Enfermería basada en la evidencia. La investigación y el cuidado

En esta presentación se abordan conceptos relacionados con los atributos del rol avanzado relativos a la investigación y la práctica basada en la evidencia (PBE), se definen los conceptos relacionados con la enfermería basada en la evidencia (EBE) y se plantea brevemente sugerencias finales sobre cómo promover la PBE

Effects of Osteopathic Visceral Treatment in Patients with Gastroesophageal Reflux: A Randomized Controlled Trial

Osteopathic manual treatment has been recommended as a non-pharmacological therapy for Gastroesophageal Reflux Disease (GERD). However, to date, no study has supported the effectiveness of this intervention with respect to the symptoms of the disease. Our goal was to assess the effect of an osteopathic manual technique for the lower esophageal sphincter on GERD symptoms, cervical mobility and on the C4 spinous process pressure pain threshold (PPTs). Methods: A randomized, double-blind placebo-controlled trial was performed. Sixty subjects suffering from GERD participated in this study and were randomly assigned to either an experimental group (EG) (n = 29), who received the osteopathic technique for the lower esophageal sphincter, or to a control group (CG) (n = 31), who received a manual contact, which mimicked the osteopathic technique without exerting any therapeutic force. Randomization was computer-generated, with allocation concealed by sequentially numbered, opaque, sealed envelopes. The GerdQ questionnaire was used to assess symptom changes the week after intervention. Cervical Range of Motion (CROM) and algometer were used to evaluate cervical mobility and PPTs before and after both treatments. Before-after between groups comparison (t-test) was used for statistical analysis of the outcome, with two measurement points (GerdQ), while repeated-measures ANOVA was used for those outcomes with four measurement points (CROM and PPT). Results: The application of the osteopathic manual treatment in subjects with GERD produced a significant improvement in symptoms one week after the intervention (p = 0.005) with a between-groups difference of 1.49 points in GerdQ score (95% CI: 0.47-2.49). PPT C4 improved in the EG after the treatment (p = 0.034; eta(2) = 0.048) (between-groups difference 8.78 Newton/cm(2); 95% CI: 0.48-17.09). CROM also increased in the EG compared to the CG (p < 0.001; eta(2) = 0.108) (between-groups difference 33.89 degrees; 95% CI: 15.17-52.61). Conclusions: The manual osteopathic technique produces an improvement in GERD symptoms one week after treatment, cervical mobility, and PPTs. This may mean that osteopathic treatment is useful for improving symptoms of GERD

Investigación cualitativa en Cuidados Paliativos. Un recorrido por los enfoques más habituales

The use of qualitative research in Palliative Care (PC) is increasing, probably because PC and qualitative methodology have many things in common. Both focus on the person and his or her environment, and they are particularly interested in human experience. The aim of this paper is to present some of the most often used qualitative research approaches in health science, providing examples of PC studies. The aim is to help beginners to explore the possible approaches that they could use to carry out research in PC. The armchair walk-through exercise, which helps to specify key aspects in research, is developed for each of the approaches: ethnography, phenomenology, personal narrative, and grounded theory. Becoming familiar with qualitative methodology and some of the approaches will help PC health professionals to raise new questions and address new challenges with rigorous research.La utilización de la investigación cualitativa en Cuidados Paliativos (CP) está en auge, quizás porque tienen muchos aspectos en común. Ambos se centran en la persona y su entorno y están especialmente interesados en la experiencia humana. El objetivo de este artículo es presentar algunos de los enfoques más frecuentemente utilizados en las ciencias de la salud, proporcionando ejemplos de estudios de CP. Esto con el fin de ayudar a quienes se están iniciando en la investigación cualitativa a explorar los posibles enfoques que podrían utilizar para realizar investigación en CP. A través del ejercicio «armchair walkthrough», se concretan los aspectos clave de un proyecto de investigación, considerando los distintos enfoques: la etnografía, la fenomenología, la narrativa y la teoría fundamentada. Familiarizarse con la metodología cualitativa y algunos de los enfoques ayudará a los profesionales de CP a plantear nuevas preguntas y retos con investigación rigurosa

