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1.
Front Public Health ; 9: 629872, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33796496

RESUMEN

Background: A non-pharmaceutical treatment offered as psychological support is bibliotherapy, which can be described as the process of reading, reflecting, and discussing literature to further a cognitive shift. The coronavirus disease 2019 (COVID-19) pandemic demands a response to prevent a peak in the prevalence of mental health problems and to avoid the collapse of mental health services, which are scarce and inaccessible due to the pandemic. Thus, this study aimed to review articles on the effectiveness of bibliotherapy on different mental health problems. Methods: A systematic review was conducted to examine relevant studies that assess the effectiveness of bibliotherapy in different clinical settings as a treatment capable of enhancing a sense of purpose and its surrounding values. To achieve this, a systematic review, including a bioethical meta-analysis, was performed. A variant of the PICO (Participants, Intervention, Comparison, and Outcome) model was used for the search strategy, and the systematic review was conducted in three databases: PubMed, Bireme, and OVID. Inclusion criteria were relevant studies that included the keywords, excluding documents with irrelevant topics, studies on subjects 15 years or younger, and in languages besides Spanish or English. Starting with 707 studies, after three rounds of different quality criteria, 13 articles were selected for analysis, including a hermeneutic analysis, which was followed by a fourth and final recovery round assessing bibliotherapy articles concerning healthcare workers. Results: Our findings showed that through bibliotherapy, patients developed several capacities, including the re-signification of their own activities through a new outlook of their moral horizon. There are no research road maps serving as guides to conduct research on the use of bibliotherapy to enhance mental health. Additionally, values such as autonomy and justice were closely linked with positive results in bibliotherapy. This implies that bibliotherapy has the potential to have a positive impact in different settings. Conclusions: Our contribution is to offer a road map that presents state-of-the-art bibliotherapy research, which will assist institutions and healthcare professionals to plan clinical and specific interventions with positive outcomes.


Asunto(s)
Biblioterapia , Personal de Salud/psicología , Salud Mental , Hermenéutica , Humanos , Servicios de Salud Mental
2.
Nurs Sci Q ; 34(1): 81-87, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33349187

RESUMEN

The purpose of this article is to report the details of the humanbecoming hermeneutic sciencing of presence in In Harm's Way. Humanbecoming hermeneutic sciencing is dialoguing with an artform by discoursing with penetrating engaging, interpreting with quiescent beholding, and understanding with inspiring envisaging. The artform explored in this article is the comments and images of 60 nurses from around the world included in The New York Times story titled "In Harm's Way." The report is on the meaning of presence as lived and talked about by nurses on the front lines at the peak of the COVID-19 outbreak.


Asunto(s)
/enfermería , Hermenéutica , Humanismo , /epidemiología , Salud Global , Humanos , Periódicos como Asunto
3.
Enferm. foco (Brasília) ; 11(5): 34-39, dez. 2020.
Artículo en Portugués | LILACS, BDENF - Enfermería | ID: biblio-1177103

RESUMEN

Objetivo: Desvelar os significados e sentidos do cuidado de enfermagem, na perspectiva de mulheres que vivenciam o câncer de mama em situação de metástase óssea. Métodos: Estudo qualitativo baseado na fenomenologia hermenêutica de Martin Heidegger. Realizaram-se 24 entrevistas fenomenológicas com mulheres em tratamento oncológico, em um hospital público de referência localizado no norte do país. As entrevistas ocorreram no ano de 2017 com apoio de um roteiro semiestruturado. Os depoimentos foram transcritos e analisados em dois momentos: a compreensão mediana e a interpretação. Resultados: As mulheres significam o cuidado de enfermagem a partir de manifestações cotidianas de zelo, carinho, atenção, preocupação, paciência e competência profissional. Por sua vez, o sentido desse cuidado para elas desvela-se na impessoalidade e na existência do outro, quando as mulheres demonstram uma necessidade de se sentirem acolhidas e reconhecidas em sua humanidade. Conclusão: Os resultados do estudo demonstram semelhanças nas experiências de vida das mulheres e sugerem a necessidade de reflexões e ações para o impulsionamento de práticas de enfermagem voltadas ao ser-no-mundo e às diferentes possibilidades de cuidado, diante de seus diferentes significados e sentidos. (AU)


Objective: To reveal the meanings and senses of nursing care, from the perspective of women who experience breast cancer in a situation of bone metastasis. Methods: Qualitative study based on Martin Heidegger's hermeneutic phenomenology. Twenty-four phenomenological interviews were carried out with women undergoing cancer treatment, in a public reference hospital located in the north of the country. The interviews took place in 2017 with the support of a semi-structured script. The testimonies were transcribed and analyzed in two moments: median comprehension and interpretation. Results: Women mean nursing care based on daily manifestations of zeal, affection, attention, concern, patience and professional competence. In turn, the meaning of nursing care for women is revealed in the impersonality and in the existence of the other, when women demonstrate a need to feel welcomed and recognized in their humanity. Conclusion: The results of the study demonstrate similarities in women's life experiences and suggest the need for reflections and actions to encourage nursing practices aimed at being-in-the-world and the different possibilities of care, given their different meanings and senses. (AU)


