Colombia Médica

SCHOOL OF NURSING: 65 YEARS IN THE FORMATION OF HEALTH- AND LIFE-CARE PROFESSIONALS

**Prevalence of Staphylococcus aureus in saliva of healthcare workers**

Introdução: O estado de portador de Staphylococcus aureus resistente à meticilina é apontado como preditor de infecção e fator para a disseminação ambiental e de pessoa a pessoa, incluindo trabalhadores de serviço de saúde. Estes quando colonizados são freqüentemente associados a surtos. Objetivo: Analisar a prevalência de Staphylococcus aureus na saliva de trabalhadores de hospital universitário. Metodologia: Estudo epidemiológico longitudinal realizado em Curitiba, Paraná, Brasil, com 486 trabalhadores no período de abril de 2006 a junho de 2008 compreendeu a coleta de três amostras de saliva e aplicação de instrumento de coleta de dados. Staphylococcus aureus foram isolados dos espécimes clínicos e caracterizados fenotipicamente. Os dados foram organizados e processados no Programa EPI-Info e analisados por meio de estatística descritiva. Resultados:Entre os trabalhadores investigados, 60,9% estavam colonizados por Staphylococcus aureus na saliva, sendo 67.9% carreadores transitórios e 32.1% carreadores persistentes; a prevalência de Staphylococcus aureus resistente à meticilina (MRSA) entre os isolados foi de 15.7%. A prevalência média de MRSA foi de 12.7% sendo maior entre técnicos em enfermagem (21.4%) e auxiliares de limpeza (20.6%) e menor entre enfermeiros (4.5%) e médicos (5.9%). Conclusões: Os trabalhadores apresentaram alta prevalência de Staphylococcus aureus na saliva, indicando a boca como importante sítio corporal para a investigação da colonização por MRSA e potencial fonte para sua disseminação.

Background: The carrier state of methicillin-resistant Staphylococcus aureus is pointed as an infection predictor and a factor for environmental and person-to-person dissemination, including health service workers. These, when colonized are commonly associated to outbreaks. Objective: Analyze the prevalence of Staphylococcus aureus in saliva of workers at a university hospital. Methodology: Epidemiologic longitudinal study carried out in Curitiba, Paraná, Brazil, with 486 workers between April 2006 and June 2008. Three saliva samples were collected and a data collection instrument was applied. Staphylococcus aureus were isolated from the clinical specimen and characterized by phenotypes. The data from the instrument and the laboratory results were organized and processed with EPI-Info software and analyzed via descriptive statistics. Results: Among the healthcare workers studied, 60.9% were colonized by Staphylococcus aureus in saliva; of those, 67.9% were transitory carriers and 32.1% were persistent carriers; the prevalence of meticillin-resistant Staphylococcus aureus (MRSA) among the isolated cases was 15.7%. The average prevalence of MRSA was 12.7% and higher among nurses’ aides (21.4%) and cleaning aides (20.6%) and lower among nurses (4.5%) and doctors (5.9%). Conclusions: Healthcare workers presented high prevalence of Staphylococcus aureus in saliva, indicating the mouth as an important body site to investigate colonization by MRSA and a potential source to its dissemination.

The health status and life satisfaction of caregivers of elderly with Alzheimer’s

Introdução: A condição de saúde do cuidador familiar está associada à satisfação com a vida e consequentemente com o modo de prestar o cuidado ao idoso com Alzheimer. Objetivo: Avaliar a condição de saúde e satisfação com a vida dos cuidadores familiares de idosos com Alzheimer, usuários de um Centro de Referência em Atendimento em Doença de Alzheimer (DA). conveniência foi composta de 208 cuidadores familiares e selecionada no período de dezembro de 2009 a fevereiro de 2010, por meio de critérios de inclusão e exclusão. O estudo foi realizado no próprio Centro de Referência. Os dados foram coletados por entrevistas semi-estruturadas e aplicação das escalas: Inventário de Sobrecarga de Zarit, Bem-Estar Subjetivo e Estadiamento Funcional. Para a análise estatística, aplicaram-se os testes Qui-quadrado, Mann-Whitney e Kruskal-Wallis, utilizando-se o programa Epi Info 6.04. Os resultados foram considerados estatisticamente significativos quando o nível descritivo foi menor que 5% (p<0,05). Resultados: Para o nível de sobrecarga dos cuidadores prevaleceu o grau moderado (46.2%), com média de 33.29 (4-85, +15.33). A média do escore (percentual) relacionada à satisfação com a vida foi de 63% (1.7%-100%). As variáveis estatisticamente associáveis ao nível de sobrecarga foram: sexo (p=0.040), idade (p=0.016), doença (p=0.003) e satisfação com a vida (p<0.001). Os cuidadores doentes estão significativamente associados a menores médias percentuais de EBES (p=0.032). Conclusões: A sobrecarga do cuidador familiar é uma situação que precisa ser encarada pela enfermagem com medidas de suporte e amparo (medidas protetoras). O cuidado gerontológico constitui um âmbito privilegiado de políticas de proteção, que devem ser planejadas, contemplando o cuidador na sua vulnerabilidade e desamparo.

