Conocimiento y cumplimiento del cuidado de catéteres centrales en un Hospital Mexicano / Conhecimento e cumprimento dos cuidados de saúde relacionados ao cateter venoso central em um hospital do México / Knowledge and Compliance regarding Central Venous Catheter (CVC) Care in a Mexican Hospital

Introducción: El uso de catéteres intravasculares constituye una herramienta fundamental para el cuidado de los pacientes, mismos que han sido asociados a las bacteriemias nosocomiales entre un 15 y 30%. El objetivo de estudio fue determinar el nivel de conocimiento y cumplimiento del personal de enfermería respecto al protocolo de cuidados de accesos vasculares centrales. Materiales y Métodos: Estudio descriptivo, transversal, observacional, que incluyó a 67 profesionales de enfermería que tuvieron a su cuidado pacientes con catéter venoso central. Para la recolección de datos se utilizaron dos instrumentos diseñados a partir del protocolo de cuidados emitido por la Comisión Permanente de Enfermería. Resultados: Se encontró personal con antigüedad laboral promedio de 7.9 años. En conocimiento el 58.2% se ubicó en categoría Conoce, en contraste con el cumplimiento resultando el 91% del personal en categoría Cumple. No hubo correlación entre conocimiento y cumplimiento (rho = -0.181, p = 0.797). Discusión: El cumplimiento contrastó con el conocimiento, sin embargo, los enunciados para ambas variables se relacionaron con la falta de lavado de manos, dejar el tiempo adecuado de los antisépticos y la desinfección de lúmenes a la hora de la manipulación. Conclusiones: La falta de conocimiento y cumplimiento de elementos del protocolo se relacionan directamente con situaciones procedimentales que realiza el profesional de enfermería, por lo que la falta de material e insumos no son factores para no seguir la estandarización del cuidado.

Introduction: The use of intravascular catheters is essential for patient care, which has been also associated with nosocomial bacteremia developed in 15 to 30% of cases. This study is aimed to determine the level of knowledge and compliance among nurses on the guidelines for central venous access care. Materials and Methods: A descriptive cross-sectional observational study was conducted with 67 nursing professionals caring for patients with central venous catheters. Two instruments based on the guidelines for CVC management developed by the Permanent Nurses' Committee were used for data collection. Results: The average length of employment was 7.9 years in nurses. 58.2% were classified as knowledgeable in the Knowledge category compared to 91% classified as compliant in the Compliance category. No correlation was found between knowledge and compliance (rho = -0.181, p = 0.797). Discussion: Compliance ranked in contrast to knowledge. However, the statements for both variables were related to lack of handwashing, adequate antiseptic time and catheter lumen disinfection during handling. Conclusions: The lack of knowledge and compliance with guidelines is directly related to procedural situations performed by nurses, which is why the lack of resources and supplies is not a factor in failing to follow care standardization

Introdução: O uso de cateteres intravasculares é fundamental para o cuidado dos pacientes, os qual também têm sido associados às infecções nosocomiais em 15 a 30% dos casos. O objetivo deste estudo é determinar o nível de conhecimento e o cumprimento dos enfermeiros em relação ao protocolo de cuidado dos cateteres venosos centrais. Materiais e métodos: Um estudo descritivo, transversal e observação foi realizado com 67 enfermeiros que cuidaram de pacientes com cateteres venosos centrais. Dois instrumentos elaborados a partir do protocolo de cuidado da Comissão Permanente de Enfermagem foram utilizados para a coleta de dados. Resultados: O tempo médio de assistência dos enfermeiros foi de 7,9 anos. 58,2% foram classificados como conhecedores na categoria Conhecimento em comparação com 91% classificados como cumpridores na categoria Cumprimento. Não se encontrou correlação entre conhecimento e cumprimento (rho = -0,181, p = 0,797). Discussão: O cumprimento foi superior em contraste com o conhecimento. Entretanto, as observações para ambas as variáveis estavam relacionadas à falta de lavagem das mãos, tempo suficiente para a antissepsia e desinfecção do lúmen do cateter durante sua manipulação. Conclusões: A falta de conhecimento e o cumprimento das os elementos do protocolo estão diretamente relacionados às situações procedimentais realizadas pelos enfermeiros, portanto, a falta de recursos e suprimentos não é um fator determinante para não seguir a padronização dos cuidados.

