Nurses’ clinical communication skills

Abstract Background: Providing nursing care involves an interpersonal relationship between the nurse and the patient which is created through communication. The importance of clinical communication skills is a current priority when it comes to health care workers’ education and training and has been attracting more and more attention. As a consequence clinical communication skills are now present in more and more academic programmes. Objectives: To assess nurses’ clinical communication skills; to identify the variables that might inluence the clinical communication skills; to analyse nurses’ perspective regarding the training in the clinical communication ield. Material and methods: Quantitative, non-experimental, descriptive and correlational and crosssectional study. We used the questionnaire to collect socio-demographic and professional data, and the Clinical Communication Skills Scale based on the Kalamazoo Consensus Statement (KCS)1,2 and which had already been used in Portugal.3 The sample was formed by 275 practitioner nurses who have been working in health care institutions located in the center of Portugal. Results: The Scale we used presents 5 factors that explain 64.33% of the total variation: To in‑ volve the patient; To facilitate dialogue; To understand concerns; To communicate in an asser‑ tive way; To carry out the interview. The majority of the nurses consider that the training they had in the communication skills ield during their nursing course was good or very good, however we could see that 23.3% think it was mediocre. Almost all of them (98.9%) agree that there should be a better and more speciic training in the ield of clinical communication skills as far, as nurses as concerned. Nurses who had training in this area, older nurses, those who work directly with patients and those who have been working for a longer period of time show better communication skills. Conclusion: Although they think that the training they has was good, we could conirm that there was a deicit in nurses’ clinical communication skills and that nurses themselves refer they need more training in this area. Data point out to a more signiicant investment in clinical communication as far as nurses’ training is concerned and they suggest the promotion of lifelong learning opportunities in this area.

Satisfaction with the healthcare provided of women who had undergone a mastectomy

Abstract Introduction: Breast cancer is the most common form of cancer among women worldwide and, therefore, deserves the highest attention and assistance from medical services. Considering patients’ satisfaction as an indication of healthcare quality, women who have undergone a mastectomy will assess the medical care received. This assessment will be based on what is expected from that medical care and on the expected improvement of her health condition. . Objective: To determine the level of satisfaction of women who have undergone a mastectomy with the medical care provided by nurses, doctors and by the way hospital services are organized. Design: A descriptive and cross-sectional study, developed in Portugal. Participants: A non-probabilistic sample formed by 153 women who underwent a mastectomy with an average age of 55, married (67.3%), unemployed (56.2%), living in a rural area (71.2%) and living on minimum wage (54.9%). Measurement instrument: European Organization for Research and Treatment of Cancer (EORTC) IN-PATSAT32 questionnaire. Results: 113 (73.85%) of the 153 women are satisied with the medical care provided and 40 (26.14%) of them show their lack of satisfaction. A highly signiicant percentage of women (49.01%) feel fairly satisied with the medical care provided by nurses and with the way services are organized (37.9). On the other hand (37.9%) show their dissatisfaction towards doctors. The family network proved to be a predictor of the satisfaction with doctors (β = 0.163; P = .044) and the period of hospitalization predicts the satisfaction with the organization (β = 0.171; P = .011). Both predictors will be useful to explain the 3% variability in patients’ satisfaction. Conclusions: Monitoring the satisfaction with the medical care received is a fundamental strategy to promote the well-being of women who underwent a mastectomy.

