A arte de ressignificar: a educação permanente tecendo saberes entre a atenção básica e a saúde mental / The art of reframing: permanent education weaving knowledge between primary care and mental health

Trata de relato de experiência apresentado na 1ª Mostra Estadual Educação Permanente em Saúde da SES Tocantins que relata as ações coordenadas por duas Psicólogas e uma Assistente Social e com o Núcleo de Apoio à Saúde de Família (NASF). Apresenta a realização de ações de Educação Permanente em Saúde (EPS) a partir da identificação de problemas e dificuldades detectadas nas equipes. Assim foi criado um espaço destinado a compartilhar saberes, processos de trabalho, gestão compartilhada, atuação profissional e em equipe, tecnologias leves, como aborda Merhy (2002). As ações ocorriam nos bairros Taquari e Aureny III, onde tinham uma demanda considerável de pacientes com transtorno mental, alguns eram acompanhados pelos Centros de Atenção Psicossocial. Percebeu-se que as equipes não tinham o hábito em realizar momentos de discussão sobre os processos de trabalho realizados, dificuldades e potencialidades encontradas para dirimir algumas situações de saúde, principalmente no que tange à saúde mental.

It deals with an experience report presented at the 1st State Permanent Education in Health Show of SES Tocantins, which reports the actions coordinated by two Psychologists and a Social Worker and with the Family Health Support Center (NASF). It presents the implementation of Permanent Education in Health (EPS) actions based on the identification of problems and difficulties detected in the teams. Thus, a space was created to share knowledge, work processes, shared management, professional and team performance, light technologies, as discussed by Merhy (2002). The actions took place in the neighborhoods of Taquari and Aureny III, where there was a considerable demand from patients with mental disorders, some were monitored by the Psychosocial Care Centers. It was noticed that the teams were not in the habit of having moments of discussion about the work processes performed, difficulties and potentialities found to resolve some health situations, especially with regard to mental health.

Whose centre is it anyway? Defining person-centred care in nursing: An integrative review.

AIM: The aims of this literature review were to better understand the current literature about person-centred care (PCC) and identify a clear definition of the term PCC relevant to nursing practice. METHOD/DATA SOURCES: An integrative literature review was undertaken using The Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, Scopus and Pubmed databases. The limitations were English language, full text articles published between 1998 and 2018 within Australian, New Zealand, Canada, USA, Europe, Ireland and UK were included. The international context off PCC is then specifically related to the Australian context. REVIEW METHODS: The review adopted a thematic analysis to categorise and summarise themes with reference to the concept of PCC. The review process also adhered to the Preferred Reporting System for Meta-Analysis (PRISMA) and applied the Critical Appraisal Skills Programme (CASP) tools to ensure the quality of the papers included for deeper analysis. RESULTS: While definitions of PCC do exist, there is no universally used definition within the nursing profession. This review has found three core themes which contribute to how PCC is understood and practiced, these are People, Practice and Power. This review uncovered a malalignment between the concept of PCC and the operationalisation of the term; this misalignment was discovered at both the practice level, and at the micro, meso and micro levels of the healthcare service. CONCLUSION: The concept of PCC is well known to nurses, yet ill-defined and operationalised into practice. PCC is potentially hindered by its apparent rhetorical nature, and further investigation of how PCC is valued and operationalised through its measurement and reported outcomes is needed. Investigation of the literature found many definitions of PCC, but no one universally accepted and used definition. Subsequently, PCC remains conceptional in nature, leading to disparity between how it is interpreted and operationalised within the healthcare system and within nursing services.

Exploring Current Evidence on the Past, the Present, and the Future of the Heart Team: A Narrative Review.

INTRODUCTION: Including healthcare professionals dealing with cardiovascular diseases, Heart Team is a concept/structure designed for selecting diagnostic strategies, facilitating therapeutic decisions, and improving cardiovascular outcomes in patients with complex heart pathologies, requiring input from different subspecialties and the necessity of a multidisciplinary approach. The aim of this narrative review is to search for and to summarize current evidence regarding Heart Team and to underline the future directions for the development of this concept. METHODS: We searched the electronic database of PubMed, SCOPUS, and Cochrane CENTRAL for studies including Heart Team. Forty-eight studies were included, if reference was made to Heart Team structure and functionality. RESULTS: We depicted the structure and the timeline of Heart Team, along with actual evidence-based recommendations from European Guidelines. We underlined the importance of quality of knowledge-sharing and decision-making inside the Team, analyzing bad decisions which did not reflect members' true beliefs due to "uniformity pressure, closed mindedness, and illusion of invulnerability." The observation that Guidelines' indications regarding Heart Team carry a level C indication underlines the very future of this Team: randomized controlled trials proving solid benefits in an evidence-based world. CONCLUSIONS: Envisioned as a tool for optimizing the management of various complex cardiovascular pathologies, Heart Team should simplify and facilitate the activity in the cardiovascular ward. Finally, these facts should be translated into better cardiovascular outcomes and a lower psychological distress among Team participants. Despite all future changes, there must always be a constant part: the patient should remain at the very center of the Team.