Introduction: The health status of caregivers is associated with satisfaction with life and so in the way of delivering care to the elderly with Alzheimer’s. Objective: To evaluate the health status and life satisfaction of family caregivers of elderly with Alzheimer’s, users of a Reference Center for Care in Alzheimer’s disease in Curitiba, Paraná, Brazil. Materials and methods: This is a cross-sectional quantitative study. The convenience sample consisted of 208 family caregivers and selected during the period December 2009 to February 2010, through the inclusion and exclusion criteria. The study was conducted in the Reference Center. Data were collected through semi-structured interviews and application of the scales: Zarit caregiver burden interview, Subjective Well-Being and Functional Staging. For statistical analysis, we applied the Chi-square, Mann-Whitney and Kruskal-Wallis test, using Epi-Info 6.04. Results were considered statistically significant if their level was less than 5% (p<0.05). Results: For the level of caregiver burden prevailed moderate (46.2%), with a mean of 33.29 (4-85, ±15.33). The mean score (percentage) related to life satisfaction was 63% (1.7%- 100%). Variables statistically associable to overload level were gender (p=0.040), age p=0.016), disease (p=0.003) and life satisfaction (p<0.001). Caregivers patients are significantly associated with lower mean percentage of EBE (p=0.032). Conclusions: The burden of family caregivers is a situation that needs to be faced by nurses with support and protection measures (protective measures). The geriatric care is a privileged field of protection policies, which must be planned, considering the caregiver in their vulnerability and helplessness.

Factors associated with breastfeeding in children less than one year of age in the city of Cartagena, Colombia

Introduction:The practice of breastfeeding represents multiple benefits to children; however, several studies show that there has been a gradual loss of breastfeeding habits in industrialized and developing countries, mainly because the great diversity of types of milk. Additionalliy, there was the presence of biological and socio-cultural factors, which influence and modify this practice and generate a negative impact on the health of the infant population. In Colombia, in 2005, it was reported that the median duration of exclusive breastfeeding was 2.2 months and the median duration was 14.9 months total; likewise, the department of Bolivar reported a median slightly over a month. Objective: To determine the relationship between social and biological factors in the prevalence of exclusive breastfeeding in children under one year of age in Cartagena, Colombia. Materials and methods: Cross-sectional study, the population consisted of the mothers of 23,109 children less than one year of age, the sample was 562 mothers. The probability sampling was stratified by clusters of three locations in the city where every neighborhood was a cluster. After selecting the neighborhood, a simple random sampling was conducted by city blocks. Mothers of children under one year of age were sought in their homes in the city blocks selected. The information was collected through the survey «Breastfeeding and complementary feeding» used by PROFAMILIA, demographic characteristics were demographic characteristics were also investigated. Results: The median for breastfeeding was 2 months, social factors associated were: not using a feeding bottle (CI: 2.37-5.38), nuclear family membership (CI: 1.29-2.72), not being a mother head of household (CI: 0.27-0.62), and the biological factor showing association was temporary suspension of breastfeeding (CI: 0.23-0.70). Conclusion: The duration of the exclusive breastfeeding practice among women turned out to be very short and the practice until the sixth month of life for their children was low. It was found that children born through caesarean section had a higher prevalence of maternal of maternal breastfeeding than those born vaginally.

Introducción: La práctica de la lactancia materna representa múltiples beneficios en los niños; sin embargo, diversos estudios muestran que ha existido una pérdida paulatina del hábito de la lactancia en los países industrializados y en vía de desarrollo, debido sobre todo a la gran diversidad de tipos de leche, además de la presencia de factores biológicos y socioculturales que influyen y modifican esta práctica y generan un impacto negativo en la salud de la población infantil. En Colombia, en el año 2005, se informó que la mediana de duración de la lactancia materna exclusiva fue de 2.2 meses y la duración mediana total 14.9 meses; igualmente, el departamento de Bolívar informó un poco más de medio mes. Objetivo: Determinar la relación de los factores sociales y biológicos en la prevalencia de la lactancia materna exclusiva en niños menores de un año en Cartagena. Material y método: Estudio transversal con población constituida por las madres de 23,109 niños menores de un año, la muestra fue 562 madres. El muestreo fue probabilístico estratificado por conglomerados de las tres localidades de la ciudad, donde cada barrio representaba un conglomerado. Una vez seleccionado el barrio se realizó un muestro aleatorio simple por manzanas. En las manzanas que resultaron seleccionadas se buscaron en sus domicilios las madres de los niños menores de un año. La información se recolectó a través de la encuesta «Lactancia y alimentación complementaria» utilizada por PROFAMILIA; también se indagó acerca de las características sociodemográficas. Resultados: La mediana de la lactancia fue 2 meses, los factores sociales que se asociaron fueron no usar biberón (IC: 2.37-5.38), pertenecer a familia nuclear (IC: 1.29-2.72), no ser madre jefe de hogar (IC: 0.27-0.62), y el factor biológico que mostró asociación fue suspensión temporal de la lactancia materna (IC: 0.23-0.70). Conclusión: La duración de la práctica de lactancia materna exclusiva en las mujeres resultó muy corta y la práctica hasta el sexto mes de vida de sus hijos fue baja. Se encontró que los niños nacidos por cesárea tuvieron mayor prevalencia de lactancia materna que los nacidos por vía vaginal.

