Implementación de programas de transición de la adolescencia a la edad adulta / Implementation of programmes for the transition of adolescents to adult care

Hasta un 15-20% de adolescentes tienen algún problema de salud crónico. La adolescencia representa un periodo de riesgo especial para la evolución de las enfermedades crónicas, tanto en aquellos con padecimientos con mayor prevalencia como en los afectados por enfermedades raras. La transición de la asistencia pediátrica a la adulta empieza con la preparación y capacitación del paciente pediátrico, acostumbrado a los cuidados tutelados, para que asuma la responsabilidad de su autocuidado en una unidad de adultos. La transferencia es el momento en el que la persona joven pasa a los servicios de adultos y es dada de alta de los servicios pediátricos. La transición sólo se completa cuando los jóvenes están integrados y funcionan con total competencia dentro del servicio de adultos. Los profesionales de adultos tienen un rol crucial al momento de recibir e integrar a los adultos jóvenes. Un programa de transición puede incluir transiciones de diferente complejidad, desde enfermedades frecuentes y conocidas como el asma, que requieren un proceso más sencillo, hasta enfermedades raras complejas con necesidad de participación de personal muy especializado. La transición requiere un trabajo en equipo con participación de numerosos profesionales: pediatras y médicos de adultos, enfermeras, psicólogos clínicos, trabajadores sociales sanitarios, equipo de Farmacia, y personal administrativo. Es importante implicar a los adolescentes en la toma de decisiones y que los padres los dejen ir progresivamente. Un programa de transición bien estructurado puede mejorar los resultados en salud, la experiencia del paciente y la utilización y coste de los cuidados sanitarios.(AU)

Up to 15%–20% of adolescents have a chronic health problem. Adolescence is a period of particular risk for the development or progression of chronic diseases for both individuals with more prevalent conditions and those affected by rare diseases. The transition from paediatric to adult care begins with preparing and training the paediatric patient, accustomed to supervised care, to assume responsibility for their self-care in an adult care setting. The transition takes place when the young person is transferred to adult care and discharged from paediatric care services. It is only complete when the youth is integrated and functioning competently within the adult care system. Adult care providers play a crucial role in welcoming and integrating young adults. A care transition programme can involve transitions of varying complexity, ranging from those required for common and known diseases such as asthma, whose management is more straightforward, to rare complex disorders requiring highly specialized personnel.(AU)

Prevalencia y características clínicas del dolor en pacientes con enfermedad crónica avanzada / Prevalence and clinical characteristics of pain in patients with advanced chronic disease

Objetivos: Determinar la prevalencia y las características clínicas del dolor en pacientes con enfermedad crónica avanzada, e identificar la frecuencia del dolor irruptivo. Diseño: Estudio observacional, descriptivo y transversal. Emplazamiento: Tres equipos de atención primaria y un hospital de cuidados intermedios. Participantes: Se seleccionaron todos los pacientes con enfermedad crónica avanzada. Mediciones principales: Se realizó una entrevista semiestructurada para recoger variables demográficas, clínicas y específicas de dolor mediante escalas validadas. Se registraron la ubicación (domicilio, residencia u hospital) y la trayectoria de cronicidad avanzada (insuficiencia de órgano, enfermedad oncológica, demencia o multimorbilidad). Se valoró la presencia de dolor según la Brief Pain Inventory (BPI) y, en los casos de demencia invalidante, según la Pain Assessment in Advanced Dementia (PAINAD). Análisis estadístico descriptivo y comparativo entre variables utilizando el programa R. Resultados: Se incluyeron 223 pacientes (60,4% de los seleccionados). Prevalencia del dolor: 83,9% (n=187), sin diferencias según la ubicación ni según la trayectoria. Diferencias significativas en la intensidad del dolor según la ubicación (p=0,0046) (moderado-severo en domicilio, moderado en hospital y leve en residencia) y según la trayectoria (p<0,0001) (dolor moderado-severo en insuficiencia de órgano y multimorbilidad, moderado en cáncer y leve en demencia). Se observó impacto funcional por dolor leve-moderado, impacto emocional severo en el 41,5% de los pacientes (n=51) y dolor irruptivo en el 8,6% (n=13). Conclusiones: El dolor debe ser siempre explorado y evaluado en pacientes con cronicidad avanzada, ya que fue muy prevalente en todas las ubicaciones y trayectorias, especialmente intenso en la insuficiencia de órgano y en la multimorbilidad a domicilio. Apareció dolor irruptivo en trayectorias no oncológicas.(AU)

Objectives: Determine pain prevalence and clinical characteristics in patients with advanced chronic disease and identify breakthrough pain frequency. Design: Observational, descriptive, cross-sectional study. Location: Three primary care teams and one intermediate care hospital. Participants: All patients with advanced chronic disease. Main measurements: A semi-structured interview was performed to collect demographic, clinical, and specific variables of pain using validated scales. Patient location (home, nursing home or hospital) and advanced chronicity trajectory (organ failure, oncological disease, dementia, or multimorbidity) were recorded. Pain was assessed based on the Brief Pain Inventory (BPI) and, in cases of disabling dementia, using the Pain Assessment in Advanced Dementia (PAINAD). A statistical descriptive, comparative analysis between variables was performed using the R software. Results: Of all patients selected, 223 (60.4%) were included. Prevalence of pain: 83.9% (n=187), with no differences based on location or trajectory. Significant differences in pain intensity based on location (P=.0046) (moderate-severe in patients at home, moderate in hospital patients, and mild in nursing home patients) and on trajectory (P<.0001) (moderate-severe in patients with organ failure and multimorbidity, moderate in patients with cancer, and mild in patients with dementia). Global functional impact of pain was mild-moderate, emotional impact was severe in 41.5% of patients (n=51), and breakthrough pain was observed in 8.6% (n=13). Conclusions: Pain must always be explored and assessed in patients with advanced chronicity, since it was highly prevalent in all locations and trajectories, being particularly intense in patients at home with organ failure and multimorbidity. Breakthrough pain was found in non-oncological trajectories.(AU)

