Nivel de empoderamiento de las personas con insuficiencia cardíaca crónica hospitalizadas / Level of empowerment of hospitalized chronic heart failure patient

Fundamento: Conocer el nivel de empoderamiento de laspersonas con insuficiencia cardiaca crónica hospitalizadas es crucial para identificar a las personas con un nivelde empoderamiento más bajo y fundamentar el diseño deestrategias efectivas para mejorar su control sobre lasdecisiones y acciones que afectan a su salud y bienestar.La falta de estudio de este fenómeno en esta poblacióny contexto, sugiere que estos pacientes no están siendoatendidos adecuadamente. Material y métodos: Estudio descriptivo, prospectivo. Seutilizó el Cuestionario de empoderamiento del pacientecon enfermedad crónica, traducido y validado al español,que consta de 47 ítems, agrupados en tres dimensiones:Actitud positiva y sentido del control, Toma de decisiones compartida e informada, y Búsqueda de informacióny compartir entre iguales. Fue distribuido para su cumplimentación en las 24 horas previas al alta hospitalaria.Resultados: Se recogieron 25 cuestionarios (81%). La puntuación global media de empoderamiento fue de 165,92 ±20,9. La dimensión Actitud positiva y sentido de controlfue la peor puntuada, con una media de 3,4 ± 0,5. Se encontró una relación inversa y débil entre el nivel de em-poderamiento y la edad (rho = -0,240; p = 0,000) y una relación débil y positiva con la supervivencia a los 10 años(rho = 0,316; p = 0,01).Conclusión: El nivel de empoderamiento de los pacientesde este estudio fue medio-alto. Las estrategias para abordar la atención de esta población deberían centrarse entrabajar su actitud respecto a la enfermedad y percepciónde control de la situación e individualizarse conforme ala edad.(AU)

Background: Establishing the level of chronic cardiac inpatient empowerment is essential. By doing so, it is possible to identify groups with a lower level. It also providesa basis for designing effective strategies to improve theircontrol over decision making and the actions that affecttheir health and wellness. The shortage of studies of thisphenomenon for this particular population and contextsuggests that such patients are not receiving proper care. Methods: A prospective and descriptive study was carried out. A validated Spanish version of the Patient empowerment in long-term conditions scale was used. Thesurvey has 47 items, grouped into three dimensions: Positive attitude and feeling of control, Knowledge in shareddecision making, and Seeking information and sharingwith other patients. It was distributed 24 hours beforehospital discharge. Results: Twenty five questionnaires were collected (81%).The mean global empowerment score of the patients was165.92 ± 20.9. The dimension Positive attitude and senseof control showed the lowest score, with a mean of 3.4± 0.5. An inverse weak relationship was found betweenthe level of empowerment and age (rho = -0.240; p = 0.000)while a positive one was found with 10-year survival(rho = 0,316; p = 0.01). Conclusion: The level of empowerment of the patients inthis study was medium-high. The strategies used to address the care of this population should focus on workingon their attitude towards the disease and perceived control of the situation, and should be individualized according to age.(AU)

[Level of empowerment of hospitalized chronic heart failure patient].

BACKGROUND: Establishing the level of chronic cardiac inpatient empowerment is essential. By doing so, it is possible to identify groups with a lower level. It also provides a basis for designing effective strategies to improve their control over decision making and the actions that affect their health and wellness. The shortage of studies of this phenomenon for this particular population and context suggests that such patients are not receiving proper care. METHODS: A prospective and descriptive study was carried out. A validated Spanish version of the Patient empowerment in long-term conditions scale was used. The survey has 47 items, grouped into three dimensions: Positive attitude and feeling of control, Knowledge in shared decision making, and Seeking information and sharing with other patients. It was distrib-uted 24 hours before hospital discharge. RESULTS: Twenty five questionnaires were collected (81%). The mean global empowerment score of the patients was 165.92 ± 20.9. The dimension Positive attitude and sense of control showed the lowest score, with a mean of 3.4 ± 0.5. An inverse weak relationship was found between the level of empowerment and age (rho = -0.240; p = 0.000) while a positive one was found with 10-year survival (rho = 0,316; p = 0.01). CONCLUSION: The level of empowerment of the patients in this study was medium-high. The strategies used to address the care of this population should focus on working on their attitude towards the disease and perceived control of the situation, and should be individualized according to age.