Objetivo: Revelar los significados y significados de la atención de enfermería, desde la perspectiva de las mujeres que experimentan cáncer de mama en una situación de metástasis óseas. Metodos: Estudio cualitativo basado en la fenomenología hermenéutica de Martin Heidegger. Se realizaron 24 entrevistas fenomenológicas con mujeres sometidas a tratamiento contra el cáncer, en un hospital público de referencia ubicado en el norte del país. Las entrevistas tuvieron lugar en 2017 con el apoyo de un guión semiestructurado. Los testimonios fueron transcritos y analizados en dos momentos: mediana comprensión e interpretación. Resultados: las mujeres se refieren al cuidado de enfermería basado en manifestaciones diarias de celo, afecto, atención, preocupación, paciencia y competencia profesional. A su vez, el significado de este cuidado por ellos se revela en la impersonalidad y en la existencia del otro, cuando las mujeres demuestran la necesidad de sentirse bienvenidas y reconocidas en su humanidad. Conclusíon: Los resultados del estudio demuestran similitudes en las experiencias de vida de las mujeres y sugieren la necesidad de reflexiones y acciones para impulsar las prácticas de enfermería destinadas a estar en el mundo y las diferentes posibilidades de atención, dados sus diferentes significados y sentidos. (AU)


Asunto(s)
Atención de Enfermería , Mujeres , Neoplasias de la Mama , Investigación Cualitativa , Hermenéutica
4.
Rev. enferm. UERJ ; 28: e49421, jan.-dez. 2020.
Artículo en Inglés, Portugués | LILACS, BDENF - Enfermería | ID: biblio-1128423

RESUMEN

Objetivo: descrever o uso das tecnologias de cuidado da enfermeira obstétrica qualificada na modalidade de residência e sua relação com a práxis profissional. Método: estudo qualitativo com 13 enfermeiras obstétricas atuantes em duas maternidades públicas do Rio de Janeiro, Brasil. Dados coletados por entrevista individual, semiestruturada e análise hermenêutica-dialética. Resultados: a transição do modelo intervencionista estrutura-se no cuidado humanizado com a incorporação de um modelo centrado nas boas práticas e nas tecnologias não invasivas de cuidado da enfermeira obstétrica. A práxis da enfermeira obstétrica contribui para a transformação qualitativa deste cenário, com resgate sobre a fisiologia, o fortalecimento de vínculo e empoderamento da mulher, ressignificando o momento do parto. Conclusão: a prática da enfermeira e o uso das tecnologias não invasivas constituem possibilidades para ruptura do modelo hegemônico culturalmente instituído no Brasil, sendo necessária ainda a constituição de um consenso que supere o senso comum(AU)


Objective: to describe the use of care technologies by residency-qualified nurse midwives and their relationship with professional praxis. Method: in this qualitative study with 13 nurse midwives at two public maternity hospitals in Rio de Janeiro, Brazil, data were collected by individual, semi-structured interview and hermeneutic-dialectic analysis. Results: the transition from the interventionist model builds on humanized care by incorporating a model centered on nurse midwives' use of best practices and noninvasive care technologies. Their praxis contributes to qualitative change in this scenario by reinstating physiology, fostering stronger bonding, and empowering women, so as to re-signify the moment of childbirth. Conclusion: nurse midwives' praxis and use of noninvasive technologies constitute opportunities to break with the culturally established model hegemonic in Brazil, while a consensus still needs to be built to surmount common sense(AU)


Objetivo: describir el uso de tecnologías asistenciales por parte de enfermeras parteras tituladas en residencia y su relación con la praxis profesional. Método: en este estudio cualitativo con 13 enfermeras parteras de dos maternidades públicas de Río de Janeiro, Brasil, los datos fueron recolectados mediante entrevista individual, semiestructurada y análisis hermenéuticodialéctico. Resultados: la transición del modelo intervencionista se basa en la atención humanizada al incorporar un modelo centrado en el uso de las mejores prácticas y tecnologías de atención no invasiva por parte de las enfermeras parteras. Su praxis contribuye al cambio cualitativo en este escenario al reinstaurar la fisiología, fomentar vínculos más fuertes y empoderar a las mujeres, para resignificar el momento del parto. Conclusión: la praxis de las enfermeras parteras y el uso de tecnologías no invasivas constituyen oportunidades para romper con el modelo hegemónico culturalmente establecido en Brasil, mientras que aún debe construirse un consenso para superar el sentido común(AU)