Competencias profesionales de las enfermeras oncológicas: reconociendo la Práctica Avanzada en Enfermería / Professional competencies of oncology nurses: Recognizing advanced practice in nursing

Objetivo: Identificar el perfil competencial de las enfermeras de práctica avanzada que intervienen en el proceso asistencial del paciente oncológico. Método: Estudio descriptivo transversal. El estudio incluyó a todas las enfermeras que intervienen en el proceso asistencial del paciente oncológico en un hospital terciario de Barcelona. Se recogieron los datos del perfil competencial a través del instrumento de definición del rol de la enfermera de práctica avanzada (IDREPA), así como las variables sociodemográficas y laborales. Se compararon datos sociodemográficos y laborales con el desempeño de actividades de práctica avanzada. Resultados: Participaron un total de 29 (82,9%) enfermeras con una media de edad de 42,6± 12,54 años. Se han identificado 9 (31%) enfermeras que alcanzan el estándar en los 6 dominios en la escala IDREPA para considerarse enfermeras de práctica avanzada (EPA). De estas 9 (31%), cumplían los estándares de formación requeridos por el CIE, 7 (24,1%) con máster oficial y 2 (6,9%) con doctorado. Conclusiones: Existen enfermeras que desarrollan su actividad en el ámbito oncológico del Hospital del Mar con perfil de EPA. La identificación de EPA en nuestro sistema de salud es esencial para poder reconocer las competencias de dichas profesionales y crear puestos específicos que ayuden a abordar la cronicidad, la calidad de vida de los pacientes, su supervivencia y la optimización de los recursos sanitarios. Este estudio pone en relieve la importancia de la cronicidad y el cáncer como ámbitos para el desarrollo de la EPA.(AU)

Objective: To identify the competency profile of advanced practice nurses involved in the care process of cancer patients. Methods: Cross-sectional and descriptive study. The study included all nurses involved in the cancer patient care process in a tertiary hospital in Barcelona. Competence profile data were collected using the instrument for defining the role of the advanced practice nurse (APRD), as well as sociodemographic and occupational variables. Sociodemographic and occupational data were compared against the performance of advanced practice activities. Results: A total of 29 (82.9%) nurses participated with a mean age of 42.6±12.54 years. Nine (31%) nurses were identified as meeting the standard in all 6 domains on the APRD scale to be considered advanced practice nurses. Of these 9 (31%) nurses, 7 (24.1%) met the training standards required by the International Council of Nurses (ICN) with an official master's degree and 2 (6.9%) with a PhD. Conclusions: There are nurses who carry out their activity in the oncology field of the Hospital del Mar with the EPA profile. The identification of advanced practice nurses (APNs) in our health system is essential to be able to recognize the competencies of these professionals and create specific positions that help to address chronicity, patients’ quality of life, their survival, and the optimization of health resources. Our study highlights the importance of chronicity and cancer as areas for the development of the APNs.(AU)

Morbilidad por enfermedades crónicas y su atención sanitaria en Asturias: análisis de género / Morbidity due to chronic diseases and their health care in Asturias: a gender analysis

Objetivo: Determinar las diferencias según sexo de la magnitud y la complejidad por enfermedades crónicas, y las desigualdades de género, en la atención sanitaria de la población adulta en Asturias en el año 2022. Método: Estudio transversal poblacional en mayores de 14 años con al menos un diagnóstico de enfermedad crónica (780.566 habitantes). Fuentes de información: programa informático de grupos de morbilidad (Ministerio de Sanidad), Historia clínica electrónica de atención primaria y hospitalaria. Análisis comparativo por sexo y edad: medias de patologías crónicas e índice de complejidad (t de Student y ANOVA de un factor), y probabilidad (odds ratio e intervalo de confianza del 95%) de padecer enfermedades crónicas específicas, realizar una o más visitas a urgencias, e ingresos hospitalarios. Resultados: En atención primaria se registraron un 89,9% de mujeres y un 82,1% de hombres con al menos una enfermedad crónica. La media fue mayor en las mujeres (4,36) que en los hombres (3,22) (p < 0,001). Índice de complejidad: hombres 4,56 y mujeres 5,85 (p < 0,001). Mientras que la probabilidad de acudir a urgencias es superior en las mujeres en el 50% de las patologías (hombres 29%), la probabilidad de ingresar es superior en los hombres en 13 de las 14 patologías estudiadas (85%). Conclusiones: El análisis de género también se puede aplicar en fuentes secundarias del Sistema Nacional de Salud. Pese a la mayor magnitud y complejidad en las mujeres, la mayor frecuencia de hospitalizaciones en los hombres que en las mujeres con las mismas patologías supone un perfil de atención desigual en el ámbito de ingresos hospitalarios que la literatura científica relaciona con sesgos de género en la atención sanitaria.(AU)

