Relaciones personales entre la enfermera y el paciente

Attitudes and Behaviors of Nurses and Nursing Students Toward Patients with Obesity: A Systematized Review

Background: The prevalence of people with obesity is increasing worldwide, facing challenges in terms of discrimination and prejudice across all settings, including healthcare. Objective: The objective of this review is to compare and synthesize recent scientific literature regarding nurses' behaviors and attitudes toward patients with obesity. Methods: A systematized methodology was employed, conducting a literature search of studies published in the bibliographic resources (Academic Search Complete, CINAHL Complete, Web of Science, and Scopus from 2018 to 2023); using specific terms combined with the Boolean operators, AND and OR. Inclusion criteria: Quantitative, qualitative, or mixed research conducted on nurses and/or nursing students in a context focused on the care of adult patients with obesity. Critical appraisal tools from the Joanna Briggs Institute (JBI) were used to evaluate the included studies, and their level of evidence was also determined. Results: Initially, the search yielded 166 articles, of which 14 were included in this review. The results found focused on the use of scales and tools heterogeneous to each other. The findings can be categorized into two main areas: studies investigating interventions aimed at reducing negative behaviors related to weight bias and prejudice, and studies focusing on assessing these attitudes. The evidence points in a consistent direction: nurses exhibit negative attitudes toward patients with obesity. Conclusions: The need for multilevel strategies, from clinical to academic training, to address this challenge is highlighted, alongside the development of research that complements the current evidence with a deeper and more detailed understanding of this phenomenon.

Ibero-American Consensus on Communication Skills for Nursing Degree students

OBJECTIVE

as a health care profession focused on caring for people, Nursing requires sound communication skills. Based on an international expert consensus, a proposal on learning outcomes in clinical communication for undergraduate Nursing education curricula in Spanish speaking countries is presented.

METHOD

a steering committee, consisting of 5 nurses and experts in communication in health care sciences, drew up the first list of communication skills specific to the Nursing degree. Their proposal was reviewed and improved by a committee of 7 international scientific advisers. 70 experts from 14 countries were selected using a snowball sampling procedure and invited to participate in a distance modified Delphi consensus process in two survey rounds. Statistical analysis was carried out to establish the final consensus level for each item.

RESULTS

a questionnaire with 68 learning outcomes in clinical communications was submitted for panel assessment. In the first Delphi round, the panel reached a statistical consensus on all the items assessed. There was no need for a second round to reconcile positions.

CONCLUSION

an academic proposal, approved by a high level of international consensus, is presented to guide and unify the learning outcomes on the clinical communication curriculum for undergraduate Nursing studies in Spanish speaking countries.

Ibero-American Consensus on Communication Skills for Nursing Degree students

Objective:

as a health care profession focused on caring for people, Nursing requires sound communication skills. Based on an international expert consensus, a proposal on learning outcomes in clinical communication for undergraduate Nursing education curricula in Spanish speaking countries is presented.

Method:

a steering committee, consisting of 5 nurses and experts in communication in health care sciences, drew up the first list of communication skills specific to the Nursing degree. Their proposal was reviewed and improved by a committee of 7 international scientific advisers. 70 experts from 14 countries were selected using a snowball sampling procedure and invited to participate in a distance modified Delphi consensus process in two survey rounds. Statistical analysis was carried out to establish the final consensus level for each item.

Results:

a questionnaire with 68 learning outcomes in clinical communications was submitted for panel assessment. In the first Delphi round, the panel reached a statistical consensus on all the items assessed. There was no need for a second round to reconcile positions.

Conclusion:

an academic proposal, approved by a high level of international consensus, is presented to guide and unify the learning outcomes on the clinical communication curriculum for undergraduate Nursing studies in Spanish speaking countries.