Effect of the Program «Caring for caretakers»: Findings of a multicenter study

Objective: To assess the effectiveness of the program Caring for the Caregivers on the caring ability of family caregivers of people with chronic illnesses attended by programs coordinated by the Latin American nodes for the care of caregivers with chronically ill family members. Methods: The study had a Quasi-experimental method with an experimental group (family caregivers that took the Program Caring for the caregivers and a control group. Data was collected with the Ngozi Nkongho’s Caring Ability Inventory (CAI). The sample was taken by convenience in (8) nodes, with an average of 60-100 family caregivers for a total group of 643 individuals (417 in the experimental group and 226 in the control group). Statistical tests were used to evaluate proposals of normality and the Mann-Whitney U test to evaluate data. Results: Findings report similar study groups with small differences in ages and socioeconomic levels. Family caregivers that took part in the Program significantly improved their caring ability with improvement in each of the dimensions of the caring ability. Discussion: The effectiveness of the Program Caring for the caregivers in the caring ability of family caregivers is a significant finding that match with previous reports and it confirm the importance of having specific proposals for the care of caregivers in the Latin American context. Findings shows a strengthening of the general caring ability of family caregivers, as well as an straightening of each one of their dimensions that is favorable to the Program effect. These findings slightly differ from previous findings because in previous studies the caring ability never showed increase in all its components.

Objetivo: evaluar la efectividad del programa «Cuidando a los cuidadores» sobre la habilidad de cuidado de cuidadores familiares de personas con enfermedad crónica atendidos por nodos vinculados a la Red Latinoamericana de Cuidado al Paciente Crónico. Métodos: Casi experimental con grupo muestra (cuidadores que asistieron al Programa Cuidando a los cuidadores) y grupo control. Los datos se recolectaron con el Inventario de Habilidad de Cuidado (CAI) de Ngozi O. Nkongho. La muestra fue tomada en ocho (8) nodos, a conveniencia, con un promedio de entre 60 y 100 cuidadores, para un total de 643 personas (417 grupo experimental y 226 grupo control). Se utilizaron pruebas estadísticaspara evaluar supuestos de normalidad y las pruebas U de Mann-Whitney para analizar los datos. Resultados: Hay grupos de estudio similares con algunas diferencias en las edades y el nivel socioeconómico. Los cuidadores familiares que participaron en el programa mejoraron su habilidad de cuidado en forma significativa, con incremento en todas las dimensiones que componen dicha habilidad. Discusión: La efectividad del programa «Cuidando a los cuidadores» sobre la habilidad de cuidado de los cuidadores familiares, es un hallazgo significativo que concuerda con hallazgos anteriores y ratifica la importancia de contar con propuestas propias para el cuidado de los cuidadores familiares, es decir adaptadas al contexto latinoamericano. Los hallazgos muestran un fortalecimiento de la habilidad de cuidado de los cuidadores en general y en cada uno de sus componentes favorable al programa. Esto difiere ligeramente de hallazgos anteriores donde la habilidad había mostrado incremento pero no se reflejaba en todos sus componentes.

Suicidal ideation in adolescence: an explanation from three of its associated variables in Bogotá, 2009

Objetivo: Determinar la relación entre desesperanza, soledad y grado de salud familiar en adolescentes escolarizados, con y sin ideación suicida, para profundizar en el conocimiento del fenómeno desde la disciplina de enfermería y plantear opciones de promoción y prevención en Bogotá, Colombia. Métodos: Se utilizó el estudio cuantitativo descriptivo correlacional comparativo de corte transversal. La muestra se seleccionó en el período comprendido entre febrero y abril de 2009, a través de un muestreo mixto y estuvo constituida por 482 adolescentes escolarizados entre 14 y 17 años. A través del empleo de análisis estadísticos de tipo univariado, bivariado y multivariado se describió el comportamiento de cada una de las variables, se exploraron las relaciones y contrastes entre éstas y se estimó el efecto de las variables independientes en la presencia de ideación suicida. Se siguieron todas las consideraciones éticas para el desarrollo de investigaciones con seres humanos. Resultados: Entre los adolescentes investigados 20% de la muestra informó presencia de pensamientos o deseos suicidas de variada intensidad. Todas las variables estudiadas influyen la presencia de ideación suicida en los adolescentes a excepción de edad, estrato socioeconómico, localidad y tipo de colegio. Sin embargo a partir de la construcción de modelos de regresión logística se observó que las variables que mejor explican la presencia de ideación suicida son: antecedente de intento de suicidio, baja autoestima, depresión y pertenecer a una familia poco saludable. Conclusiones: Los datos sobre ideación e intento suicida obtenidos en este estudio apoyan la idea de implementar mayores esfuerzos preventivos al interior de las familias y las escuelas. Identificar los adolescentes en riesgo de suicidio o de alteraciones de la salud mental y construir programas efectivos de prevención y programas de tratamiento es una prioridad.