Objective: To determine gender differences in the magnitude and complexity of chronic diseases and gender inequalities in health care in the adult population of Asturias in 2022. Method: A cross-sectional population study in people (>14 years) with at least one diagnosis of chronic disease (780,566 inhabitants). Sources of information: computer program for morbidity groups (Ministry of Health), Electronic medical record of primary care and hospital. Comparative analysis by sex and age, the mean values of chronic diseases and complexity index (Student's t test and one-way ANOVA), and probability (odds ratio and 95% CI) of suffering from specific chronic diseases, making one or more visits to the hospital emergency department or one or more admissions to hospital. Results: 89.9% of women and 82.1% of men were registered with at least one chronic disease. The mean was higher in women (4.36) than in men (3.22) (p < 0.001). Complexity index: men 4.56 and women 5.85 (p < 0.001). Results show that women are more likely to attend the hospital emergency department, with an attendance rate of 50% for the diseases cited, compared with men at 29%. The rate of hospital admission is higher in men in 13 of the 14 diseases studied (85%). Conclusions: Gender analysis can also be applied to secondary sources of the National Health System. Despite the greater magnitude and complexity of chronic diseases in women, there is a higher frequency of hospital admissions in men compared to women with the same diseases. This implies an unequal care profile in the field of hospital admissions that the scientific literature associates with gender biases in health care.(AU)

La experiencia de la persona cuidadora no profesional del paciente con enfermedad crónica: un estudio observacional / The experience of chronically ill patient’s non-professional caregivers: an observational study

Objetivos: Evaluar la experiencia de las personas cuidadoras no profesionales de pacientes crónicos. Metodología: Estudio descriptivo desarrollado en un hospital de pacientes crónicos pluripatológicos. Se aplicó el cuestionario de evaluación de la experiencia de personas cuidadoras no profesionales del paciente crónico (IEXPAC© 2018-Cuidadores) a cuidadores/as no profesionales de pacientes dados de alta, seleccionados de forma aleatoria. Resultados: Participaron 90 cuidadores/as no profesionales. La puntuación media (± desviación estándar) global del cuestionario fue de 3,8 (± 1,4) puntos, sobre un máximo de 5. Los ítems con puntuaciones subóptimas fueron los referidos a la ayuda recibida para formarse a través de Internet y los ánimos para hablar con otras personas cuidadoras. Conclusiones: La encuesta IEXPAC© 2018-Cuidadores es una herramienta fiable, que permite identificar aspectos de mejora y necesidades percibidas, a partir de las cuales desarrollar acciones concretas y definidas orientadas a mejorar la experiencia de las personas cuidadoras no profesionales de pacientes con enfermedades crónicas (AU)

Objectives: To assess the experience of chronically ill patient’s non-professional caregivers. Methodology: A descriptive study was carried out in a chronically ill patients’ hospital. The questionnaire for evaluating the experience of the non professional caregiver of the chronic patient (IEXPAC© 2018-Caregivers) was applied to a randomly selected sample of non-professional caregivers of discharged patients. Results: 90 non-professional caregivers were enrolled. The mean (± standard deviation) overall score of the questionnaire was 3.8 (± 1.4) points, over 5. The items with suboptimal scores were those referring to the help received for training through the Internet and the encouragement to talk to other caregivers. Conclusion: The IEXPAC© 2018-Caregivers survey is a reliable tool that allows us to identify areas for improvement and perceived needs from which to develop specific and defined actions aimed at improving the experience of non-professional caregivers of patients with chronic diseases (AU)

Plan de cuidados de enfermería desarrollado con la teoría de rango medio de autocuidado de las enfermedades crónicas / Nursing care plan developed with the mid-range theory of self care of chronic diseases

El concepto de empoderamiento se ha extendido en nuestra práctica clí nica durante los últimos años. Una per sona empoderada es aquella que es ca paz de deliberar, solucionar sus contra tiempos y complacer sus necesidades, con control y juicio crítico sobre su vida y su salud. Para que consigan estas habi lidades, nosotros como profesionales tenemos la responsabilidad de informar y formar a los pacientes para que mejoren su conocimiento y habilidades en el au tocuidado de sus enfermedades crónicas (1). A propósito de un caso clínico abor da, desde una teoría de rango medio, como podemos abordar a este tipo de pacientes para un correcto mantenimien to de su autocuidado (AU)

The concept of empowerment has spread in our clinical practice in recent years. An empowered person is one who is capable of deliberating, solving their setbacks and satisfying their needs, with control and critical judgment over their life and health. In order for them to achieve these skills, we as professionals have the responsibility of informing and training patients so that they improve their knowledge and skills in self-care for their chronic diseases. Regarding a clini cal case, he addresses, from a mid-ran ge theory, how we can approach this type of patients for proper maintenance of their self-care (AU)

A aplicabilidade das pics na assistencia de enfermagem em pacientes com doença crônica: revisão integrativa / The applicability of pics in nursing care for patients with chronic disease: integrative review / La aplicabilidad de la pics en los cuidados de enfermería a pacientes con enfermedades crónicas: revisión integradora

A implementação das PICs no Brasil é uma realidade, dessa forma, compreende-se que o enfermeiro é o profissional que em tese deve possuir habilidades para aplicar as técnicas em pacientes. Com base nisso, o objetivo do trabalho foi descrever a atuação da enfermagem através de Planos de ações por intermédio das PICs em individuos com diminuição da qualidade de vida em razão do desenvolvimento de doenças crônicas degenerativas. Dessa forma, o presente artigo trata-se de uma revisão integrativa de literatura. Os resultados obtidos mostram que a aplicabilidade das PICs, está consolidada, sendo uma prática bastante utilizada na intervenção terapêutica de indivíduos portadores de doenças crônicas degenerativas, na qual as mais utilizadas são: plantas medicinais, reiki, homeopatia, acupuntura e auricuoterapia, entretanto, em relação a assistência de enfermagem, foi observado impasses em relação a capacitação profissional. Logo, concluímos que com base nas produções cientificas existentes a respeito das PICs, a prática infere em diversos benefícios ao indivíduo, estas que se convergem a promoção de maior qualidade de vida ao paciente com doenças crônicas, porém, a falta de capacitação profissional revela um impasse ainda persistente.