Adherence to therapeuthic regimen and metabolic control of type 1 diabetes

Abstract Objectives: To assess the adherence to therapeutic regimen; to determine the Hemoglobin Glycation Index (HbA1c); to analyse the relationship that exists between the adherence to therapeutic regimen and metabolic control. Design: correlational analytical study, carried out according to a cross-sectional perspective. Participants: A non-probabilistic sample of 266 people with type 1 diabetes aged between 18 and 78 years old (mean M = 51.02 ± SD = 18.710), attending follow-up diabetes consultations. Mostly male individuals (51.88%), with low schooling level (50.75% had only inished elementar school). Measuring Instruments: We used the following data collection tools: a questionnaire on clinical and socio-demographic data, blood analysis of venous blood to determine the glycated hemoglobin level (HbA1c).Three self-report scales were used: Accession to Diabetes Treatment (Matos, 1999), Self-perception Scale (Vaz Serra, 1986) and Social Support Scale (Matos & Rodrigues, 2000). Results: In a sample in which the mean disease duration is 12.75 years, 69.17% of the sample run glycemic control tests between once a day and four times a year and 42.86% of them undergo insulin treatment. In the last 3 weeks, 26.32% of these people have experienced an average of 4.22 to 44.36%, hypoglycemic crises and experienced an average of 6.18 hyperglycemic crises. 57% of the individuals have showed a poor metabolic control (mean HbA1c higher than 7.5% (HbA1c mean M ≥ 7.50%). The mean psychosocial proile revealed individuals who show a decent self-esteem (M = 70.81) and acceptable social support (M = 58.89). Conclusions: The results suggest we should develop a kind of investigation that could be used to monitor the strenght of the mediation effect effect of the psychosocial predictive dimension of the adherence, since it has become essential to support a multidisciplinary approach which center lays in the promotion of a co-responsible self-management from the person who suffers from diabetes. This will enable a better quality of life; fewer years of people’s lives lost prematurely and a better health with less economical costs for citizens and healthcare systems.

Life quality and the wellness in elderly. study case of the Casa do Menino Jesus

This research aims to present an analysis on the absence of innovative social responses to elderly, taking into account the need for stimulation of this population segment. Our main goal is not only a theoretical approach about the issue of elderly, but also present a study on the potentialities of the Casa do Menino Jesus, our case study, can apply for funding of a multisensorial stimulation response for elderly. This paper is divided into three parts: theoretical framework and characterization of our social organization, according to an exploratory research, structuring a strategic plan of the organization, through field research, and as final result, to present a proposal for funding and implementation of an innovative social response, according to the underlying legislation to Portugal 2020. The sample is focused on the population of Mirandela municipality. To conclude, it is important to make this local approach, because of the increasing number elder people with dementia problems and specific needs of treatment and stimulation.

Life quality and the wellness of local population and the sustainability of social organizations. Study case of a Foundation

This research aims to present an analysis on the absence of innovative social responses related with continuing care, taking into account the need to answer to all kind of social needs. Our main goal is not only a theoretical approach about the social challenges and social policies, but also present a study on the potentialities of the Fundação Elísio Ferreira Afonso, our case study, can apply for funding of an UCC (Continuing Care Unit) in order to meet the needs of the local population on one hand, and on the other, in order to contribute to the self-sustainability of the Foundation. This paper is divided into three parts: theoretical framework and characterization of our social organization, according to an exploratory research, structuring a strategic plan of the organization, through field research, and as final result, to present a proposal for funding and implementation of an innovative UCC, according to the underlying legislation to Portugal 2020. The sample is focused on the population of Sátão municipality. To conclude, it is important to make this local approach, because of the increasing demand for this kind of caring services.

Life quality and the wellness of victims of domestic violence. study case of the Centro Social, Recreativo e Cultural de Vilar de Maçada

This research aims to present an analysis on the absence of social responses that address the problem of domestic violence in Alijó. Our main goal is not only a theoretical approach about the issue of domestic violence, regional conditions in relation to domestic violence, but also present a study on the potentialities of Centro Social Recreativo e Cultural de Vilar de Maçada, our case study, can apply for funding of an emergency housing for victims of domestic violence. This paper is divided into three parts: theoretical framework and characterization of our social organization, according to an exploratory research, structuring a strategic plan of the organization, through field research, and as final result, to present a proposal for funding and implementation of an innovative social response, according to the underlying legislation to Portugal 2020. The sample is focused on the population of Alijó municipality. To conclude, it is important to make this local approach, because of the increasing number of cases not detected and reported. Thus, the quality of life is increased, reducing the incidence of violence in the family.

