Pelota de parto versus petidina y haloperidol en la satisfacción en el parto / Birthing ball versus pethidine and haloperidol in satisfaction with childbirth

Objetivo: Determinar los efectos en la satisfacción materna del uso de la pelota de parto como método de alivio del dolor, comparado con la administración subcutánea de petidina (50mg) y haloperidol (2,5mg), en el periodo de latencia de parto. Método: Ensayo clínico aleatorizado, unicéntrico, paralelo y controlado. Participantes: gestantes de bajo riesgo, ingresadas en la planta de embarazo patológico del HGU Gregorio Marañón, por gestación cronológicamente prolongada, rotura prematura de membranas o pródromos de parto. Intervención: una vez que la paciente manifestaba dolor con su proceso, se implementaban una serie de movimientos predeterminados con la pelota de partos, en el caso del grupo intervención, o se administraba petidina más haloperidol, vía subcutánea. Tras la intervención y en planta de puérperas la satisfacción era medida con la escala Mackey Satisfaction Childbirth, validada al castellano en 2016, en las primeras 48-72h posparto. Análisis: comparación de grupos: la t de Student para las variables continuas y la Chi-cuadrado para las categóricas. Resultados: La satisfacción materna fue significativamente mayor en el grupo experimental que en el grupo de comparación, en todas las esferas de la escala: obstetra (4,24/3,87), dilatación (4,02/3,35), expulsivo (4,27/3,67), recién nacido (4,72/4,43) y acompañamiento y comodidad (4,78/4,44). No hubo, sin embargo, diferencias estadísticamente significativas en la subescala matrona, aunque las puntuaciones fueron igualmente altas (4,65/4,45). Conclusión: El uso de pelotas de parto durante el periodo de latencia aumenta la satisfacción de la mujer en el proceso de parto, en mayor medida que la administración conjunta de petidina y haloperidol

Objective: To determine the effects on maternal satisfaction of the use of the birthing ball as a method of pain relief compared to the subcutaneous administration of pethidine (50mg) and haloperidol (2.5mg), during the latent phase of labour. Method: Randomised, unicentric, parallel and controlled clinical trial. Participants: Low-risk pregnant women hospitalised in a pathological pregnancy ward at the Gregorio Marañón University General Hospital (Madrid) due to prolonged pregnancy, premature rupture of membranes, or labour prodromes. Intervention: once the patient's labour had become painful, a series of pre-established movements were implemented with a birthing ball in the intervention group, or pethidine and haloperidol were administered at the same dose subcutaneously. After the intervention and on the post-natal ward, satisfaction was measured with the Mackey Satisfaction Childbirth scale, validated in Spanish in 2016, in the first 48-72hours after delivery. Analysis: group comparisons: Student's t for continuous variables and Chi-squared for categorical variables. Significance at p<0.05. Results: The maternal satisfaction was significantly higher in the experimental group than in the comparison group, in all the domains of the scale: obstetrician (4.24/3.87), dilatation (4.02/3.35), second stage (4.27/3.67), newborn (4.72/4.43), accompaniment and comfort (4.78/4.44). There were, however, no statistically significant differences in the midwife subscale, although the scores were equally high (4.65/4.45). Conclusion: Using birthing balls during the latent phase of labour increases women's satisfaction with their labour process more than administering pethidine and haloperidol during this period

Birthing ball versus pethidine and haloperidol in satisfaction with childbirth. / Pelota de parto versus petidina y haloperidol en la satisfacción en el parto.

OBJECTIVE: To determine the effects on maternal satisfaction of the use of the birthing ball as a method of pain relief compared to the subcutaneous administration of pethidine (50mg) and haloperidol (2.5mg), during the latent phase of labour. METHOD: Randomised, unicentric, parallel and controlled clinical trial. PARTICIPANTS: Low-risk pregnant women hospitalised in a pathological pregnancy ward at the Gregorio Marañón University General Hospital (Madrid) due to prolonged pregnancy, premature rupture of membranes, or labour prodromes. INTERVENTION: once the patient's labour had become painful, a series of pre-established movements were implemented with a birthing ball in the intervention group, or pethidine and haloperidol were administered at the same dose subcutaneously. After the intervention and on the post-natal ward, satisfaction was measured with the Mackey Satisfaction Childbirth scale, validated in Spanish in 2016, in the first 48-72hours after delivery. ANALYSIS: group comparisons: Student's t for continuous variables and Chi-squared for categorical variables. Significance at p<0.05. RESULTS: The maternal satisfaction was significantly higher in the experimental group than in the comparison group, in all the domains of the scale: obstetrician (4.24/3.87), dilatation (4.02/3.35), second stage (4.27/3.67), newborn (4.72/4.43), accompaniment and comfort (4.78/4.44). There were, however, no statistically significant differences in the midwife subscale, although the scores were equally high (4.65/4.45). CONCLUSION: Using birthing balls during the latent phase of labour increases women's satisfaction with their labour process more than administering pethidine and haloperidol during this period.

The life and death construct in heart transplant patients.