The implementation of PICs in Brazil is a reality, therefore, it is understood that the nurse is the professional who, in theory, must have the skills to apply the techniques to patients. Based on this, the objective of the study was to describe the role of nursing through Action Plans through PICs in individuals with reduced quality of life due to the development of chronic degenerative diseases. Thus, this article is an integrative literature review. The results obtained show that the applicability of PICs is consolidated, being a practice widely used in the therapeutic intervention of individuals with chronic degenerative diseases, in which the most used are: medicinal plants, reiki, homeopathy, acupuncture and auricutherapy, however, in regarding nursing care, impasses regarding professional training were observed. Therefore, we conclude that based on the existing scientific productions regarding PICs, the practice infers in several benefits to the individual, these that converge to the promotion of a better quality of life for the patient with chronic diseases, however, the lack of professional training reveals a stalemate still persistent.

La implementación de los PICs en Brasil es una realidad, por lo tanto, se entiende que la enfermera es el profesional que, en teoría, debe tener las habilidades para aplicar las técnicas a los pacientes. Con base en esto, el objetivo del estudio fue describir el papel de la enfermería a través de Planes de Acción por medio de PICs en individuos con calidad de vida reducida debido al desarrollo de enfermedades crónico degenerativas. Así, este artículo es una revisión bibliográfica integradora. Los resultados obtenidos muestran que la aplicabilidad de los PICs está consolidada, siendo una práctica ampliamente utilizada en la intervención terapéutica de individuos con enfermedades crónicas degenerativas, en la que las más utilizadas son: plantas medicinales, reiki, homeopatía, acupuntura y auricuterapia, sin embargo, en lo que respecta a los cuidados de enfermería, se observaron impasses en cuanto a la formación profesional. Por lo tanto, concluimos que con base en las producciones científicas existentes en relación a las PICs, la práctica infiere en varios beneficios al individuo, estos que convergen a la promoción de una mejor calidad de vida para el paciente con enfermedades crónicas, sin embargo, la falta de formación profesional revela un impasse aún persistente.

Transição do cuidado da pessoa com doença crônica na alta hospitalar: perspectiva de enfermeiros / Transición del cuidado de la persona con enfermedad crónica en el hospital: perspectiva de enfermeros / Transitional care of people with chronic disease at hospital discharge: perspective of nurses

Objetivo: compreender a perspectiva de enfermeiros sobre a transição do cuidado da pessoa com doença crônica não transmissível do hospital para o domicílio. Método: estudo qualitativo, exploratório e descritivo. O cenário do estudo foi um Hospital Universitário no Sul do Brasil. A coleta de dados ocorreu mediante entrevistas semiestruturadas com 28 enfermeiros assistenciais e gestores, entre julho de 2018 a maio de 2019, em que foram feitas as análises pelas temáticas. Resultados: Os enfermeiros apontam algumas estratégias de transição do cuidado, como a inclusão do cuidador nas orientações e o contato telefônico. Indicam, ainda, a necessidade de reconhecimento da rede de saúde pelos profissionais e o desafio da articulação entre diferentes serviços. Considerações finais: a transição do cuidado extrapola a lógica reducionista de simples orientação individualizada para alta hospitalar. O enfermeiro pode protagonizar a mudança e promover a consolidação de práticas seguras e qualificadas, devido sua inserção nos diversos cenários de atenção à saúde.

Objetivo: comprender la perspectiva de enfermeros sobre la transición del cuidado de la persona con enfermedad crónica no transmisible del hospital al domicilio. Método: estudio cualitativo, exploratorio y descriptivo. El escenario del estudio fue un Hospital Universitario en el Sur de Brasil. La recolección de datos se realizó mediante entrevistas semiestructuradas con 28 enfermeros asistenciales y gestores, entre julio de 2018 y mayo de 2019, en las que se realizaron los análisis por las temáticas. Resultados: Los enfermeros apuntan algunas estrategias de transición del cuidado, como la inclusión del cuidador en las orientaciones y el contacto telefónico. Indican, además, la necesidad de reconocimiento de la red de salud por los profesionales y el desafío de la articulación entre diferentes servicios. Consideraciones finales: la transición del cuidado extrapola la lógica reduccionista de simple orientación individualizada para alta hospitalaria. El enfermero puede protagonizar el cambio y promover la consolidación de prácticas seguras y cualificadas, debido a su inserción en los diversos escenarios de atención a la salud.

Objective: to understand the perspective of nurses on the transitional care of the person with chronic non-communicable disease from hospital to home. Method: qualitative, exploratory and descriptive study. The study scenario was a University Hospital in southern Brazil. Data collection occurred through semi-structured interviews with 28 nurses and managers, between July 2018 to May 2019, in which the analyses were made by the themes. Results: The nurses point out some strategies of transition of the care, as the inclusion of the caregiver in the orientations and the telephone contact. They also indicate the need for recognition of the health network by professionals and the challenge of articulation between different services. Final considerations: the transitional care goes beyond the reductionist logic of simple individualized orientation to hospital discharge. The nurse can lead the change and promote the consolidation of safe and qualified practices, due to its insertion in the various scenarios of health care.