Asunto(s)
Humanos , Femenino , Adulto , Parto Humanizado , Parto Obstétrico/tendencias , Enfermeras Obstetrices/educación , Enfermería Obstétrica/métodos , Brasil , Poder Psicológico , Epidemiología Descriptiva , Investigación Cualitativa , Hermenéutica , Maternidades
5.
Rev. colomb. obstet. ginecol ; 71(4): 323-344, oct.-dic. 2020. tab, graf
Artículo en Español | LILACS | ID: biblio-1149811

RESUMEN

RESUMEN Objetivo: Comprender las prácticas institucionales en salud que se realizan en las mujeres en embarazo parto y posparto, según la clase social, en Bogotá. Materiales y métodos: Estudio cualitativo, desde el paradigma de la hermenéutica crítica. Método de etnografía crítica, con muestreo teórico. Participaron 9 mujeres y 8 profesionales de la salud de la ciudad de Bogotá, que asistieron a instituciones públicas y privadas, pertenecientes a los regímenes subsidiado y contributivo del Sistema General de Seguridad Social en Salud (SGSS). Se realizaron 38 entrevistas a profundidad durante 13 meses y 62 acompañamientos a las maternas en las actividadesde control prenatal, vacunación, trabajo de parto, consulta posparto, exámenes de seguimiento, curso psicoprofiláctico, hospitalización y sala de espera, tanto en servicios públicos como privados. Análisis por triangulación en Atlas Ti. Resultados: Teniendo en cuenta los discursos de los actores, la observación participante y el contexto, se encontraron dos categorías que determinan estas inequidades, denominadas el mercado regula la salud, y la vigilancia y el control en los servicios de salud. Conclusiones: En la práctica médica es conveniente fortalecer las competencias ciudadanas para garantizar los derechos del personal de salud y de las mujeres. Estudiar desde la investigación cualitativa es una oportunidad para promover la transformación de las racionalidades médicas que afectan a las mujeres.


ABSTRACT Objective: To understand institutional practices in healthcare as relates to women during pregnancy, childbirth and the postpartum period according to social class in Bogota. Materials and methods: Qualitative study based on the critical hermeneutics paradigm. Critical ethnographic method with theoretical sampling. The participants included 9 women and 8 health-care professionals from the city of Bogotá, attending public and private healthcare institutions that serve populations under both the subsidized as well as the contributive regimes of the General Social Security System. Overall, 38 in-depth interviews were conducted during a 13 month period, with 62 instances of support to the mothers in terms of prenatal care, vaccination, labor, postpartum visits, follow-up tests, psychoprophylactic course, hospitalization and waiting room. Triangulation analysis on Atlas Ti. Results: Taking into account the discourse of the different players, observations and context, two categories were found to be determining factors of inequities: "Market-regulated health" and "Over- sight and control in health services". Conclusions: It is advisable in medical practice to build competencies in the population in order to ensure the realization of the rights of women and healthcare personnel. Qualitative research offers the opportunity to promote the transformation of medical rationale affecting women.


Asunto(s)
Humanos , Femenino , Embarazo , Adulto , Salud Materna , Clase Social , Mujeres , Conocimientos, Actitudes y Práctica en Salud , Parto , Periodo Posparto , Hermenéutica
6.
Enferm. clín. (Ed. impr.) ; 30(5): 309-316, sept.-oct. 2020. graf, tab
Artículo en Español | IBECS | ID: ibc-196773

RESUMEN

OBJETIVO: Conocer el significado de las experiencias vividas por personas con enfermedad pulmonar obstructiva crónica. MÉTODO: Estudio con enfoque cualitativo de tipo fenomenológico hermenéutico. Se realizaron entrevistas en profundidad a 10 personas que presentaban enfermedad pulmonar obstructiva crónica grave y muy grave. RESULTADOS: Se describen los hallazgos encontrados en 3 temas emergentes y sus consecuentes subtemas que relatan: el proceso de la enfermedad enfatizado en 5 subtemas relacionados con el conocimiento de la enfermedad, el ahogo y cansancio como síntomas desagradables cotidianos, el ahogo como amenaza de muerte, la negación a la dependencia del oxígeno y los sistemas de afrontamiento para el control de la enfermedad; en el segundo tema se describe el apoyo familiar con 2 subtemas, pérdida de roles y carga de cuidado; y en el tercer tema se describe el apoyo del sistema de salud con 2 subtemas, atención médica y cuidado enfermero. CONCLUSIÓN: Los síntomas y los cambios funcionales, en general, denotan un significado distinto tanto en momentos cotidianos como en momentos de exacerbación. Así mismo, se develan cambios en el estilo de vida a causa de la pérdida de roles y de los procesos de atención en salud, como experiencias que no permiten un afrontamiento y adaptación efectivos


