Digitalización de la comunicación y atención a personas LGBTIQ+: dos conflictos éticos emergentes para la Psicología en la Atención Primaria de Salud chilena / Digitalització de la comunicació i atenció a persones LGBTIQ+: dos conflictes ètics emergents per a la psicologia en l'Atenció Primària de Salut xilena / Digitalization of communication and attention to LGBTIQ+ people: Two emerging ethical conflicts for psychology in Chilean Primary Health Care

El artículo analiza los conflictos éticos detectados por Psicólogas/os en la Atención Primaria de Salud en Chile, centrando la descripción y análisis en los percibidos como emergentes, a través de un estudio cualitativo, tipo exploratorio-descriptivo. Dos fueron los principales conflictos identificados: a) resguardo de información sensible en ficha clínica electrónica y b) atención a personas LGBTIQ+ sin capacitación correspondiente. El estudio transparenta la importancia de visibilizar demandas incipientesen salud pública a través de las perspectivas de los propios profesionales, dotándoles de notoriedad para avanzar en su priorización y resolución. Explorar la dimensión ética es relevante para el ejercicio de la psicología contemporánea, porque da cuenta de las necesidades de la sociedad, permitiendo incluso anticiparse a ellas.(AU)

L'article analitza els conflictes ètics detectats pels psicòlegs en l'Atenció Primària de Salut a Xile, centrant-se en la descripció i anàlisi dels que es perceben com a emergents mitjançant un estudi qualitatiu de tipus exploratori-descriptiu. Es van identificar dos conflictes principals: a) la protecció de la informació sensible en els registres clínics electrònics i b) l'atenció a persones LGBTIQ+ sense la formació adequada. L'estudi destaca la importància de fer visibles les demandes incipients en la salut pública a través de les perspectives dels mateixos professionals, donant-los rellevància per avançar en la seva prioritat i resolució. Explorar la dimensió ètica és rellevant per a l'exercici de la psicologia contemporània, ja que reflecteix les necessitats de la societat, fins i tot permetent anticipar-se a elles.(AU)

The article analyzesthe ethical conflicts detected by psychologists in Primary Health Care in Chile, centering the description and analysis on those perceived as emerging, through an exploratory-descriptive qualitative study. There were two main conflicts identified: a) safeguarding of sensitive information in electronic clinical records and b) healthcare for LGBTIQ+ persons without the corresponding qualification. The study illustrates the importance of highlighting developing demands in public healthcare through the perspectives of the professionals themselves, providing the demands with notoriety in order to advance in their prioritization and resolution. Exploring the ethical dimension is relevant for contemporary psychology practice because it accounts for the needs of society, even making it possible to anticipate them.(AU)

Marketing and the Most Trusted Profession: The Invisible Interactions Between Registered Nurses and Industry.

BACKGROUND: The mainstay for addressing conflicts of interest in health care is disclosure of personal financial ties to industry. However, this approach fails to capture the complexity of industry interactions that are built into clinical practice. Further, the policy climate focuses on physicians and traditional pharmaceutical marketing. OBJECTIVE: To describe industry activities targeted at registered nurses. DESIGN: Qualitative, ethnographic study conducted from January 2012 to October 2014. SETTING: Four acute care hospitals in a western U.S. city. PARTICIPANTS: A purposive sample of 72 participants with direct experience with industry, including staff nurses, administrators, and industry and supply chain professionals. MEASUREMENTS: Fieldwork, including observations (102 hours), semistructured in-depth interviews (n = 51), focus groups (n = 4), and documents analysis. RESULTS: Nurses' reported financial relationships with industry were similar to those reported by prescribers. However, nurses reported that their most significant interactions with industry occurred in daily practice. The current policy environment rendered these interactions invisible, leaving nurses with little guidance to ensure that the boundary between service and sales remained intact. LIMITATIONS: This study could not determine the frequency or prevalence of nurse-industry interactions. The sample is not representative. CONCLUSION: Nurse-industry interactions may be common and influential, but they remain invisible in the current policy climate. Although some aspects of these interactions may be beneficial, others may pose financial risks to hospitals or safety risks to patients. Disclosure strategies alone do not provide health professionals with adequate support to manage day-to-day interactions. Management of industry interactions must include guidance for nurses. PRIMARY FUNDING SOURCE: Agency for Healthcare Research and Quality; Canadian Institutes of Health Research; and University of California, San Francisco.

