Práctica pedagógica de los formadores expertos en la formación clínica de estudiantes de enfermería

[spa] El objetivo de este estudio es comprender las prácticas pedagógicas de las profesoras expertas de la formación clínica de estudiantes de enfermería, y el significado que le otorgan a dichas prácticas, mediante una aproximación fenomenológica hermenéutica, desarrollada específicamente como estudio de caso. Para identificar a las mejores formadoras de enfermería para este estudio, se aplican encuestas a estudiantes de segundo y tercer año de la Diplomatura en enfermería de las Escuelas Universitarias de Enfermería de Vall d´Hebron y Sant Pau y Santa Creu, además de consultar a las docentes vinculadas a las asignaturas que contemplaban prácticas clínicas y a las jefaturas directas de los servicios clínicos donde se desempeñaban las candidatas a formadoras expertas. Se definen 3 profesoras que son caracterizadas para lograr mayor contextualización del estudio. Se recolecta información directamente con las profesoras seleccionadas mediante un diario del profesor, entrevistas en profundidad, observaciones de actividades de aula, y observaciones directas de tutoría clínica, las cuales daban origen a entrevistas emergentes. Por su parte, se recoge información respecto a las acciones pedagógicas favorecedoras de los aprendizajes, a los estudiantes que participaron de actividades formadoras con las docentes de nuestro estudio, a través de entrevistas y grupos focales. Por último, se realiza la escritura de un diario del investigador, el cual constituye un metarelato respecto a mi forma de percibir la realidad educativa investigada. Se aplican los criterios de rigor metodológico, propuestos por Guba (1983), y se lleva a cabo un proceso de análisis con tres niveles, realizando una reducción de datos desde la extracción de unidades de significado, categorización de las mismas, agrupamiento en metacategorías y establecimiento de núcleos temáticos emergentes. Mediante todo el proceso de investigación se utiliza el sistema de identificadores establecido, con el objeto de asegurar la confidencialidad de la información aportada por los participantes. Los principales resultados giran en torno a los cinco núcleos temáticos, a saber: Relación tutora estudiante en la formación de enfermería, práctica pedagógica de la formadora clínica experta, cuidado del estudiante y cuidado de enfermería, proceso formativo pedagógico profesional, y por último discurso y realidad sobre la relación enfermera-paciente.[eng] The objective of this study is to understand the pedagogical practices of expert teachers of the clinical formation of nursing students, and the meaning they assign to these practices through a hermeneutic phenomenological approach, developed specifically as a case study. To identify the best nursing forming for this study, surveys were applied to second-and third-year nursing degree in two university schools of nursing in Barcelona , further consultation with the teachers related to the subjects that contemplated clinical practice and to the headquarters direct clinical services where the candidates played to expert forming. Three teachers that are characterized for greater contextualization of the study are defined. Information is collected directly with the teachers selected through teacher diary, in-depth interviews, observations of classroom activities, and direct observations of clinical mentoring, which gave rise to emerging interviews. Meanwhile, information is collected regarding actions favoring pedagogical learning, to the students who participated in forming educational activities from our study, through interviews and focus groups. Finally, writing a research diary, which is a grand narrative about perceptions of the educational reality takes investigated. Methodological rigor criteria proposed by Guba (1983) is applied and takes place an analysis process with three levels, performing a data reduction from the extraction of meaning units, categorizing them, and metacategories grouping and establishment of thematic nuclei emerging. Through all the research process the established system identifiers is used, in order to ensure the confidentiality of information provided by participants. The main results revolve around five central themes: Tutor student relationship in nursing training, pedagogical practice teacher clinical expert, student care and nursing care, professional educational formative process , and finally, speech and reality on the nurse-patient relationship

