Rafael Montoya-Juárez

Cultural Adaptation and Validation of the Cultural Self-Efficacy Scale for Colombian Nursing Professionals.

Purpose: The level of cultural self-efficacy indicates the degree of confidence nursing professionals possess for their ability to provide culturally competent care. Cultural adaptation and validation of the Cultural Self-Efficacy Scale was performed for nursing professionals in Colombia. Design: A scale validation study was conducted. Method: Cultural adaptation and validation of the Cultural Self-Efficacy Scale was performed using a sample of 190 nurses in Colombia, between September 2013 and April 2014. This sample was chosen via systematic random sampling from a finite population. Results: The scale was culturally adapted. Cronbach’s alpha for the revised scale was .978. Factor analysis revealed the existence of six factors grouped in three dimensions that explained 68% of the variance. Conclusion: The results demonstrated that the version of the Cultural Self-Efficacy Scale adapted to the Colombian context is a valid and reliable instrument for determining the level of cultural self-efficacy of nursing professionals.

Meaning of loss in patients who have digestive stomas / Significado de la pérdida en personas portadoras de estomas digestivos

Abstract A qualitative systematic review was carried out with the purpose of exploring the meaning of loss experienced by patients who have digestive stomas. Seventy-seven studies were reviewed, of which 54 addressed the above objective. Studies show that the person’s body undergoes a resignification process, characterized by a sense of contradiction in regard to the stoma, as they experience it as a real loss while also believing it is an option to continue living.

Factores sociodemográficos y de participación social relacionados con el bienestar psicológico en adultos mayores en la región de Magallanes, Chile

Background: Subjective aspects such as personal growth and the development of their potential are relevant for the perception of wellbeing of older adults. These dimensions appear to be connected with meaningful group participation. Aim: To assess the perception of psychological wellbeing of older adults in a Chilean region and determine its association with socio-demographic variables and participation in organizations. Material and Methods: Ryff’s scale of psychological wellbeing perception was applied to 101 adults (43 men) from Magallanes, aged 60 and 88 years. Sociodemographic data was also collected. Results: Mean wellbeing scores reported were 193.7 ± 20 (maximum score: 234). Those older adults who participated in organizations had higher scores than those who did not take part in them. Participation in organizations appeared to be specifically associated to positive relationships (p= 0.03) and personal growth (p<0.01). The number of organizations in which older adults participated was positively correlated with the perception of wellbeing (p< 0.01). Greater personal wellbeing was associated with leadership roles in organizations (p=0.01). Significant differences between level of schooling and personal growth (p= 0 .01) were also observed found. There were no differences associated with sex, age and marital status. Conclusions: The perception of wellbeing of older adults is influenced by their participation in organizations. Leadership is associated with the highest levels of wellbeing.BACKGROUND Subjective aspects such as personal growth and the development of their potential are relevant for the perception of wellbeing of older adults. These dimensions appear to be connected with meaningful group participation. AIM To assess the perception of psychological wellbeing of older adults in a Chilean region and determine its association with socio-demographic variables and participation in organizations. MATERIAL AND METHODS Ryffs scale of psychological wellbeing perception was applied to 101 adults (43 men) from Magallanes, aged 60 and 88 years. Sociodemographic data was also collected. RESULTS Mean wellbeing scores reported were 193.7 ± 20 (maximum score: 234). Those older adults who participated in organizations had higher scores than those who did not take part in them. Participation in organizations appeared to be specifically associated to positive relationships (p = 0.03) and personal growth (p < 0.01). The number of organizations in which older adults participated was positively correlated with the perception of wellbeing (p < 0.01). Greater personal wellbeing was associated with leadership roles in organizations (p = 0.01). Significant differences between level of schooling and personal growth (p = 0.01) were also observed found. There were no differences associated with sex, age and marital status. CONCLUSIONS The perception of wellbeing of older adults is influenced by their participation in organizations. Leadership is associated with the highest levels of wellbeing.

Suffering in children experiencing a terminal disease: the perspective of parents and professionals

Diagnostico de situacion con una metodologia cientifica de caracter exploratorio y descriptivo (observacion participante con tratamiento estadistico descriptivo) con el fin de identificar las practicas de enfermeria en el ambito de la promocion de la salud durante la consulta de enfermeria para la salud infantil. De las 31 consultas observadas (n = 31) se mostro que la mayoria de las observaciones se produjeron en ninos menores de 2 anos siendo que el tema mas discutido es alimentacion con el uso predominante de la metodologia expositiva. Se verifico poca utilizacion de apoyo informativo y cuando se utilizan se refieren a temas de seguridad y nutricion. La mayoria de los proveedores ha hecho preguntas y se verifico reducido registro de la interaccion proveedores/ninos con un expendio promedio de 23 minutos por consulta. Teniendo en cuenta los resultados y reflectando en ellos se destaca como intervencion la elaboracion de un manual para la promocion de la salud con la integracion de la teoria y la evidencia de las buenas practicas en este ambito.