Valoración del dolor en personas con demencia y problemas de comunicación en España. Revisión sistemática / Pain assessment in individuals with dementia and communication problems in Spain. A systematic review

Antecedentes y objetivo: La valoración del dolor en personas con demencia avanzada y problemas de comunicación continúa siendo infradiagnosticada e infratratada debido a la dificultad que conlleva realizar esta valoración. Esta revisión pretende explorar y sintetizar cómo se está valorando el dolor en personas con demencia avanzada y problemas de comunicación en el contexto sanitario español. Materiales y métodos: Revisión sistemática de la literatura siguiendo los criterios PRISMA. Se revisaron las bases de datos Pubmed, Web of Science, Cinahl, Scopus, Dialnet y Cuitatge hasta diciembre de 2017. Cuatro revisores independientes identificaron los estudios que incluían instrumentos para evaluar el dolor en personas con demencia y problemas de comunicación, en el contexto sanitario español. Se realizó una síntesis narrativa de los artículos incluidos. Resultados: Después de aplicar los criterios de inclusión se seleccionaron 10 estudios. De estos 4 fueron estudios metodológicos de validaciones de escalas al español (Abbey, Algoplus, Doloplus y PAINAD-Sp) y uno del desarrollo de la escala original EDAD. Además, se identificaron 3 estudios realizados en España, que utilizaban una traducción de la PAINAD, un estudio que utilizó una traducción al español de la Doloplus2 y una publicación que incluyó el uso en España de una escala no validada para este perfil de pacientes (Pain-VAS). Conclusiones: Actualmente, existen varios instrumentos validados en español para valorar el dolor en personas con demencia avanzada y problemas de comunicación (Abbey, Algoplus, Doloplus y PAINAD-Sp). Aunque aún estos instrumentos no han sido muy utilizados en investigación y las propiedades psicométricas de los mismos pueden mejorar

Background and objective: Pain assessment in individuals with advanced dementia and communication problems continue to be underdiagnosed and undertreated due to the difficulty in performing this assessment. This review explores and synthesises how pain in individuals with advanced dementia and communication problems are being assessed in the context of Spanish healthcare. Materials and methods: A systematic review of the literature was conducted following the PRISMA criteria. We reviewed the databases of PubMed, Web of Science, Cinahl, Scopus, Dialnet and Cuitatge up to December 2017. Four independent reviewers identified studies that included instruments to assess pain in individuals with dementia and communication problems in the Spanish healthcare context. We performed a narrative synthesis of the included articles. Results: After applying the inclusion criteria, 10 studies were included. Of these, 4 were methodological studies validating Spanish versions of scales (Abbey, Algoplus, Doloplus and PAINAD-Sp), and 1 was on the development of the original EDAD scale. We also identified 3 studies conducted in Spain that used a translation of the PAINAD, 1 study that used a Spanish translation of Doloplus2 and 1 publication that included the use in Spain of a scale not validated for this patient profile (Pain-VAS). Conclusions: There are currently several instruments validated in Spanish to assess pain in individuals with advanced dementia and communication problems (Abbey, Algoplus, Doloplus y PAINAD-Sp). However, these instruments have still not been widely used in research, and their psychometric properties could be improved

Pain assessment in individuals with dementia and communication problems in Spain. A systematic review. / Valoración del dolor en personas con demencia y problemas de comunicación en España. Revisión sistemática.

BACKGROUND AND OBJECTIVE: Pain assessment in individuals with advanced dementia and communication problems continue to be underdiagnosed and undertreated due to the difficulty in performing this assessment. This review explores and synthesises how pain in individuals with advanced dementia and communication problems are being assessed in the context of Spanish healthcare. MATERIALS AND METHODS: A systematic review of the literature was conducted following the PRISMA criteria. We reviewed the databases of PubMed, Web of Science, Cinahl, Scopus, Dialnet and Cuitatge up to December 2017. Four independent reviewers identified studies that included instruments to assess pain in individuals with dementia and communication problems in the Spanish healthcare context. We performed a narrative synthesis of the included articles. RESULTS: After applying the inclusion criteria, 10 studies were included. Of these, 4 were methodological studies validating Spanish versions of scales (Abbey, Algoplus, Doloplus and PAINAD-Sp), and 1 was on the development of the original EDAD scale. We also identified 3 studies conducted in Spain that used a translation of the PAINAD, 1 study that used a Spanish translation of Doloplus2 and 1 publication that included the use in Spain of a scale not validated for this patient profile (Pain-VAS). CONCLUSIONS: There are currently several instruments validated in Spanish to assess pain in individuals with advanced dementia and communication problems (Abbey, Algoplus, Doloplus y PAINAD-Sp). However, these instruments have still not been widely used in research, and their psychometric properties could be improved.