Reflexões sobre a enfermagem desde a biopolítica: relações de poder e cuidado

Este ensayo tiene como objetivos reflexionar desde la perspectiva foucaultiana, el cuidado que se entrega y se enseña a los futuros profesionales y analizar las relaciones de poder en el ámbito de la enfermería y el vínculo con las personas “objetos de cuidado” desde un enfoque bioético. La metodología incorpora un análisis de textos desde la perspectiva foucaultiana en salud, una mirada retrospectiva sobre experiencias profesionales y la instalación de dispositivos de poder en enfermería. Se analizan fuentes relacionadas con la historia de enfermería y la formación profesional con énfasis en las relaciones profesores/estudiantes y enfermeros/pacientes. Se contrastan aspectos bioéticos y contextos profesionales. La enfermería ha normalizado la instalación de lógicas de control en la atención directa de personas y en el cuidado, lo cual además se transfiere a la formación de enfermeras y enfermeros. Actualmente, el pensamiento de enfermería se ha ampliado, independizado y adaptado a los contextos, lo que invita a visualizar desde una perspectiva más amplia el propósito del quehacer disciplinar y profesional, abriendo una mirada introspectiva que permita comprender, que el ejercicio de la enfermería desde lo cotidiano, perpetúa lógicas de subordinación y poder tanto en la atención directa como en los equipos de trabajo.This essay invites to a reflection, from the Foucauldian perspective, about the viewpoint of nursing-care delivery and teaching to future professionals, as well as the analysis of the relations of power in nursing and the link with people “caring objects” from a bioethical point of view. The methodology includes texts analysis from a Foucauldian perspective in health, a retrospective view about the experiences of professionals nurses and the installation of mechanism of power in nursing. Sources related to nursing history and the professional formation with emphasis on professor/student and nurse/patient relationship were analyzed. Bioethical aspects and professional contexts were compared. Currently nurses have normalized the existence of control mechanism within the direct attention of people and their care, which is transferred to the formation of nurses. Nowadays, nursing thoughts have been expanded, become independent and adapted to different contexts. This invites to use a broader perspective to observe the purpose of the discipline and the profession of nursing, using an introspective view that allows to understand that the nursing practice perpetuates subordination and power in both direct care teams and work teams.Este tema tem como objetivos reflexionar desde a perspectiva foucaultiana, o cuidado que se entrega e se ensina a os futuros professionais e analizar as relações de poder em o ámbito da enfermería e o vínculo com as pessoas “objetos de cuidado” desde um enfoque bioético. A metodología incorpora um análises de textos desde a perspectiva foucaultiana em saúde, uma olhada retrospectiva sobre experiências professionais e a instalação de dispositivos de poder em enfermería. Se analizam fontes relacionadas com a história da enfermaría e da formação professional com énfases em as relacões professores/estudantes e enfermeros/pacientes. Se contrastam aspectos bioéticos e contextos professionais. A enfermería ha normalizado a instalação de lógicas de controle em a atenção direta de pessoas e em o cuidado, do qual se transfere a formação de enfermeiras e enfermeiros. Atualmente, o pensamento de enfermaría se ha ampliado, independizado e adaptado a os contextos, o que convidam a visualizar desde uma perspectiva mais ampla o proposto de que fazer disciplinar e professional, abrindo uma nova forma de observar, a introspectiva que permita compreender, que o exercício da enfermería desde o cotidiano, perpetue lógicas de subordinação e poder tanto em a atenção direta como em as equipes de trabalhos

O caminho de um bom educador de enfermagem. A perspectiva dos protagonistas

Los buenos educadores son vitales como referentes en la formación de los docentes noveles y de estudiantes de enfermería. Objetivo: Explorar aspectos trascendentes para el desempeño docente de los buenos formadores en enfermería, desde sus propias perspectivas y en ámbitos de su historia personal y profesional. Materiales y métodos: Investigación cualitativa, tipo estudio de caso. Se identificaron a los mejores educadores consultando estudiantes y docentes de dos Escuelas Universitarias de Enfermería de Barcelona. Se utilizaron entrevistas, observaciones participantes y diario del profesor. Además, se usaron criterios de rigor científico, consentimiento informado y sistema de identificadores, asegurando confidencialidad y anonimato. Resultados: Se describieron como trascendentes para su desempeño, la influencia de modelos como padres y docentes clínicos, el valor de la relación docente-estudiante, la intuición pedagógica y la relevancia del escenario de la práctica clínica. Discusión y Conclusiones: Variados aspectos de la vida personal e historia profesional fueron influyentes para el desempeño como buenos educadores, con una potente coherencia entre el actuar profesional y el formador, corroborando la relevancia que adquiere el conocimiento práctico construido en base a experiencias personales sin requerir necesaria participación en programas formales de formación pedagógica.Good educators are vital as referents in the education process for novice nurse teachers and nursing students. Objective: To explore transcendental aspects for the educational performance of the good trainers in nursing, from their own perspectives and in spheres related to their personal and professional history. Methods: Qualitative research, case study methodology. To identify the best nursing educators, students and teachers of two University Nursing Schools were consulted in Barcelona. Professor’s diary, interviews and participant observations were used. Criteria of scientific rigor were applied. Informed consent and an identification system were used, ensuring confidentiality and anonymity. Results: The influence of models as parents and clinical teachers, the value of the teacher-student relationship, the pedagogical intuition and the relevance of the clinical practice scenario were described as transcendental for their performance. Discussion and Conclusions: Several aspects of personal life and professional history were influential to the performance of good nursing educators, with a potent coherence between the professional act and the educative action, corroborating the importance of the practical knowledge built based on personal experiences without requiring a necessary participation in formal pedagogical training programs.Bons educadores são vitais como referentes no treinamento de docentes novatos e dicentes de enfermagem. Objetivo: Explorar aspectos que tenham sido importantes para o desempenho docente de bons treinadores de enfermagem, desde suas próprias perspectivas e em áreas de sua história pessoal e profissional. Métodos: Pesquisa qualitativa, estudo de caso. Os melhores educadores foram identificados consultando a estudantes e professores de duas Escolas Universitárias de Enfermagem de Barcelona. Os bons professores foram questionados sobre o diário do professor, as entrevistas e as observações dos participantes. Foram utilizados critérios de rigor científico, assentimento informado e o sistema de identificação, assegurando anonimato. Resultados: A influência dos modelos como pais e professores clínicos, o valor do relacionamento professor-aluno, a intuição pedagógica e a relevância do cenário de prática clínica foram descritos como transcendentes para o desempenho. Discussão e Conclusões: Tantos aspectos da vida pessoal como da história profissional foram influentes para o desempenho como bons educadores, com uma forte coerência entre a atuação profissional e o formador, corroborando a relevância adquirida pelo conhecimento prático construído sobre experiências pessoais sem requerer a participação necessária em programas formais de treinamento pedagógico