Transitando desde las fases de cambio de comportamiento hacia el automanejo de personas con condiciones crónicas / Transiting from phases of behavior change to the self-management of people with chronic conditions

Introducción: A nivel mundial existe una constante preocupación debido a que cada día proliferan más personas con enfermedades crónicas. Para su abordaje, se han propuesto una serie de medidas que enfatizan el rol preponderante que tiene la persona en el logro del automanejo de su salud y enfermedad. El objetivo de este trabajo fue reflexionar acerca de elementos que favorecen el avance desde las etapas de cambio hacia el automanejo de personas con condiciones crónicas. Desarrollo: Para lograr el automanejo, resulta trascendental considerar en la atención a la persona con enfermedades crónicas, entre otros aspectos, el proceso de cambio de comportamiento y el grado de autoeficacia percibida. Asimismo, el personal profesional de la atención primaria de salud y enfermería requieren desarrollar habilidades específicas y de alta idoneidad para una atención integral, oportuna y continuada. Todos estos aspectos se interrelacionan para converger juntos en un plan de atención de salud colaborativo, consensuado y centrado en la persona. Conclusión: Para favorecer el avance del automanejo existen elementos tanto de la persona con enfermedad crónica como de la profesional que se articulan. Entre estas personas se dan relaciones de bidireccionalidad, que han de ser vistas como un proceso funcional continuo y no como elementos discretos en el cuidado en salud.

Introdução: Em todo o mundo existe uma preocupação constante, pois a cada dia proliferam mais pessoas com doenças crônicas. Para sua abordagem, foi proposta uma série de medidas que enfatizam o papel preponderante que a pessoa tem na realização do autogerenciamento de sua saúde e doença. O objetivo deste trabalho foi refletir sobre elementos que favorecem a passagem das etapas de mudança para a autogestão de pessoas com condições crônicas. Desenvolvimento: A fim de alcançar a autogestão, é crucial considerar, entre outros aspectos, o processo de mudança de comportamento e o grau de auto-eficácia percebido no cuidado da pessoa cronicamente doente. Do mesmo modo, os profissionais de cuidados de saúde primários e de enfermagem precisam desenvolver competências específicas e altamente qualificadas para cuidados abrangentes, atempados e contínuos. Todos estes aspectos se inter-relacionam para convergir em um plano de cuidados de saúde colaborativo, consensual e centrado na pessoa. Conclusão: Para favorecer o avanço da autogestão, há elementos tanto da pessoa quanto do profissional que se articulam, existindo relações bidirecionais entre eles, que devem ser vistos como um processo funcional contínuo e não como elementos discretos no cuidado à saúde.

Introduction: There is worldwide constant concern because of the increasing number of people with chronic diseases every day. When it comes to approaching this situation, a series of measures have been proposed to emphasize the preponderant role that the people have has in achieving the self-management of their health and disease. The objective of this work was to reflect on the elements that favor progress from the stages of change towards self-management in people with chronic conditions. Development: To achieve self-management, it is essential to consider - among other aspects - the process of behavioral change and the degree of perceived self-efficacy in the care of chronically ill people. Likewise, primary healthcare and nursing professionals need to develop specific and highly suitable skills for comprehensive, timely, and continuous care. All these aspects interrelate to converge together in a collaborative, consensual, and person-centered healthcare plan. Conclusion: To favor the advancement of self-management, there are elements that both the person and the professional need to articulate, for instance, the existing bidirectional relationships between them must be seen as a continuous functional process and not as discrete elements in healthcare.

NPs caring for people who are incarcerated and negatively impacted by social determinants of health.

ABSTRACT: This article explores roles filled and care provided by NPs in diverse carceral settings along with the impact of health disparities experienced as a result of social determinants of health on the chronic disease burden of people who are incarcerated. Opportunities abound for NPs to positively influence this patient population's health, but specialized education is needed.

Práticas do enfermeiro no monitoramento das Doenças Crônicas Não Transmissíveis na Atenção Primária à Saúde / Prácticas del enfermero en el seguimiento de las Enfermedades Crónicas No Transmisibles en la Atención Primaria de Salud / Practices of nurses in monitoring Chronic Non-communicable Diseases in Primary Health Care

Resumo Objetivo analisar as práticas do enfermeiro da Atenção Primária à Saúde para o monitoramento das quatro principais Doenças Crônicas Não Transmissíveis (doenças do aparelho circulatório, câncer, diabetes e doenças respiratórias crônicas) em um município do interior do Estado de Santa Catarina. Método estudo de caso único, de abordagem qualitativa. Os dados foram coletados por meio de triangulação de técnicas: entrevistas focadas, análise documental e banco de dados on-line, de janeiro a julho de 2019. As técnicas de análise deram-se por meio de proposições teóricas e da construção da explicação relativas às práticas dos enfermeiros. Resultados as práticas do enfermeiro para o monitoramento das doenças crônicas identificadas foram: Grupo HiperDia; educação em saúde; telemonitoramento; acolhimento; visita domiciliar; consulta de Enfermagem; plano de cuidados; automonitoramento e protocolos. Conclusão e implicações para a prática os enfermeiros do contexto estudado realizam práticas diversas para o monitoramento das doenças crônicas, contribuindo para a efetividade das políticas para esta condição e, possivelmente, com a queda no indicador de mortalidade por essas causas.

Resumen Objetivo analizar las prácticas de los enfermeros en la Atención Primaria de Salud para el seguimiento de las cuatro principales Enfermedades Crónicas No Transmisibles (enfermedades del aparato circulatorio, cáncer, diabetes y enfermedades respiratorias crónicas) en un municipio del interior del Estado de Santa Catarina. Método estudio de caso único, con abordaje cualitativo. Los datos fueron recolectados a través de triangulación de técnicas: entrevistas focalizadas, análisis de documentos y base de datos en línea, de enero a julio de 2019. Las técnicas de análisis ocurrieron a través de proposiciones teóricas y la construcción de la explicación relacionadas con las prácticas de los enfermeros. Resultados las prácticas de enfermería para el acompañamiento de las enfermedades crónicas identificadas fueron: Grupo HiperDia; educación para la salud; televigilancia; recepción; visita a casa; consulta de Enfermería; plan de cuidados; autocontrol y protocolos. Conclusión e implicaciones para la práctica los enfermeros en el contexto estudiado realizan diferentes prácticas de seguimiento de enfermedades crónicas, contribuyendo para la efectividad de las políticas para esta condición y, posiblemente, con una caída en el indicador de mortalidad por esas causas.