Consenso Iberoamericano sobre Habilidades de Comunicación para Estudiantes de Grado de Enfermería

Resumen Objetivo: en su carácter de profesión de atención de la salud enfocada en cuidar a las personas, la Enfermería requiere habilidades de comunicación sólidas. Sobre la base de un consenso internacional de expertos, se presenta una propuesta sobre resultados de aprendizaje en la comunicación clínica para planes de estudio de las carreras de grado de Enfermería en países de habla hispana. Método: un comité orientador, compuesto por 5 enfermeros y expertos en comunicación en ciencias de atención de la salud, elaboró la primera lista de habilidades de comunicación específicas para la carrera de Enfermería. Un comité de 7 asesores científicos internacionales revisó y mejoró dicha propuesta. Se seleccionó a 70 expertos de 14 países a través del procedimiento de muestreo “bola de nieve”, y se los invitó a participar en un proceso de consenso Delphi modificado a distancia en dos rondas de encuesta. Se realizó un análisis estadístico para establecer el nivel de consenso final correspondiente a cada ítem. Resultados: se presentó un cuestionario con 68 resultados de aprendizaje en comunicaciones clínicas para que lo evaluara el panel. En la primera ronda Delphi, el panel llegó a un consenso estadístico en todos los ítems evaluados. No fue necesaria una segunda ronda para conciliar posiciones. Conclusión: se presenta una propuesta académica, aprobada con un elevado nivel de consenso internacional, a fin de orientar y unificar los resultados de aprendizaje en los planes de estudio sobre comunicación clínica para carreras de grado de Enfermería en países de habla hispana.

Defining and characterising the nurse-patient relationship: A concept analysis

The nurse-patient relationship involves complex attitudes and behaviours with ethical and deontological implications. It has been linked to improvements in patient health outcomes, although there is still no consensus in the scientific literature as to the definition and characterisation of the concept. This article aim to define the concept of the nurse-patient relationship. A concept analysis was conducted using the Walker and Avant method to identify the attributes defining the nurse-patient relationship. An integrative review of the literature was conducted using the PubMed, Web of Science, Scopus, and Cumulative Index to Nursing & Allied Health Literature databases. A review of the grey literature and other minor non-indexed publications on the topic was also conducted. A total of 36 articles were included in the review. A model case, a contrary case, a related case, and empirical references were produced to clarify the concept and identify its essential attributes. The concept is defined as a helping relationship involving interaction between different players. It is the basis of nursing care and is intended to meet the healthcare needs of the individual receiving this care. It is also viewed as an intervention in itself, requiring a specific training process just like any other nursing skill. The essential attributes of the relationship are empathy, presence, contact, authenticity, trust, and reciprocity. In conclusion, the nurse-patient relationship is a helping relationship established with the patient and/or their family based on interaction, communication, respect for ethical values, acceptance, and empathy in order to encourage introspection and behavioural change. Key components include communication, active listening, and respect. Bioethical values and confidentiality must also be present to ensure that the relationship is built on equality and intimacy.

Transcultural adaptation and validity of a pictogram to assess communication needs in adults with artificial airway in intensive care

OBJECTIVE

To perform the cross-cultural adaptation and validity of a pictogram to assess communication needs in adults with artificial airway in ICU in Cartagena, Colombia.

METHOD

Scale validation study, population comprising all the patients who were hospitalized in six ICU of Cartagena-Colombia. The sample was made up of 181 adult patients with artificial airway, the adaptation to Spanish was determined (translation, backtranslation, expert review, pre-final version, pilot test, final version), facial validity by expert agreement, content validity with the Lawshe index modified by Tristan (cut-off point 0.58), exploratory factor analysis (AFE) with the Bartlett's test of sphericity and Cattell's graph; internal consistency measured through the Cronbach alpha statistic.

RESULTS

Patients between the ages of 19 and 88 years participated (mean = 54 ± 17), 91.71% expressed frequent needs for accompaniment, knowing date and time; 61% of the experts agreed with the cross-culturally adapted items, the overall Content Validity Index (CVI) was 0.86 with agreement in understanding eleven items. The AFE suggested retaining 13 items and 3 factors (perception/cognition, elimination and exchange, comfort), which explain the construct. The internal alpha Cronbach consistency was 0.64.