Responsabilidad en la labor que asumió. Un requisito para las enfermeras en el cuidado humanizado / Responsibility for the assumed work. A requirement for nurses in humanized care

Objetivo: Comprender el significado de la experiencia de cuidado de enfermería humanizado para pacientes, familiares y enfermeras. Metodología: Estudio fenomenológico interpretativo que incluyó a 16 participantes adultos y se basó en entrevistas en profundidad para la construcción de la información. Resultados: La responsabilidad de las enfermeras en el cuidado es un requisito para pasar de la atención impersonal al cuidado humanizado y se refl eja en el interés por actuar bien y hacer bien las cosas, en lograr las habilidades comunicativas y relacionales, en basar las actuaciones en enfoques teóricos y en estudiar para conocer sobre nuevas orientaciones y prácticas en el cuidado. Conclusiones: La concordancia en las enfermeras entre saber lo que se hace y actuar con orientación al bien favorece el cuidado humanizado

To understand the meaning of the experience of humanized nursing care for patients, families and nurses. Methodology: Interpretative phenomenological study involving 16 adult participants, based on in-depth interviews for building information. Results: The responsibility of nurses in care as a requirement to move from an impersonal attention to a humanized care is refl ected in the interest in acting well and doing things well, achieving communicative and relational skills, in performing care based on theoretical proposals, in studying and learning about new approaches and practices in the care. Conclusions: The nurses’ concordance between knowing what to do and acting with orientation towards the good contributes to humanized care

Simulação clínica em cardiologia / Clinical simulation in cardiology

A educação continuada constitui um critério de avaliaçãode qualidade do ensino das instituições, sendo uma das ferramentasmais importantes na capacitação dos profissionaisda saúde, na atualização profissional e no aprimoramentoda equipe multidisciplinar. A simulação diminui a distânciaexistente entre o que se ensina na teoria e sua aplicabilidadena prática profissional. O treinamento com cenários é dividido,didaticamente, em três momentos: elaboração, execuçãoe debriefing. O debriefing é o momento utilizado para análisee reflexão do que foi vivido durante a simulação, para que sedescubra o que foi aprendido e sua aplicabilidade a partir deexperiências vividas em situações reais. A simulação clínicatambém permite que os profissionais estejam mais aptos a anteversituações clínicas adversas, possam cometer erros e, atémesmo, tirar suas dúvidas antes de lidar com situações reais,sempre em ambientes controlados e sob constante supervisão...

Continuing education is a major criterion for the evaluationof the quality of teaching institutions, so it is one of the mostimportant tools in the training of health professionals in professionalupdating and improving the multidisciplinary team.Simulation decreases the gap between what is taught in theoryand its applicability in practice. The training scenario is divideddidactically in three stages: preparation, execution anddebriefing. The debriefing is the time required for analysis andreflection of what was experienced during the simulation, sothat they disco ver what they have leamed and their applicabilityfrom experiences in real situations. Simulation also allowsclinical professionals to be more able to predict adverse clinicalsituations, so that they can make mistakes or even get therequestions solved before dealing with real situations, alwaysin controlled environments and under constant supervision...

