La atención humanizada en el cuidado del paciente oncológico / Cuidados humanizados no tratamento de doentes oncológicos / Humanized care in oncology patient care

Introduction: This paper states the need for comprehensive and humanized care in thecare of the oncological patient. Method: We present a theoretical reflection on relevant issues relatedto humanization: on the one hand, what it is and how interventions can be implemented from ahumanizing approach, and on the other hand, communication as a key tool in the professionalpatient relationship. From a practical perspective, we present our experience based on the development of the Humanization Plan we carried out at the Hospital Fundación General de la SantísimaTrinidad in Salamanca (Spain). Results: We present the humanization initiatives we developed inthe hospital grouped in three blocks; a) the hospital environment and the treatment room as a healthspace; b) the relationship with the team of professionals and communication with patients and theirfamilies; c) the management and occupation of time in the treatment room. Conclusions: The difficulty in establishing quality standards in humanization makes it difficult to determine the degreeof success of the interventions and to draw conclusions in this regard. In our case, the achievementsare endorsed mainly by the satisfaction and gratitude expressed by patients and companions. (AU)

Introducción: Este trabajo constata la necesidad de una atención integral y humanizadaen el cuidado del enfermo oncológico. Material y Método: En primer lugar, presentamos una reflexión teórica sobre cuestiones relevantes vinculadas con la humanización. Por una parte, qué es ycómo pueden implementarse intervenciones desde un enfoque humanizador, y por otra, la comunicación como herramienta clave de la relación profesional-paciente. En segundo lugar, desde unaperspectiva práctica, exponemos nuestra experiencia basada en el desarrollo del Plan de Humanización que llevamos a cabo en un hospital general en la ciudad de Salamanca (España). Resultados:Presentamos las iniciativas de humanización que desarrollamos en el hospital agrupadas en tres bloques; a) el entorno hospitalario y la sala de tratamientos como espacio de salud; b) la relación conel equipo de profesionales y la comunicación con los enfermos y sus familias; c) la gestión y ocupación del tiempo en la sala de tratamiento. Conclusiones: La dificultad a la hora de establecer estándares de calidad en humanización hace complicado determinar el grado de éxito de las intervenciones y establecer conclusiones al respecto. En nuestro caso los logros vienen avalados principalmentepor la satisfacción y gratitud que manifiestan pacientes y acompañantes. (AU)

Introdução: Este documento afirma a necessidade de cuidados abrangentes e humanizados no cuidado do paciente oncológico. Método: Apresentamos uma reflexão teórica sobre questõesrelevantes relacionadas com a humanização: por um lado, o que é e como as intervenções podemser implementadas a partir de uma abordagem humanizadora, e por outro lado, a comunicaçãocomo um instrumento chave na relação profissional-paciente. De uma perspectiva prática, apresentamos a nossa experiência baseada no desenvolvimento do Plano de Humanização que realizámosno Hospital Fundación General de la Santísima Trinidad em Salamanca (Espanha). Resultados:Apresentamos as iniciativas de humanização que desenvolvemos no hospital agrupadas em trêsblocos; a) o ambiente hospitalar e a sala de tratamento como espaço de saúde; b) a relação com aequipa de profissionais e a comunicação com os pacientes e as suas famílias; c) a gestão e ocupaçãodo tempo na sala de tratamento. Conclusões: A dificuldade em estabelecer padrões de qualidade nahumanização torna complicado determinar o grau de sucesso das intervenções e estabelecer conclusões a este respeito. No nosso caso, as realizações são endossadas principalmente pela satisfaçãoe gratidão expressas pelos doentes e companheiros. (AU)

La revelación del diagnóstico en oncología: una investigación transcultural Brasil-España / Cancer disclosure: a cross-cultural research Brazil-Spain