CONCLUSIONS

The pictographic material, Spanish version, was shown to be a multidimensional instrument composed of 18 items grouped in 3 factors. Therefore, it is recommended it be applied to the patient with artificial airway and to establish communication as a preliminary point of care in nursing.

Comunicación entre la enfermera y el familiar: una relación entre seres humanos honesta, directa y real

Introducción: la estancia en la unidad de cuidados intensivos (UCI) genera en el paciente y sus familias sentimientos de falta de control, incertidumbre y ansiedad que se encuentran relacionados con falta de información y comunicación tanto sobre el proceso de salud-enfermedad vivido como sobre el tratamiento. Objetivo: describir las características de la comunicación en un etnos determinado entre la enfermera y el familiar del paciente hospitalizado. Método: estudio cualitativo con enfoque microetnográfico que utilizó para el análisis la propuesta de Bardin. Los participantes fueron 12 familiares de pacientes hospitalizados en la UCI adultos de las ciudades de Bucaramanga y Floridablanca (Colombia) durante el 2016. Se realizó entrevista semiestructurada con cinco preguntas sobre la comunicación con el profesional de enfermería. Resultados: en su mayoría, los participantes fueron mujeres, universitarias e hijas procedentes de ciudades diferentes del lugar de la entrevista. Surgió un tema principal: la comunicación: una relación entre seres humanos honesta, directa y real, conformado por cuatro categorías: la información como eje central de la comunicación en UCI; la comunicación que no se expresa con palabras, aún más importante en la relación; la comunicación no fluye si no hay tiempo, disposición y condiciones para entablar la relación; y la comunicación genera sentimientos positivos y satisfacción. Conclusión: la comunicación como proceso social enmarcado en la UCI como etnos particular demanda de la enfermera profesional cualidades como amabilidad, cordialidad, empatía, reconocimiento y lenguaje entendible, al igual que la realimentación y disposición para entablar y mantener este proceso vital para las relaciones humanas.

[Significance of comfort for chronically hospitalized patientsSignificado do conforto para pacientes internados cronicamente]

Introduction

comfort, a quality of life component, seeks the preservation and recovery of health.

Objective

was to understand the meaning of comfort in patients with chronic disease hospitalized in Medellin-Colombia.

Material and methods

particularistic ethnographic research, with 14 participants, through semi-structured interviews and observation. Analysis was carried out with grounded theory tools, reading and rereading, data coding, and categories/ subcategories were generated until theoretical saturation through theoretical sampling.

Results

Categories: Interacting with others: The partner on the side and The death of another. Interacting with the health care team: Attributes of care; and Between comfort and discomfort with caregivers. Elements: communication and information.

Discussion

comfort is given in part by the interaction that patients have with the health care team, especially with nursing. It was also understood what generates comfort and discomfort in patients. Personal attributes such as empathy, professional skills and the use of appropriate language are the most frequently mentioned. Likewise, information and communication are vital in the perception of comfort.

Conclusions

the meaning that patients attribute to comfort is given by the interaction with the healthcare team, their personal attributes and the information provided about their health status and evolution as well as the effects of their treatment. Among those that cause discomfort: not being listened to, the negative attitude of the nursing staff, not attending to their call in a timely manner and witnessing the death of a partner.

Middle-Range Theory for the Nursing Diagnosis of Low Self-Efficacy in Health

OBJECTIVES

theoretical validation of the concept of low self-efficacy in health as a nursing diagnosis construct.

METHODS

construction of a middle-range theory for validating diagnoses, comprised of five stages: definition of the approach for building the theory; definition of the main concepts; creation of a pictorial diagram; formulation of proposals; establishment of causal relationships and evidence for clinical practice. The main concepts were identified through a literature review and the studies were taken from the LILACS, SCOPUS, CINAHL and PubMed/MEDLINE databases. The final sample was comprised of 92 articles.

RESULTS

eighteen etiological factors and 16 clinical indicators were identified; characterized as antecedents and manifestations for inferring a diagnosis of low self-efficacy in health.

CONCLUSIONS

the related concepts of the new nursing diagnosis of low self-efficacy in health, to be applied in clinical nursing practice, were identified and defined.