BACKGROUND: The technological advances of medicine, and specifically the techniques of organ transplants, have allowed crossing the border of life and death. This is especially relevant in the case of heart transplant, since its symbolism requires a redefinition not only of these traditional concepts, but also of the body or of one's own identity. AIMS: To explore the experiences of patients after receiving a heart from a donor. METHODS: A phenomenological qualitative approach, through Merleau Ponty and Levinas perspectives, was conducted to capture the subjective experiences of heart transplant patients. We conducted 22 in-depth interviews: 12 with heart transplant patients from two hospitals in Madrid (Spain), and 10 with relatives who lived with them. RESULTS: The line between life and death is erased for heart transplant patients. Three main themes arose from the analysis: towards death, the frontier between life and death, and towards life. The need to redefine the concepts of life and death is structured around issues such as the thought of facing one's own death and the concept of gift and resurrection. CONCLUSION: Organ transplant techniques open the door to a new definition of death, of the identity of the body and its parts and the limits of life. Considering the cultural, legal, psychological, social and symbolic elements involved in the heart transplant process, a qualitative approach provides new avenues of understanding the clinical process from the patients' perspective.

Proceso de atención al parto en la muerte fetal tardía / Delivery care process in late fetal death

Objetivo: analizar la evidencia disponible acerca del proceso de atención al parto en la muerte fetal tardía, que permita conocer la experiencia y las necesidades de madres y padres, y la experiencia y dificultades de los profesionales que atienden estos casos. Método: revisión narrativa de estudios cualitativos publicados desde 2005 hasta agosto de 2017 en las bases de datos Pubmed, Cinahl, Embase, Scielo, Cuiden y Lilacs en el campo de la muerte fetal tardía, atendiendo a su definición en el contexto español (a partir de 28 semanas de gestación) y en el internacional (a partir de la semana 24 de gestación). Se llevó a cabo un análisis temático de los artículos seleccionados, identificándose cuatro áreas temáticas en función a la experiencia de las madres y padres, por un lado, y dos áreas temáticas según la experiencia de los profesionales. Resultados: se seleccionaron siete artículos cualitativos (cuatro análisis de contenido, dos análisis fenomenológicos y una teoría fundamentada). Los temas identificados respecto a la experiencia de madres y padres estuvieron relacionados con un diagnóstico devastador, comienzo de la despedida, construcción de la maternidad y la paternidad, e impacto de la actuación de los profesionales. Los temas identificados en relación a la experiencia de los profesionales fueron impacto personal y profesional, y manejo del caso. Conclusiones: esta revisión pone de manifiesto tanto lo traumático de la experiencia de las madres y padres que sufren una pérdida fetal tardía como la afectación personal de los profesionales que les atienden, que presentan dificultades para afrontar adecuadamente el caso, y demandan formación específica para ayudar de forma eficiente en el proceso de duelo

Objective: to analyze the evidence available about the delivery care process in late fetal death, allowing to learn about the experience and needs of mothers and fathers, and the challenges for the professionals managing these cases. Method: a narrative review of qualitative studies published from 2005 to August, 2017 in the following databases: Pubmed, Cinahl, Embase, Scielo, Cuiden and Llilacs, on the area of late fetal death, according to its definition in the Spanish setting (from 28 gestation weeks onwards), and in the international setting (from week 24 of gestation). A themed analysis was conducted on the articles selected, and four theme areas were identified, based on the experience of mothers and fathers on one hand, and two theme areas according to the experience of professionals. Results: seven qualitative articles were selected: four content analyses, two phenomenological analyses, and one grounded theory. The themes identified regarding the experience of mothers and fathers were associated with a devastating diagnosis, the initial goodbye, building maternity and paternity, and the impact of the action by professionals. The themes identified associated with the experience of professionals were: personal and professional impact, and case management. Conclusions: this review shows the traumatic experience of mothers and fathers suffering a late fetal loss, as well as the personal impact on those professionals managing them, who will be faced with difficulties for addressing the case adequately, and demand specific training to help in the mourning process in an efficient way

El Reto del Malvavisco: trabajando competencias de trabajo en equipo, liderazgo y resolución de problemas / The Marshmallow Challenge: Working on skills for teamwork, leadership, and problem solving

Según la orden CIN (CIN/2134/2008) y el Libro Blanco de Enfermería, el personal docente ha de trabajar con los estudiantes de Enfermería en cuatro dominios diferentes: valores profesionales, habilidades de comunicación y relaciones interpersonales, toma de decisiones en la práctica clínica y gestión del trabajo en equipo. En el marco de la pedagogía basada en el juego se planteó introducir en el aula el Reto del Malvavisco como una actividad para reflexionar y profundizar sobre aspectos de trabajo en equipo, fomentando las capacidades de colaboración, liderazgo distribuido, empatía y creatividad desde un planteamiento lúdico y a través de situaciones cotidianas alejadas del plano clínico. Se trabajó con estudiantes del Grado de Enfermería de tercer curso, en la asignatura de Prácticas Tuteladas III. La actividad consistió primeramente en trabajar habilidades de trabajo en equipo y liderazgo compartido a través del juego para, posteriormente, transferir el conocimiento generado a una situación clínica mediante la resolución de un caso. La actividad fue evaluada por los estudiantes de forma muy positiva. Consideraron que introducir el juego en el aula es una forma muy creativa y muy útil para desarrollar habilidades que pueden implementar posteriormente en el desempeño de su rol profesional (AU)