Abstract Objective to analyze the Primary Health Care nurses' practices for monitoring the four main Chronic Non-communicable Diseases (circulatory system diseases, cancer, diabetes, and chronic respiratory diseases) in a city in the interior of Santa Catarina State. Method single case study, qualitative approach. Data was collected through triangulation of techniques: focused interviews, document analysis, and online database, from January to July 2019. The analysis techniques were given by means of theoretical propositions and the construction of explanation regarding the nurses' practices. Results the nurse's practices for monitoring chronic diseases identified were: HiperDia Group; health education; tele-monitoring; welcoming; home visits; nursing consultation; care plan; self-monitoring and protocols. Conclusion and implications for the practice the nurses in the studied context perform several practices for the monitoring of chronic diseases, contributing to the effectiveness of policies for this condition and, possibly, with the drop in the mortality indicator for these causes.

Visão de familiares sobre o cuidado compartilhado da criança com condição crônica hospitalizada / Visión familiar sobre el cuidado compartido de niños con condición crónica hospitalizada / Family view on the shared care of hospitalized children with chronic condition

Objetivo: compreender a visão dos familiares de criança com condição crônica hospitalizada sobre o cuidado compartilhado com a equipe de enfermagem. Método: estudo transversal, realizado com 231 universitários da área da saúde entre os meses de setembro e outubro de 2020. Aplicou-se o Maslach Burnout Inventory/ Student Survey para avaliar a Síndrome de Burnout e associou-se um questionário para levantamento das variáveis sociodemográficas e acadêmicas. A associação entre variáveis categóricas foi avaliada por meio dos testes Qui-quadrado e Exato de Fisher. Considerou-se nível de significância de 5%. Resultados: identificou-se quatro categorias: Buscando uma definição para cuidado compartilhado; Ajudando e aprendendo durante a hospitalização; Exemplificando as formas de realizar cuidado compartilhado no ambiente hospitalar; Sensações vivenciadas pelos cuidados compartilhados. Considerações Finais: na visão dos cuidadores de crianças em condição crônica, o compartilhamento do cuidado nas hospitalizações é percebido como ajuda dos acompanhantes aos profissionais, e não como parte do cuidado. Foram identificados momentos de troca e aprendizado, porém o cuidado pareceu ser mais compartimentado do que compartilhado.

Objetivo: comprender la visión de los familiares de niños con enfermedades crónicas hospitalizadas sobre la atención compartida con el equipo de enfermería. Método: estudio cualitativo, exploratorio y descriptivo, realizado con diez familiares de niños con enfermedades crónicas hospitalizados en las salas intensivas clínicas, quirúrgicas y pediátricas de un Hospital Universitario de Río de Janeiro, Brasil. La recolección de datos se produjo mediante la aplicación de entrevistas semiestructuradas. Los datos fueron analizados por análisis de contenido. Resultados: se identificaron cuatro categorías: Búsqueda de una definición de atención compartida; Ayudar y aprender durante la hospitalización; Ejemplificar las formas de realizar la atención compartida en el ámbito hospitalario; Sensaciones experimentadas por el cuidado compartido. Consideraciones finales: en opinión de los cuidadores de niños en condiciones crónicas, el reparto de cuidados en las hospitalizaciones se percibe como la ayuda de los acompañantes a los profesionales, y no como parte de los cuidados. Se identificaron momentos de intercambio y aprendizaje, pero el cuidado parecía estar más compartimentado que compartido.

Objective: to understand the view of family members of children with chronic hospitalized conditions about shared care with the nursing team. Method: qualitative, exploratory and descriptive study, conducted with ten relatives of children with chronic conditions hospitalized in the clinical, surgical and pediatric intensive wards of a University Hospital in Rio de Janeiro, Brazil. Data collection occurred through the application of semi-structured interviews. The data were analyzed by content analysis. Results: four categories were identified: Seeking a definition for shared care; Helping and learning during hospitalization; Exemplifying the ways to perform shared care in the hospital environment; Sensations experienced by shared care. Final considerations: in the view of caregivers of children in chronic conditions, the sharing of care in hospitalizations is perceived as the help of companions to professionals, and not as part of care. Moments of exchange and learning were identified, but care seemed to be more compartmentalized than shared.

The 4Ms of an Age-Friendly Health System.

This article is the first in a new series, Supporting Family Caregivers in the 4Ms of an Age-Friendly Health System, published in collaboration with the AARP Public Policy Institute as part of the ongoing Supporting Family Caregivers: No Longer Home Alone series. The 4Ms of an Age-Friendly Health System (What Matters, Medication, Mentation, and Mobility) is an evidence-based framework for assessing and acting on critical issues in the care of older adults across settings and transitions of care. Engaging the health care team, including older adults and their family caregivers, with the 4Ms framework can help to ensure that every older adult gets the best care possible, is not harmed by health care, and is satisfied with the care they receive. The articles in this new series present considerations for implementing the 4Ms framework in the inpatient hospital setting and incorporating family caregivers in doing so. Resources for both nurses and family caregivers, including a series of accompanying videos developed by AARP and the Rush Center for Excellence in Aging and funded by the John A. Hartford Foundation, are also provided. Nurses should read the articles first, so they understand how best to help family caregivers. Then they can refer caregivers to the informational tear sheet-Guide to the 4Ms of an Age-Friendly Health System for Family Caregivers-and instructional videos, encouraging them to ask questions. For additional information, see Resources for Nurses.