Transcultural adaptation and validity of a pictogram to assess communication needs in adults with artificial airway in intensive care

OBJECTIVE

To perform the cross-cultural adaptation and validity of a pictogram to assess communication needs in adults with artificial airway in ICU in Cartagena, Colombia.

METHOD

Scale validation study, population comprising all the patients who were hospitalized in six ICU of Cartagena-Colombia. The sample was made up of 181 adult patients with artificial airway, the adaptation to Spanish was determined (translation, backtranslation, expert review, pre-final version, pilot test, final version), facial validity by expert agreement, content validity with the Lawshe index modified by Tristan (cut-off point 0.58), exploratory factor analysis (AFE) with the Bartlett's test of sphericity and Cattell's graph; internal consistency measured through the Cronbach alpha statistic.

RESULTS

Patients between the ages of 19 and 88years participated (mean: 54±17); 91.71% expressed frequent needs for accompaniment, knowing date and time; 61% of the experts agreed with the cross-culturally adapted items, the overall Content Validity Index (CVI) was 0.86 with agreement in understanding eleven items. The AFE suggested retaining 13 items and 3 factors (perception/cognition, elimination and exchange, comfort), which explain the construct. The internal alpha Cronbach consistency was 0.64.

CONCLUSIONS

The pictographic material, Spanish version, was shown to be a multidimensional instrument composed of 18 items grouped in 3 factors. Therefore, it is recommended it be applied to the patient with artificial airway and to establish communication as a preliminary point of care in nursing.

Experiences of women with preeclampsia in an Obstetric Intensive Care Unit in Colombia

OBJECTIVE

To describe the meaning that pregnant women with preeclampsia attach to nursing care in an obstetric intensive care unit of a hospital in Neiva (Colombia).

METHOD

Qualitative-phenomenological study, guided by the theoretical guidelines of Diekelmann, Allen and Tanner. The data was collected during the second semester of 2017 and the first semester of 2018, through in-depth interviews with eleven participants, which were subsequently analysed until reaching theoretical saturation.

RESULTS

273 significant fragments, eight common meanings and four emerging themes: establishing links that satisfy, an invisible woman, approaching a transpersonal relationship of care, and the pursuit of understanding emerged from this study.

CONCLUSION

Admission to the obstetric intensive care unit due to severe pre-eclampsia represents a change of role for women who, in addition to undergoing physical changes, also manifest a variety of emotions related to the circumstances of care and the actions of nurses.

Intervención comunitaria para el cuidado de la salud en la comuna 7 de Santa Marta, Colombia

Los problemas sociales son considerados, una condición que afecta a un número significativamente de personas, los cuales deben ser corregidos mediante acciones colectivas, teniendo en cuenta que el barrio seleccionado para este proyecto que alberga una gran población desplazada por la violencia lo que hace que haya un incremento en el analfabetismo, pobreza, drogadicción, desnutrición, hacinamiento, violencia intrafamiliar, problemas de salud en general, situación que impide el desarrollo o el progreso de una comunidad o de uno de sus sectores. La Universidad Cooperativa de Colombia a través del Programa de Enfermería, realizó el diagnóstico de salud con énfasis en salud familiar a partir de la aplicación del censo poblacional, lo que nos sirvió como insumo para los indicadores de salud y posterior intervención en la comunidad y de esta manera, asegurando la existencia y continuidad del proyecto e inserción de la comunidad. El proyecto involucro además de la Universidad otras organizaciones cívicas, educativas y sociales del sector. Por tal razón se concibe como una experiencia participativa de la comunidad, en el cual se impartirán conocimientos éticos y morales para contribuir así con el desarrollo integral del ser mismo y por ende de la comunidad de Santa Marta.

Impact of Nurse-Patient Relationship on Quality of Care and Patient Autonomy in Decision-Making

BACKGROUND

The patient is observed to acquire a passive role and the nurse an expert role with a maternalistic attitude. This relationship among others determines the capacity for autonomy in the decision making of patients.