PERCEPÇÃO DA ENFERMAGEM EM RELAÇÃO A ATENÇÃO HOSPITALAR DADA PARA PESSOAS QUE VIVEM COM HIV

Given the epidemiological context in Chile concerning the increased quantities of people with HIV, improving the care given to these patients becomes relevant. The objective of this research is to find about the perception of nurses concerning the care given to people living with HIV (PLHIV) in a tertiary health care hospital service, seeking to contribute to nursing improvements. In order to accomplish this task a qualitative research paradigm was used as a type of case study, collecting the information with a semi-structured interview, ending with a semiotic analysis of the discourse. It was pointed out that in the first sessions there is some fear generated in the attention to PLHIV, which gradually disappears with the increase of the professional’s knowledge. Participating nurses referred to the lack of differences in care between PLHIV and other patients, evidencing incongruence between the speech and the action by taking greater precautions when performing procedures for PLHIV. The strengths identified in the attention to PLHIV were the no discrimination to these patients, the ability to face different contexts of attention and the procedural skills, among others, while aspects to improvement in care were linked to the relationship that is generated with PLHIV and their families. In conclusion, nurses do not make noticeable distinctions in the care of PLVIH. It is important that professionals recognize their skills and the aspects that can be improved in order to continue humanizing the attention to PLHIV, acting as educators and agents of change.Dado el contexto epidemiológico en Chile referente al alza de la cantidad de personas con VIH, cobra relevancia el fortalecimiento del cuidado otorgado a estos pacientes. Por esto, el objetivo de esta investigación es conocer la percepción de enfermeras(os) respecto a la atención otorgada a personas que viven con VIH (PVVIH) en un servicio hospitalario de atención terciaria de salud, buscando contribuir a la enfermería. Para ello se utilizó un paradigma de investigación cualitativo tipo estudio de caso, recolectando la información con una entrevista semiestructurada, finalizando con un análisis del discurso de tipo semiótico. Se destacó que en las primeras atenciones se generaba “temor” en la atención a PVVIH, el que desaparecía a medida que aumentaban los conocimientos de la(el) profesional. Enfermeras(os) participantes refirieron la inexistencia de diferencias en la atención entre PVVIH y otros pacientes, evidenciándose una incongruencia entre el discurso y el actuar en enfermería al ocupar mayores medidas de precaución al realizar procedimientos a PVVIH. Como fortalezas identificadas en la atención a PVVIH se encontró el no discriminar a pacientes, la capacidad de enfrentar distintos contextos de atención y la destreza procedimental, entre otras, mientras que los aspectos a mejorar en la atención se vincularon con la relación que se genera con los PVVIH y sus familiares. Como conclusión, las(os) enfermeras(os) no hacen mayores distinciones en la atención con PVVIH. Es importante que las(os) profesionales reconozcan sus habilidades y aspectos a mejorar para seguir humanizando la atención a PVVIH, siendo agentes educadores y de cambio.Dado o contexto epidemiológico no Chile referente ao aumento das pessoas com HIV, é relevante a necessidade de fortalecer os cuidados desses pacientes. Devido a isso, o objetivo de esta pesquisa é conhecer a percepção de enfermeiros(as) em relação a atenção fornecida para as pessoas que vivem com HIV num serviço hospitalar de atenção terciária em saúde, buscando contribuir para a disciplina e profissão de enfermagem. Para isso se utilizou um paradigma de pesquisa qualitativo tipo estudo de caso, o meio para reunir informação foi a entrevista semiestruturada, finalizando com uma análise de discurso.Destacou que nas primeiras atenções de pessoas portadoras de HIV o “temor” era perceptível. “Temor” que desaparecia à medida que o conhecimento do profissional aumentava. Enfermeiros(as) participantes falaram que não existe diferença alguma na forma de atenção de pacientes portadores de HIV, mas se notou uma incongruência entre o discurso e a atuação da enfermagem ao tomar maiores medidas de precaução no momento de realizar procedimentos com esses pacientes. Pontos fortes identificados na atenção de portadores de HIV foram a não discriminação dos pacientes, a capacidade de enfrentar-se a distintos contextos na atenção, as habilidades de procedimentos, entre outras. Enquanto aos aspectos a melhorar na atenção se vincularam com a relação que se gera como os pacientes portadores de HIV e seus familiares Como conclusão os enfermeiros(as) não fazem maiores distinções na atenção de pacientes com HIV. É importante que os profissionais reconheçam suas habilidades e pontos para melhorar e assim continuar avançando na humanização da atenção dos portadores de HIV conseguindo ser agentes educadores e de mudança