Conflict resolution strategies : influence of organizational and professional commitment nurses

Introduction: The changes in the health area and the set of structural changes in the nursing profession and career interfere in the dynamics and stability of the future of the nurses. Objectives: To study the influence of organizational and professional commitment of the nurses in the strategies of conflict resolution. Methods: This is a quantitative, transversal and non-experimental research, following a descriptive-correlational way. Data were obtained by applying a questionnaire to nurses that work on different types of Primary Health Care Units. As measuring instruments we used three scales that grouped a total of nine subscales used to evaluate: the organizational commitment, the professional commitment and the strategies of conflict resolution. Results: The majority of nurses present moderate scores of organizational and Professional commitment with higher affective commitment to the normative commitment or instrumental commitment and feel that nursing is an interesting and challenging profession, but personal and social perception of nursing relevance is moderately weak. Nurses adopt the domination conflict resolution strategies and accommodation over the head and less integrative strategies and commitment. With subordinates more nurses adopt the avoidance strategy. When the conflictual situation arises with colleagues more endow the integrative strategies and commitment and less domination strategy. The organizational and professional commitment is significantly associated with some solving strategies conflict adopted by nurses as the conflictual situation arises with the boss, with subordinates or colleagues. Some dimensions of organizational commitment and professional foretell to significantly shape the adoption of conflict resolution strategy adopted.

Validez de contenido de un cuestionario para evaluar las etapas del cambio de comportamiento en estilos de vida en escolares, Colombia: Estudio FUPRECOL

Estudio de validación en escolares pertenecientes a instituciones educativas oficiales de la ciudad de Bogotá, Colombia. Se diseñó y aplicó el CCC-FUPRECOL que indagó por las etapas de cambio para la actividad física/ejercicio, consumo de frutas, verduras, drogas, tabaco e ingesta de bebidas alcohólicas, de manera auto-diligenciada por formulario estructurado.

Estado nutricional y etapas de cambio comportamental frente a la actividad física niños y adolescentes de Bogotá, Colombia: Estudio FUPRECOL

Objetivo: El propósito del estudio fue relacionar la etapa en el cambio en el comportamiento frente a la actividad física y el estado nutricional en escolares entre 9 y 17 años de Bogotá- Colombia, pertenecientes al estudio FUPRECOL. Método: Se trata de un estudio transversal, en 6.606 niños y adolescentes entre 9 y 17 años, pertenecientes a 24 instituciones educativas, de Bogotá-Colombia. Se aplicó de manera auto-diligenciada el cuestionario de cambio de comportamiento en función a la intensión de realizar actividad física (CCC-Fuprecol) y se midió el peso y la estatura para determinar el estado nutricional con el índice de masa corporal (IMC). Resultados: El porcentaje de respuesta fue 94% y se consideraron válidos 6,606 registros, siendo 58.3 % (n=3.850) niñas con un promedio de edad de 12,7±2,3 años. En la población general, el 5,3 % de los escolares se encontraban en etapa de pre-contemplación, 31,8 % en contemplación, el 26,7 % en acción y el 36,2 % en etapa de mantenimiento. Al comparar la etapa de cambio con el estado nutricional por IMC, los escolares clasificados en obesidad mostraron mayor frecuencia de respuesta en la etapa de pre-contemplación, mientras que los escolares con peso saludable acusaron mayores porcentajes en la etapa de mantenimiento. Conclusión: En escolares de Bogotá, Colombia, se encontró una relación estadísticamente significativa entre a la intensión de realizar actividad con el estado nutricional medido con el IMC. Fomentar la promoción de la actividad física y monitorear el estado nutricional, deberá ser una prioridad en las agendas y políticas públicas dentro del ámbito escolar.

