Solange Campos

Estrategias innovadoras para el cuidado y el autocuidado de personas con enfermedades crónicas en América Latina

OBJETIVOS: Identificar estrategias innovadoras dirigidas a mejorar el cuidado y el autocuidado de los pacientes con enfermedades cronicas (EC) en America Latina y explorar el interes en crear una red latinoamericana de profesionales en ese campo. METODOS: Estudio descriptivo exploratorio basado en una encuesta aplicada a expertos clave con reconocido liderazgo nacional o regional en la atencion de pacientes con EC. El cuestionario de 25 preguntas recababa informacion sobre su experiencia en iniciativas de cuidado y autocuidado de pacientes con EC, la descripcion de las iniciativas exitosas, la percepcion de la capacidad de los paises para innovar en este ambito y el interes en participar en una red de profesionales latinoamericanos en ese campo, entre otras. Se realizo un analisis de contenidos para elaborar recomendaciones para la Region. RESULTADOS: Se obtuvo respuesta de 17 (37,8%) de los 45 expertos invitados; 82,4% afirmo conocer o participar en alguna iniciativa innovadora en el tema planteado. Existe un incipiente desarrollo de los tres tipos de estrategias innovadoras: cuidado por pares, cuidadores informales y telecuidado, esta ultima es la menos explorada. Hay un real interes en conformar una red latinoamericana para el desarrollo de estrategias innovadoras dirigidas al autocuidado de pacientes con EC. CONCLUSIONES: Las bases para una red de trabajo conjunto son promisorias y es prioritario fortalecer las competencias en esta area y desarrollar propuestas innovadoras para mejorar la atencion de los pacientes con EC en la Region. Las medidas innovadoras deben ser complementarias y se deben ajustar al contexto especifico de cada escenario.

Validación de una versión en español de la Escala de Conflicto Decisional

Background: In Chile, in approximately 50% of nursing students, nursing was not their first choice as career. Usually, during the first year, these students must decide whether they would like to continue in the same career. A valid tool is needed to identify decisional conflicts and their contributing factors among these students and to develop an appropriate strategy to support them during their decision-making process. Aim: To translate into Spanish and validate the Generic Decisional Conflict Scale (DCS). Material and methods: The DCS was translated from English to Spanish and was used with 331 first-year nursing students at the Pontificia Universidad Catolica de Chile. The scale was assessed for validity and reliability using statistical tests, including factor analysis and Cronbach alpha test. Results: The Spanish version of the DCS had acceptable validity and reliability. Factorial analysis identified four factors and only the item: “advice” loaded the other factors. Cronbach alpha was 0.80. Conclusions: DCS is a valid and useful instrument to identify decisional conflicts and contributing factors to continue studies among nursing students (Rev Med Chile 2008; 136:1439-47). (Key words: Decision makings; Education, nursing; student dropouts)

Perceptions on technology for volunteer respite care for bedridden elders in Chile

ABSTRACT Purpose: Informal caregivers of bedridden elders need a respite. One form of obtaining a respite is through volunteers who are contacted by means of information and communication technology (ICT). Method: A qualitative study was carried out in a low-income district in Santiago, Chile, to learn about how caregivers of bedridden elders perceive the possibility of using ICT to access this respite. In-depth interviews were carried out and transcribed verbatim, then analysed using open coding. Results: The results reveal that caregivers are willing to receive a volunteer in their home and use ICT to communicate with them, although a discrepancy exists between the use of devices connected to the Internet and feature phones. Conclusion: This study concludes that informal caregivers of bedridden elders have a favourable disposition towards accessing a respite system by means of ICT based on a peer-to-peer economy.

Patient-centred care and shared decision-making in Chile: Rising momentum for progress and implementation in clinical practice

The Chilean legislation establishes that patients have rights and responsibilities in regards to their healthcare. This is an important statement as it declares that people must be informed and become actively involved in their care; meanwhile, the health system needs to coordinate the provision of personalised and effective services. Although patient-centred care (PCC) and shared decision making (SDM) are relatively new concepts in Chile, the country is experiencing an interesting political momentum to create more interventions to achieve PCC and SDM and explore clinical implementation. Currently, research efforts in Chile have focused on better understanding the state of the art related to both concepts and how new clinical approaches could help to operationalize them.

Cardiopulmonary resuscitation/Emergencies

The records of hospital in-patients at King Faisal Specialist Hospital and Research Center who received external cardiac massage as part of their cardiopulmonary resuscitation were reviewed. Success of resuscitation was analyzed as (1) short term (restoration of spontaneous circulation), and (2) long term (discharge from hospital). Of 234 such patients, 171 (73.1%) survived the initial resuscitation, and 66 (28.2%) were discharged. Success of outcome was not related to age, location of patient, time of day, or rhythm at arrest, including asystole. Longer resuscitation time was associated with less chance of restoration of spontaneous circulation (p<0.001), but not associated with Hospital discharge rate. Results for patients with congenital heart disease were similar to those with other medical or surgical conditions. In this series, 36.7% of ward in-patients survived to discharge, compared to two other series where the results were 9% and 15% Overall, 38 7% of patients who survived the initial resuscitation were discharged from hospital Where resuscitation continued for more than 30 minutes, 18.9% of patients had long term survival. Outcome from asystole was no worse than for other cardiac rhythms. We believe that previous reports of poor outcome from asystole in pediatric cardiac arrest should not influence decisions to stop resuscitation for pediatric in-patients prematurely. Successful restoration of spontaneous circulation with long term survival can be achieved after prolonged resuscitation. 045