Mechanizing medicine - Tomorrows history started yesterday.

History is by nature a retrospective subject, there usually being an interval between any event, a review or impact of the subject being considered. This NPSA Historian's paper, takes a long and quick historical view of influences that fostered changes resulting in the current state of affairs in the field of medicine and medical care. The fields of medicine and surgery, are undergoing rapid changes as a result of technological and other advances that are making tomorrow's medical history seemingly happening yesterday. Prospectively, the impact of current change and its rapidity has the potential to radically change the future practice of the art and craft of our profession.

Osler Centenary Papers: William Osler in medical education.

William Osler combined many excellent characteristics of a clinical educator being a scientific scholar, a motivational speaker and writer and a proficient physician. As we celebrate his life a century on, many of his educational ideals are as pertinent today as they were in those Victorian times. Osler's contributions to modern medicine go beyond his legacy of quotable aphorisms to a doctor, educator and leader whose proponent use of bedside teaching, careful clinical methods, and clinicopathological correlation was a great inspiration for students and junior doctors. He was also a great advocate of patient-centred care-listening to and closely observing his patients, an important message for modern medicine as the reliance on investigations strains modern healthcare systems. This review of Osler's contribution to medical education summarises his development as an educator and provides reflection on his influences to modern clinical education.

Achieving a person-centered approach to dialysis discontinuation: An historical perspective.

In this essay, we describe the evolution of attitudes toward dialysis discontinuation in historical context, beginning with the birth of outpatient dialysis in the 1960s and continuing through the present. From the start, attitudes toward dialysis discontinuation have reflected the clinical context in which dialysis is initiated. In the 1960s and 1970s, dialysis was only available to select patients and concerns about distributive justice weighed heavily. Because there was strong enthusiasm for new technology and dialysis was regarded as a precious resource not to be wasted, stopping treatment had negative moral connotations and was generally viewed as something to be discouraged. More recently, dialysis has become the default treatment for advanced kidney disease in the United States, leading to concerns about overtreatment and whether patients' values, goals, and preferences are sufficiently integrated into treatment decisions. Despite the developments in palliative nephrology over the past 20 years, dialysis discontinuation remains a conundrum for patients, families, and professionals. While contemporary clinical practice guidelines support a person-centered approach toward stopping dialysis treatments, this often occurs in a crisis when all treatment options have been exhausted. Relatively little is known about the impact of dialysis discontinuation on the experiences of patients and families and there is a paucity of high-quality person-centered evidence to guide practice in this area. Clinicians need better insights into decision-making, symptom burden, and other palliative outcomes that patients might expect when they discontinue dialysis treatments to better support decision-making in this area.

Understanding care in the past to develop caring science of the future: a historical methodological approach.

In this paper, we explore how the development of historical research methodologies during the last centuries can contribute to more diverse and interdisciplinary research in future caring science, especially towards a care focus that is more person-centred. The adding of a historical approach by professional historians to the theory of person-centredness and person-centred care can develop knowledge that enables a more holistic understanding of the patient and the development of the patient perspective from the past until today. Thus, the aim was to show how developments within historical methodology can help us to understand elements of care in the past to further develop caring science in future. Historical research methodologies have advocated a "history from below" perspective, and this has enabled the evolution of systematic approaches to historical research that can be explored and critically analysed. Linked with this, the development of a more social and cultural oriented understanding of historical research has enabled historians to explore and add knowledge from a broader societal perspective. By focusing on the life of ordinary people and taking social and cultural aspects into account when trying to reconstruct the past, we can get a deeper understanding of health, care and medical development. However, an interdisciplinary research focus on person-centredness and person-centred care that includes professional historians can be challenging. In this paper, we argue that a historical perspective is necessary to meet the challenges we face in future delivery of health care to all people, in all parts of society in an ever more global world.

Una aproximación hermenéutica de la historia de la enfermería / An approach to the historical to a hermeneutics of nursing

En el presente trabajo se presenta una revisión filológica e histórica del cuidado para evidenciar y fortalecer el sentido humano de la Enfermería, a partir de dos aspectos, a saber: primeramente, una visión general de la historia clásica del cuidado, desde el pensamiento griego antiguo y el cristianismo antiguo, para justificar que la dignidad y la identidad son elementos importantes para plantear el elevado sentido humano del estudio y ejercicio de la Enfermería

This work presents a philological and historical review of care to highlight and strengthen the human sense of Nursing, from two aspects, namely: firstly, an overview of the classical story of care, from the ancient Greek thought and ancient Christianity, to justify that dignity and identity are important elements to raise the high human consciousness for the study and practice of Nursing

Negotiating "The Social" and Managing Tuberculosis in Georgia.