OBJECTIVE: To determine the meaning of the experience of people with chronic obstructive pulmonary disease. METHOD: A qualitative approach study rooted in hermeneutic phenomenology. In-depth interviews were conducted with 10 people with critical and severe chronic obstructive pulmonary disease. RESULTS: The findings obtained are described in three emerging topics and their consequent subtopics, which describe the process of the disease focusing on five subtopics related to awareness of the disease, the choking characteristic of the disease and tiredness as daily unpleasant symptoms, as well as choking as a death threat, rejection of oxygen dependency and coping systems to control the disease. In the second topic, family support with two subtopics are described: the loss of the patient's role, the burden of care; and the third topic concerns the support of health system on two subtopics: medical care and nursing care. CONCLUSION: The symptoms and functional changes in general, denote a different meaning not only in everyday life, but also in times of exacerbation of the condition. Likewise, changes in lifestyle due to the loss of roles and health care processes are revealed, as experiences that do not allow effective coping and adaptation


Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Enfermedad Pulmonar Obstructiva Crónica/enfermería , Acontecimientos que Cambian la Vida , Atención de Enfermería , Actividades Cotidianas , Hermenéutica , Autocuidado/métodos , Adaptación Psicológica , Investigación Cualitativa , Deterioro Clínico
7.
Av. enferm ; 38(2): 191-201, May-Aug. 2020.
Artículo en Español | LILACS, BDENF - Enfermería, COLNAL | ID: biblio-1114689

RESUMEN

Resumen Objetivo: comprender la experiencia vivida por un grupo de personas con insuficiencia renal crónica que recibieron un trasplante de órgano frente a los servicios de salud y los significados del cuidado de la salud realizados por enfermeras y familiares. Materiales y métodos: estudio cualitativo con enfoque fenomenológico-hermenéutico. La muestra se compone de 11 personas con insuficiencia renal crónica trasplantadas, cinco cuidadores y cinco enfermeras. Entrevistas recolectadas y grabadas entre diciembre de 2015 y enero de 2017. Para el análisis se empleó el método propuesto por Van Manen. Resultados: uno de los temas que emerge es la experiencia de encontrarse y vivir con insuficiencia renal crónica, del cual se extrae el subtema relacionado con la vivencia en el sistema de salud por parte de las personas enfermas, sus cuidadores y los profesionales de enfermería. Conclusiones: la insuficiencia renal crónica asume un significado complejo y multidimensional para la persona con la enfermedad, sus cuidadores familiares y las enfermeras que asumen el cuidado de este grupo de personas, que los lleva a experimentar el sistema de salud con un efecto adverso que deshumaniza el cuidado de las personas.


Resumo Objetivo: compreender a experiência vivida por um grupo de pessoas com insuficiência renal crônica que receberam um transplante de órgão ante os serviços de saúde e os significados do cuidado da saúde realizados por enfermeiros e familiares. Materiais e métodos: estudo qualitativo, com abordagem fenomenológico-hermenêutica. A amostra está composta por 11 pessoas com insuficiência renal crônica transplantadas, 5 cuidadores e 5 enfermeiras. Foram realizadas entrevistas entre dezembro de 2015 e janeiro de 2017. Para a análise, foi utilizado o método proposto por Van Manen. Resultados: um dos problemas que emerge é a experiência de se deparar com a insuficiência renal crônica e conviver com ela; disso é extraído o subtema relacionado à vivência no sistema de saúde, para pessoas doentes, seus cuidadores e profissionais de enfermagem. Conclusões: a insuficiência renal crônica assume um significado complexo e multidimensional para a pessoa com a doença, seus cuidadores familiares e os enfermeiros que cuidam desse grupo de pessoas, o que os leva a vivenciar o sistema de saúde com um efeito adverso que desumaniza o cuidado de pessoas.


Abstract Objective: To understand the experience of a group of people with chronic kidney failure who received an organ transplant regarding the health services and the meanings of health care performed by nurses and family members who interact with them. Materials and methods: Qualitative study with a phenome-nological-hermeneutical approach on a sample of 11 people with chronic kidney failure who received a transplant, 5 caregivers and 5 nurses. Interviews were collected and recorded between December 2015 and January 2017. Data analysis followed the method proposed by Van Manen. Results: One of the issues that emerges from this study is the experience of living with chronic renal failure. From this, arises the sub-theme related with the experience lived by patients, their caregivers and nursing professionals within the health system. Conclusions: Chronic renal failure assumes a complex and multidimensional meaning for the person with the disease, their family care-givers, and the nurses who take care of this group of people, which leads them to experience the health system with adverse effects that dehumanize people's care.


