Perspectivas en Salud: El Rol del Enfermero Especialista, la Adherencia al Tratamiento y la Humanización del Cuidado

El Rol del Profesional de Enfermería: Perspectiva de Joyce Carne

Joyce Carne, enfermera profesional (NP) en un hospital de la ciudad de Nueva York, comparte su experiencia y visión sobre su rol en el ámbito de la salud.

Funciones y Especialización de la Enfermera Profesional

• Formación Avanzada: Como enfermera registrada, he completado una educación específica de enfermería avanzada, incluyendo un máster en medicina cardiovascular y un curso en el diagnóstico y tratamiento de enfermedades comunes en esta especialidad.
• Atención Primaria y Colaboración: Ofrezco gran parte de los cuidados básicos no emergentes proporcionados por los médicos generales, del tipo que se ve en áreas de práctica específica como consultorios de medicina familiar, centros de atención de urgencia y clínicas de salud rurales. Mantengo relaciones de colaboración con los médicos.
• Licenciamiento y Especialización: Como enfermera profesional, estoy licenciada por el estado en el cual practico a través de la Corporación Nacional de Certificación para la práctica de la especialidad. A diferencia de un enfoque educativo general, puedo especializarme en un área de estudio deseada y proporcionar cuidados dentro del ámbito de mi experiencia.
• Tratamiento y Filosofía de Cuidado: Puedo tratar condiciones agudas y crónicas, así como recetar medicamentos y terapias para el paciente en cuestión. La filosofía central de mi campo es la atención individualizada. Los profesionales de enfermería se centran en las condiciones de los pacientes, así como en los efectos de la enfermedad en sus vidas y las de sus familias. Informar a los pacientes sobre su cuidado de salud y animarles a participar en decisiones fundamentales es clave para los cuidados proporcionados por los profesionales de enfermería.

La Concordancia en el Tratamiento: Una Preocupación Central

Una gran preocupación para mí y otros profesionales de la medicina de todos los niveles es la concordancia, una vez que se ha recetado un medicamento. La concordancia implica un proceso de prescripción y toma de la medicina; es un tipo de asociación. No es solo una cuestión de explicar los beneficios de los medicamentos prescritos y los posibles efectos secundarios, sino de involucrar al paciente en la toma de decisiones sobre el tratamiento para mejorar la adherencia.

Ejercicio: Preguntas y Respuestas sobre Joyce Carne

1. Is concordance a cause for concern for Nurse Carne and her fellow NPs? Yes, "A major concern for myself and other medical practitioners at all levels is concordance, once a drug has been prescribed."
2. What type of conditions can she treat? She may treat both acute and chronic conditions, as well as prescribe medications and therapies for the patient at hand.
3. What does she consider the central philosophy of working as a nurse practitioner? The core philosophy of the field is individualized care. Nurse practitioners focus on patients' conditions as well as the effects of illness on the lives of the patients and their families.
4. Why does she feel her patients need to be involved in treatment decisions? Informing patients about their health care and encouraging them to participate in decisions are central to the care provided by NPs.
5. What specific post-graduate training has she undergone? Rather than a generic focus of education, as a nurse practitioner I am able to specialize in an area of study I desire and provide care within the scope of my expertise. I have a master's in cardiovascular medicine and training in the diagnosis and management of common medical conditions in this specialty.
6. How does her work compare with that of physicians? I provide much of the same basic, non-emergency care provided by physicians, generally of the type seen in their specific practice areas like family practice offices, urgent care centers, and rural health clinics, and maintain collaborative working relationships with physicians.

Concordancia y Adherencia al Tratamiento

La concordancia, o adherencia a la medicación, es un aspecto crítico en la atención sanitaria. Este apartado explora sus desafíos y estrategias de mejora.