OBJECTIVES

The aim of this study is to analyse the nurse-patient relationship and explore their implications for clinical practice, the impact on quality of care, and the decision-making capacity of patients.

DESIGN

A phenomenological qualitative study was conducted.

SETTINGS AND PARTICIPANTS

Thirteen in-depth interviews with nurses and 61,484 nursing records from internal medicine and specialties departments in a general hospital from 2015-2016.

METHODS

A discourse analysis and triangulation for these sources were conducted.

RESULTS

The category elaborated from nursing records was defined according to the following codes: Good Patient, Bad patient, and Social Problem. Analysis of the interviews resulted in a category defined as Patient as a passive object.

DISCUSSION

A good nurse-patient relationship reduces the days of hospital stay and improves the quality and satisfaction of both. However, in contrast, the good relationship is conditioned by the patient's submissive role.

CONCLUSION

An equal distribution of power allows decisions about health and disease processes to be acquired by patients, autonomously, with the advice of professionals. The nurse-patient relationship should not pursue the change in values and customs of the patient, but position the professional as a witness of the experience of the health and illness process in the patient and family.

Reflexionar sobre el sufrimiento mental, acerca al cuidado genuino: situación de cuidado

Objetivo: visibilizar el cuidado de enfermería de calidad y dignificante, a pesar de los problemas en la atención en salud, desde la transversalidad de la salud mental con base en la teoría psicodinámica de Hildegard Peplau.Síntesis del contenido: las narrativas de enfermería contribuyen al desarrollo de la disciplina y buscan la identificación y el crecimiento de las enfermeras en su relación con los sujetos de cuidado. Publicar narrativas aporta a la investigación desde un estudio diferente que resalta la experiencia de la persona que sufre un proceso de enfermedad y demuestra cómo el profesional de enfermería es clave para la recuperación de la salud física y mental, teniendo en cuenta el proceso de atención de enfermería. Es menester la formación del profesional de la salud y de enfermería en el cuidado del paciente con sufrimiento psíquico para derribar los perjuicios y tratos diferenciales que puedan afectar los cuidados. Así mismo, el Estado debe garantizar el acceso de la población a servicios de salud mental, para que exista atención oportuna. La teoría psicodinámica de Peplau describe el papel de la enfermera a través de las relaciones interpersonales, que se convierten en un proceso terapéutico para la persona con una enfermedad.Conclusión: las personas con sufrimiento psíquico que acuden por atención de salud se enfrentan a la discriminación, a la escasa valoración de sus síntomas, lo que impide una adecuada relación enfermera-paciente y se traduce en tratos diferenciales y formas de maltrato que afectan la dignidad del sujeto de cuidado.

Design and Validation of a Questionnaire on Communicating Bad News in Nursing: A Pilot Study

Communicating bad news (CBN) is a fundamental skill in nursing; nevertheless, few instruments exist for its evaluation. This study presents a questionnaire designed to measure nurses’ knowledge and ability of CBN, as well as the analysis of its psychometric properties. Based on a literature search, the initial dimensions of CBN were identified to construct the questionnaires’ items, which were evaluated by experts for the validity of the items’ contents. Construct validity and reliability of the resulting questionnaire was carried out in a sample of 71 nurses of an Andalusian university hospital. A questionnaire with 25 items was constructed with a high internal consistency (Cronbach’s alpha 0.816). The content validity was evaluated via a literature review and additionally by the assessment of seven experts. The Kaiser-Meyer-Olkin test (KMO) obtained a score of 0.683, and the Bartlett test of sphericity a value of p < 0.001. The principal component analysis supported a construct of four dimensions. This questionnaire was found to be a valid and reliable instrument with a high internal consistency for the evaluation of CBN knowledge and skills of nursing professionals.