Imaginarios sociales de adolescentes y docentes en torno al cuerpo, la corporalidad y la actividad física. Estudio cualitativo en un colegio de Bogotá, 2014-2015.

Problema. Esta investigación se aproxima al entorno escolar con el propósito de avanzar en la comprensión de los imaginarios de los adolescentes y docentes en torno al cuerpo, la corporalidad y la AF, como un elemento relevante en el diseño de programas y planes efectivos para fomento de la práctica de AF. Objetivo. Analizar los imaginarios sociales de docentes y adolescentes en torno a los conceptos de cuerpo, corporalidad y AF. Métodos. Investigación de corte cualitativo, descriptivo e interpretativo. Se realizaron entrevistas semi-estructuradas a docentes y a estudiantes entre los 12 y 18 años de un colegio público de Bogotá. Se realizó análisis de contenido. Se compararon los resultados de estudiantes por grupos de edades y género. Resultados. Docentes y estudiantes definen el cuerpo a partir de las características biológicas, las diferencias sexuales y las funciones vitales. La definición de corporalidad en los estudiantes se encuentra ligada con la imagen y la apariencia física; los docentes la entienden como la posibilidad de interactuar con el entorno y como la materialización de la existencia. La AF en los estudiantes se asocia con la práctica de ejercicio y deporte, en los docentes se comprende como una práctica de autocuidado que permite el mantenimiento de la salud. Conclusiones. Para promover la AF tempranamente como una experiencia vital es necesario intervenir los espacios escolares. Hay que vincular al cuerpo a los procesos formativos con el propósito de desarrollar la autonomía corporal, este aspecto implica cambios en los currículos.

Modelo de gestión para la atención integral de pacientes con enfermedades huérfanas o raras en Colombia

Las enfermedades raras o huérfanas corresponden a aquellas con baja prevalencia en la población, y en varios países tienen una definición distinta de acuerdo con el número de pacientes que afectan en la población. La Organización Mundial de la Salud (OMS), las define como un trastorno que afecta de 650 a 1.000 personas por millón de habitantes, de las que se han identificado alrededor de 7.000. En Colombia su prevalencia es menor de 1 por cada 5.000 personas y comprenden: las enfermedades raras, las ultra-huérfanas y las olvidadas. Los pacientes con este tipo de enfermedades imponen retos a los sistemas sanitarios, pues si bien afectan a un bajo porcentaje de la población, su atención implica una alta carga económica por los costos que involucra su atención, la complejidad en su diagnóstico, tratamiento, seguimiento y rehabilitación. El abordaje de las enfermedades raras requiere un manejo interdisciplinar e intersectorial, lo que implica la organización de cada actor del sistema sanitario para su manejo a través de un modelo que abraque las dinámicas posibles entre ellos y las competencias de cada uno. Por lo anterior, y teniendo en cuenta la necesidad de formular políticas sanitarias específicas para la gestión de estas enfermedades, el presente trabajo presenta una aproximación a la formulación de un modelo de gestión para la atención integral de pacientes con enfermedades raras en Colombia. Esta investigación describe los distintos elementos y características de los modelos de gestión clínica y de las enfermedades raras a través de una revisión de literatura, en la que se incluye la descripción de los distintos actores del Sistema de Salud Colombiano, relacionados con la atención integral de estos pacientes para la documentación de un modelo de gestión integral.