Asunto(s)
Humanos , Sistemas de Salud , Enfermería , Cuidadores , Investigación Cualitativa , Insuficiencia Renal Crónica , Hermenéutica , Fallo Renal Crónico
8.
Av. enferm ; 38(2): 226-233, May-Aug. 2020. tab
Artículo en Portugués | LILACS, BDENF - Enfermería, COLNAL | ID: biblio-1114692

RESUMEN

Resumo Introdução: trata-se de um estudo com base filosófica de Michel Foucault que buscou analisar a constituição do sujeito; no caso em questão, buscou-se compreender a enfermeira que milita pela profissão. Objetivo: analisar os aspectos constitutivos de militantes na Enfermagem. Métodos: pesquisa com método histórico, que usa o método de história oral, com uma abordagem qualitativa; foram entrevistadas 11 enfermeiras que militaram ou militam por situações profissionais. Após o uso da técnica de entrevista semiestruturada, os dados foram organizados no software n-vivo 10, e o método de análise foi a hermenêutica dialética. Resultados: as enfermeiras se constituíram militantes a partir de vivências comunitárias, familiares, nos movimentos sociais e na militância profissional, e de convívio com as diferenças éticas e sociais. Os discursos apontam para a constituição de sujeitos militantes fora dos espaços instituídos da sala de aula. Conclusões: ao olhar para a constituição de sujeitos militantes sob a ótica da hermenêutica dialética, encontramos a convergência interna entre as subcategorias apontadas, a produção de sujeitos militantes e as categorias analíticas deste estudo. Identificamos possibilidades formativas de sujeitos militantes e indicamos a necessidade de revisão dos processos formativos de enfermeiras.


Resumen Introducción: se trata de un estudio con base filosófica de Michel Foucault que buscó analizar la constitución del sujeto. En este caso, se intentó entender a la enfermera que milita por la profesión. Objetivo: analizar los aspectos constitutivos de militantes en Enfermería. Métodos: investigación histórica, basada en el método de historia oral con enfoque cualitativo, realizada con 11 enfermeras que militaron o militan por situaciones profesionales. Los datos recopilados de entrevistas semiestructuradas se organizaron en el software n-vivo 10, y se analizaron mediante la hermenéutica dialéctica. Resultados: las enfermeras se convirtieron en militantes basadas en experiencias comunitarias, familiares, en movimientos sociales y militancia profesional, y en la convivencia con las diferencias éticas y sociales. Los discursos apuntan a la constitución de sujetos militantes fuera de los espacios establecidos en el salón de clases. Conclusiones: al observar la constitución de los sujetos militantes desde la hermenéutica dialéctica, encontramos la convergencia interna entre las subcategorías mencionadas, la producción de sujetos militantes y las categorías analíticas de este estudio. Identificamos posibilidades de capacitación de sujetos militantes y señalamos la necesidad de revisar los procesos formativos de las enfermeras.


Abstract Introduction: this study is based on Michel Foucault's philosophical theories and sought to address the constitution of the subject. In this particular case, we sought to understand nurses who militate for their profession. Objective: to study the constitutive aspects of nursing activists. Methods: historical research, based on the oral history method with a qualitative approach, was carried out with 11 nurses who worked or currently work for professional-related situations. Data collected through semi-structured interviews was organized using N-vivo software 10 and then analyzed based on dialectical hermeneutics. Results: nurses became militants due to personal experiences, including: community, social movements, living with ethical and social differences, professional activism, and family life. The speech points to the constitution of militant subjects outside the established spaces of classrooms. Conclusions: by looking at the constitution of militant subjects from the point of view of dialectical hermeneutics, we find an internal convergence between the subcategories above, the production of militant subjects, and the analytical categories of this study. We identified training possibilities for militant subjects and highlight the need to review nursing education processes.


Asunto(s)
Política , Trabajo , Educación en Enfermería , Historia de la Enfermería , Enfermería , Constitución y Estatutos , Hermenéutica
9.
Enferm. nefrol ; 23(2): 160-167, abr.-jun. 2020. tab
Artículo en Español | IBECS | ID: ibc-194133

RESUMEN

OBJETIVO: Describir las experiencias de incertidumbre de jóvenes con insuficiencia renal que viven en tratamiento dialítico. MATERIAL Y MÉTODO: Estudio etnográfico en Guadalajara, México. Participaron 12 jóvenes con insuficiencia renal y en diálisis peritoneal. Se realizaron entrevistas narrativas y observación participante. Se hizo análisis hermenéutico. RESULTADOS: Se identificaron dos modalidades de incertidumbre, la personal y la médica. Las fuentes de la personal fueron los cambios corporales, la reconfiguración identitaria y de roles, la falta de recursos materiales y al pensar en los proyectos a futuro. Las fuentes de la médica fueron falta de información, el inicio y el manejo del tratamiento y el progreso de la enfermedad. CONCLUSIONES: La incertidumbre se vuelve una constante en sus vidas y su manejo se ve influenciado por los recursos materiales y los apoyos sociales que reciben


OBJECTIVE: To describe the uncertainty experiences of young people with renal failure with dialysis treatment. MATERIAL AND METHOD: Ethnographic study in Guadalajara, Mexico. Twelve young people with renal failure and on peritoneal dialysis participated. Narrative interviews and participant observation were conducted. Hermeneutical analysis was performed. RESULTS: Two types of uncertainty were identified: personal and medical. The sources of personal uncertainty were bodily changes, identity and role reconfiguration, lack of material resources and when thinking about future projects. The sources of medical uncertainty were lack of information, the initiation and management of treatment, and the progress of the disease. CONCLUSIONS: Uncertainty becomes a constant in the patients' lives and management is influenced by the material resources and social supports they receive


Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto Joven , Adulto , Diálisis Peritoneal/enfermería , Incertidumbre , Insuficiencia Renal/terapia , Antropología Cultural , Hermenéutica , Progresión de la Enfermedad , Apoyo Social , 25783
10.
Milbank Q ; 98(2): 446-492, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-32436330

RESUMEN

Policy Points Integrated care is best understood as an emergent set of practices intrinsically shaped by contextual factors, and not as a single intervention to achieve predetermined outcomes. Policies to integrate care that facilitate person-centered, relationship-based care can potentially contribute to (but not determine) improved patient experiences. There can be an association between improved patient experiences and system benefits, but these outcomes of integrated care are of different orders and do not necessarily align. Policymakers should critically evaluate integrated care programs to identify and manage conflicts and tensions between a program's aims and the context in which it is being introduced. CONTEXT: Integrated care is a broad concept, used to describe a connected set of clinical, organizational, and policy changes aimed at improving service efficiency, patient experience, and outcomes. Despite examples of successful integrated care systems, evidence for consistent and reproducible benefits remains elusive. We sought to inform policy and practice by conducting a systematic hermeneutic review of literature covering integrated care strategies and concepts. METHODS: We used an emergent search strategy to identify 71 sources that considered what integrated care means and/or tested models of integrated care. Our analysis entailed (1) comparison of strategies and concepts of integrated care, (2) tracing common story lines across multiple sources, (3) developing a taxonomy of literature, and (4) generating a novel interpretation of the heterogeneous strategies and concepts of integrated care. FINDINGS: We identified four perspectives on integrated care: patients' perspectives, organizational strategies and policies, conceptual models, and theoretical and critical analysis. We subdivided the strategies into four framings of how integrated care manifests and is understood to effect change. Common across empirical and conceptual work was a concern with unity in the face of fragmentation as well as the development and application of similar methods to achieve this unity. However, integrated care programs did not necessarily lead to the changes intended in experiences and outcomes. We attribute this gap between expectations and results, in part, to significant misalignment between the aspiration for unity underpinning conceptual models on the one hand and the multiplicity of practical application of strategies to integrate care on the other. CONCLUSIONS: Those looking for universal answers to narrow questions about whether integrated care "works" are likely to remain disappointed. Models of integrated care need to be valued for their heuristic rather than predictive powers, and integration understood as emerging from particular as well as common contexts.


Asunto(s)
Prestación Integrada de Atención de Salud/organización & administración , Hermenéutica , Política de Salud , Humanos , Política Organizacional
12.
Nurs Ethics ; 27(4): 935-945, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32249677

RESUMEN

To practice compassion, the recognition, understanding, and alleviation of patient suffering are of utmost importance. Nursing literature provides ample guidance about the nature and meaning and patients' views about compassion and physical and psychological suffering. However, missing is the discussion about how nurses can achieve a deeper awareness of patients' suffering to practice compassion. This paper aims to describe the relational inquiry nursing approach and illustrate how this approach can enable nurses to develop a deeper awareness of patient suffering. The relational inquiry approach encompasses two components: a relational consciousness and inquiry as a form of action. Relational consciousness requires the nurses to focus on the concrete situations and relationships as well as recognize the intrapersonal, interpersonal, and contextual factors affecting the situations. The interpersonal factors are among and between the individuals, intrapersonal factors are within the individuals, and contextual factors are the hidden factors influencing the individuals and situations. Inquiry as an action requires a critical analysis of the experiences of individuals, situational contexts, and knowledge to inform the nursing care modalities and actions. This approach encourages nurses to use the philosophies of hermeneutic phenomenology, critical theory, and pragmatism. The phenomenological worldview allows nurses to interpret their own and patients' experiences, the critical theory worldview allows nurses to examine the influence of social and cultural factors, and pragmatism allows nurses to question their prior knowledge and develop new knowledge in each situation. The relational inquiry approach allows nurses to develop a deeper understanding of patient suffering through building a therapeutic and trustworthy relationship, active listening, focusing on the details, and engaging in broad and situations specific inquiries to understand the patient narrative of suffering. Two case exemplars are shared to demonstrate how relational inquiry allowed nurses to move beyond recognizing physical suffering and understand patients' emotional and psychological suffering.