The experience of family caregivers caring for a terminal patient at home: A research review.

INTRODUCTION: One of the key aspects of the care of terminal patients is care delivered in their own home. Increasingly, the process of dying is moving from hospitals to homes. Although this process is directly related to the support of the social health environment, the involvement of family caregivers is essential. Given the impact that caring for a terminally ill family member has on people's lives, it is necessary to comprehend their personal experience in a holistic way. OBJECTIVE: To reveal the experience of family caregivers who are caring for a terminal patient in their home. DESIGN: A qualitative systematic review of articles published from 2000 to 2015 was conducted between March and September of 2015. The following databases were consulted: CINAHL, PubMed, PsycINFO, Cochrane Library, SciELO and Dialnet. After applying the selection criteria, 12 relevant studies were identified. Subsequently, two of the reviewers jointly performed a qualitative content analysis of them. RESULTS: The analysis permitted the caregivers' experiences to be grouped into five themes: 1) Learning the diagnosis: uncertainty about the future and the prospects of death; 2) Feeling the physical and emotional burden of care; 3) Experiencing a limited life; 4) Redefining the relationship with the person being cared for; and 5) Valuing the importance of the support of the environment. CONCLUSIONS: This review shows that caring for a family member with advanced illness in the home has a great impact on the personal realm of the caregiver and in the relationship he or she maintains with the ill family member. Being involved in the process of dying translates into a prodigious physical and psychological effort, together with a substantial limitation on the normal development of their own life. Additionally, the caregiver must face and establish a new relationship with the family member, in accordance with the new ethos, without the help of a formal structure providing the necessary support. These results may help to focus attention on family caregiver needs and to develop the knowledge necessary to meet the current demands of end-of-life health care in the home.

The experience of living with advanced-stage cancer: a thematic synthesis of the literature.

The aim of the study was to understand the experience of people living with advanced-stage cancer through literature. The search included The Cochrane Library, PubMed, PsycInfo, CINAHL and Cuiden. Thirteen studies were included. A qualitative meta-synthesis was conducted. One thread emerged from the thematic synthesis: the desire to live as normally as possible, despite being aware of the proximity of death. Three themes also emerged: "a process that is unique" with its four sub-themes; "support network" and "health context," each of them having two sub-themes. This study concludes that living with advanced-stage cancer is a unique and complex process which has both positive and negative aspects. The review provides a comprehensive view of the experience, which considers the importance of the support network and the health context in which the person lives. In this study, "normalcy" is the adjustment to the new reality and living as closely as possible to the way one lived before the disease, while developing a new relationship with being finite and death. A better understanding of the experience of living with advanced-stage cancer will help health professionals to identify the needs of the patients in order to plan individual, high-quality care.

Análisis de un marco conceptual para el proceso de participación informal en el cuidado después de un ictus / Analysis of a conceptual framework for lay participation in stroke care

El objetivo del estudio ha sido analizar y describir un marco conceptual para la participación informal en el cuidado de los pacientes después de un ictus, desarrollado a partir del estudio de las percepciones de los pacientes y sus familiares. El material utilizado ha sido el correspondiente a una tesis de máster en ciencias de enfermería cursada en el King's College (Universidad de Londres). De ella surgió un marco conceptual que contiene cuatro fases: hospitalización, primera recuperación, alta y comienzo del cuidado en casa y autocorrección. También aparecieron una serie de elementos comunes a todas las fases: relaciones familiares, apoyo de los profesionales de la salud y legado de autoridad. Igualmente, emergieron otros elementos involucrados en el cuidado informal. Se han organizado según el momento del proceso en el que fueron considerados importantes por los participantes. El marco conceptual aporta las bases para el desarrollo de una futura investigación en enfermería (AU)