Modelo de consultoría en enfermería neurológica / Consulting model in nephrology nursing

Introducción: Los modelos son patrones a seguir o imitar debido a su contribución en la prestación del cuidado personalizado a los pacientes neurológicos y neuroquirúrgicos. Se presentan a través de la Consultoría en Enfermería Neurológica (CEN), este servicio se considerada una asesoría profesional que el personal de enfermería brinda a los beneficiarios; por medio de estas asesorías se identifican las necesidades reales y potenciales de cada enfermo y se le orienta en sus cuidados específicos. El profesional de enfermería imparte consejos y educación sobre los cuidados, todo ello con el fin de promover la salud, el autocuidado y la prevención de complicaciones. Objetivo: Establecer un modelo de Consultoría en Enfermería Neurológica con un equipo de profesionales especialistas en el área para disminuir los reingresos, días-cama-hospital y el costo hospitalario, así como proporcionar consulta de especialidad neurológica a personas afectadas para favorecer el cuidado y la calidad de vida en los enfermos. Metodología: Se aplica el proceso enfermero (PE), método científico implementado en la práctica asistencial, el cual permite la interacción con los enfermos y la familia a fin de brindar cuidados de forma organizada, racional, lógica y sistemática, así como educación y promoción de la salud a través de intervenciones educativas con planes y guías. Resultados: Se obtienen a través de la recolección y valoración de los datos personales, que permiten la elaboración de un archivo clínico, éste integra la historia individual, tomando nota de sus problemas, que posteriormente contribuyen a los diagnósticos y planes de cuidados para su ejecución. Análisis: Se evalúan los resultados de los planes e intervenciones administrados. Discusión: De acuerdo con Alfaro Lefevre, Carpenito, Bener P, Luis RT, el PE es sistemático, continuo, lógico y organizado. Conclusiones: La CEN personaliza el cuidado, lo individualiza a través de un juicio clínico y pensamiento crítico.

Introduction: Model, is a pattern to follow or imitate, for its contribution to the provision of personalized care to Neurological and Neurosurgical patients. This occurs through the Neurological Nursing Consulting (NNC) and it’s considered a professional service, which offers consultation through the interview between the beneficiary and the nurse, it identifies real and potential needs of the patient oriented to the specific care of each person, and the provision of assistance by family also provided advice on the care and education, all to promote health, self-care and prevention of complications. Objective: Establish a model for Neurological Nursing Consultancy with a team of specialists in the area to reduce readmissions, days - bed - hospital and the hospital cost; also provide neurological specialty consulting to affected people, to promote the care and quality of life in patients. Methodology: Applying the Nursing Process (NP), scientific method implemented in clinical practice, which allows interaction with patients and their families to provide care in an organized, rational, logical and systematic way. As well as education and health promotion through educational interventions with plans and guides. Results: Obtained through the collection and assessment of personal data, enabling the development of a clinical record, it integrates the individual history, noting their problems, which then contribute to the diagnosis and care plans for their implementation. Analysis: Are evaluated results of the plans and interventions administered. Discussion: According to Alfaro Lefevre, Carpenito, Bener P, Luis RT, the NP, is systematic, continuous, logical, and organized. Conclusions: The CEN personalize and individualized the care, through clinical judgment and critical thinking.

[Survey in hospitals. Nursing errors, error culture and error management]. / Befragung in Krankenhäusern. Pflegefehler, Fehlerkultur und Fehlermanagement.

Knowledge on errors is important to design safe nursing practice and its framework. This article presents results of a survey on this topic, including data of a representative sample of 724 nurses from 30 German hospitals. Participants predominantly remembered medication errors. Structural and organizational factors were rated as most important causes of errors. Reporting rates were considered low; this was explained by organizational barriers. Nurses in large part expressed having suffered from mental problems after error events. Nurses' perception focussing on medication errors seems to be influenced by current discussions which are mainly medication-related. This priority should be revised. Hospitals' risk management should concentrate on organizational deficits and positive error cultures. Decision makers are requested to tackle structural problems such as staff shortage.

Nurses' and physicians' educational needs in seclusion and restraint practices.

PURPOSE: This study aimed to explore nurses' (N= 22) and physicians' (N= 5) educational needs in the context of their perceived seclusion and restraint-related mode of action and need for support. METHOD: The data were collected by focus group (N= 4) interviews and analyzed with inductive content analysis. RESULTS: Participants recognized a need for on-ward and problem-based education and infrastructural and managerial support. The declared high ethical principles were not in accordance with the participants' reliance on manpower and the high seclusion and restraint rates. PRACTICE IMPLICATIONS: Future educational programs should bring together written clinical guidelines, education on ethical and legal issues, and the staff's support aspect.