The complete mitochondrial and plastid genomes of the invasive marine red alga Caulacanthus okamurae (Caulacanthaceae, Rhodophyta) from Moss Landing, California, USA.

Caulacanthus okamurae is an invasive red alga that forms extensive mats in sheltered marine habitats around the world. To determine its genomic structure and genetic relationship to native and other non-native populations of C. okamurae, high-throughput sequencing analysis was performed on an introduced specimen from Bennett Slough, Moss Landing, California, USA. Assembly of 23,146,595 filtered 150 bp paired-end Illumina sequencing reads yielded its complete mitogenome (GenBank accession MT193839) and plastid genome (GenBank accession MT193838). The mitogenome is 25,995 bp in length and contains 50 genes. The plastid genome is 173,516 bp and contains 234 genes. Comparison of the organellar chromosomes to other Gigartinales revealed a high-level of gene synteny. BLAST analysis of marker sequences (rbcL, cox1, cox2) of C. okamurae from Moss Landing identified four identical DNA sequences: one from a specimen from a native population of C. okamurae from South Korea and three from specimens representing invasive populations from France, Spain, and the USA. These genetic results confirm the presence of C. okamurae in central California, USA, and represent the first complete mitogenome and plastid genome from the Caulacanthaceae.

La trayectoria de cuidado del paciente en hemodiálisis: de la noticia inesperada al desenlace final / The trajectory of patient care in hemodialysis: From the unexpected news to the final outcome

Introducción: Las complicaciones de la enfermedad renal crónica y su tratamiento degeneran el estado de salud del paciente condicionando su dependencia en el autocuidado de su salud, lo que desencadena la necesidad de cuidado de otra persona, por lo que, desde el momento en que el paciente y su familia reciben el diagnóstico y la noticia del tratamiento, llevan a cabo un proceso que los llevará a afrontar la nueva situación que se les presenta. Objetivos: Describir las vivencias de las cuidadoras de pacientes en hemodiálisis, para generar estrategias e intervenciones de enfermería derivadas de sus necesidades de apoyo. Material y Método: Investigación cualitativa, mediante el empleo de la teoría fundamentada, la recolección de información fue mediante la entrevista en profundidad de tipo semiestructurada y la observación participante. Resultados: La trayectoria de cuidado que experimenta el cuidador primario del paciente en hemodiálisis atraviesa por tres etapas: el inicio, donde a través de la noticia inesperada se convierte en cuidador y experimenta una serie de cambios que envuelven su vida personal, familiar y social. Una etapa intermedia, en donde lleva a cabo un proceso de adaptación y da significado al cuidado que brinda a su familiar y una etapa final, en donde enfrenta diferentes tipos de duelo. Conclusión: El aceptar la situación, asumir su rol de cuidadoras, el tiempo y la creencia en un ser superior fueron los recursos de donde obtuvieron la fortaleza para afrontar los procesos por lo que pasaran en cada una de las etapas de la trayectoria de cuidado

Introduction: Complications of chronic kidney disease and treatment degenerate the patient's state of health, conditioning independence in health self-care. Situation that triggers the need for care of another person. From the moment that the patient and the family receive the diagnosis and the news of the treatment, they carry out a process that will lead them to face the new situation that is presented. Objectives: To describe the caregivers' experience in hemodialysis patients, to generate strategies and nursing interventions derived from their support needs. Material and Method: Qualitative research, using grounded theory, the collection of information was carried out through an in-depth semi-structured interview and participant observation. Results: The care path experienced by the primary caregiver of the hemodialysis patient goes through three stages: the first stage, after the unexpected news becomes a caregiver and experiences a series of changes that involve the personal, family and social sphere. An intermediate stage, in which there is a process of adaptation and gives meaning to the care provided to your family member; and a final stage, where different types of grief are faced. Conclusions: Accepting the situation, assuming the role of caregivers, time and belief in a superior being were the resources from which they obtained the got the strength to face the processes that they will go through in each of the stages of the care path

Nuclear and plastid DNA phylogeny of tribe Cardueae (Compositae) with Hyb-Seq data: A new subtribal classification and a temporal diversification framework.