Efecto del programa Ruta para la gestión del autocuidado en el control de cifras tensionales en pacientes con hipertensión arterial en una EPS privada de Bogotá, en el año 2015

Introducción. La hipertensión arterial es una de las patologías más representativas en términos de morbi-mortalidad y afectación de la calidad de vida de los usuarios de una EPS privada en Bogotá. Se cuenta en la literatura con múltiples prácticas para favorecer la adherencia al tratamiento de la hipertensión, pero se evidencia que en muchos pacientes no se logran las metas terapéuticas establecidas, generando a largo plazo complicaciones que impactan en la calidad de vida de los pacientes y en el costo en salud. Es por esto que en la EPS se establece desde el 2012 el programa: Ruta para la gestión del autocuidado, como una estrategia de intervención complementaria sobre los pacientes con enfermedades crónicas, con el fin de apoyar a los usuarios del programa de promoción y prevención Atención Específica integral (AEI) en el cumplimiento de las recomendaciones terapéuticas farmacológicas y no farmacológicas generadas por el equipo de salud. La ruta está dirigida especialmente al grupo de pacientes hipertensos con dificultades en la adherencia al programa de promoción y prevención, o en el logro de metas terapéuticas, y busca implementar estrategias de intervención educativa orientadas a fomentar la capacidad de las personas para adaptarse y auto gestionar los desafíos que representa convivir con el diagnóstico de una patología crónica. Por lo anterior la presente investigación busca evaluar el efecto del programa Ruta para la gestión del autocuidado en el control de cifras tensionales en pacientes hipertensos en en una EPS privada de Bogotá en el año 2015. Objetivo. Establecer si la participación en el programa Ruta para la gestión del autocuidado influye en los valores de cifras tensionales de pacientes hipertensos, graduados del programa en una EPS privada de Bogotá en el año 2015. Metodología. Estudio con enfoque cuantitativo, observacional longitudinal retrospectivo de una intervención antes y después, para evaluar el efecto del programa Ruta de gestión de autocuidado, en el control de cifras tensionales, índice de masa corporal y perímetro abdominal de pacientes con diagnóstico de hipertensión arterial afiliados a la EPS privada en Bogotá, graduados del programa entre el 1 de Enero de 2015 a Diciembre de 2015. Población del estudio 409 pacientes, con muestreo por conveniencia. La recolección de datos fue a partir de fuentes secundarias de historia clínica sistematizada de la EPS. Resultados. La población de estudio fueron 409 pacientes, de los cuales el 69,2% son mujeres (n=283). El promedio de la edad de los pacientes fue de 60,16+/-0.9 años, los mayores de 60 años son el grupo más representativo con un 54% (n=220), el estrato socioeconómico 1 es el 77% (n=315), , el tiempo de duración de la ruta de autocuidado de la población analizada más frecuente fue de 4 a 6 meses con un 60,4% (n=247) y el tratamiento más utilizado es el combinado con 53,1% (n=217). Antes del inicio de la Ruta de gestión de autocuidado, 138 pacientes tuvieron valores de tensión arterial sistólica en rangos de hipertensión, al finalizar la misma disminuyeron los valores a rangos de normalidad 96 pacientes (69,6%). De los pacientes que iniciaron con tensión arterial sistólica en rangos de normalidad (n=271), el 12,5% al finalizar la ruta tuvieron valores en rangos de hipertensión (n=34). El cambio en los rangos de tensión arterial sistólica evidenció que es estadísticamente significativo (p=0.000) con un OR de 2,8:1, lo cual indica que la variación de pacientes con valores de tensión arterial sistólica en rangos de hipertensión a valores en rango de normotensión, ocurre 2,8 veces más en quienes realizan la ruta de gestión de autocuidado que los que no. Antes del inicio de la Ruta de gestión de autocuidado, 70 pacientes tuvieron valores de tensión arterial diastólica en rangos de hipertensión, al finalizar la misma disminuyeron los valores a rangos de normalidad 56 pacientes (80%). De los pacientes que iniciaron con tensión arterial diastólica en rangos de normalidad (n=339), el 8,3% al finalizar la ruta tuvieron valores en rangos de hipertensión (n=28). El cambio en los rangos de tensión arterial diastólica, evidenció que es estadísticamente significativo (p=0.001) con un OR de 2,0:1, lo cual indica que la variación de pacientes con valores de tensión arterial diastólica en rangos de hipertensión a valores en rango de normotensión, ocurre 2 veces más en quienes realizan la ruta de gestión de autocuidado que los que no. Conclusión. La implementación de modelos educativos en la atención primaria en salud en las unidades de atención de servicios ambulatorios en la EPS, generan un impacto positivo en el control de las cifras tensionales. El tener pacientes controlados incide en la disminución de morbimortalidad, costos de hospitalización médica y mejora en la calidad de vida.