Latent Class Analysis of Symptom Burden Among Seriously Ill Adults at the End of Life.

BACKGROUND: Serious illness is characterized by high symptom burden that negatively affects quality of life (QOL). Although palliative care research has highlighted symptom burden in seriously ill adults with cancer, symptom burden among those with noncancer serious illness and multiple chronic conditions has been understudied. Latent class analysis is a statistical method that can be used to better understand the relationship between severity of symptom burden and covariates, such as the presence of multiple chronic conditions. Although latent class analysis has been used to highlight subgroups of seriously ill adults with cancer based on symptom clusters, none have incorporated multiple chronic conditions. OBJECTIVES: The objectives of this study were to (a) describe the demographic and baseline characteristics of seriously ill adults at the end of life in a palliative care cohort, (b) identify latent subgroups of seriously ill individuals based on severity of symptom burden, and (c) examine variables associated with latent subgroup membership, such as QOL, functional status, and the presence of multiple chronic conditions. METHODS: A secondary data analysis of a palliative care clinical trial was conducted. The latent class analysis was based on the Edmonton Symptom Assessment System, which measures nine symptoms on a scale of 0-10 (e.g., pain, fatigue, nausea, depression, anxiousness, drowsiness, appetite, well-being, and shortness of breath). Clinically significant cut-points for symptom severity were used to categorize each symptom item in addition to a categorized total score. RESULTS: Three latent subgroups were identified (e.g., low, moderate, and high symptom burden). Lower overall QOL was associated with membership in the moderate and high symptom burden subgroups. Multiple chronic conditions were associated with statistically significant membership in the high symptom burden latent subgroup. Older adults between 65 and 74 years had a lower likelihood of moderate or high symptom burden subgroup membership compared to the low symptom burden class. DISCUSSION: Lower QOL was associated with high symptom burden. Multiple chronic conditions were associated with high symptom burden, which underlines the clinical complexity of serious illness. Palliative care at the end of life for seriously ill adults with high symptom burden must account for the presence of multiple chronic conditions.

Applying Community-Engaged Intervention Mapping to Preparing Nurse Scientists.

BACKGROUND: Preventing and managing chronic illness necessitates multilevel, theory-based interventions targeting behaviors, environmental factors, and personal determinants that increase risk for illness onset, greater burden, and poorer outcomes. OBJECTIVES: The purpose of this article is to provide the basis for multilevel interventions, describe community-engaged intervention mapping as an approach to designing theory-based interventions, and discuss potential benefits of applying community-engaged intervention mapping in preparing nurse scientists to build programs of interdisciplinary research in preventing and managing chronic illness. METHODS: Community-engaged intervention mapping integrates two methodological approaches: intervention mapping and community-engaged research. RESULTS: The six-step intervention mapping approach provides a logical structure for preparing nurse scientists in designing, adapting, and implementing multilevel, theory-based interventions. Community-engaged research approaches offer principles and direction for engaging patients, clinicians, community members, and other stakeholders throughout the research process. Integrating these methods retains the theoretical integrity of interventions; improves the relevance and timely completion of the research and its products; and enhances intended beneficiaries and the community's understanding, trust, and use of the results. DISCUSSION: Potential benefits of preparation in community-engaged intervention mapping to nurse scientists and nursing science include explicit consideration of multilevel factors influencing health. Additional benefits include guidance for linking relevant constructs from behavior- and environment-oriented theories with evidence-based methods for affecting desired changes in care and quality of life outcomes. Moreover, enhancement of the theoretical fidelity of the intervention, explication of the mechanisms influencing change in the primary outcome, and improved relevance and feasibility of interventions for intended beneficiaries and potential adopters are other benefits.

Effectiveness of a nurse-led, face-to-face health coaching intervention in enhancing activation and secondary outcomes of primary care users with chronic conditions.

Prevalence of chronic diseases and multimorbidity is rising, and it remains unclear what the best strategy is for activating people with chronic conditions in their self-care. We designed a two-group quasi-experimental time series trial to examine the effectiveness of a nurse-led, face-to-face, individually-tailored health coaching (HC) intervention in improving patient activation and secondary outcomes (self-efficacy, quality of life, anxiety and depression symptoms, medication adherence, hospitalization and emergency visits) among primary care users with chronic conditions. A total of 118 people with chronic conditions were recruited through a primary care center and allocated to either the intervention group (IG) (n = 58) or control group (CG) (n = 60). The IG received a nurse-led individually-tailored HC intervention involving 4-6 face-to-face multicomponent sessions covering six core activation topics. The CG received usual primary care. Data were collected at baseline, after the intervention (6 weeks after baseline for controls) and at 6 and 12 months from baseline. Compared with controls, the IG had significantly higher patient activation scores after the intervention (73.29 vs. 66.51, p = .006). However, this improvement was not maintained at follow-up and there were no significant differences in secondary outcomes across the study period. HC may be an effective strategy for achieving short-term improvements in the activation of primary care users with chronic conditions. Further studies with different methodological approaches are needed to elucidate how HC may improve and sustain changes in patient activation.