Classification of tribe Cardueae in natural subtribes has always been a challenge due to the lack of support of some critical branches in previous phylogenies based on traditional Sanger markers. With the aim to propose a new subtribal delimitation, we applied a Hyb-Seq approach to a set of 76 Cardueae species representing all subtribes and informal groups defined in the tribe, targeting 1061 nuclear conserved orthology loci (COS) designed for Compositae and obtaining chloroplast coding regions as by-product of off-target reads. For the extraction of the target nuclear data, we used two strategies, PHYLUCE and HybPiper, and 776 and 1055 COS loci were recovered with each of them, respectively. Additionally, 87 chloroplast genes were assembled and annotated. With three datasets, phylogenetic relationships were reconstructed using both concatenation and coalescent approaches. Phylogenetic analyses of the nuclear datasets fully resolved virtually all nodes with very high support. Nuclear and plastid tree topologies are mostly congruent with a very limited number of incongruent nodes. Based on the well-solved phylogenies obtained, we propose a new taxonomic scheme of 12 monophyletic and morphologically consistent subtribes: Carlininae, Cardopatiinae, Echinopsinae, Dipterocominae (new), Xerantheminae (new), Berardiinae (new), Staehelininae (new), Onopordinae (new), Carduinae (redelimited), Arctiinae (new), Saussureinae (new), and Centaureinae. In addition, we further updated the temporal framework for origin and diversification of these subtribes. Our results highlight the power of Hyb-Seq over Sanger sequencing of a few DNA markers in solving phylogenetic relationships of traditionally difficult groups.

Effectiveness of the Epley manoeuvre in posterior canal benign paroxysmal positional vertigo: a randomised clinical trial in primary care.

BACKGROUND: Evidence on the effectiveness of the Epley manoeuvre in primary care is scarce. AIM: To evaluate effectiveness at 1 week, 1 month, and 1 year of a single Epley manoeuvre versus a sham manoeuvre in primary care. DESIGN AND SETTING: Multicentre, double-blind randomised controlled trial in two primary care practices in Spain from November 2012 to January 2015. METHOD: Patients were ≥18 years diagnosed with subjective or objective posterior benign paroxysmal positional vertigo (vertigo only, or vertigo and nystagmus after a Dix-Hallpike test [DHT]). The intervention group received the Epley manoeuvre, and the control group received a sham manoeuvre. Betahistine was prescribed following the same regimen in both groups. The main outcome measures were the DHT result classified as negative (neither vertigo nor nystagmus) or positive. Positive results were further divided into a positive result for both vertigo and nystagmus (positive DHT with nystagmus), and a positive result for vertigo only (positive DHT without nystagmus); self-reported resolution of vertigo; and self-reported severity of vertigo evaluated on a 10-point Likert scale (10 = worst imaginable vertigo). RESULTS: In total, 134 patients were randomised to either the intervention group (n = 66) or the sham group (n = 68). The intervention group showed better results in the unadjusted analyses at 1 week, with a lower rate of positive DHT with nystagmus (P = 0.022). A positive baseline DHT with nystagmus was associated with a reduction in vertigo severity (marginal effect for 10-point Likert-like question -1.73, 95% confidence interval [CI] = -2.95 to -0.51) and better positive DHT rates in the intervention group (adjusted odds ratio 0.09, 95% CI = 0.01 to 0.92) in the multivariate analyses. CONCLUSION: A single Epley manoeuvre performed in primary care is an effective treatment for reversing a positive DHT and reducing vertigo severity in patients with baseline nystagmus in the DHT.

