Recomendaciones para mejorar la atención en enfermería / Recommendations to improve attention in nursing

El personal de enfermería desempeña una actividad fundamental en los servicios de salud, con fuerte apego a principios científicos y éticos; sus intervenciones permiten fortalecer la calidad en los servicios de salud, através de acciones interdisciplinarias. Se analizaron las inconformidades relacionadas con atención de enfermería que recibió la Comisión Nacional de Arbitraje Médico (CONAMED) de junio de 1996 a diciembre de 2001. Con base en el análisis se elaboraron recomendaciones dirigidas a prevenir el conflicto, mejorar la práctica de enfermería y propiciar la adecuada comunicación con el paciente, familiares y equipo interprofesional de salud. Se integró un grupo representativo de las instituciones educativas y gremiales de enfermería más prestigiadas y reconocidas, para su validación externa. De esta manera, la CONAMED y el grupo de validación externa, proponen al personal de enfermería atender las siguientes recomendaciones: 1) Mantener una comunicación efectiva con las personas a las que proporciona atención; 2) Reconocer en la persona su concepción holística; 3) Proporcionar cuidados que garanticen la atención libre de riesgos y daños innecesarios; 4) Establecer una coordinación efectiva con el equipo interprofesional de salud; 5) Actuar con base en los principios éticos que rigen la práctica profesional de enfermería.

Nurse personnel performs a fundamental activity in t health services, with strong attach at scientific and ethical principles, whose interventions can fortify the services of health quality, through interdisciplinary actions. We analyzed the compliants related to nursing attention that were received in CONAMED since June 1996 to December 2001. Wedevised recommendations directed to prevent patient-health care professionals conflicts, improve the practice of nursing and favor adequate communication with the patient, family and interprofessional health care team. Those recommendations were presented to the more prestigious and recognized educational and professional groups of nursing, for their external validation. In this manner, CONAMED and the external group of validation, propose to nurses to attend the following recommendations: 1) Maintain an effective communication with the patients that provides attention; 2) Recognize the holistic concept in the person; 3) Provide cares that guarantee tree-risk attention and prevent unnecessary damages; 4) Establish an effective coordination with the health care interprofessional team and 5) Act based on ethical principles that govern the professional practice of nursing.

[Medical liability in gynecology and obstetrics. Analysis of 25 cases]. / El arbitraje médico en ginecología y obstetricia. Análisis de 25 casos.

The authors studied 175 severe medical complaints which ended in Arbitration veredicts or expert opinions, handled by and Alternative Disputes Resolution Institution (CONAMED) between June 1996 and December 1999. The study was focused on 25 cases with complete medical records. Belonged to Gynecology area, 8 cases (32%), and 17 cases (68%) to Obstetrics. The physicians involved were ob/gyn specialists in 14 cases. Health public institutions were involved in 14 cases (56%), and private practitioners, 11 cases (44%). The main sources of unsatisfaction were injuries or technical failures during surgical procedures in 24% (6 cases) or diagnostic failures in 6 cases (24%). The outcomes were: deaths 8 (32%), amputation or another sequelae in three cases (12%), and fetus or newborns deaths or injuries in two cases (6%). The claimers asked for monetary benefits in 15 cases (60%), disclosure of medical responsibility in 8 cases (24%), and to probe murder or injuries in 3 cases (12%). The CONAMED conclusions were medical malpractice in 14 cases (56%), administrative failures in 14 cases (56%), and patient responsibility in 4 cases (16%).

[Medical student traits associated with future success as physicians]. / Características del estudiante de medicina asociadas al éxito ulterior como médico.

OBJECTIVE: To identify the individual and family factors present during medical studies which are associated to success as a physician. RESEARCH DESIGN: Prolective case-control study. SETTING: Mexico City metropolitan area. STUDY UNITS: 120 physicians considered to be successful and 245 physicians who according to an established criteria were considered to be non-successful. MAIN MEASUREMENTS: A success-achieving index was constructed on the opinion of 134 physicians from different health-care institutions private and public. The index was composed by criteria such as being a member of prestiged academic associations; having a practice in third level institutions; having done postgraduate studies; being a professor with teaching and research activities; having obtained directive medical positions; and a high income at the moment of the interview. RESULTS: The main factors associated to success were: frequent attendance to cultural activities by the family of the subjects (OR = 5.2, IC 95% = 3.15-8.60, p = 0.00000001); the global score obtained during their medical studies, i.e. higher than 8.5 over 10 (OR = 4.43, IC 95% = 2.64-7.49, p = 0.00000001); and having been awarded recognitions, prizes or scholarships during their medical studies (OR = 4.3, IC 95% = 2.64-7.03, p = 0.00000001). A logistic regression model selected the cultural activities of the family, global score during medical studies and earning of recognitions, prizes and scholarships as independent variables associated to success achievement (p = 0.00001). CONCLUSIONS: Frequent cultural activities by the family and academic behavior were the factors present during medical studies which were associated to ulterior success as a physician.