[Decision making among older adults in hemodialysis. A qualitative assessment]. / Toma de decisiones en hemodiálisis crónica: estudio cualitativo en adultos mayores.

BACKGROUND: In Chile there are 22,310 people in Chronic Hemodialysis (CHD), 53% of them older adults (OA). Shared decision-making and advance directives (AD) are especially important in OA with end-stage chronic renal failure, since they have greater levels of disability, morbidity and mortality, raising doubts about the benefit of therapy. AIMS: To understand the experience in decision making and explore ways to express AD, in OA in CHD. MATERIAL AND METHODS: A qualitative phenomenological study, performing 12 in-depth interviews to OA who had been at CHD for at least one year. RESULTS: The analysis revealed four broad comprehensive categories, two related to participation in the decision to enter CHD, namely the experience of subjects as spectators and their lack of interest for decision support and two referred to the expression of AD, namely the difficulty in facing their own finitude and resistance to express AD. CONCLUSIONS: There is little participation of older adults in the decision about their admission to dialysis therapy, and once they enter the CHD program they are not prepared to discuss AD in general, nor an eventual suspension of dialysis in particular.

Toma de decisiones en hemodiálisis crónica: estudio cualitativo en adultos mayores / Decision making among older adults in hemodialysis. A qualitative assessment

Background: In Chile there are 22,310 people in Chronic Hemodialysis (CHD), 53% of them older adults (OA). Shared decision-making and advance directives (AD) are especially important in OA with end-stage chronic renal failure, since they have greater levels of disability, morbidity and mortality, raising doubts about the benefit of therapy. Aims: To understand the experience in decision making and explore ways to express AD, in OA in CHD. Material and Methods: A qualitative phenomenological study, performing 12 in-depth interviews to OA who had been at CHD for at least one year. Results: The analysis revealed four broad comprehensive categories, two related to participation in the decision to enter CHD, namely the experience of subjects as spectators and their lack of interest for decision support and two referred to the expression of AD, namely the difficulty in facing their own finitude and resistance to express AD. Conclusions: There is little participation of older adults in the decision about their admission to dialysis therapy, and once they enter the CHD program they are not prepared to discuss AD in general, nor an eventual suspension of dialysis in particular.

Significados de la experiencia de una enfermera con su madre hospitalizada en una unidad intensiva coronaria / Meanings of the experience of a nurse with her mother hospitalized in an intensive coronary unit

El ingreso de un paciente a una Unidad de Cuidados Intensivos (UCI), es un acontecimiento estresante para los miembros de la familia y las experiencias que viven al separarse resultan traumáticas, pero pocas veces son acogidas por los profesionales del staff clínico. Se realizó un estudio de caso para develar la experiencia de una enfermera cuya madre estuvo hospitalizada en una unidad de cuidados intensivos coronaria, para contribuir a generar conocimiento comprensivo en enfermería sobre este fenómeno y aportar a la humanización del cuidado de los familiares. Metodología: Para ello, se aplicó el método de investigación cualitativa de aproximación fenomenológica de Husserl. Se entrevistó en profundidad a una enfermera, quien firmó previamente un consentimiento informado. El proceso de análisis fue realizado basado en Streubert & Carpenter y triangulado con investigadores expertos. Resultados: Se develaron cuatro grandes unidades de significado. La experiencia de tener a su madre hospitalizada en una UCI significa: (1) vivir como un divagar de sentimientos en torno a la muerte, (2) significa, también, una incapacidad de desvincularse del rol de enfermera y tener conciencia de gravedad, (3) significa contar con diferentes apoyos y, por último, significa un (4) cambio de roles al interior de la familia. Conclusión: Se evidencian los aspectos más importantes para realizar intervenciones de cuidados de enfermería personalizados considerando los aspectos emocionales y psicológicos de acuerdo a las singularidades de la enfermera como familiar de paciente hospitalizado en una unidad de paciente crítico.