Apoyo educativo y patrón de vida en el paciente con tratamiento de hemodiálisis / Educational support and pattern-of-life in the patient treated with hemodialysis

Introducción: Actualmente el número creciente de personas en tratamiento de hemodiálisis aunado al incremento de incidencia de complicaciones agudas, pone de manifiesto implementar estrategias que favorezcan conductas o hábitos saludables disminuyendo las consecuencias personales, familiares y gastos institucionales. Objetivos: Determinar la influencia del apoyo educativo de enfermería en el patrón de vida del paciente con insuficiencia renal crónica en tratamiento de hemodiálisis. Metodología: Estudio pre-experimental donde participaron 22 pacientes en hemodiálisis, se diseñó y ejecutó un programa educativo bajo el referente teórico de Orem con enfoque en tres dimensiones: Responsabilidad en Salud, Alimentación e Higiene, consistió en diez sesiones de media hora dos veces por semana durante la primera hora de tratamiento del paciente. Resultados: Edad promedio de 36.4 ± 16.7 años, con igual distribución tanto para hombres como mujeres (n=11); el 68.1% (n=15) de los pacientes son económicamente activos, reportando un tiempo promedio de 20.6 ± 15.6 meses de tratamiento en hemodiálisis. Se obtuvo un valor de mediana en la fase de pre-intervención de 92 y, de 107.5 en la fase post-intervención. Con una diferencia estadísticamente significativa entre ambas de p<0.001. Conclusión: El 100% de los sujetos mantiene un patrón de vida protector, lo que sugiere que el Apoyo Educativo de Enfermería aumenta el patrón de vida del paciente con tratamiento de hemodiálisis. Lo que hace trascendente el papel de enfermería en la promoción de conductas generadoras de salud (AU)

Introduction: The increase in the number of persons in hemodialysis treatment, together with the greater incidence of acute complications, illustrate the necessity of designing strategies that emphasize the promotion of health-generating behavior in these patients, reducing the consequences personal, family and institutional costs. Aims: To determine the influence of educational support provided by the nursing professional on the pattern-of-life of the patient with hemodialysis treatment. Methodology: A pre-experimental study was conducted on 22 patients undergoing hemodialysis treatment. An educational program based on the Orem theoretical reference was designed and put into practice, concentrating on three aspects: responsibility in relation to health, hygiene, and diet. The program consisted of a total of ten half-hour sessions, each one given twice a week for a period of five weeks during the patient’s first hour of hemodialysis treatment. Results: The mean age of the patients was 36.4 ± 16.7 years. A total of 68.1% (n=15) of the patients were economically active, and the mean time of the patient in the hemodialysis treatment program was 20.6 ± 15.6 months. The median questionnaire score was 92 in the pre-intervention phase and 107.5 in the post-intervention phase. With a statistically significant difference of p<0.001. Conclusion: One hundred percent of the subjects maintained a protective pattern-of-life, suggesting that educational support provided by the nursing professional increased the pattern-of-life score of the patients treated with hemodialysis (AU)

Validation of an instrument to measure tutor performance in promoting self-directed learning by using confirmatory factor analysis / Validación de un instrumento para medir el desempeño de los tutores en la promoción del aprendizaje autodirigido usando análisis factorial confirmatorio / Validação de um instrumento para medir o desempenho dos tutores na promoção da aprendizagem autodirigido usando análise fatorial confirmatório

Objective.This work sought to validate and propose an instrument to measure the performance of tutors in promoting self-directed learning in students involved in processes of problem-based learning. Methods. Confirmatory factor analysis (CFA) was applied to validate the instrument composed of 60 items and six factors (self-assessment of learning gaps within the United Nations specific context: self-assessment, reflexion, critical thinking, administration of information, group skills), using a sample of 207 students from a total of 279, which comprise the student population of the Faculty of Nursing at Universidad de Colima in Mexico. (2007). Results. The CFA results demonstrated that the instrument is acceptable to measure performance of tutors in promoting self-directed learning, given that all the indicators, variances, covariances, and thresholds are statistically significant. Conclusion. The instrument permits obtaining students' opinions on how much professors contribute for them to develop each of the 60 skills described in the scale. Lastly, the results could report if professors are placing more emphasis in some areas than in other areas they should address during the problem-based learning (PBL) process, or if definitely their actions are removed from the premises of PBL, information that will be useful for school management in decision making on the direction of teaching as a whole.