In this paper I utilize anthropological insights to illuminate how health professionals and patients navigate and negotiate what for them is social about tuberculosis in order to improve treatment outcomes and support patients as human beings. I draw on ethnographic research about the implementation of the DOTS (Directly Observed Therapy, Short Course) approach in Georgia's National Tuberculosis Program in the wake of the Soviet healthcare system. Georgia is a particularly unique context for exploring these issues given the country's rich history of medical professionalism and the insistence that the practice of medicine is a moral commitment to society. I argue for critical attention to the ways in which treatment recipients and providers navigate what, for them, is "social" about therapeutic practices and their significance for avoiding biological and social reductionism.

Evolution of an Evidence Collaboration: From Initial Goals to Current Initiatives.

Best practices based on evidence are needed by every clinician to provide safe, effective, patient-centered care. Determining best practice for a given situation can be difficult. Ideally, the clinician understands how to critically appraise the relevant research, and integrates high-quality research with interdisciplinary clinical expertise and patient and family values and preferences to choose best care for an individual or family. At our organization, we are taking the integration of research, clinical expertise, and patient/family preferences and values to the next level by aligning the evidence work of multiple functional areas and disciplines to improve the safety and effectiveness of clinical practice. The Evidence Collaboration, an interdisciplinary community of practice, has evolved to meet the challenges of helping novices and experts of all disciplines identify, critically appraise, synthesize, and disseminate evidence to inform best practices for patients and families, staff, and institutional processes. By creating a common language for evidence work, resources such as the Let Evidence Guide Every New Decision system, and templates for dissemination, the Evidence Collaboration has moved the organizational culture toward one that encourages the use of evidence in all decisions. Our progress continues as we strive to include patients and families in the decisions about best practices based on evidence.

Edmund Pellegrino and the art of civilized dialectics.

I had the good fortune to work with Edmund Pellegrino from 2005 until 2009, while he was chairman and I was a member of the President's Council on Bioethics. We came from different disciplines--medicine and law--and from different generations. Until that point, our paths had rarely crossed. I am so glad that I finally did have an opportunity to get to know him. Pellegrino contributed a great deal to the council during his time as chairman. I cannot begin to cover all that he brought to the council during his four years of leadership. In this essay, I describe how his views of both public bioethics and clinical ethics shaped his council participation.

History and evolution of surgical ethics: John Gregory to the twenty-first century.

As surgery grew to become a respected medical profession in the eighteenth century, medical ethics emerged as a response to the growing need to protect patients and maintain the public's trust in physicians. The early influences of John Gregory and Thomas Percival were instrumental in the formulation of patient-centered medical ethics. In the late nineteenth century, the modern surgical advances of anesthesia and antisepsis created the need for a discipline of ethics specific to surgery in order to confront new and evolving ethical issues. One of the founding initiatives of the American College of Surgeons in 1913 was to eliminate unethical practices such as fee-splitting and itinerant surgery. As surgery continued to advance in the era of solid organ transplantation and minimally invasive surgery in the latter half of the twentieth century, surgical innovation and conflict of interest have emerged as important ethical issues moving forward into the twenty-first century. Surgical ethics has evolved into a distinct branch of medical ethics, and the core of surgical ethics is the surgeon-patient relationship and the surgeon's responsibility to advance and protect the well-being of the patient.

Review of the history and development in the field of psychosocial oncology.

Psychosocial oncology is a multi-disciplinary field of practice and, as a recently developed speciality, covers the psychological, social and behavioural dimensions of cancer. We describe the historical background and changing ethos in medical practice in order to understand factors that contributed to the emergence of this new discipline. Modern psychosocial oncology covers a number of topics; the diagnosis and management of psychological morbidity and distress across the cancer continuum from diagnosis through survivorship and, for some patients, terminal illness, the recognition that behaviour and lifestyle contribute to cancer risk and prognosis, the need to include families and carers alongside patients in a comprehensive model of supportive cancer care. Best practice, based on evidence and nationally and internationally accepted guidelines, is being integrated into national cancer plans, and services are briefly described. Future challenges include the need to recognize that the behavioural and mental health sciences have a role to play in comprehensive cancer care and that multi-disciplinary care, which includes psychosocial care, is the best model for ensuring patients needs are comprehensively and adequately met. The return of modern medicine to a more holistic person-focused ethos is needed in order to put the patient back into patient-centred cancer care.

Key aspects and health care benefits of patient-centered medical homes part 1 of 3.

The concept of patient-centered medical homes (PCMHs) is one of the latest efforts to provide higher quality of life for patients while aiming to reduce overall health care costs. As part of this health care reform effort, PCMHs strive to provide patient-centered, coordinated, effective, and efficient care that leads to long-term relationships with patients. The objective of this three-part series is to provide a comprehensive review of the PCMH for health care practice sites and professionals, its key features, recognition of quality programs, support and payment models from government and third-party insurers, and patient and professional benefits. Part 1 describes the history and development of PCMHs, the overall concept of the health care model, and the process that is used to recognize quality PCMHs. Because of the current weaknesses and deficiencies in the United States' health care system, there is a definitive need for the establishment and expansion of PCMHs.