Desafíos en la Adherencia a la Medicación

• Problema Persistente: El incumplimiento en la toma de la medicación es un problema de toda la vida en todas las áreas terapéuticas, incluyendo el tratamiento del cáncer. A pesar de la introducción de nuevos medicamentos con menos efectos secundarios y mayor conveniencia, muchas personas aún no los toman según lo prescrito, incluso cuando no hacerlo puede tener consecuencias potencialmente mortales.
• Medicamentos Preventivos: Los medicamentos prescritos con fines preventivos son especialmente propensos a no ser tomados según las indicaciones. Esto puede deberse a que las personas no se sienten inmediatamente amenazadas y, en el caso de condiciones asintomáticas como niveles elevados de colesterol e hipertensión, no perciben ningún beneficio evidente en el momento de tomar los medicamentos.
• Factores de Mal Cumplimiento: Los factores asociados con el mal cumplimiento incluyen:
  • Regímenes complejos que implican múltiples dosis o varios medicamentos.
  • Efectos secundarios no deseados.
  • Preocupaciones sobre el valor o la conveniencia de tomar los medicamentos en contextos particulares.
  • La negación de la enfermedad, especialmente entre los jóvenes.
  • Confusión o dificultades físicas asociadas con la toma de medicamentos, que afectan con mayor frecuencia a las personas mayores.

Estrategias para Mejorar la Adherencia

• Intervenciones Integrales: Las formas eficaces de mejorar las tasas de cumplimiento implican el uso complementario de intervenciones educativas, prácticas, emocionales y de apoyo conductual, más allá de la mera provisión de información. Hay pruebas de que, independientemente de los conocimientos específicos impartidos, los programas de autocuidado ayudan a elevar el sentido de autoeficacia y la confianza de las personas, promoviendo una mejor toma de la medicación.
• Respeto a la Autonomía del Paciente: Los profesionales de la salud deberían respetar la autonomía de los pacientes y aceptar que aumentar el cumplimiento de las instrucciones de prescripción no es tan importante como satisfacer las necesidades y prioridades individuales de los pacientes. Los pacientes necesitan ayuda para tomar decisiones informadas sobre el tratamiento; por ejemplo, es necesario diferenciar claramente entre situaciones donde variar el horario o la cantidad de dosis de la medicina puede causar poco daño o incluso ser beneficioso, y situaciones en las que hay una alta probabilidad de resultados clínicos adversos.
• Beneficios del Autocuidado: Las mejoras en las habilidades de autocuidado y el cumplimiento en la toma de la medicación pueden generar importantes beneficios para los individuos y la población en su conjunto. La combinación de revisiones de la medicación con otras formas de apoyo oportuno y adecuado para los pacientes y cuidadores representa una vía importante hacia un uso mejor y más rentable de los medicamentos.

Ejercicio: Preguntas y Respuestas sobre Concordancia

1. What features of new medicines should make people take the medicines prescribed to them? There is strong evidence that, despite the introduction of new medicines which have fewer side effects and are more convenient to use, many people still do not take them as prescribed.
2. Which medicines are least likely to be taken by patients? Medicines prescribed for preventive purposes are especially likely not to be taken as prescribed.
3. Which group is more likely not to take medicine prescribed because they do not believe the illness is there? Among younger people.
4. Besides providing information, what effective ways can improve compliance? Effective ways of improving compliance rates involve the complementary use of educative, practical, and emotionally and behaviorally supportive interventions, rather than the provision of information alone.
5. What is more important than increasing compliance in patients? Health professionals should respect patients' autonomy and accept that increasing compliance with prescribing instructions is not as important as meeting patients' individual needs and priorities.
6. What do patients need to be helped to make? Patients need help to make informed choices about treatment. For example, there is a need to differentiate clearly between situations where varying the timing or quantity of medicine doses may do little harm or even be beneficial, and situations in which there is a high probability of adverse clinical outcomes.
7. What can be of help to both the individual and the general population? Improvements in self-management skills and compliance in medicine taking can generate significant benefits for individuals and the population as a whole.

Sobrepeso y Obesidad: Factores y Consecuencias

Este ejercicio aborda los factores clave y las implicaciones para la salud relacionadas con el sobrepeso y la obesidad.