Objetivo.Validar y proponer un instrumento que mide el desempeño de los tutores en la promoción del aprendizaje autodirigido en los estudiantes involucrados en procesos de ABP. Métodos. Se aplicó el Análisis Factorial Confirmatorio (AFC) para validar el instrumento compuesto por 60 ítems y seis factores (Autoevaluación de las Brechas de Aprendizaje dentro de las Naciones Unidas Contexto Especifico: Autoevaluación, Reflexión, Pensamiento Crítico, Administración de la Información, Habilidades de Grupo), utilizando una muestra de 207 estudiantes de un total de 279, que conforman la población estudiantil de la Facultad de Enfermería de la Universidad de Colima, México. (2007). Resultados. Los resultados del AFC demostraron que el instrumento es aceptable para medir el desempeño de los tutores en la promoción del aprendizaje autodirigido ya que todos los indicadores, las varianzas, covarianzas y thresholds son estadísticamente significativos. Conclusión. El instrumento permite obtener la opinión de los estudiantes sobre cuánto el profesor contribuye para que ellos desarrollen cada una de las 60 habilidades descritas en la escala. Al final, los resultados podrían informar si el profesor está haciendo más énfasis en una área que debe atender durante el proceso del ABP o en otra, o si definitivamente su actuación se aleja de las premisas del ABP, información que será útil para la administración escolar en la toma de decisiones sobre el rumbo de la docencia en su conjunto.

Objetivo.Validar e propor um instrumento que meça o desempenho dos tutores na promoção da aprendizagem autodirigido nos estudantes envolvidos em processos de ABP. Métodos. Se aplicou uma Análise Fatorial Confirmatório (AFC) para validar o instrumento composto por 60 itens e seis fatores (Auto-avaliação das Brechas de Aprendizagem dentro das Nações Unidas Contexto Especifico: Auto-avaliação, Reflexão, Pensamento Crítico, Administração da Informação, habilidades de Grupo), utilizando uma amostra de 207 estudantes de um total de 279, que conformam a população estudantil da Faculdade de Enfermagem da Universidad de Colima, México. (2007). Resultados. Os resultados do AFC demostraram que o instrumento é aceitável para medir o desempenho dos tutores na promoção da aprendizagem autodirigido já que todos os indicadores, as variâncias, covariâncias e thresholds são estatisticamente significativos. Conclusão. O instrumento permite obter a opinião dos estudantes sobre quanto o professor contribui para que eles desenvolvam cada uma das 60 habilidades descritas na escala. Ao final, os resultados poderiam informar se o professor está fazendo mais ênfase em uma do que em outras das áreas que deve atender durante o processo do ABP, ou se definitivamente sua atuação se afasta e as premissas do ABP, informação que será útil para a administração escolar na toma de decisões sobre o rumo da docência em seu conjunto.

Validation of an instrument to measure tutor performance in promoting self-directed learning by using confirmatory factor analysis.

OBJECTIVE: This work sought to validate and propose an instrument to measure the performance of tutors in promoting self-directed learning in students involved in processes of problem-based learning. METHODS: Confirmatory factor analysis (CFA) was applied to validate the instrument composed of 60 items and six factors (self-assessment of learning gaps within the United Nations specific context: self-assessment, reflexion, critical thinking, administration of information, group skills), using a sample of 207 students from a total of 279, which comprise the student population of the Faculty of Nursing at Universidad de Colima in Mexico. (2007). RESULTS: The CFA results demonstrated that the instrument is acceptable to measure performance of tutors in promoting self-directed learning, given that all the indicators, variances, covariances, and thresholds are statistically significant. CONCLUSION: The instrument permits obtaining students' opinions on how much professors contribute for them to develop each of the 60 skills described in the scale. Lastly, the results could report if professors are placing more emphasis in some areas than in other areas they should address during the problem-based learning (PBL) process, or if definitely their actions are removed from the premises of PBL, information that will be useful for school management in decision making on the direction of teaching as a whole.

