colombia, sobre las variables: auto percepción de salud, funcionalidad familiar, carga del cuidador y depresión. Métodos Estudio cuasiexperimental con pre-prueba y pos-prueba. Participaron 56 cuidadores familiares, 37 en el grupo experimental (ge) y 19 en el grupo control (gc).El programa educativo aplicado al grupo experimental constaba de seis sesiones grupales con intervalo de 30 días. Cada sesión tiene cinco fases: sensibilización, información culturalmente adaptada, toma de decisiones, compromisos de acción y cierre. Fue aplicado por una enfermera experta en geronto-geriatría y enfermería transcultural. Se aplicaron las escalas de Autopercepción de Salud, Apgar familiar, Carga del cuidador y Escala de Depresión. Resultados El programa educativo con enfoque cultural tuvo efectos significativos, sobre las variables: funcionalidad familiar (T=2,506; p=0,015) y carga del cuidador (T=-2,149; p=0,036). La autopercepción en salud y depresión no presentaron diferencias significativas. Discusión Las acciones en educación en salud abordadas desde la perspectiva cultural abren una puerta a co-crear diversidad de terapéuticas derivadas del diálogo y la mediación entre los saberes populares y profesionales. Podría ser una clave frente al escaso éxito en la adherencia de los usuarios a las instituciones de salud y a los tratamientos.

Objective Determining the effect of implementing an educational programme using a cultural approach for caregivers looking after elderly disabled and poor people living in a sector of Bogota, Colombia regarding the following variables: perceived health, family functioning, caregiver burden and depression. Methods This was a quasi-experimental study involving pre-test and post-test. 56 family caregivers participated in the study, 37 in the experimental group and 19 in the control group. The educational program being applied consisted of six group sessions with a 30-day interval. Each session had five phases: awareness-raising, culturally-appropriate information, making decisions, commitments for action and closure. They were led by a nurse specializing in gerontology-geriatrics and transcultural nursing. Several scales were applied: self-perception of health, family APGAR, caregiver burden, and a depression scale. Results The educational program involving a cultural approach had statistically significant effects on family functioning (T=2.506; p=0.015) and caregiver burden (p=-2.149 T=0.036). Self-perception of health and depression revealed no statistically significant differences. Discussion Health education activities addressed from a cultural approach opens the way forward for creating therapeutic diversity arising from dialogue and mediation between popular and professional knowledge. It could be a key against the lack of success in users' adherence to health facilities and treatment.

Efecto de un programa educativo para cuidadores de personas ancianas: una perspectiva cultural / The effect of an elderly people caregivers' educational program: a cultural perspective

Objetivo Determinar el efecto de la aplicación de un programa educativo con perspectiva cultural para cuidadores de personas ancianas en situación de discapacidad y pobreza en un sector de Bogotá-Colombia, sobre las variables: autopercepción de salud, funcionalidad familiar, carga del cuidador y depresión. Métodos Estudio cuasi experimental con pre-prueba y pos-prueba. Participaron 56 cuidadores familiares, 37 en el grupo experimental y 19 en el grupo control. El programa educativo aplicado al grupo experimental constaba de seis sesiones grupales con intervalo de 30 días. Cada sesión tiene cinco fases: sensibilización, información culturalmente adaptada, toma de decisiones, compromisos de acción y cierre. Fue aplicado por una enfermera experta en geronto-geriatría y enfermería transcultural. Se aplicaron las escalas de Autopercepción de Salud, Apgar familiar, Carga del cuidador y Escala de Depresión. Resultados El programa educativo con enfoque cultural tuvo efectos significativos, sobre las variables: funcionalidad familiar (T=2,506; p=0,015) y carga del cuidador (T=-2,149; p=0,036). La autopercepción en salud y depresión no presentaron diferencias significativas. Discusión Las acciones en educación en salud abordadas desde la perspectiva cultural abren una puerta a co-crear diversidad de terapéuticas derivadas del diálogo y la mediación entre los saberes populares y profesionales. Podría ser una clave frente al escaso éxito en la adherencia de los usuarios a las instituciones de salud y a los tratamientos.