El comienzo de la lactancia: experiencias de madres primerizas

Fundamento. La lactancia materna es importante para promover el desarrollo saludable del recién nacido. A pesar de sus beneficios, el abandono es masivo durante el primer trimestre de vida. El objetivo de esta investigación fue explorar cómo las madres primerizas percibían y experimentaban la lactancia materna para poder identificar así los aspectos que influyen en su instauración. Material y métodos. Se llevó a cabo un estudio cualitativo con un enfoque fenomenológico descriptivo, en el que participaron 12 madres primíparas que fueron entrevistadas en profundidad en dos ocasiones, una los primeros días tras el parto y otra al mes de haber dado a luz. Los datos obtenidos se grabaron y transcribieron para analizarlos con el método de Giorgi. Resultados. El significado esencial de la experiencia vivida por las madres que participaron en este estudio se puede resumir en los cinco temas que se detallan a continuación: la idealización de la lactancia; la incertidumbre ante las dificultades; el deseo de privacidad durante las tomas; la responsabilidad compartida con el niño para lograr el éxito; y finalmente, la desorganización en sus vidas y la modificación del rol de la mujer. Conclusiones. Conocer las experiencias de las madres primíparas en la etapa de instauración de la lactancia, permitirá a los profesionales diseñar intervenciones específicas adaptadas a ellas. Los profesionales deberían tener en cuenta las expectativas de cada madre y cómo hace frente al nuevo rol, la necesidad de proporcionar apoyo práctico y emocional con unanimidad de criterios y la importancia del apoyo del padre.Background. Breastfeeding is important for promoting the healthy development of the newborn. Despite its benefits, the abandonment of breastfeeding is massive in the first three months of life. The aim of this research was to explore how first-time mothers perceived and experienced breastfeeding in order to identify issues affecting its establishment Methods. A qualitative study with a descriptive phenomenological approach was used. Twelve first-time mothers were interviewed in-depth on two occasions: once a few days after childbirth, and another time one month from giving birth. The data were recorded and transcribed verbatim. Giorgi’s method was used for the analysis. Results. The essential meaning of the experience undergone by the mothers who took part in this study can be described by the following five themes: an idealization of breastfeeding; uncertainty over the difficulties; a desire for privacy during breastfeeding; shared responsibility with the child for breastfeeding to succeed; and, finally, disruption to the women’s lives and changes in their role. Conclusions. This study allowed access to the experiences of first-time mothers during the establishment of breastfeeding. This information will facilitate the design of tailored interventions taking into account the mothers’ reports. Health professionals should: consider women’s expectations and how they face their new role, provide practical and emotional support, be consistent and avoid giving conflicting advice, and acknowledge the importance of the fathers’ support

A valid and reliable scale to assess cultural sensibility in nursing

Background: Cultural sensibility is an important concept linked to the achievement of cultural competence. Health professionals must first improve their cultural sensibility to become culturally competent and to be able to offer competent care to culturally diverse populations. Aim To develop and psychometrically test the Cultural Sensibility Scale for Nursing (CUSNUR), a cultural sensibility scale that can be used in nursing for the achievement of competencies needed to care for culturally diverse populations. Design and methods: The cross-sectional survey was conducted over two stages. The first stage involved the cross- cultural and discipline-specific adaptation of an existing scale addressing this concept in the field of law using the reverse translation method. Second, validation of the scale was carried out from October 2016–June 2017 by studying the psychometric properties of the questionnaire through an analysis of content acceptability and reliability and through exploratory factor analysis (EFA). Results: The questionnaire was designed to be clear, easy to understand, and of adequate length, and experts involved in content validation agreed that the scale meets these criteria. A total of 253 nursing students participated in the validation stage. Four factors were identified from the EFA: (1) patient and health professional behaviours, (2) self-assessments, (3) self-awareness, and (4) cultural influence. Two items were excluded. Factorial saturation is adequate for all factors (>0.30). The Cronbach alpha was measured as 0.75. Conclusions: This study presents the first version of the CUSNUR and demonstrates that the scale is valid and reliable

Five paradoxes in health promotion

The World Health Organization states that health promotion is a key strategy to improve health, and it is conceived as a global process of enabling people to increase control over, and to improve, their health. Health promotion does not focus solely on empowering individuals dealing with their knowledge, attitudes and skills, but it also takes political, social, economic and environmental aspects influencing health and wellbeing into account. The complexity of applying these concepts is reflected in the five paradoxes in health promotion; these arise in between the rhetoric in health promotion and implementation. The detected paradoxes which are described herein involve the patient versus the person, the individual versus the group, disease professionals versus health professionals, disease indicators versus health indicators, and health as an expense versus health as an investment. Making these contradictions explicit can help determine why it is so complex to put the concepts related to health promotion into practice. It can also help to put forward aspects that need further work if health promotion is to put into practice. (C) 2017 SESPAS: Published by Elsevier Espaila, S.L.U

Los retos de la promoción de la salud en una sociedad multicultural: revisión narrativa de la literatura