Mirada del estudiante de enfermería sobre el aprendizaje y la aplicación del proceso de atención de enfermería / Nursing students’ view on learning and implementing the nursing process

Resumen:

Introducción: el proceso de atención de enfermería (PAE) es una herramienta para sistematizar y evaluar el cuidado a la persona; por ello, es imprescindible que durante el proceso formativo de los estudiantes de licenciatura de enfermería se promueva el desarrollo de competencias intelectuales, técnicas y relaciónales que les permitan la buena práctica de dicha herramienta. Objetivo: analizar los factores que favorecen o limitan el aprendizaje y la práctica del PAE a los estudiantes de licenciatura de enfermería.

Metodología: se realizó un abordaje mixto en dos fases: la fase cuantitativa descriptiva incluyó a 235 estudiantes de licenciatura en enfermería, procedentes de dos instituciones educativas; para esta, se estructuró una encuesta para la recolección de los datos. En la fase cualitativa se trabajó con dos grupos focales, cada grupo de siete estudiantes por institución educativa. Resultados: más del 50 % de los estudiantes tienen conocimientos de promoción de la salud, comunicación y teorías y modelos, entre otros aspectos. Consideran que una limitante es el tiempo que se dedica para realizar esas actividades y que saber utilizar las taxonomías les facilitó hacerlo. Al respecto, los estudiantes de los grupos focales coinciden al opinar que los profesores proporcionaron herramientas para realizar el proceso de enfermería; sin embargo, una limitante fue la metodología de enseñanza y los criterios de evaluación empleados por los profesores. Conclusión: se debe mejorar en el proceso educativo en cuanto a enseñanza y evaluación.

Abstract:

Introduction: Nursing Process (NP) is a tool to systematize and evaluate care to the individual, so it is essential that during the learning process of undergraduate nursing students the development of intellectual, technical and relationship skills is promoted to allow the good practice of this tool. Objective: To analyze the factors that favor or hinder learning and practicing of NP for undergraduate nursing students.

Methods: A mixed approach was conducted in two phases, descriptive quantitative phase included 235 undergraduate nursing students from two educational institutions; a survey for data collection was structured. In the qualitative phase, the work was developed with two focus groups, each group of seven students per school.

Results: More than 50 % of students have knowledge of health promotion, communication and theories and models, among others. They consider that a limitation is the time spent to do it, to know how to use taxonomies made easier for them to develop NP. In this regard, students in the focus groups agree to review that teachers provided tools to perform the nursing process; however, a limitation was teaching methodology and evaluation criteria used by teachers. Conclusion: Although the results with the two approaches are similar, it should be considered improvements in the educational process in regard to the teaching and assessment.

La relación de ayuda en el campo de la enseñanza - aprendizaje / A relação de ajuda área de ensino e aprendizagem / The aid relationship in the of teaching and learning

A través de un análisis retrospectivo acerca de las características educativas de la enseñanza de enfermería, se plantea una reflexión acerca del tipo de aprendizaje promovido desde una práctica docente universitaria ad hoc y cómo ello ha influido en la formación de enfermería. Se esbozan algunos planteamientos sobre el cambio de mentalidad que ha estado ocurriendo dentro de las escuelas de enfermería, mediante la promoción de nuevas formas de enseñar y de aprender, que dan valor al protagonismo del estudiante, con el fin de lograr su desarrollo integral. Se plantea la construcción del aprendizaje facilitado a través de la relación de ayuda, concepción ética y creativa del proceso de construcción del conocimiento profesional (AU)