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

First Report on the Molecular Detection of Canine Astrovirus (CaAstV) in Dogs with Gastrointestinal Disease in Ecuador Using a Fast and Sensitive RT-qPCR Assay Based on SYBR Green^®

Enteric viruses are responsible for a significant number of gastrointestinal illnesses in dogs globally. One of the main enteric viruses is the canine astrovirus (CaAstV), which causes diarrhea in dogs of various ages. It is linked to symptoms such as diarrhea, vomiting, depression and a significant mortality rate due to gastrointestinal disorders. It is a single-stranded positive RNA virus, with three open reading frames, ORF1a, ORF1b and ORF2, where the last one codes for the virus capsid protein and is the most variable and antigenic region of the virus. The aim of this work is to develop and standardize a quick detection method to enable the diagnosis of this etiological agent in dogs with gastroenteritis in Ecuador in order to provide prompt and suitable treatment. The assay was specific for amplification of the genome of CaAstV, as no amplification was shown for other canine enteric viruses (CPV-2, CCoV and CDV), sensitive by being able to detect up to one copy of viral genetic material, and repeatable with inter- and intra-assay coefficients of variation of less than 10% between assays. The standard curve showed an efficiency of 103.9%. For the validation of this method, 221 fecal samples from dogs affected with gastroenteritis of various ages from different provinces of Ecuador were used. From the RT-qPCR protocol, 119 samples were found positive for CaAstV, equivalent to 53.8% of the samples processed. CaAstV was detected in dogs where both the highest virus prevalence in the tested strains and the highest viral loads were seen in the younger canine groups up to 48 weeks; in addition, different strains of the virus were identified based on a sequenced fragment of ORF1b, demonstrating the first report of the presence of CaAstV circulating in the domestic canine population affected by gastroenteritis in Ecuador, which could be associated with the etiology and severity of enteric disease

Development of a fast and sensitive RT-qPCR assay based on SYBR® green for diagnostic and quantification of Avian Nephritis Virus (ANV) in chickens affected with enteric disease

Abstract Background Enteric viruses are among the most prominent etiological agents of Runting-Stunting Syndrome (RSS). The Avian Nephritis Virus (ANV) is an astrovirus associated with enteric diseases in poultry, whose early diagnosis is essential for maintaining a good poultry breeding environment. ANV is an RNA virus that rapidly mutates, except for some conserved regions such as ORF1b. Therefore, the approach of a diagnostic method based on fast-RT-qPCR using SYBR® Green that focuses on the amplification of a fragment of ORF1b is presented as a feasible alternative for the diagnosis of this viral agent. In this study, the proposed assay showed a standard curve with an efficiency of 103.8% and a LoD and LoQ of 1 gene viral copies. The assay was specific to amplify the ORF 1b gene, and no amplification was shown from other viral genomes or in the negative controls. 200 enteric (feces) samples from chickens (broilers) and laying hens with signs of RSS from Ecuadorian poultry flocks were examined to validate the proposed method. Results Using our method, 164 positive results were obtained out of the total number of samples run, while the presence of viral RNA was detected in samples collected from one day to 44 weeks old in both avian lines. Conclusions Our study presents a novel, rapid, robust, and sensitive molecular assay capable of detecting and quantifying even low copy numbers of the ANV in commercial birds, therefore introducing a handy tool in the early diagnosis of ANV in enteric disease outbreaks in poultry