La realidad multicultural en la que vivimos hoy en día, hace que los profesionales de la salud interactúen a diario con personas y familias de culturas diversas. La interacción entre una persona o familia y un profesional de la salud de una cultura diferente se denomina “encuentro cultural”. Los encuentros no van a estar exentos de dificultades a las que los profesionales van a tener que hacer frente para poder proporcionar un buen cuidado y promover estilos de vida saludables. En la revisión narrativa llevada a cabo se han observado que las dificultades están relacionadas con factores culturales y linguísticos, la alfabetización en salud, las desventajas en el estado socio-económico y los prejuicios y estereotipos de los profesionales de la salud. Las estrategias sugeridas para vencer esas dificultades son: el desarrollo de programas culturalmente adaptados; utilizar una pedagogía y recursos apropiados, y materiales cultural y lingüísticamente adaptados; el uso de intérpretes y la organización de cursos para aprender el idioma mayoritario. Además de esas estrategias, la bibliografía enfatiza la necesidad de un cambio de enfoque en el que el objetivo sea la formación de los profesionales de la salud para el desarrollo de lo que los autores denominan “competencia cultural”. La formación en competencia cultural está orientada a favorecer que los profesionales ofrezcan y promuevan cuidados congruentes y adaptados a los valores culturales, creencias y prácticas de cualquier persona, familia o grupo sin caer en prejuicios ni estereotipos.Nowadays multicultural reality leads health professionals to interact in their daily work with individuals and families from diverse cultures. The interaction between a person or family and a health professional from a different culture is called “cultural encounter”. These encounters involve difficulties, complications and barriers, which health professionals will have to face in order to provide good care and promote healthy lifestyles. This narrative review shows that the difficulties are related to cultural and linguistic factors, health literacy, disadvantages in socio-economic status and the prejudices and stereotypes of healthcare professionals. Different strategies are described in the literature that could help health professionals to overcome these difficulties, namely: the development of culturally appropriate programmes; appropriate pedagogy and resources, and the use of culturally and linguistically sensitive materials; the use of interpreters and the organization of courses to learn the most widely spoken language. In addition to these strategies, the need is underscored for a change of approach in which the objective should be training health professionals to achieve “cultural competence”. Training in cultural competence would encourage professionals to offer tailored care plans, taking into account the cultural values, beliefs and practices of any person or family, and would help them to avoid stereotypes and prejudices

Los retos de la promoción de la salud en una sociedad multicultural: revisión narrativa de la literatura

La realidad multicultural en la que vivimos hoy en día, hace que los profesionales de la salud interactúen a diario con personas y familias de culturas diversas. La interacción entre una persona o familia y un profesional de la salud de una cultura diferente se denomina “encuentro cultural”. Los encuentros no van a estar exentos de dificultades a las que los profesionales van a tener que hacer frente para poder proporcionar un buen cuidado y promover estilos de vida saludables. En la revisión narrativa llevada a cabo se han observado que las dificultades están relacionadas con factores culturales y linguísticos, la alfabetización en salud, las desventajas en el estado socio-económico y los prejuicios y estereotipos de los profesionales de la salud. Las estrategias sugeridas para vencer esas dificultades son: el desarrollo de programas culturalmente adaptados; utilizar una pedagogía y recursos apropiados, y materiales cultural y lingüísticamente adaptados; el uso de intérpretes y la organización de cursos para aprender el idioma mayoritario. Además de esas estrategias, la bibliografía enfatiza la necesidad de un cambio de enfoque en el que el objetivo sea la formación de los profesionales de la salud para el desarrollo de lo que los autores denominan “competencia cultural”. La formación en competencia cultural está orientada a favorecer que los profesionales ofrezcan y promuevan cuidados congruentes y adaptados a los valores culturales, creencias y prácticas de cualquier persona, familia o grupo sin caer en prejuicios ni estereotipos.Nowadays multicultural reality leads health professionals to interact in their daily work with individuals and families from diverse cultures. The interaction between a person or family and a health professional from a different culture is called “cultural encounter”. These encounters involve difficulties, complications and barriers, which health professionals will have to face in order to provide good care and promote healthy lifestyles. This narrative review shows that the difficulties are related to cultural and linguistic factors, health literacy, disadvantages in socio-economic status and the prejudices and stereotypes of healthcare professionals. Different strategies are described in the literature that could help health professionals to overcome these difficulties, namely: the development of culturally appropriate programmes; appropriate pedagogy and resources, and the use of culturally and linguistically sensitive materials; the use of interpreters and the organization of courses to learn the most widely spoken language. In addition to these strategies, the need is underscored for a change of approach in which the objective should be training health professionals to achieve “cultural competence”. Training in cultural competence would encourage professionals to offer tailored care plans, taking into account the cultural values, beliefs and practices of any person or family, and would help them to avoid stereotypes and prejudices