Through a retrospective analysis on the educational characteristics of nursing education, there is a reflection on the type of learning promoted from an ad hoc university teaching practice and how it has influenced nursing education. It outlines some perspectives about change in mentality that has been occurring in nursing schools, by promoting new forms of teaching and learning, from which value the role of the student in order to achieve their full development. It proposes the construction of facilitated learning through the aid relationship, ethical and creative design of the constructive process of professional knowledge (AU)

Através de uma análise retrospectiva sobre as características educacionais de ensino de enfermagem, propõe-se uma reflexão sobre o tipo de aprendizagem promovido desde uma prática docente universitária ad hoc e comoisso tem influenciado o ensino da enfermagem. Descreve-se algumas perspectivas sobrea mudança de mentalidade que vem ocorrendo nas escolas de enfermagem, promovendo novas formas de ensino e aprendizagem, que valorizam o papel do aluno, a fim de alcançar o seu pleno desenvolvimento. Propõe-se aconstrução de aprendizagem facilitado através da relação de ajuda, concepção ética e criativado processo de construção do conhecimento profissional (AU)

Aplicabilidad de los criterios de rigor y éticos en la investigación cualitativa / Applicability of the Criteria of Rigor and Ethics in Qualitative Research / Aplicabilidade dos critérios de rigor e éticos na pesquisa qualitativa

Este trabajo tiene como propósito realizar una reflexión acerca de cómo garantizar la calidad de un estudio cualitativo. Se destacan como conceptos básicos los criterios de rigor y los aspectos éticos que necesitan ser considerados en el desarrollo de una investigación bajo este paradigma. A su vez, se describen la fiabilidad y la validez, y los respectivos criterios que permiten su verificación. También, se detallan aquellos componentes éticos que requieren ser vigilados en el proceso de la investigación y que contribuyen a que exista un cuidado riguroso de la calidad y el rigor científico. En conclusión, el artículo resalta como pilares fundamentales los criterios de rigor y éticos, y su respectiva vinculación, para la evaluación de estudios que busquen explorar aspectos subjetivos de naturaleza humana.

The purpose of this paper is to reflect on how to guarantee quality in a qualitative study. The criteria of rigor and ethics that need to be considered in research pursuant to this model are highlighted as basic concepts. Reliability and validity, and the respective criteria that allow for their verification, also are described. Details are provided on some of the ethical elements that require careful oversight during the research process and contribute to quality and scientific rigor. In conclusion, the article cites the criteria of rigor and ethics, and their respective interrelationship, as fundamental pillars in evaluating research intended to explore subjective aspects of human nature.

Este trabalho tem como propósito realizar uma reflexão sobre como garantir a qualidade de um estudo qualitativo. Destacam-se como conceitos básicos os critérios de rigor e os aspectos éticos que precisam ser considerados no desenvolvimento de uma pesquisa sob este paradigma. Ao mesmo tempo, descrevem-se a fiabilidade e a validade, bem como os respectivos critérios que permitem sua verificação. Também se detalham aqueles componentes éticos que requerem ser controlados no processo da pesquisa e que contribuem para que exista um cuidado rigoroso da qualidade e do rigor científico. Em conclusão, o artigo ressalta como pilares fundamentais os critérios de rigor e éticos, e sua respectiva vinculação para a avaliação dos estudos que buscam explorar aspectos subjetivos de natureza humana.