Estudio desde la percepción de pacientes y familiares del proceso de participación informal en el cuidado después de un ictus: metodología y primeros resultados / Study of patients' and families' perception of lay caregiver participation in the care of stroke patients: methodology and preliminary results

En la actualidad, entre las enfermedades con mayor incidencia se encuentra el accidente cerebrovascular. Por ello, la participación de la familia en el cuidado de las personas que lo han padecido es de gran relevancia. El objetivo general de este estudio ha sido conocer el proceso de participación informal en el cuidado de los pacientes después de un ictus. Se ha desarrollado en el Departamento de Neurología de la Clínica Universitaria de la Universidad de Navarra y del Hospital de Navarra y en la Asociación de Daño Cerebral de Navarra (ADACEN). Se realizó un análisis cualitativo del contenido de las entrevistas semiestructuradas llevadas a cabo con 8 pacientes que habían sufrido un ictus y con 14 familiares, para obtener un total de 23 temas y 83 categorías para pacientes, y 28 y 107, respectivamente, para familiares. El análisis fue un proceso inductivo que objetivó la necesidad de que los cuidadores informales y los pacientes reciban información y educación sobre este proceso, su tratamiento y rehabilitación. Todo ello mediante un asesoramiento y educación continuos. (AU)

Correspondencia entre los problemas de salud y los cuidados de enfermería al ingreso del paciente / Correspondence between health problems and nursing care on patient admission

Objetivos: Conocer si los diagnósticos enfermeros derivan de las manifestaciones identificadas al valorar, y determinar si los cuidados registrados se corresponden con los diagnósticos enunciados. Material: Documentos de enfermería -"hoja de valoración" y "hoja de cuidados"-, de 800 pacientes ingresados en dos unidades de hospitalizació -Cirugía Cardiovascular y Medicina Interna- de la Clínica Universitaria de la Universidad de Navarra. Método: Análisis de contenido a posteriori de los documentos. Primera fase: se determinaron los características definitorias de 33 diagnósticos enfermeros, y se reagruparon y codificaron los cuidados. Se elaboró una base de datos, obteniendo 1.829 hojas de datos informatizados. Segunda fase: análisis de aspectos cualitativos/cuantitativos de hojas de datos informatizados. Estadística descriptiva. Comparación entre ambas unidades: test de la ji al cuadrado, exacto de Fischer y U de Mann-Witney. Resultados: Los diagnósticos eran correctos en 1.499 (88,4 por ciento) de las hojas de datos informatizados. Media de cuidados por paciente: 7,26. De los 4.592 cuidados registrados, los correctos sobrepasan el 85 por ciento. Predominan los terapéuticos (2.428), seguidos de los de valoración (2.428), y sólo se registran 280 de educación. Conclusiones: La mayoría de los diagnósticos se realiza en base a datos recogidos en la valoración y los cuidados registrados se corresponden con los problemas existentes. El registro de la valoración, diagnósticos y cuidados permite establecer criterios de control de calidad (AU)

[Standardizing care. When the intervention is valid]. / Estandarizar los cuidados. Cuando lo hecho es válido.

The objectives of this study were: A) to assemble a Standard Care Plan Guide taken from both nursing care records as well as data from a bibliography review; B) to know the number of nursing interventions and evaluate their suitability according to the stated nursing diagnosis. These results can then be compared before and after using the Standard Care Plan Guide. An analysis of 1827 nursing care records was performed. The first phase, after studying 1255 records, consisted of standardizing the care to correspond with 36 nursing diagnoses previously selected from the NANDA taxonomy. The second phase saw the standard care practice incorporated by the nursing staff. And finally, a comparison was made of the results between phase one and three (before and after the incorporation of the Standard Care Plan Guide.) The number of nursing interventions notably increased, jumping from 3263 in the first phase up to 4271 in the third. The average nursing action per patient rose from 3.03 to 9.09. Also, the diagnostic categories increased, going from 930 in the first phase up to 1624 in the third. The average number of correctly stated diagnoses per patient climbed from 1.56 to 2.78. The authors state that better nursing care and attention to the patient can occur if the nurses are given the conceptual instruments and training that will facilitate their daily tasks.