Objective: To determine the relationship between hopelessness, loneliness and the level of family health in school-age adolescents with and without suicidal ideation to deepen in the knowledge of this phenomenon from a nursing point of view and to pose promotion and prevention options in Bogotá, Colombia. Method: This was a cross-sectional, comparative, correlational, descriptive and quantitative study. The sample was selected in the period between February and April 2009, through mixed sampling and 482 school-attending 14-17 year-old adolescents were included. Widely recognized and highly qualified psychometric tools were used to measure the variables concerned. Univariate, bivariate and multivariate statistic analysis were used to describe the behavior of each variable, to explore the relationships and contrasts between these variables and to estimate the effect of the independent variables on the presence of suicidal thoughts. This study has followed the ethical considerations necessary for research involving human beings. Results: 20% of the sample used reported the presence of suicidal thoughts or desires. All variables studied influence the presence of suicidal thoughts except age, socioeconomic strata, borough and type of school. However, with the use of logistic regression methods, the variables that best express the presence of suicidal thoughts are: previous suicide attempt, low self-esteem, depression and belonging to an unhealthy family. Conclusions: Data on suicidal ideation and attempts made in this study support the idea of implementing greater preventive efforts within families and schools. Identifying adolescents at risk of suicide or mental health disorders, and build effective prevention and treatment programs is a priority.

Causes of relapse and search for treatment reported by drug users in a rehabilitation unit

Objetivos: Identificar as causas de recaída e de busca por tratamento pelos dependentes químicos. Metodologia: Pesquisa qualitativa, exploratória, realizada em Unidade de Reabilitação de Adictos de um hospital psiquiátrico do Paraná, Brasil. Os dados foram coletados nos meses de maio a junho de 2010, através de entrevista semiestruturada com 12 dependentes químicos. Posteriormente, foram analisados e organizados em categorias temáticas. Resultados: Da análise, emergiram cinco categorias: o meio influencia a recaída; o não reconhecimento da impotência perante o vício; dificuldade de lidar com frustrações; a inatividade desperta o desejo pelo uso de substâncias psicoativas; perdas, comorbidades e o reconhecimento da impotência motivam a busca de tratamento. Discussão: Evidenciou-se dentre as motivações atribuídas à recaída, influências externas relacionadas ao contexto social e internas, como a dificuldade de autopercepção. Os sujeitos atribuíram às perdas, diversos aspectos da vida e o reconhecimento do déficit de controle perante o vício, como fatores decisivos para a busca por tratamento. Conclusão: Conclui-se que a recuperação destes indivíduos é favorecida pela união dos fatores físicos, emocionais e sociais. Assim, é necessário que os profissionais de saúde busquem constantemente aprimorar seus conhecimentos acerca desta temática, a fim de estarem capacitados para prestar cuidado integral a essa clientela.

Objectives: To identify the causes of relapse and search for treatment by drug users. Methodology: This was a qualitative exploratory research carried out in an Addiction Rehabilitation Unit at a psychiatric hospital in Paraná State, Brazil. Data were collected from May to June 2010 through a semistructured interview with 12 drug addicts. They were further analyzed and organized into thematic categories. Results: Five categories emerged from the analysis: Environment influences relapse; Non-recognition of the powerlessness facing addiction; Difficulty in coping with frustrations; Inaction fosters cravings for psychoactive substances; Losses, co-morbidities, and recognition of powerlessness lead to the search for treatment. Discussion: Among the motivations for relapse, external influences related to the social context, as well as internal ones such as difficulties with self-perception were pointed out. The subjects attributed to losses, several aspects of their lives and the recognition of the control deficit over the addiction as the ultimate factors to search for treatment. Conclusion: It can be concluded that those subjects’ recovery is favored by the conjunction of physical, emotional, and social factors. Thus, it is deemed necessary that health professionals continuously refine their knowledge on this theme to be qualified to deliver thorough care to these clients.

Treatment of mental patients in the presence of the Brazilian Psychiatric Reform: family members’ perceptions

Objetivo: Apreender as percepções de familiares de pessoas com transtorno mental quanto ao tratamento em face da Reforma Psiquiátrica Brasileira. Metodologia: Pesquisa qualitativa, exploratória, desenvolvida em 2010 em um hospital psiquiátrico do Estado do Paraná/Brasil. Os sujeitos foram 10 familiares de portadores de transtorno mental em tratamento. Os dados foram coletados por meio de entrevista semiestruturada e analisados pela técnica de análise temático-categorial. Resultados: Da análise, emergiram três categorias: Tratamento do portador de transtorno mental face à Reforma Psiquiátrica; Serviços de saúde mental extra-hospitalares; Sobrecarga física e emocional do familiar. Discussão: As famílias percebem que existe uma nova forma de tratar o portador de transtorno mental baseado na sua reinserção social com a participação da equipe multiprofissional. Conclusão: Há necessidade de maior apoio às famílias de pessoas com transtorno mental, mediada pelas políticas públicas brasileiras.