Objetivo: examinar aspectos transculturales de la revelación del diagnóstico de cáncer en pacientes brasileños y españoles. Método: Se realizó una investigación cualitativa en la que fueron entrevistados 28 pacientes en quimioterapia (14 brasileños y 14 españoles). El análisis de contenido identificó tres ejes temáticos: 1) Cómo fue revelado el diagnóstico; 2) Contexto en que el diagnóstico fue revelado y 3) Quién reveló el diagnóstico. Resultados: existen particularidades en la manera de revelar el diagnostico entre los dos países. En Brasil aún ocurre que el enfermo puede ser derivado a un oncólogo sin una explicación satisfactoria previa sobre su estado de salud. Aunque en los dos países existan relatos de comunicación de diagnóstico en el contexto apropiado (consulta), también ha aparecido revelación de manera informal (por teléfono) sin un ambiente adecuado para que el paciente sea acogido y tenga posibilidad de expresar sus miedos y sus dudas. Conclusión: es necesario invertir en la formación profesional para mejorar la habilidad de comunicación y educación en salud para tratar pacientes con cáncer (AU)

Objective: The aim of this study was to examine cross-cultural aspects of the disclosure of cancer diagnosis in Brazilian and Spanish patients. Method: A qualitative research was carried out in which 28 chemotherapy patients (14 Brazilian and 14 Spanish) were interviewed. Content analysis identified three thematic categories: 1) How the diagnosis was disclosured; 2) Context in which the diagnosis was disclosured; 3) Who disclosured the diagnosis. Results: Particularities in the diagnosis disclosure between the two countries was found. In Brazil, it still happens that patient can be referred to an oncologist without a satisfactory explanation about his health status. Although there are reports of diagnosis disclosure in the appropriate context (consultation), also there are reports informal disclosure (by telephone), without an adequate environment for the patient to be welcomed and able to express their fears and doubts. Conclusion: It is necessary to improve the professional training to improve communication skills and health education to treat cancer patients (AU)

Differences in pain perception, health-related quality of life, disability, mood, and sleep between Brazilian and Spanish people with chronic non-specific low back pain

ABSTRACT Background Cultural and social factors play an important role in the development and persistence of Low Back Pain (LBP). Nevertheless, there are few studies investigating differences in LBP features between countries. Objective To determine differences in pain perception between individuals with LBP living in Brazil and Spain. Method Thirty Spanish individuals and 30 age- and sex-comparable Brazilian individuals with LBP were recruited from the Public Health Services of both countries. The Numerical Pain Rating Scale and the pain rating index (PRI), the number of words chosen (NWC), and the present pain index (PPI) extracted from the McGill Pain Questionnaire were used to assess pain. The Oswestry Disability Index, the Short Form-36, Beck Depression Inventory-II, and Pittsburgh Sleep Quality Index were also applied. Differences between countries and the correlation between demographic and clinical variables in each country were assessed with parametric and the nonparametric tests. Results A significant Country by Gender interaction was found for the PRI total score (P=0.038), but not for intensity of pain, disability, PPI, or NWC, in which Spanish women exhibited greater pain ratio than Spanish men (P=0.014), and no gender differences were identified in Brazilians. The Spanish group showed a consistent pattern of correlations for clinical data. Within Brazilian patients, fewer correlations were found and all of the coefficients were lower than those in the Spanish group. Conclusion The pain perception in patients with LBP is different depending on the country. Within Spanish patients, LBP is considered a more global entity affecting multidimensional contexts.

Socio-Cultural Factors and Experience of Chronic Low Back Pain: a Spanish and Brazilian Patients' Perspective. A Qualitative Study.

BACKGROUND: Low back pain (LBP) could be influenced by socio-cultural factors. Pain narratives are important to understand the influence of environment on patients with chronic LBP. There are few studies that have explored the experience of patients with chronic LBP in different socio-cultural environments. The aim of this study was to describe the experience of patients with chronic LBP in Spain and Brazil. METHODS: A qualitative phenomenology approach was implemented. Chronic LBP patients from the University Hospital of Salamanca (Spain), and/or Federal University of São Carlos (Brazil) were included, using purposeful sampling. Data were collected from 22 Spanish and 26 Brazilian patients during in-depth interviews and using researchers' field notes and patients' personal diaries and letters. A thematic analysis was performed and the guidelines for reporting qualitative research were applied. RESULTS: Forty-eight patients with a mean age of 50.7 years (SD: ± 13.1 years) were included in the study. The themes identified included: a) ways of perceiving and expressing pain-the participants focused constantly on their pain and anything outside it was considered secondary; b) the socio-familial environment as a modulator of pain-most participants stated that no one was able to understand the pain they were experiencing; c) religion as a modulator of pain-all Brazilian patients stated that religious belief affected the experience of pain; and d) socio-economic and educational status as a modulator of pain-the study reported that economic factors influenced the experience of pain. CONCLUSIONS: The influences of LBP can be determined based on the how a patient defines pain. Religion can be considered as a possible mechanism for patients to manage pain and as a form of solace.