A patient admitted in an Intensive Care Unit (ICU) is a stressful event for the members of a family, the experiencesbe separated can be traumatic, but rarely are understood by clinical staff. A case study was conducted to reveal the experience of a nurse whose mother was in a Coronary Intensive Care Unit in order to contribute to the construction of comprehensive knowledge in Nursing about this phenomenon, and make a contribution in the humanization of caring for family. Methodology: was applied a qualitative investigation method of approximation phenomenological from Husserl In depth was interviewed a nurse who previously signed an informed consent. The process of analysis was performed based on Streubert & Carpenter and triangulated with expert researchers. Results: Four major units of meaning were unveiled. The experience of having her mother hospitalized in an ICU means: (1) live as a ramble from feelings about death, (2) also means an inability to disengage from the role of nurse and be aware of gravity, (3) means having diff erent supports and fi nally, means a (4) Change of roles within the family. Conclusion: The results indicated the most important interventions of nursing care considering the custom and human emotional and psychological aspects according to the singularities of the nurse as a relative of an ill patient in a critical inpatient unit.

El transitar del sobrevivir al revivir: comprender la vivencia de padres y madres que han perdido a sus hijos a causa del cáncer / Moving from survival to revival: understanding pareents who have lost children due to cancer

Introduction: A child's death due to cancer impacts parents deeply, and generates great suffering. However, some parents manage to overcome this pain, and discover a new purpose for their lives. Objective: To understand the experiences which assist fathers and mothers to revive after the death of a child due to cancer. Patients and Methods: A qualitative phenomenological model was applied. In-depth-interviews of consenting fathers and mothers who took part in a group called "Corporación Re-Viviendo" ("Re-Living"), were recorded and transcribed verbatim. For the analysis of the data, methodological precision and ethical criteria were utilized. Results: Data analysis revealed a dynamic and continuous process of multiple lived experiences, facilitating a transition from survival to revival for the participants. Conclusion: Through a process of personal growth and active renewal, parents can give meaning to the life, agony and death of a son or daughter. Thus, they allow themselves to develop the course of grief.

Introducción: La muerte de un hijo a causa del cáncer genera un gran impacto y sufrimiento en los padres, sin embargo algunos de ellos logran sobreponerse y encontrar un nuevo sentido a su vida, Objetivo: Investigar sobre las experiencias vividas que ayudan a los padres y madres a revivir después de la muerte de un hijo(a) por cáncer. Metodología: Estudio cualitativo fenomenológico, en el que se recogieron las vivencia a través de entrevistas en profundidad a padres y madres que participaban en la Corporación Re-Viviendo, las que fueron grabadas y transcritas textualmente, con previo consentimiento de los participantes. Para el análisis de los datos se cumplió con el rigor metodológico. Resultados: Tras analizar las entrevistas, se develó un proceso dinámico y continuo de múltiples vivencias que permitieron a los participantes transitar desde la sobrevivencia tras la pérdida, hasta el revivir a sí mismos. Conclusiones: Mediante un proceso de crecimiento personal y activo, los padres logran atribuirle sentido a la vida, agonía y muerte de su hijo(a), lo que les permite elaborar el duelo.

Bienestar materno durante el proceso de parto: desarrollo y aplicación de una escala de medición / Maternal wellbeing in childbirth: application and development of a scale score

Objetivo: Diseñar y validar un instrumento objetivo y autoaplicable para evaluar el nivel de bienestar que experimentan las mujeres en situación de parto. Método: Se consideró la combinación de las metodologías cualitativas y cuantitativas. A través de grupos de focos y entrevistas individuales, se recogió la percepción subjetiva del bienestar materno, sus indicadores y sus distintas dimensiones. En la tapa cuantitativa, a través de un diseño correlacional de corte transversal, se validó la escala y se exploró el nivel de bienestar materno en 303 mujeres puérperas que tuvieron su parto en un hospital público del área sur oriente de Santiago. Resultados: La Escala de Bienestar Materno en Situación de Parto BMSP, exploró el bienestar materno en tres niveles: óptimo, adecuado y malestar; más de un 60 por ciento de las mujeres reportaron un nivel de bienestar adecuado u óptimo, referido al "buen trato", asociándose significativamente al tipo de parto y la paridad de la mujeres. El puntaje de bienestar no se relaciona con la hora del turno, con la situación de pareja, ni con el nivel educacional y socioeconómico de las mujeres. La dimensión que mejor se correlaciona con el bienestar corresponde al cuidado profesional de calidad, la que reportó mejor puntaje como subescala. Conclusión: El instrumento permitió evaluar el bienestar materno durante el parto