Objective: To apprehend family members’ perceptions on treatment of mental patients in the presence of the Brazilian Psychiatric Reform. Methodology: Qualitative exploratory research carried out in 2010 at a psychiatric hospital in Paraná State/Brazil. Ten family members of mental patients were the subjects. Data were collected by means of a semistructured interview and analyzed through thematic analysis. Results: From the analysis, three categories emerged: Treatment of mental patients in the presence of the Brazilian Psychiatric Reform; Outpatient Mental Health Services; Family members’ physical and emotional distress. Discussion: The families perceived a new way of treating mental patients based on social reinsertion with the participation of a multiprofessional team. Conclusion: More support is deemed necessary on the part of mental patients’ families mediated by Brazilian public policies.

The nursing ethnographic research into complex societies

Introdução: As sociedades multiculturais do mundo pós-moderno caracterizam-se pela complexidade de sua estrutura, organização e funcionamento. Nessas sociedades, há um conjunto de atores sociais heterogêneos que experimentam uma variedade de fenômenos no seu cotidiano nas cidades. Nesse contexto desenvolvem-se os cuidados profissionais em Enfermagem e nos últimos anos os enfermeiros têm recorrido à etnografia como ferramenta para conhecer a realidade sócio-cultural e a experiência dos fenômenos na perspectiva de quem os vivencia. Trata-se de estudo teórico com o objetivo de refletir sobre a aplicação da abordagem etnográfica nas pesquisas brasileiras em Enfermagem nas sociedades complexas. Etnografia nas pesquisas brasileiras em enfermagem nas sociedades complexas: Os enfermeiros brasileiros têm se apropriado dos recursos metodológicos e das teorias antropológicas e da Enfermagem para desenvolver estudos sobre as vivências, experiências e significados atribuídos ao processo saúde-doença, influência cultural sobre os comportamentos relacionados à saúde e a avaliação e gerenciamento dos processos de trabalho. Ressalta-se ainda, estudos que buscam teorizar e refletir a respeito da construção metodológica nessas pesquisas. Esse movimento evidencia uma mudança de enfoque nas pesquisas e práticas da Enfermagem, para uma visão mais integrativa e complexa dos seres humanos e da realidade. O método etnográfico possibilita apreender elementos da cultura de uma realidade e, como resultado, obter novas perspectivas de conhecimento destes fenômenos. Reflexão final: Considera-se que os conhecimentos antropológicos ampliam a visão do enfermeiro sobre os sujeitos aos quais destina a sua prática, refinando-a. A aproximação na vivência e experiência dos sujeitos permite a percepção dos fenômenos na perspectiva dos atores envolvidos, oferecendo ao profissional um olhar diferenciado para as necessidades e resultados do cuidado de Enfermagem.

Introduction: Multicultural societies of the postmodern world are characterized by the complexity of their structure, organization, and operation. In such societies, there is a heterogeneous set of social players who experience a variety of phenomena in their daily lives in cities. Within this context, nursing care has developed and nurses in recent years have turned to ethnography as a tool in understanding socio-cultural reality and experience from the perspective of those living these experiences. This is a theoretical study seeking to reflect upon the application of an ethnographic approach in Brazilian nursing research in complex societies. Ethnography in Brazilian nursing research in complex societies: Brazilian nurses have appropriated the methodological tools and theories of nursing and anthropological studies to investigate the experiences and meanings attributed to health-disease process, cultural influence on health-related behaviors, as well as to evaluate and manage work processes. Further studies are emphasized to attempt to theorize and reflect upon the methodological construction of this research. This move highlights a shift in focus on nursing research and practice for a more integrative and complex view of human beings and reality. Ethnography helps us learn about a given reality and, as a result, we obtain new insights for understanding the phenomena. Reflection: It is considered that anthropological knowledge extends the nurses’ views on the subject about which they devote their practice, refining it. Being closer to the lives and experience of subjects, permits the perception of phenomena from the perspective of the players involved, offering professionals a different view on the needs and outcomes of nursing care.

Disciplinary development: the reason for being, sensing, thinking, and doing in nursing

Introducción: Durante seis décadas y media, la Escuela de Enfermería de la Universidad del Valle ha movilizado múltiples búsquedas en la perspectiva de construir y proyectar un ejercicio de la profesión comprometido socialmente. El presente artículo pretende exponer los procesos, reflexiones y acciones conectados con el desarrollo disciplinar como preocupación central de la Escuela así como también, enunciar las responsabilidades hacia el futuro que presenta complejos e ineludibles desafíos. El desafío del desarrollo disciplinar en la Escuela de Enfermería: Se propuso encaminar el desarrollo conceptual en enfermería a través de la producción y validación de conocimientos propios de la disciplina y de la práctica profesional sustentada en el cuidado humano, a través del desarrollo de tres áreas: la formación de docentes, estudiantes, y profesionales de asistencia; el desarrollo de investigación en alianza con los servicios asistenciales para facilitar la innovación en el cuidado de enfermería y la implementación de modelos de servicio de enfermería fundamentados en el cuidado humano. Cómo se visualiza el futuro: La gestión de este proyecto, ha llevado a comprender que el proceso de reflexión disciplinar va más allá de un proyecto y entraña una apuesta más ambiciosa que un plan de escuela; esto es, tendrá que convertirse en un plan de Gobierno sin olvidar que lo importante es el cuestionamiento de la disciplina y que esto implica un impacto real en el cuidado que se ofrece en los servicios de salud por parte de enfermería.