VALIDATION STUDY OF HEALTH BELIEFS SCALE

Introduction: The Health Belief Scale is a questionnaire used to assess a wide range of beliefs related to health. The objective of this study was to undertake construction and culturally adapt the Health Belief Scale (HBS) to the Portuguese language and to test its reliability and validity. Methods: This new version was obtained with forward/backward translations, consensus panels and a pre-test, having been inspired by some of the items from “Canada’s Health Promotion Survey” and the “European Health and Behaviour Survey”, with the inclusion of new items about food-related beliefs. The Portuguese version of Health Belief Scale and a form for the characteristics of the participants were applied to 849 Portuguese adolescents. Results: Reliability was good with a Cronbach’s alpha coeficient of 0.867, and an intraclass correlation coeficient (ICC) of 0.95. Corrected item-total coeficients ranged from 0.301 to 0.620 and weighted kappa coeficients ranged from 0.72 to 0.93 for the total scale items. We obtained a scale composed of 13 items divided into ive factors (smoking and alcohol belief, food belief, sexual belief, physical and sporting belief, and social belief), which explain 57.97% of the total variance. Conclusions: The scale exhibited suitable psychometric properties, in terms of internal consistency, reproducibility and construct validity. It can be used in various areas of research.

ABSTINENCE AND ALCOHOL CONSUMPTION AMONG STUDENTS: THE INFLUENCE OF PERSONAL, FAMILY AND SOCIO-CULTURAL SPHERES

Introduction: Among young people, regular or alcohol abuse seems to ally with individual factors, which congregate to other generators behaviors health risk, in social environment, including family and school. The consumption of alcoholic beverages in the younger age groups, according to the World Development Report goes beyond 60%. In the Portuguese case, the Alentejo is the region that recorded higher consumption among schoolchildren. Objectives: This study aims to know the personal inluences of family, of belonging to the group and the school environment, on the withdrawal and consumption habits among young people. Methods: A qualitative nature of research, using comprehensive semi-structured interviews. The study was developed in a school district of Evora, Portugal. The sample consists of ten students from the 8th school grade, ive non-consumers-ive consumers aged between 13 and 15 years old. Results: The trial takes place between 12 and 14 years old as a result of curiosity, explicit or tacit motivation, “give style”, the environment, entertainment and observing behavior. Among the effects of intake indicated as motivators consumption highlight the joy of reaching states and willingness. Family members tend to encourage moderate drinking on festive occasions. family models exaggerated consumption repudiate ingestion. The elements of the group of belonging tend to motivate explicitly, the intake among consumers students. The school promotes initiatives on the theme, punctually. Conclusions: The consumption of alcohol among young people suffer the personal, family and belonging group inluences. The initiatives in school tend to have no effect.

Announcing Motherhood

Introduction: Pregnancy is associated with experiences that integrated socio-cultural contexts of space and time, bring changes in family and/or maternal-fetal relationship. Parenthood is a generational task, and one of the most complex in humans. Aimo: To describe the construction of motherhood. Method: Cross-sectional qualitative study. We used the interview technique. Convenience sample of 10 pregnant women at the end of 3rd trimester. Results: The analysis of the narrative reveals four categories: a) conceiving pregnancy idea, b) imagining maternity, c) claiming herself through pregnancy and d) announcing attachment Conclusion: pregnant women essentially express positive and tipical feelings of pregnancy, seeming an healthy evolution. The transition to parenthood is underway, as well as a developing performance to the best role.