Level of Cultural Self-Efficacy of Colombian Nursing Professionals and Related Factors:

Purpose: To describe the level of cultural self-efficacy of Colombian nursing professionals and determine the main influencing factors. Method: A descriptive, analytical cross-sectional study was conducted in 211 nursing professionals selected by systematic random sampling for a finite population, using the Colombian version of the Cultural Self-Efficacy Scale. After descriptive statistical analysis, nonparametric tests were applied to determine between-variable associations, followed by multiple linear regression analysis. Results: The mean Cultural Self-Efficacy Scale score was 2.58. An association with sex and age (p < .05) was observed in regression analysis. The mean score for knowledge of cultural concepts was 3.20 and associated with age, years of experience, educational level, and cross-cultural experiences (p < .05). The mean score for confidence in performing cultural nursing skills was 3.29. Conclusions and Implications for Practice: The cultural self-efficacy level of this sample of nursing professionals, with their consequent capacity to provide culturally competent care, is moderate and is associated with sex and age. Confidence in knowledge of cultural concepts is affected by age, educational level, years of experience, and cross-cultural experiences. This evidence supports the implementation of changes to improve the cultural knowledge and therefore cultural self-efficacy of these professionals.

Prognostic Models Associated with 6-Month Survival of Patients Admitted to Nursing Homes

Background: Health status and the needs presented by people admitted to nursing homes make it necessary to contemplate aspects such as prognosis to offer quality palliative care. Objective: To compare the prognostic utility in nursing homes of two prognostic models of 6-month survival based on the Palliative Prognostic Index (PPI) or Palliative Performance Status (PPS) instruments and palliative needs indicators. Methods: A longitudinal prospective observational and analytical cohort study of survival and prognostic models in 88 patients with palliative needs (assessed by the NECPAL-ICO-CCOMS©) from an Andalusian (Spain) nursing home was performed. Sociodemographic and clinical variables were assessed, and 6 months later, in September 2017, survival was checked. Multiple logistic regression analysis was performed using the R-Commander program (version 3.2.2). Results: Two models of the logistic regression analysis met the fit criteria. The two models combined the Surprise Question, the presence of persistent symptoms, and the clinical indicators of severity from the NECPAL tool, in addition to the Charlson Comorbidity Index, and varied only in terms of the latter variable, including the PPI in the first model and the PPS in the second. In the first model, significant associations were identified between 6-month survival and the persistent symptoms variable (OR = 7.78, p = 0.025, 95% CI = 1.45–60.92) and PPI (OR = 1.94, p < 0.001, 95% CI = 1.21). In the second model, 6-month survival was also significantly associated with the persistent symptoms variable (OR = 4.57, p = 0.045, 95% CI = 1.07–22.41) and the PPS (OR = 0.93, p = 0.001, 95% CI = 0.88–0.96). Conclusions: Prognostic models such as ours that include variables commonly included in clinical assessments can help nursing home professionals prioritize and ensure adequate mobilization of palliative care resources, which are very limited in these institutions.

The concept of death in children aged from 9 to 11 years: Evidences through inductive and deductive analysis of drawings

Abstract The objective of the research was to analyze children’s conceptualization of death through drawings, using a mixed approach, which combines deductive and inductive qualitative analysis. The sample consisted of 99 children aged 9–11 years, who were asked to elaborate a drawing about their idea of death and to explain it to the researchers. Drawings were coded basing on Tamm and Granqvist’s model (deductive analysis) and codes and categories were created and modified (inductive analysis). Three main categories were identified in the analysis and four sub-categories were modified and/or created: causes of death, good death, anxiety-fear and symbolization.

Percepciones de los profesionales sobre la atención prestada, obstáculos y dilemas éticos relacionados con el final de la vida en hospitales, centros de Atención Primaria y residencias de ancianos