Introduction: For six and a half decades, the School of Nursing at Universidad del Valle has been involved in multiple searches on the perspective of constructing and projecting a socially committed exercise in the profession. This article seeks to expose the processes, reflections, and actions having to do with the discipline’s development as a central concern of the School, as well as to also declare the future responsibilities presented by complex and inescapable challenges. The challenge of the disciplinary development in the School of Nursing: We sought to guide the conceptual development in Nursing through the production and validation of knowledge appertaining to the discipline and of the professional practice substantiated on Human Care, via the development of three areas: formation of professors, students, and healthcare professionals; development of research in alliance with healthcare services to facilitate innovation in Nursing Care, and the implementation of Nursing Service Models based on Human Care. How is the future perceived: Management of this project has led to understanding that the process of disciplinary reflection goes beyond a project and involves a more ambitious wager than a School Plan; i.e., it will have to become a Government Plan without overlooking that what is important is to challenge the discipline and that this implies a real impact on the care offered in health services by Nursing professionals.

Student counseling with nursing students from Universidad del Valle: Search, meeting, permanent challenge

Introducción: El tema de la consejería estudiantil, como todos los temas implicados en la perspectiva de una formación universitaria integral, contiene tensiones quizás irresolubles pero siempre reveladoras de una búsqueda que no dejará de tener sentido y de interpelar a todas las instancias y a todos los actores de la comunidad educativa: ¿Qué ser humano se está formando en la universidad y que sociedad se construirá con él? Consejería estudiantil, formación integral y cuidado humano: El ejercicio de la consejería estudiantil entraña oportunidades de crecimiento personal, profesional y de proyección social para estudiantes y docentes. Para la institución y sus programas académicos se constituye en un campo de concreción de principios del «deber ser» del proyecto misional en ambos niveles. Para cuidar al «otro» es indispensable saber quién es ese otro. La Consejería Estudiantil en la Escuela de Enfermería de la Universidad del Valle se ha movilizado alrededor de esta premisa en tanto su ejercicio no sólo reclama sino que posibilita el conocimiento de los estudiantes, sus contextos de origen, sus expectativas, sus preocupaciones y dificultades, sus potencialidades humanas y profesionales. El presente artículo recoge hechos y voces, procesos y aprendizajes, límites y alcances de esta experiencia, con el ánimo de recuperar una memoria que reclama un lugar, y de aportar a la discusión, por fortuna siempre vigente, acerca del estudiante como centro y sentido principal de todo proceso formativo.

Introduction:The issue of student counseling, as all the issues involved in a comprehensive higher education perspective, includes irresolvable tensions which are always enlightening in discovering the answer to the question: what kind of human beings are formed in the university and what kind of society is going to be built with them? The search for the answer to this question has meaning and matters to all instances and participants in the educational community. Student counseling, comprehensive education, and human care: The practice of Student Counseling includes opportunities for personal and professional growth, along with social projection of students and faculty. For the institution and its academic programs, it constitutes a field for the concrete appplication of the principles and goals of what «ought to be» according to the institutional mission at both levels. In caring for the «other», it is essential to know who that other is. Student Counseling in the School of Nursing at Universidad del Valle has been based on this premise. Its practice has demanded and enhanced knowing the students, their original contexts, expectations, concerns, and difficulties plus their human and professional potentials. The reflections presented here include facts and voices, learnings and processes, limits and scopes of this experience, seeking to recall a memory that demands a place and to contribute to the discussion, fortunately ever-present, about the student as the center and sense of every educational process.

Social responsibility of nursing in policies of health humanization

Antecedentes: As novas concepções de mundo têm dado ênfase à reestruturação das políticas de saúde e ao delineamento de um novo modelo assistêncial à saúde. Objetivo: Refletir sobre a política de humanização como parte da Promoção da Saúde com destaque no cuidado de enfermagem. Conteúdo: Evoca as mudanças paradigmáticas e refere o modelo biomédico e a nova condição de diversidade em modelos assistenciais nas práticas de promoção da saúde e a co-responsabilidade da enfermagem em gerar e sustentar a humanização nos cuidados de enfermagem. Repensa estratégias e compromissos de co-responsabilidade do profissional de enfermagem na promoção da saúde da população. A participação de enfermeiros na dinamização das políticas de humanização do cuidado tem mostrado desdobramentos nas manifestações de acolhimento e vínculos entre profissionais e usuários de Serviços de Saúde. Destaca-se a entrevista-conversação como estratégia de coleta de informações do usuário seja para o cuidado ou para pesquisa que está baseada em referencias de humanização. Conclusões: A escuta sensível, as modalidades de diálogos, o método da entrevista-conversação, são tecnologias das relações e significa a aquisição de competências à política da humanização para o desenvolvimento do cuidado na promoção da saúde.