Objective: To design and test an objective and self-administered instrument in order to evaluate the wellbeing of women during childbirth. Method: Combinations of qualitative and quantitative methodologies were considered. Using focus groups and individual interviews, the subjective perception of maternal wellbeing in its distinct dimensions was explored. In the quantitative phase, using a cross sectional correlational design, the scale was tested and validated in 303 women post-partum in a public hospital in the south west section of Santiago, and at the same time the level of wellbeing of women in childbirth was explored. Results: The Scale of Maternal Wellbeing in Childbirth, explored maternal wellbeing in three levels: optimal, adequate and unpleasant; more than 60 percent of the women reported their level of wellbeing as adequate or optimal, significantly associated with the type of delivery and parity of the women. The score of wellbeing was not associated with time of shift, partner status, level of education, or socio-economic status of the women. The dimension that significantly correlated with the wellbeing score was the quality of professional care, this one reported de highest score as a subscale. Conclusion: The instrument allow to evaluate the maternal wellbeing during childbirth

Promover la salud mental con mujers chilenas en desvantaja social / Promoting mental health in socially disadvantaged chilean women

Se descrive una parte de la experiencia del proyecto Chileno/Canadiense: "Promover la salud mental de las mujeres chilenas en desventaja social: Los Secretos de Maruja". Se describen los objetivos, las etapas del proceso, de intervención y los resultados de las evaluaciones preliminares. Con la participación de las mujeres usuárias de los centros de salud, profesionales y autoridades de la comuna de La Pintana, se construyó, aplicó y evaluó un proyecto de intervención para apoyar a las mujeres en la toma de decisiones que favorezcan su salud mental personal, familiar y social. La intervención contempló el diseño, producción, distribución y evaluación de 12 folletos educativos tipo calendarios, cada uno respecto a tres temas de salud mental identificados por las mismas mujeres: Identidad y autoestima, Vínculo y Comunicación y Autocuidado. Además se involucró a las enfermeras que trabajan en los Centros de Salud, quienes incorporaron esta estrategia a la atención de salud habitual y evaluaron su impacto en la identidad, autonomía profesional y en la mejoría de la calidad del cuidado.

This paper describes a Chilean/Canadian intervention project about Mental Health Promotion with socially disadvantaged women called "Maruja´s secrets". We present their objectives, each stage of the intervention process and preliminary evaluations. With the participation of women of the community, health professionals and authorities of health members of La Pintana, we conceive, develop and evaluate an intervention to support and coach women in decision making to improve their personnel and social mental health. The intervention process include design, engaged community nurses, distribution and evaluation of 12 educative color calendars, each one with 14 messages about mental health issues, that were discovered in focus groups with the same women: Identity and self- esteem; communication and self-care. Each calendar has 14 messages, a self-diagnosis test and addresses of community social resources. Community nurses were involved in the distribution and they evaluate their experience as a way of strengthening nursing identity and the quality of nursing care...

Descreve-se uma experiência do projeto chileno-canadense, intitulado "Promover a saúde mental de mulheres chilenas em desvantagem social: os Segredos de Maruja". Apresentam-se os objetivos, as etapas das intervenções e as avaliações preliminares. Com a participação das mulheres usuárias dos Centros de Saúde, profissionais de saúde e autoridades da comunidade de La Pintana, foi construído, aplicado e avaliado um projeto de intervenção para apoiar as mulheres na tomada de decisões que favorecessem sua saúde mental, pessoal, familiar e social. A intervenção contemplou o desenho, a produção, a distribuição e a avaliação de 12 cartilhas educativas tipo calendários, cada uma referente a três temas de saúde mental considerado importante pelas mesmas mulheres: identidade e auto-estima; vínculos e comunicação; e autocuidado. Cada cartilha tem um teste de autodiagnóstico e endereços dos recursos sociais comunitários. Ademais, comprometeu as enfermeiras que trabalham nos Centros de Saúde que incorporaram esta estratégia no seu atendimento habitual e avaliaram seu impacto tanto na sua identidade e autonomia profissional quanto na melhoria da qualidade do cuidado brindado às mulheres...