Asunto(s)
Concienciación , Empatía , Relaciones Enfermero-Paciente , Atención de Enfermería/psicología , Filosofía en Enfermería , Estrés Psicológico , Hermenéutica , Humanos
13.
Artículo en Inglés | MEDLINE | ID: mdl-32344504

RESUMEN

Volunteering in non-Western countries, such as South Africa, is subject to poor infrastructure, lack of resources, poverty-stricken conditions and often conducted by volunteers from lower socio-economic spheres of society. Sustaining the well-being of volunteers in this context is essential in ensuring their continued capacity to volunteer. To do so, it is important to understand the psychological resilience of these volunteers and the resistance resources they employ to positively adapt to their challenging work-life circumstances. The aim of this qualitative hermeneutic phenomenological study was to explore volunteers' psychological resilience from a salutogenic perspective. In-depth interviews were conducted with eight volunteers servicing government-run hospitals. Data were analysed through phenomenological hermeneutical analysis. Findings show a characteristic work-life orientation to be at the root of volunteers' resilience. Their work-life orientation is based on a distinct inner drive, an other-directedness and a "calling" work orientation. It is proposed that this work-life orientation enables volunteers in this study context, to cope with and positively adapt to challenging work-life circumstances and continue volunteering. The elements of their work-life orientation are presented as intrapersonal strength resources fundamental to their psychological resilience. It is suggested that organisations invest in developmental interventions that endorse and promote these intrapersonal strengths.


Asunto(s)
Personal de Salud , Hermenéutica , Resiliencia Psicológica , Voluntarios , Adaptación Psicológica , Adulto , Femenino , Personal de Salud/psicología , Humanos , Masculino , Persona de Mediana Edad , Investigación Cualitativa , Sudáfrica
14.
Intensive Crit Care Nurs ; 59: 102850, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-32229184

RESUMEN

AIM: To acquire an understanding of the emotional universe of intensive care unit nurses, working in Spain and the United Kingdom. METHODOLOGY: The study used a hermeneutic study design and was set in an academic environment. Participants included nurses with clinical experience in intensive care units. Data were collected from seven in-depth interviews, four in Spanish and three in English. The analysis followed Ricoeur's Theory of Interpretation. The affective taxonomy Universe of Emotions, served to establish starting categories in it. FINDINGS: Six themes were identified: 1) Critical patient care, critical context; 2) Intensive care… for whom?; 3) Nursing a dying patient; 4) In the company of others; 5) But… is it worth it? and 6) Emotional labour is crucial. These all describe different, multifaceted nurses' affective journeys, through categories such as: So little time-so much to do, Relatives, Young death vs. elderly death, Poorly-valued work and I'm in the profession I want to be. CONCLUSION: The sociocultural context shared by the Spanish and English nurses working in intensive care units generates a complex emotional universe, with opposing affective experiences, such as those related to fear, anxiety, sadness, anger, shame, love, surprise and happiness.


Asunto(s)
Emociones , Enfermeras y Enfermeros/psicología , Adulto , Enfermería de Cuidados Críticos/métodos , Enfermería de Cuidados Críticos/normas , Femenino , Hermenéutica , Humanos , Unidades de Cuidados Intensivos/organización & administración , Unidades de Cuidados Intensivos/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Enfermeras y Enfermeros/estadística & datos numéricos , España , Reino Unido
15.
Ciênc. Saúde Colet ; 25(4): 1251-1260, abr. 2020. tab, graf
Artículo en Portugués | LILACS | ID: biblio-1089517

RESUMEN

Resumo No Brasil, o descompasso entre a formação médica e as necessidades assistenciais na atenção primária à saúde, em especial para as populações mais vulneráveis, demandou mudanças nas Diretrizes Curriculares Nacionais do curso de Medicina, com ampliação da carga horária do Internato na APS. Este trabalho é uma pesquisa qualitativa exploratória, que investigou documentos da avaliação formativa do Internato Integrado em Medicina de Família e Comunidade e Saúde Mental da Universidade Federal do Rio de Janeiro, que atendem populações vulneráveis no município do Rio de Janeiro. Ao todo, foram analisados documentos produzidos por 55 estudantes e utilizou-se a hermenêutica dialética como método de análise. A investigação apontou distintos graus de sensibilidade ao sofrimento social experimentado por usuários de Clínicas da Família, ao longo das 22 semanas de estágio. As narrativas foram agrupadas em 5 eixos: tensionando a cisão medicina/sociedade; vulnerabilidade extrema e saúde; violência estrutural cotidiana e saúde; serviço de saúde como recurso ou intruso; território como potência de vida. O internato contribuiu para aprimorar visões clínicas centradas nas necessidades dos usuários, sendo necessários estudos adicionais para avaliar a incorporação efetiva destas competências à prática profissional.


Abstract In Brazil, the mismatch between medical education and care needs in primary health care, especially for the most vulnerable populations, required changes in the National Curriculum Guidelines of the Medical School, with an increased workload of the internship in PHC. This work is exploratory, qualitative research, which investigated documents of the formative evaluation of the Integrated Internship in Family and Community Medicine and Mental Health of the Federal University of Rio de Janeiro, which serves vulnerable populations in the city of Rio de Janeiro. The documents produced by 55 students were analyzed, and dialectical hermeneutics was used as a method of analysis. The investigation showed different levels of sensitivity to social distress experienced by users of Family Clinics during the 22 weeks of internship. The narratives were grouped into five axes: highlighting the Medicine-society split; extreme vulnerability and health; daily structural violence and health; health service as a resource or intruder; territory as the power of life. The internship contributed to improve clinical views focused on users' needs, and further studies are required to evaluate the effective incorporation of these competencies into professional practice.