According to 'orden CIN' (CIN/2134/2008) and the White Paper on Nursing, the teaching staff must work with Nursing students on four different areas: professional values, communication skills and interpersonal relations, decision making in clinical practice, and teamwork management. In the setting of game-based pedagogy, the introduction in the classroom of the 'Marshmallow Challenge' was considered a useful activity to reflect and delve into teamwork aspects, promoting the skills of collaboration, shared leadership, empathy and creativity from a recreational approach and through everyday situations away from the clinical level. This work was conducted with Nursing Degree students in their third year, within the subject Tutored Practices III. The activity consisted primarily in working on teamwork and shared leadership skills through the game, and subsequently translating the knowledge generated into a clinical situation by solving a case. The activity was evaluated very positively by students; they considered that introducing the game in the classroom was a very creative and useful manner to develop skills that can be subsequently implemented in the performance of their professional role (AU)

La enfermera ante el reto de la gestión del paciente crónico complejo / The challenge of care continuity in complex chronic patients from nurses´perspective

Introducción. La enfermedad crónica compleja requiere de un modelo asistencial basado en equipos multidisciplinares. El objetivo del estudio fue analizar el desarrollo del liderazgo enfermero en el manejo del paciente crónico complejo (PCC) e identificar cómo gestiona los recursos en la atención y seguimiento de estos pacientes. Método. Estudio cualitativo descriptivo, mediante observación participante, entrevistas en profundidad a 7 profesionales sanitarios y un grupo de discusión con 9 profesionales de enfermería de centros de Atención Primaria madrileños, seleccionados mediante muestreo intencional. Para el análisis del discurso se siguió el procedimiento propuesto por Conde: determinación de las posiciones discursivas, creación y análisis de las configuraciones simbólicas, análisis e interpretación de las configuraciones semánticas y elaboración del discurso. Resultados. Del discurso emergieron dos dimensiones de significado del liderazgo y la gestión enfermera en el manejo del PCC: a) el profesional de enfermería, líder de los cuidados: se reconoce la necesidad de liderazgo de los enfermeros y de mejorar las estructuras de coordinación, y b) el profesional de enfermería, gestor de recursos en la atención al PCC, en relación con los riesgos sociosanitarios y la coordinación de los recursos. Conclusiones. Los hallazgos resaltan la gestión de casos y la atención domiciliaria como los pilares centrales para el manejo eficaz del PCC, donde enfermería ocupa una posición privilegiada (AU)

Introduction. The complex chronic disease requires a model of care based found on multidisciplinary teams. The aim of this study was to analyse the development of nursing leadership in managing the complex chronic patient (CCP) and to identify how the resources for the attention and follow up of these patients are managed. Method. A qualitative descriptive approach was followed through participant observation, in-depth interviews to 7 health professionals (5 nurses, a doctor, and a social worker) and a discussion group with 9 Primary Health Care nurses from a intentional sample. Discourse analysis was undertaken following Conde approach: fixing discursive positions, creating and analysing symbolic configurations, analysing and interpreting semantic configurations and drawing up the discourse. Results. From discourse analysis two main dimensions emerged on the nursing leadership and management: a) nursing as the leader of care: the need of nursing leadership and of improvement in the coordination structures were recognized, and b) nursing as resources manager in the CCP care related to social and health risks and resources coordination. Conclusions. Our findings enhance the case management and the home delivery care as foundations to effective handle of CCP, where nursing has a privileged role (AU)

[The Challenge of Care Continuity in Complex Chronic Patients from Nurses' Perspective]. / La enfermera ante el reto de la gestión del paciente crónico complejo.

Introduction: The complex chronic disease requires a model of care based found on multidisciplinary teams. The aim of this study was to analyse the development of nursing leadership in managing the complex chronic patient (CCP) and to identify how the resources for the attention and follow up of these patients are managed. Method: A qualitative descriptive approach was followed through participant observation, in-depth interview to 7 health professionals (5 nurses, a doctor, and a social worker) and a discussion group with 9 Primary Health Care nurses from a intentional sample. Discourse analysis was undertaken following Conde approach: fixing discurse positions, creating and analyzing symbolic configuratons, analyzing and interpreting semantic configurations and drawing up the discourse. Results: From discourse analysis two main dimensions emerged on the nursing leadership and management: a) nursing as the leader of care: the need of nursing leadership and of improvement in the coordination structures were recognized, and b) nursing as resources manager in the CCP care related to social and health risks and resources coordination. Conclusions: Our findings enhance the case management and the home delivery care as foundations to be effective handle of CCP, where nursing has a privileged role.