Differences in pain perception, health-related quality of life, disability, mood, and sleep between Brazilian and Spanish people with chronic non-specific low back pain.

BACKGROUND: Cultural and social factors play an important role in the development and persistence of Low Back Pain (LBP). Nevertheless, there are few studies investigating differences in LBP features between countries. OBJECTIVE: To determine differences in pain perception between individuals with LBP living in Brazil and Spain. METHOD: Thirty Spanish individuals and 30 age- and sex-comparable Brazilian individuals with LBP were recruited from the Public Health Services of both countries. The Numerical Pain Rating Scale and the pain rating index (PRI), the number of words chosen (NWC), and the present pain index (PPI) extracted from the McGill Pain Questionnaire were used to assess pain. The Oswestry Disability Index, the Short Form-36, Beck Depression Inventory-II, and Pittsburgh Sleep Quality Index were also applied. Differences between countries and the correlation between demographic and clinical variables in each country were assessed with parametric and the nonparametric tests. RESULTS: A significant Country by Gender interaction was found for the PRI total score (P=0.038), but not for intensity of pain, disability, PPI, or NWC, in which Spanish women exhibited greater pain ratio than Spanish men (P=0.014), and no gender differences were identified in Brazilians. The Spanish group showed a consistent pattern of correlations for clinical data. Within Brazilian patients, fewer correlations were found and all of the coefficients were lower than those in the Spanish group. CONCLUSION: The pain perception in patients with LBP is different depending on the country. Within Spanish patients, LBP is considered a more global entity affecting multidimensional contexts.

La representación social de los malos tratos infantiles en la familia: Factores psicosociales que influyen en la percepción de las conductas de maltrato / Social representation of child maltreatment in the family: Psychosocial factors that influence perceived maltreatment behaviors

En este estudio se analiza la representación social de los malos tratos infantiles desde una perspectiva psicosocial y entendiendo el maltrato desde el modelo del bienestar del menor. Los objetivos son: analizar las representaciones sociales en función del género, la edad, la paternidad/maternidad y la experiencia personal en relación con el maltrato y determinar las falsas creencias y mitos que predicen la percepción de la gravedad y la frecuencia del maltrato. La muestra está formada por 261 sujetos, mujeres y hombres con edades comprendidas entre los 18 y 89 años. Los participantes fueron elegidos al azar y entrevistados individualmente. Los resultados obtenidos muestran que el género condiciona el concepto de maltrato infantil haciendo que hombres y mujeres piensen de forma diferente respecto a su gravedad y frecuencia. La edad determina la representación de la gravedad del maltrato de forma que los jóvenes atribuyen mayor severidad a las conductas. La experiencia de maltrato afecta a la gravedad del maltrato percibido, declarando menor severidad los que piensan que han sido maltratados. La gravedad y la frecuencia de las conductas analizadas no son agrupadas por los participantes atendiendo a la naturaleza del maltrato sino a la cualidad de la conducta y a su severidad (AU)

In this study the social representation of child abuse is analyzed from a psychosocial perspective. Abuse is considered from the child welfare model. The main objectives are (1) to analyze social representation of abuse according to gender, age, parenthood and personal experience and (2) to identify false beliefs and myths that predict the perception of severity and frequency of abuse. The sample consisted of 261 subjects, both men and women aged between 18 and 89. Participants were randomly selected and individually interviewed. The results show that gender affects the concept of child abuse -men and women think differently about severity and frequency of abuse. Age determines the representation of the severity of abuse, so that young people take the abuse behavior more severely. The experience of abuse affects the severity of perceived mistreatment -those who think they have been mistreated take it less severely. Severity and frequency of abuse behaviors are grouped by the participants based not on the nature of abuse but on the quality and severity of the behaviour (AU)