El papel de los tutores en la auto-dirección del aprendizaje de los estudiantes de Enfermería / The role of tutors in self-directing the learning of the students of nursing

Introducción: El Método de Aprendizaje Basado en Problemas se fundamenta en las teorías constructivistasdel aprendizaje, en los principios del aprendizaje de los adultos y en el desarrollo de modelos andragógicos.Tiene el propósito de ayudar a los estudiantes a desarrollar habilidades para dirigir su propio aprendizaje.Objetivo: Analizar el papel de los profesores en su rol de facilitadores del aprendizaje autodirigido de los estudiantes de Licenciatura en Enfermería de la Universidad de Colima, México. Metodología: Estudiodescriptivo y transversal; se utilizó una muestra por conveniencia de 121 estudiantes. Para evaluar si los profesores facilitan la formación de habilidades,se diseñó un instrumento tipo inventario con 20 reactivos, los cuales fueron integrados en tres áreas: administración de la información, proceso de grupo, reflexión y pensamiento crítico. Por medio del alpha de Cronbach se obtuvo una confiabilidad de 0.96. Resultados: Al aplicar la prueba Kruskal-Wallis se encontraron diferencias estadísticamente significativas sólo para la dimensión “Proceso de grupo” entre los grupos de 4º y 6º semestres (H = 6.77; P < 0.05). Sin embargo, aunque en las otras dimensiones no se encontraron diferencias estadísticamente significativas, sí se logra identificar cambios en la tendencia de la opinión de los estudiantes hacia el rol de los tutores. Conclusiones: La evaluación sobre las tareas del tutor es favorable; los estudiantes afirman que “casi siempre” facilita, ayuda, promueve o colabora en el desarrollo de las habilidades que les permitirán ser estudiantes autodirigidos

Problem-Based Learning method is based on constructivist theories of learning, the principles of adult learning and the development of andragogical models. Its objective is to help students develop skills to direct their own learning. Objective: to analyse the role of professors of the bachelor’s degree in nursing as facilitators of self-directed learning Licenciatura in nursing of the University of Colima Mexico. Methodology: with the use of a descriptive survey integrated with 20 items answered by 121 students, we assessed the role of the professors of a bachelor’s degree in nursing. The 20 items assessed three areas of the facilitation process: Management of information, group process and reflection and critical thinking. These items were verified with Cronbach’s alpha and a reliability of 0.96. Results: when the Kruskal-Wallis survey was conducted, statistically significant differences were found only with regard to the “Group processing” dimension among sophomores and juniors (H = 6.77; P < 0.05). Even though no statistically significant differences were found with regard to the other dimensions, it is possible to detect shifts in the students’ opinion trend about the role of tutors. Conclusion: The overall average score per scale makes it possible to conclude that the “the work of the tutor” is viewed favourably, considering that the students report that their tutor “almost always” facilitates, assists, promotes or collaborates on the development of the skills for being a self directed learner

Multiple antibiotic-resistance mechanisms including a novel combination of extended-spectrum beta-lactamases in a Klebsiella pneumoniae clinical strain isolated in Argentina.

Klebsiella pneumoniae M1803, isolated from a paediatric patient with chronic urinary infection, presented nine antimicrobial resistance mechanisms harboured on two conjugative megaplasmids, in addition to the chromosomally mediated SHV-1 beta-lactamase. These nine antimicrobial resistance mechanisms comprised two extended-spectrum beta-lactamases (ESBLs) (PER-2 and CTX-M-2), TEM-1-like, OXA-9-like, AAC(3)-IIa, AAC(6')-Ib, ANT(3")-Ia and resistance determinants to tetracycline and chloramphenicol. During fluoroquinolone treatment, a variant derived from M1803 (named M1826) was selected, with an overall increase of MICs, in particular of cefoxitin and carbapenems. No enzymic activity against these latter drugs was found. Mutations in the region analogous to the quinolone resistance-determining region were not found. Strain M1826 was deficient in OmpK35/36 expression, which produced the decrease in the susceptibility to cefoxitin, carbapenems and fluoroquinolones. The blaCTX-M-2 gene was located in an unusual class 1 integron, which includes Orf513, as occurred in the recently described In35. In addition, Tn3 and Tn1331 were detected in both K. pneumoniae isolates. This is the first report of in vivo selection of an OmpK35/36 deficiency in a K. pneumoniae strain that produced a novel combination of two ESBLs (CTX-M-2 and PER-2) during fluoroquinolone treatment in a paediatric patient with chronic urinary infection.