Background: new conceptions of the world have focused on restructuring health policies and designing a new healthcare model. Objective: to reflect on the humanization policy as part of health promotion with emphasis on nursing care. Content: The article mentions paradigm changes and refers to the biomedical model and the new condition of diversity in models of care practices for health promotion and co-responsibility of nursing in generating and sustaining the humanization of nursing care. It rethinks strategies and commitment to co-responsibility by nursing staff in promoting population health. Participation of nurses in promoting humanization care has shown signs of development in its acceptance, bonding healthcare service professionals and its users. An interview-conversation as a strategy for collecting information is highlighted, whether to care or to research based on a humanization framework. Conclusions: Sensitive listening, modality of dialogue, and the conversational interview method are relationship techniques and means to acquire skills for policy development in humanizing care in health promotion.

Student involvement and leadership: A commitment to active citizenship

El liderazgo asumido como postura ética con corresponsabilidad hacia la acción plantea un reto complejo en su alcance, por múltiples aspectos inherentes a los seres humanos y sus procesos evolutivos. Es necesario emprender caminos y aventurarse a tejer formas y experiencias quelleven a este. La Escuela de Enfermería de la Universidad del Valle, interpretando la misión universitaria y basada en su Plan Estratégico 2005-2015; toma como propia la responsabilidad de promover espacios e iniciativas que fomenten el liderazgo en los estudiantes a través del desarrollo de dos estrategias: Formación y Promoción del Liderazgo, a partir del acompañamiento en iniciativas y representaciones de los estudiantes del Programa de Enfermería. Este artículo recoge diferentes voces de estudiantes que han sido participes de iniciativas generadas a partir del Proyecto de Liderazgo y del desarrollo de sus estrategias, con el propósito de rescatar y revelar la riqueza de sus posibilidades, lo mismo que las dificultades que entraña una propuesta movilizadora democrática y humanista que comprende diversas formas de asumir la vida individual y proyectarse en el horizonte de lo colectivo. Reflexion final: La experiencia en la Escuela de Enfermería de la Universidad del Valle, sobre liderazgo y participación estudiantil, aporta la necesidad de fomentar un liderazgo cimentado en lo colectivo, pero centrado en potencialidades individuales, crecimiento personal y profesional de estudiantes y docentes, para lo cual se requiere, conjugar esfuerzos desde lo humano, económico, académico y administrativo.

Assuming leadership from an ethical stance with responsibility for action proposes a complex challenge to achieve, because of the many aspects inherent to human beings and their evolutionary processes. It is necessary to undertake ways and ventures to weave forms and experiences that lead to it. The School of Nursing at Universidad del Valle, interpreting the university mission and based on its 2005-2015 Strategic Plan, assumes the responsibility of promoting opportunities and initiatives that foster leadership in students through the development of two strategies: promotion of Leadership and Training, through accompanying initiatives and representations of the Nursing Program students. This article describes different voices of students who have been participating in initiatives generated from the Leadership Project and the development of their strategies to recover and reveal the richness of its possibilities, as well as the difficulties of mobilizing a proposal involving democratic and humanist views on various forms of individual life and projected onto the horizon of the collective. Final reflection: The experience at the School of Nursing at Universidad del Valle about leadership and student participation provides the necessity to promote leadership based on the collective, but focusing on individual potential, as well as the personal and professional growth of students and teachers, which requires the conjunction of human, economic, academic and administrative efforts.

Understanding workload in occupational health research on nursing

Introdução: O conceito de cargas de trabalho vem sendo usado pela enfermagem com vários significados, entre eles o de dependência do paciente e intensidade do trabalho. Propomos acrescentar a compreensão de cargas de trabalho como processos biopsíquicos com reflexos no corpo do trabalhador. Desenvolvimento: Trazemos uma discussão teórica sobre esse conceito, tendo como base a contribuição latino-americana para este campo conceitual. Reflexão final: Essa discussão possibilita novos caminhos teóricos para operacionalizar esse conceito na pesquisa e na prática profissional com enfoque na saúde do trabalhador. Igualmente, essa concepção na pesquisa em enfermagem contribui para aprofundar o estudo do processo de trabalho e sua relação com a saúde, de modo a analisar a contribuição dos seus componentes na saúde dos trabalhadores de enfermagem.