Objective Determining the effect of implementing a culturally-based educational program for caregivers working with the elderly in conditions of disability and poverty in a sector of Bogota, Colombia; perceived health, family functioning, caregiver burden and depression were the variables of interest. Methods This was a quasi-experimental study, involving using pre-test and post-test;56 family caregivers participated: 37 in the experimental group and 19 in the control group. The educational program consisted of six group sessions with a 30-day interval. Each session had five phases: sensitization, culturally-appropriate information, decision-making, commitment to action and closure. These were led by a nurse who was an expert in gerontology-geriatrics and transcultural nursing. Several scales were applied: self-perception of health, family Apgar, caregiver burden and depression scale. Results The culturally-based educational program had statistically significant effects on the variables being considered: family functioning (T=2.506; p=0.015) and caregiver burden (p=-2.149 T=0.036). Self-perception of health and depression revealed no statistically significant differences. Discussion Health education activities addressed from a cultural approach may lead to co-creating therapeutic diversity arising from dialogue and mediation between popular and professional knowledge. It could be a key against the lack of success in users' adherence to health facilities and treatment.

Una mirada de la rehabilitación desde la perspectiva de la profesión de enfermería: [revisión] / A look at rehabilitation from the nursing profession’s perspective: [review] / Um olhar para a reabilitação desde a perspectiva da profissão de enfermagem: [revisão]

Se presenta una aproximación a lo que es e implica la rehabilitación para los profesionales de enfermería, sobre todo cuando se enfrentan al cuidado de las personas en situación de discapacidad y vejez. Parte de una revisión de literatura sobre la conceptualización de la rehabilitación desde la perspectiva de la profesión de enfermería y su desarrollo histórico para continuar con algunos aspectos relacionados con la legislación en esta materia, y seguir con una breve ilustración sobre el abordaje de la rehabilitación dado por distintos autores. Aproximación que permite plantear lo que es y significa este tema para los profesionales de enfermería con base, también, en las reflexiones a partir de la experiencia y los resultados de la investigación realizada por las autoras, sobre el diseño y evaluación de un modelo de cuidado cultural de la salud para personas ancianas en situación de discapacidad y pobreza en zonas urbano-marginal y rural aledañas a Bogotá D. C., durante tres años consecutivos a partir de 2004. Se espera que este artículo sea fuente de motivación para seguir indagando, profundizando y estableciendo prácticas de enfermería culturalmente adaptadas y orientadas a la rehabilitación de las personas en situación de discapacidad.

A definition is presented on what rehabilitation is and entails for nursing professionals, especially when they are faced with the care of the disabled or the elderly. It begins with a literature review on the conceptualization of rehabilitation from the nursing profession’s perspective and its historical development to continue with some aspects related with legislation on this subject matter, followed by a brief illustration on the rehabilitation approach given by the different authors. A definition that enables us to state what this topic is and means for the nursing professionals based on reflections about experiences as well as on the results of the study conducted by the authors, on the design and in the assessment of a culture based care model for the elderly in a situation of disability and poverty in urban and in rural deprived areas in the outskirts of Bogotá D. C., during three consecutive years as of 2004. This article is expected to become a source of motivation to continue researching, studying in depth and establishing nursing practices culturally adapted and geared towards the rehabilitation of people in a condition of disability.

Apresenta-se uma aproximação sobre o significado e implicações da reabilitação para os profissionais de enfermagem, especialmente, frente ao cuidado das pessoas em situação de discapacidade e velhice. O estudo está baseado em uma revisão de literatura sobre a conceituação da reabilitação desde a perspectiva da profissão de enfermagem e seu desenvolvimento histórico, continua com alguns aspectos relativos à legislação nesta matéria e com uma pequena ilustração sobre a abordagem da reabilitação na opinião de diversos autores. O trabalho oferece uma aproximação que permite colocar o que este tema significa para os profissionais de enfermagem, com base em reflexões obtidas a partir da experiência e dos resultados da pesquisa realizada pelas autoras, sobre o desenho e avaliação de um modelo de cuidado cultural da saúde para pessoas idosas em situação de discapacidade e pobreza em zonas urbano-marginais e rurais vizinhas a Bogotá, D.C., durante três anos consecutivos contados a partir de 2004. Espera-se que este artigo seja fonte de motivação para continuar indagando, aprofundando e estabelecendo práticas de enfermagem culturalmente adaptadas e voltadas para as pessoas em situação de discapacidade.