Indicadores de saúde em usuários de uma unidade básica de saúde da cidade de Santarém, Pará, Brasil / Health indicators in users of a basic health unit in the city of Santarém, Pará, Brazil

Introdução: Usuários do sistema de saúde com doenças crônicas não transmissíveis devem estar em acompanhamento constante para evitar complicações em seu estado de saúde. Objetivo: Analisar os indicadores laboratoriais de saúde em usuários de uma Unidade Básica de Saúde com e sem o diagnóstico para a diabetes e hipertensão. Métodos: A amostra foi de 231 usuários de uma unidade básica de saúde da cidade de Santarém-PA, maiores de idade, que foram agrupados em pacientes com DM/HAS (DM/HAS; n=144), e sem o diagnóstico para DM/HAS (AUS; n=87). As coletas envolveram informações socioeconômicas, clínicas e laboratoriais. Os dados foram tratados com estatística descritiva e inferencial, adotando-se p<0.05. Resultados: Tanto no DM/HAS como no AUS predominou o sexo feminino, estado civil casado, com vínculo empregatício, cor de pele parda, com 4-7 anos de estudo, renda de 1-2 salários, não tabagistas, não etilista e faixa etária de 38-77 anos. A HAS foi a doença mais presente de forma geral, bem como por sexo. Identificou-se no DM/HAS valores menores para a taxa de filtração glomerular (TFG) e maiores valores para a glicemia, triglicerídeos, colesterol total, LDL-c e não HDL-c. Conclusão: De acordo com a proposta desenvolvida, destaca-se que os usuários com DM/HAS apresentam associação positiva para valores alterados de glicemia, colesterol total, não HDL-c, triglicerídeos, TFG e para a presença da síndrome metabólica e risco cardiovascular moderado/alto.

Introduction: Users of the health system with chronic non-communicable diseases must be constantly monitored to avoid complications in their health status. Objective: Analyze laboratory health indicators in users of a Basic Health Unit with and without a diagnosis for diabetes and hypertension. Methods: The sample consisted of 231 users of a basic health unit in the city of Santarém-PA, all of them of age, grouped into patients with DM/SAH (DM/SAH; n=144), and without the diagnosis for DM/SAH (ABS; n=87). The collections involved socioeconomic, clinical, and laboratory information. The data were treated with descriptive and inferential statistics, adopting p <0.05. Results: In both DM/SAH and ABS groups, there was a predominance of female individuals, married status, employed, brown skin color, with 4-7 years of study, income of 1-2 salaries, non-smokers, non-alcoholic drinkers, and aged between 38-77 years. SAH was the most common disease in general, as well as when analyzing by gender. Lower values for the glomerular filtration rate (GFR) were identified in the DM/SAH and higher values for the glycemia, triglycerides, total cholesterol, LDL-c, and non-HDL-c. Conclusion: According to the proposal of this paper, it is noteworthy that users with DM/SAH have a positive association for altered values of blood glucose, total cholesterol, non-HDL-c, triglycerides, GFR, and for the presence of metabolic syndrome and moderate/high cardiovascular risk.

Radiofrecuencia en la cicatrización de heridas crónicas. Una revisión en hospital de media estancia / Radiofrequency in the healing process in chronic wounds. A review in a half-stay hospital

Las heridas crónicas son un problema de salud significativo. Parece que la estimulación eléctrica produce una reducción significativamente mayor en el área de superficie y cicatrización más completa de las úlceras de difícil cicatrización y de evolución tórpida en comparación con la terapia habitual, sin vendaje compresivo. OBJETIVOS: Evaluar el efecto que la radiofrecuencia a baja intensidad y con efectos no térmicos tiene sobre los diferentes componentes del mecanismo del proceso de cicatrización. METODOLOGÍA: Para el tratamiento, se utilizó un dispositivo de tecarterapia (CAPENERGY C200). Se aplicaron un total de 10 sesiones de radiofrecuencia con una periodicidad de 1 vez a la semana con una potencia del 60% y una frecuencia de 1,2 MHz durante 30 minutos. RESULTADOS: La presencia de edema, observada en todos los pacientes en la región de la extremidad inferior, desapareció en 30 de los 36 pacientes (Wilcoxon p = 0,004). Este resultado fue confirmado por ultrasonido. El edema celular subcutáneo medio disminuyó en 1,73 cm (Friedman p = 0,000). La temperatura del área tomada antes y después del tratamiento se incrementó en un promedio de 1,4 °C. Estas diferencias son estadísticamente significativas (Wilcoxon p = 0,000). CONCLUSIONES: La radiofrecuencia parece que puede reducir el largo proceso de cicatrización de las lesiones de evolución tórpida, y nos encontramos con unas diferencias significativas a lo largo del tratamiento y con una reducción progresiva en las mediciones de las lesiones y mayor rapidez en la cicatrización de las heridas complejas

Chronic wounds are a significant health problem. Electrical stimulation seems to produce a significantly greater reduction in surface area and more complete healing of difficult-to-heal and poorly healing ulcers compared to standard therapy without compressive bandaging. OBJECTIVES: To evaluate the effect that radiofrequency at low intensity and with non-thermal effects has on the different components of the mechanism of the healing process. METHODOLOGY: A tecartherapy device (CAPENERGY C200) was used for the treatment. A total of 10 radiofrequency sessions were applied once a week with a power of 60% and a frequency of 1.2 MHz for 30 minutes. RESULTS: The presence of oedema, observed in all patients in the lower extremity region, disappeared in 30 of the 36 patients (Wilcoxon p = 0.004). This result was confirmed by ultrasound. The mean subcutaneous cellular oedema decreased by 1.73 cm (Friedman p = 0.000). The temperature of the area taken before and after treatment increased by an average of °C. These differences are statistically significant (Wilcoxon p = 0.000). CONCLUSIONS: Radiofrequency appears to be able to reduce the long healing process of torpidly evolving lesions, and we found significant differences throughout the treatment and a progressive reduction in lesion measurements and faster healing of complex wounds