Introduction: The concept of workload has been used by nursing with multiple meanings. Among them, we have considered patient dependency and nursing intensity. We propose to add to this understanding that workloads are biopsychic processes with effects on the worker's body. Development: We discuss this theoretical concept based on the Latin American contribution and the importance of theory in the conceptual field. Final reflection: This discussion provides other theoretical ways to operate this concept in areas of research, focusing on the worker's health. Also, this concept in nursing research helps to further study the work process and its relationship with health to analyze the contribution of each component of this in the health nursing workers.

Nursing at Universidad del Valle in Cali: 65 years at the vanguard; contributions, achievements, and perspectives

Introducción: El propósito de este artículo es mostrar de qué manera la Escuela de Enfermería a través de sus 65 años de vida, que celebra al unísono con la Universidad del Valle, ha estado a la vanguardia contribuyendo con sus programas de pregrado y postgrado, sus proyectos de extensión e investigación al desarrollo de los servicios de salud y de enfermería y al mejoramiento permanente de la formación del recurso humano de enfermería en el suroccidente colombiano, en Colombia y en Latinoamérica. Objetivo: Describir la creación y desarrollo de los programas y proyectos de enfermería en respuesta a las necesidades del medio y su orientación hacia la innovación en la formación del profesional de enfermería. Metodología: Se revisaron documentos existentes en los archivos de la Dirección de la Escuela, las direcciones de los programas académicos de pregrado y postgrado, literatura publicada, documentos de archivos personales de docentes y entrevistas con docentes pensionadas y la memoria de las autoras. Resultados: Se demarcan cuatro épocas vividas durante los 65 años de historia señalando el desarrollo y los aportes de los programas académicos y de los proyectos de extensión; se presentan algunos retos para el futuro. Conclusión: Enfermería-UniValle ha estado durante sus 65 años de historia a la vanguardia; en adelante, su reto es responder a los desafíos del futuro.

Introduction: The purpose of this paper is to depict how the Nursing School throughout its 65-year history, celebrated at the same time as Universidad del Valle does, has been at the forefront in Colombia's southwest and Latin America, contributing to the continuous enhancement of nursing education with its undergraduate and graduate programs, as well as research and extension projects. Objective: To describe the creation and development of the nursing programs and projects in response to the contextual needs and their orientation toward innovating in nursing education. Materials and methods: Historical research, analysis of documents found in the office of the director of the Nursing School, the directors of undergraduate and graduate nursing programs, publications, personnel archives of faculty members, interviews of retired faculty, and the authors´ recollections. Results: Four periods are depicted along the 65-year history, showing the development, achievements, and contributions of the academic programs and main extension projects; some challenges for the future also are included. Conclusions: Nursing-UniValle has been in the front line during its 65 years of history; now it has to meet the challenges of the future.

ITC in the School of Nursing at the Valle University: A transformative experience

Introducción: Con el fin de difundir la experiencia de la Escuela de Enfermería en el uso de estrategias innovadoras que facilitan la formación de los estudiantes en la educación superior con difícil acceso a la educación presencial por cumplir diversos roles en la sociedad, se presenta el siguiente artículo donde sesistematizaesta estrategia, haciendo un recorrido a partir de la década de 1960 hasta el uso de las Tecnologías de la Información y las Comunicaciones (TIC) en la actualidad. Métodos: Se recopilaron documentos históricos de la Escuela de Enfermería, artículos de investigación, sistematización y evaluación de estudiantes y profesores relacionados con el tema. Resultados: Se describen lasmetodologías utilizadas de acuerdo con la tecnología del momento así como las ganancias y aspectos por mejorar tanto de profesores como de estudiantes con el uso efectivo de las TIC. Conclusiones: Uno de los factores principales para el éxito de la implementación de las TIC en la educación superior es la percepción favorablede los docentes frente a ellas, pues a pesar de que algunos docentes no consideran necesario introducir nuevas formas de enseñanza o de aprendizaje, muchos otros están dispuestos y comprometidos a innovar y a plantear nuevos retos pedagógicos con los recursos queproveen estas tecnologías. Los resultados de esta experiencia muestran que lainnovación tecnológica y pedagógica esfundamental para la ampliación de cobertura, la formación de pregrado y posgrado en Enfermería, así como para el fortalecimientodisciplinar,la conceptualización y la práctica del cuidado humano.

Introduction: In order to spread the experience of the School of Nursing in the use of innovative strategies, which facilitate the formation of the students in higher education, with difficult access to the education classroom for fulfilling diverse roles in society; this article presents this systematized strategy, doing a tour from the years 60 up to the use of ITC at present. Methods: Historical documents were collected from the School of Nursing, research papers, systematization and evaluation of students and teachers related to the topic. Results: The methodologies used according to the state of technology as well as gains and areas for improvement both teachers and students with effective use of ITC. Conclusions: One of the main factors for the successful implementation of ITC in higher education is the favorable perception of teachers in front of them, because even though some teachers do not consider it necessary to introduce new ways of teaching and learning, many others are willing and committed to innovate and propose new pedagogical challenges using the resources provided by these technologies. The results of this experience show that the technological and pedagogical innovation is key to expanding coverage, undergraduate and postgraduate nursing as well as for the strengthening to discipline, the conceptualization and the practice of the human care.