Fundamento. Este estudio compara la percepcion de la practica profesional, los obstaculos percibidos y los dilemas eticos de profesionales de medicina y enfermeria en la atencion al final de la vida en atencion primaria (AP), atencion hospitalaria (AH) y residencias de ancianos (RA). Material y Metodos. Estudio descriptivo, transversal y multicentrico. Se realizo un muestreo intencional de profesionales de medicina y enfermeria con mas de cuatro meses de antiguedad de cuatro hospitales, cinco centros de AP y veintinueve RA de Granada. Se recogieron mediante un cuestionario ad hoc : la percepcion de la practica profesional en ocho dimensiones (estructura y procesos, aspectos fisicos, psicologicos, sociales, espirituales, culturales, eticos y cuidados del moribundo), la frecuencia percibida de dilemas eticos, y los obstaculos para el cuidado. Se compararon las puntuaciones de los distintos contextos con la prueba ANOVA y analisis post hoc . Resultados. Participaron 378 profesionales, 215 (56,9%) de AH, 97 (25,7%) de AP y 66 (17,5%) de RA. En comparacion a los profesionales de AP y AH, los de RA fueron significativamente (p <0,01) mas jovenes y con mayor experiencia profesional, y puntuaron significativamente mejor (p <0,01) tanto su propia practica profesional como la de la institucion en relacion a las dimensiones de estructura y procesos de atencion, aspectos fisicos, psicologicos, sociales, espirituales, culturales y atencion al moribundo. Los aspectos psicologicos y eticos fueron los peor valorados en todos los contextos, no encontrandose diferencias respecto a estos ultimos. En comparacion a los otros ambitos estudiados, los profesionales de AP identificaron menos dilemas y los de RA percibieron mayores obstaculos. Conclusiones. Profesionales de AP y AH presentan resultados similares en la percepcion de la atencion al final de la vida, e inferiores a los de RA, pese a que en las RA se presentan mas dilemas y obstaculos.BACKGROUND This study compares the perceptions of physicians and nurses regarding professional practice, perceived obstacles and ethical dilemmas in end-of-life care in primary care (PC), hospitals and nursing homes (NH). METHODS Descriptive, cross-sectional and multicentre study. Intentional sampling of physicians and nurses with more than four months professional practice from four hospitals, five PC centres and twenty-nine NH in Granada was carried out. An ad hoc questionnaire was developed to assess perception of professional practice in eight dimensions (structure and processes of care, physical, psychological, social, spiritual, cultural, ethical aspects and care for the dying), frequency of ethical dilemmas, and obstacles to optimum care. Scores of different settings were compared using the ANOVA test and post hoc analysis. RESULTS A total of 378 professionals participated, 215 (56.9%) from hospitals, 97 (25.7%) from PC and 66 (17.5%) from NH. NH professionals were older and had more professional experience than those from PC and hospitals, and they also rated both the institution and their own professional practice significantly better (p<0.01) than other professionals with respect to the dimensions of structure and processes of care, physical, psychological, social, spiritual, cultural aspects and care for the dying. Psychological and ethical aspects were the worst valued in all settings, with no differences regarding ethical aspects. Fewer ethical dilemmas were identified by PC professionals, while NH professionals perceived greater obstacles to end-of-life care in relation to other settings. CONCLUSION Primary care and hospitalization presented similar results on the perception of end-of-life care, and lower results than those of nursing homes, although in these centres more ethical dilemmas and more obstacles were identified.

End of life care in nursing homes in Spain: Exploratory analysis and evidences of validity of a new scale

Quality end-of-life care is a central issue in nursing homes, requiring the assessment of individual and family needs by health professionals. Although previous instruments have been developed, they usually rely on family reports and have been adapted from other clinical contexts (hospital or primary care). It is important to consider how health care professionals working in nursing homes perceive what is necessary to achieve quality end-of-life care. In this study, the objective was to develop an instrument to assess quality of end-of-life care in the context of Spanish care homes. A 24 item scale Nursing Home End of Life Care Scale (NHEOLC) was developed through a systematic evaluation of existing tools combined with an iterative process of consultation with group experts in end of life care in long term care settings. A total of 307 health care professionals agreed to participate in the study and completed the scale. The scale was grouped in six dimensions: physical, psychological aspects and spiritual aspects of care, family care, bereavement, and patient/family preferences management. The results suggest an adequate factorial structure of the scale and good internal consistency for the total score and the subscales. In addition, the results showed significant differences depending on the size of the nursing home, the category of health professionals, and their own perceptions of his work regarding end-of-life care.

Sufrimiento en infantes con enfermedad terminal: perspectiva de padres y profesionales

Diagnostico de situacion con una metodologia cientifica de caracter exploratorio y descriptivo (observacion participante con tratamiento estadistico descriptivo) con el fin de identificar las practicas de enfermeria en el ambito de la promocion de la salud durante la consulta de enfermeria para la salud infantil. De las 31 consultas observadas (n = 31) se mostro que la mayoria de las observaciones se produjeron en ninos menores de 2 anos siendo que el tema mas discutido es alimentacion con el uso predominante de la metodologia expositiva. Se verifico poca utilizacion de apoyo informativo y cuando se utilizan se refieren a temas de seguridad y nutricion. La mayoria de los proveedores ha hecho preguntas y se verifico reducido registro de la interaccion proveedores/ninos con un expendio promedio de 23 minutos por consulta. Teniendo en cuenta los resultados y reflectando en ellos se destaca como intervencion la elaboracion de un manual para la promocion de la salud con la integracion de la teoria y la evidencia de las buenas practicas en este ambito.