Elementos facilitadores y limitadores del cambio en la atención a los familiares del paciente crítico / Limiting and facilitating factors of changes in the care of families of the critically ill patient

Introducción En una unidad de cuidados intensivos (UCI), se llevó a cabo una investigación-acción participativa (IAP), cuyo objetivo general era promover el cambio de práctica clínica para mejorar los cuidados ofertados a los familiares del paciente crítico. Como resultado de este proceso se implantaron cuatro iniciativas de cambio. Además, uno de los objetivos específicos era explorar cómo el contexto de esta unidad limitaba y facilitaba el cambio. Este artículo presenta los hallazgos derivados de este objetivo. Material y métodos Metodología cualitativa. Diseño IAP. Técnicas de recogida de datos11 grupos de discusión con profesionales, 5 entrevistas en profundidad a profesionales, diarios de campo de los participantes y diario de campo de la investigadora principal. Participaron 11 profesionales en los grupos de discusión (cada uno trasmitía las aportaciones de 3-5 compañeros), 5 profesionales en las entrevistas, 11 profesionales llevaron a cabo diario de campo. Se realizó análisis de contenido. Resultados Los aspectos que limitan el cambio son: 1) no reconocer la legitimidad de la evidencia científica acerca de los familiares del paciente crítico; 2) relaciones de poder desequilibradas en el equipo multidisciplinar; 3) falta de participación de las enfermeras en los flujos de información; 4) organización del tiempo y del espacio de la unidad. Los que lo facilitan: 1) el compromiso individual y el compromiso compartido; 2) el liderazgo en lo cotidiano; 3) el proceso reflexivo. Conclusiones Un proceso de IAP puede conducir el cambio en la práctica clínica, aunque este es complejo y requiere de una alta inversión de energía personal. Los factores contextuales que lo limitan están integrados en la estructura de la unidad, mientras que los facilitadores son coyunturales y dependen de personas individuales. En este sentido, los profesionales a pie de cama tienen capacidad para introducir cambios en su contexto (AU)

Introduction: Participatory action research (PAR) was conducted in an intensive care unit (UCI),with the general purpose of fostering change in clinical practice so as to improve the care offered to families of critically ill patients. As a result of this process, four change-related initiatives were introduced. One specific additional objective was to explore how the unit’s background context limited or facilitated change. This paper presents findings based on this objective. Materials and methods: Qualitative methodology. Design: Participatory-action research (PAR).Data gathering techniques: 11 discussion groups incorporating professionals, 5 in-depth interviews with professionals, field diaries kept by the participants, and field diary kept by the lead researcher. Eleven professionals took part in the discussion groups (each one conveyed information made known to them by 3-5 colleagues), 5 professionals were involved in the interviews, and 11 professionals filled in a field diary. A content analysis was performed. Results: Factors limiting change included: 1) Not acknowledging the legitimacy of scientific evidence regarding the families of critically ill patients; 2) Imbalanced power relationships among the members of multi-disciplinary teams; 3) Nurses’ lack of involvement in informationflow; 4) The organization of time and physical space in the unit. Factors facilitating change: 1)A sense of individual and shared (..) (AU)

[Limiting and facilitating factors of changes in the care of families of the critically ill patient]. / Elementos facilitadores y limitadores del cambio en la atención a los familiares del paciente crítico.

INTRODUCTION: Participatory action research (PAR) was conducted in an intensive care unit (UCI), with the general purpose of fostering change in clinical practice so as to improve the care offered to families of critically ill patients. As a result of this process, four change-related initiatives were introduced. One specific additional objective was to explore how the unit's background context limited or facilitated change. This paper presents findings based on this objective. MATERIALS AND METHODS: Qualitative methodology. DESIGN: Participatory-action research (PAR). DATA GATHERING TECHNIQUES: 11 discussion groups incorporating professionals, 5 in-depth interviews with professionals, field diaries kept by the participants, and field diary kept by the lead researcher. Eleven professionals took part in the discussion groups (each one conveyed information made known to them by 3-5 colleagues), 5 professionals were involved in the interviews, and 11 professionals filled in a field diary. A content analysis was performed. RESULTS: Factors limiting change included: 1) Not acknowledging the legitimacy of scientific evidence regarding the families of critically ill patients; 2) Imbalanced power relationships among the members of multi-disciplinary teams; 3) Nurses' lack of involvement in information flow; 4) The organization of time and physical space in the unit. Factors facilitating change: 1) A sense of individual and shared commitment; 2) Leadership in day-to-day matters; 3) A process based on reflection. CONCLUSIONS: A process of participatory action research can lead to change in clinical practice, although this is complex and requires substantial input in terms of personal energy. Contextual factors limiting this change are related to the actual structure of the unit, while factors facilitating it are circumstantial ones and are dependent upon individual people. In this sense, professionals working at the bedside are capable of introducing changes to the context in which they work.