Empathic decline and training in nursing students

ABSTRACT Objective The objective of this article is to examine whether the levels of empathy fit the concept of empathic decline. Method This was a non-experimental and cross-sectional study. Two populations of nursing students in two nursing programs were studied: Universidad San Sebastián (Santiago, Chile) and Universidad Mayor (Temuco, Chile). The original data on empathy, assessed by the Jefferson Scale of Empathy, were combined into a single data base. They were then analyzed by means of normality tests and homoscedasticity, Cronbach’s alpha, analysis of variance; the standard deviation of the dependent outcome measure (Sy.x) and the coefficient of determination (R2) were estimated. Results The sample sizes from the two programs were 479 and 277, respectively. It was found that the distributions of the averages over the course of study for empathy (and its components) were constant, and in some cases increased. Conclusion It was found that the distribution of the means of empathy in the nursing students analyzed did not conform to the classical empathic decline observed in other studies. Therefore, it is inferred that the traditional factors identified as causes of empathic erosion were not operating in the same way in the studied context.

EMPATHY IN NURSING STUDENTS FROM THE METROPOLITANA UNIVERSITY OF BARRANQUILLA (COLOMBIA)

ABSTRACT Objective: to evaluate the Empathic Orientation in Nursing students of the Universidad Metropolitana of Barranquilla (Colombia). Method: a descriptive, exploratory and transversal study in which the Jefferson Medical Empathy Scale in an anonymous and confidential manner was applied to 489 students from the first to fourth undergraduate year of the Nursing Program of the Universidad Metropolitana (Barranquilla, Colombia); the corresponding ethical and methodological rigor was kept. Results: the ANOVA results were not significant in the Academic Year factor and in the interaction (p=0.261), but significant by Gender. It was observed that behavior was different in both genders. The masculine gender tends to descend between the first and third undergraduate year and female gender also descends between first and second undergraduate year to later reach the average levels of empathy of the male gender. Conclusion: the results obtained show that the means of the variable studied do not show a great difference between the different undergraduate courses, nevertheless, a slight increase in the fourth undergraduate year is observed. There were significant differences between genders, the scores observed in men students were higher than those obtained from women students.

Percepción del paciente crítico sobre los comportamientos de cuidado humanizado de enfermería

Objetivo: describir la percepción del paciente crítico adulto sobre los comportamientos de cuidado humanizado de enfermería en la unidad de cuidado intensivo (UCI) adulto en un hospital de III nivel de Bogotá, Colombia.Metodología: estudio descriptivo con abordaje cuantitativo, se utilizó el instrumento “Percepción de comportamientos de cuidado humanizado de enfermería 3ª versión”, el cual cuenta con validez facial, de contenido y de constructo. Se aplicó a 55 pacientes hospitalizados en UCI, entre junio y octubre de 2016.Resultados: la percepción global del grupo obtenida fue de 83,39 en la escala estandarizada. En la categoría Priorizar el sujeto de cuidado, siempre obtuvo una calificación del 60 %, casi siempre 14 %, algunas veces 22 % y nunca 4 %. En la categoría Apertura a la comunicación para proporcionar educación en salud a la persona se tuvieron resultados favorables: 42 % para siempre, casi siempre 24 %, algunas veces 25 % y 9 % nunca. Por último, en la categoría Cualidades del hacer de enfermería se encontró que 27 % siempre percibe estos comportamientos, casi siempre 35 %, algunas veces 24 % y 14 % nunca.Conclusión: de acuerdo con los hallazgos, los comportamientos de cuidado humanizado se perciben globalmente como buenos, y en la categoría Priorizar el sujeto de cuidado se obtuvo el mayor puntaje de satisfacción por parte del paciente.

[Parent-child-interaction in infancy (author's transl)]

On the basis of many experimental studies it is demonstrated that not only mother-child-relationship in infancy but also father-child-relationship is important for child development. Different patterns of mother-child-interaction as well as father-child-interaction during the first weeks after birth are reported and intervening variables are discussed. Kind and degree of interactions of both parents with the newborn and infant influence the emotional, social, and cognitive development of the child. On the other hand the birth of child and the behavior of the newborn determine personal development of father and mother, too. The growth of the family is to be regarded as a process which is based on the differentiated net work of conditions. The concentration of research on mother-child-contacts has to be rejected in the light of these new findings and has to be regarded as hostile against the family as a whole.