[Ethical and training in intensive care]. / Etica e formação em cuidados intensivos.

In clinical practice and management of Intensive Care Units (ICU) there is a need for a continuous updating of scientific and technical nature, as well as ethical, in order to appropriately respond to the demands placed on professional competence and care quality. In a society where, for decades, possessing information was synonymous of having power, the most difficult challenge is the internalization of a new paradigm: allowing to share information is giving everyone the power to go further, considering that training is a valuable tool for managing and continuous improvement of individual performance, for the innovation and efficiency of the results of the Unit. By generating situations/problems in the context of bioethics, the ICU is also a place capable of developing the knowledge and intersecting skills, in which lies the ethical competence. We have adopted an exploratory-descriptive methodology, using a questionnaire, to find out the opinion of doctors and nurses in the context of clinical practice and management, in polivalents units for adults and children, with mechanical ventilation, in the northern region. The results show that respondents recognize the role of in-service training mainly as an incentive to validate practical knowledge, and as an opportunity to examine values, beliefs and moral convictions, integrating the professional ethics code.

A residência médica: articulações entre a prática e o ensino / Medical residence: articulations between practice and teaching

O objetivo desta tese de doutorado é o estudo da residência médica e de suas articulações com o campo educacional e o da saúde. Propõe-se uma análise histórico - dialética, tomando como ponto de partida a articulação da medicina e da educação na estrutura social. Parte-se da concepção segundo a qual a prática e o saber no campo educacional e na saúde estão ligados à transformação histórica do processo de produção econômica. Essa compreensão remete à chamada determinação em última instância: a estrutura econômica determina o lugar e a forma de articulação da medicina e da educação na estrutura social. Para compreender as peculiaridades do ensino e da residência médica no Brasil faz-se uma caracterização da assistência médica, sobretudo do papel assumido pelo Estado na configuração do campo: primeiro, a adoção de um sistema em que compete ao Estado a responsabilidade pela universalização da atenção básica, através de serviços próprios ou em parceria com organizações não governamentais; segundo, a atenção especializada, com maior incorporação tecnológica, seria prestada pelo setor privado, mediante incentivos concedidos pelo Estado. Dessa divisão, resulta, no desenho atual, ao invés de um único sistema, a conformação de dois ou mais sistemas de saúde, em que a segmentação da assistência implica em práticas diferenciadas. O efeito desta divisão no mercado de trabalho repercute na escola e na residência médicas. A residência, em particular, por suas características de treinamento em serviço, responde diretamente aos condicionantes do mundo do trabalho, reproduzindo o modelo de prática hegemônica.

[Clinical and ethical stakes of external supervision of mental health teams]. / Enjeux cliniques et éthiques de la supervision externe des équipes en santé mentale.

External supervision of teams is increasingly part of mechanisms put in place both in public networks and community organizations to contribute in supporting professional mental health workers in developing their abilities and improving their clinical practices. It also plays a role in the analysis of ethical questions and in the prevention of deontological errors. The supervision of teams also includes its share of challenges, notably with regards to group dynamics and mechanisms to favour in order for supervision to rightly adjust to the needs and levels of participating professionals. Finally, the supervisor must also consider his own ethical responsibilities towards those supervised and towards their clients.

[Clinical ethics in psychiatry: the experience at Douglas Hospital]. / Ethique clinique en psychiatrie: l'expérience de l'Hôpital Douglas.

The authors present a brief overview of the clinical ethics committee within their mental health university institute as well as its evolving mandates over the past few decades. The main functions include case consultation, input on elaboration of institutional policy, and staff education as well as public information on issues of ethics and mental illness. With examples and questions brought to the committee's attention, the authors demonstrate how these functions are intertwined. The authors conclude that ethical questioning helps examine clinical practices and serves ultimately in guiding towards best practices in mental health.