Asunto(s)
Humanos , Atención Primaria de Salud , Condiciones Sociales , Medicina Comunitaria , Medicina Familiar y Comunitaria , Distrés Psicológico , Internado y Residencia , Investigación Cualitativa , Poblaciones Vulnerables , Hermenéutica , Exposición a la Violencia/psicología , Visita Domiciliaria
16.
Int J Qual Stud Health Well-being ; 15(1): 1734166, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-32116141

RESUMEN

Purpose: Spouses are in a vulnerable situation when caring for a frail partner late in life. Exploring their existential loneliness can be a way to understand more about their existential needs.Method: A hermeneutic approach was used. Multistage focus group interviews were conducted with two groups consisting of five spouses, respectively, who met three times each. To work with the text, an approach was adapted where quotations are converted into poems in a linguistic manner.Results: Existential loneliness can be understood as the following: 1) being in a transition from us to merely me, 2) being forced to make decisions and feeling excluded, 3) navigating in an unfamiliar situation and questioning oneself, and 4) longing for togetherness but lacking the energy to encounter other people. The main interpretation is that existential loneliness emerges when one is in moments of inner struggle, when one is forced to make impossible choices, when one is approaching and is in limit situations, and when one is experiencing the endless loss of the other.Conclusion: For health care professionals to achieve a holistic picture, person-centeredness can be a way to make the spouses' existential needs visible and to provide support based on their needs.


Asunto(s)
Cuidadores/psicología , Anciano Frágil , Hermenéutica , Soledad , Esposos/psicología , Anciano , Anciano de 80 o más Años , Existencialismo , Femenino , Grupos Focales , Humanos , Masculino
17.
Int J Qual Stud Health Well-being ; 15(1): 1736769, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-32156205

RESUMEN

Background: In-depth understanding of the experiences of both well-being and suffering in relation to being severely obese and becoming active through lifestyle intervention is lacking.Aim: to explore and describe adults' existential experiences of being active, when living within a large body-before and during a lifestyle intervention.Methods: A longitudinal design of repeated individual interviews with 16 adults with BMI ≥40, based on hermeneutic phenomenology, existential philosophy and a theory of well-being was performed. The study was approved by the Danish health authorities.Results: Two dimensions of experiences were found; "Living within a downward spiral" and "Striving for enjoyment and settlement". The themes describing suffering were: 'Sense of being thwarted and defeated ' and "Tackling energy depletion and impact of sense of self". The themes describing well-being were: "Hoping for renewal and energised resoluteness" and "Enduring discomfort and feeling safe".Conclusions: Interacting existential experiences can be facilitators or barriers for physical activity. It seems relevant for health care providers to address the individual's lifeworld experiences of well-being, lack of well-being and suffering. Well-being as a sense of feeling "at home" when physically active may break down an inactivity spiral. Promoting well-being is a legitimate aim of lifestyle intervention.


Asunto(s)
Ejercicio Físico/psicología , Existencialismo , Estilo de Vida , Obesidad Mórbida/psicología , Estrés Psicológico , Adaptación Psicológica , Adulto , Anciano , Dinamarca/epidemiología , Femenino , Hermenéutica , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad
18.
Schizophr Bull ; 46(3): 455-457, 2020 04 10.
Artículo en Inglés | MEDLINE | ID: mdl-32077953
19.
Int J Qual Stud Health Well-being ; 15(1): 1726559, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-32049605

RESUMEN

In Sweden, according to law, adolescents with extensive psychosocial problems, substance abuse or criminal behaviour can be cared for in institutions. The two-fold aim of these institutions (to rehabilitate and incarcerate) puts special demands to their socio-spatial context.Purpose: To elucidate adolescents' lived experiences of the socio-spatial environment at special youth homes run by the Swedish National Board of Institutional Care (SiS) in Sweden.Methods: Data collected through Photovoice and analysed employing a phenomenological hermeneutical method. Fourteen adolescents (age 15-19) were asked to photograph their environment, and this was followed up by in-depth interviews.Results: Two themes emerged from the material: the dense walls of institutional life and create and capture the caring space. The socio-spatial environment can be seen as an additional "other" that distances the adolescents and the staff from one another. Negotiating with their behaviour, the adolescents strive to present themselves as worthy of increased degrees of freedom and ultimately access to the desired outside life.Conclusions: In an institutional setting dominated by a security and criminal justice logic, words appear to have less impact than the environment. The adolescents appear to understand themselves through the socio-spatial other, causing reinforced feelings of social exclusion.


Asunto(s)
Adolescente Institucionalizado/psicología , Emociones , Relaciones Interpersonales , Internamiento Involuntario , Medio Social , Adolescente , Femenino , Hermenéutica , Humanos , Masculino , Fotograbar , Suecia , Adulto Joven
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