Ejercicio: Conceptos Fundamentales

1. Obesity is the result of an energy imbalance where energy intake exceeds energy expended over time.
2. Lifestyle factors associated with obesity are increased consumption of foods with high levels of sugar and saturated fats, as well as a reduction in physical activity.
3. Obesity affects long-term health by increasing the risk of chronic illnesses such as diabetes, cardiovascular disease, and some cancers.
4. The cost of obesity in Australia was $21 billion in 2005.
5. Since 1995, Australia has reported a higher rate of obesity for males than for females.
6. Self-perception of own body weight among men and older women has implications for the standard BMI definitions.

La Elección de una Especialidad Médica: Reflexiones Personales

Una estudiante de medicina comparte sus pensamientos y dilemas sobre la elección de su futura especialidad.

First of all, I would like to say I am very happy to have chosen this degree. This first year I've had good and bad experiences, but every effort is rewarded. I hope to be a great doctor. It is still too early to know what I want to specialize in. On one hand, I would like to specialize in Pediatric Oncology, because I love children, and I think that saving a life is very satisfactory. But also, I realize that not all lives can be saved, and it would be very hard to see such a young person dying slowly. On the other hand, surgery is also an interesting specialty; perhaps it involves too much responsibility, but I guess now that I think about it, it's because I have no knowledge on the subject. Once I'm ready for it, I'll know I'll be able to handle it. However, students from other medical courses have told me that over the years I will discover other specialties that I might not imagine liking.

Many times we think we choose the specialty we like, but I believe it is the specialty that chooses us. I think that when I know exactly the specialty that I want, I will feel something special and I will realize that I've been looking for it all my life, without knowing it. Therefore, right now I don't have things clear because I am young and inexperienced. There's so much world out there for me to discover. In conclusion, I hope I don't make a mistake when I choose my specialty and enjoy my job as much as I'm imagining it. Because the reasons to be a doctor are more than just knowing medicine; it is a commitment to the health of the community, individuals, and families in their environments.

"El Doctor" (The Doctor): Reflexiones sobre la Humanización en Medicina

Este apartado explora las lecciones clave de la película "El Doctor" sobre la importancia de la empatía y el trato humano en la práctica médica.

Opinión Personal

People want doctors who care about people; before being a good doctor, you must be a good person.

I think this sentence fits well with the context of the film, which tells the personal and professional life of a doctor. This film shows how one event can change the lives of each of us. Dr. McKee exemplifies several doctors who have lost the human side of medicine. It is known that a friendly and kind treatment of patients is important for their well-being; the physician should calm patients' anxiety. This doctor believed that being a great professional in his specialty allowed him to treat people disrespectfully. He believed that, as a surgeon, he fixed machines shaped like human beings, never thinking of patients' feelings, fear, pain, or embarrassment.

He believed himself superior to patients. It seems that doctors unintentionally think that by having that profession, they are safe from the possibility of any illness. And if they are ill, they think they have priority over other patients with any other profession. The film made me think and have an even clearer understanding of what I've always thought about the importance of good manners with the patient.

Although this is fiction, it is not far removed from reality. While it is true that many professionals have an exemplary attitude, many doctors act improperly, something that should be incompatible with this profession. We must know that what matters in a doctor's consultation is not us; what is important in the consultation are the patients.

The problem certainly is not a lack of good education, but rather not being clear that we are all equals and no one is superior to anyone. It is absolutely reprehensible to believe oneself superior to those who need our help, not just because one day we might need someone's help, but for our own principles, for humanity.

Resumen de la Película

In conclusion, this film shows us how doctors sometimes have advantages in getting test results, or other times they are treated like any other patient. Furthermore, it shows that being treated like any other patient is difficult for a cold and controlling doctor. It is also difficult for him to be diagnosed by another and to feel truly sick. Because when his doctor detected a throat tumor in him, he was authoritarian and wanted to know everything his doctors were doing to him, and he wanted to make the decisions, but in the end, the specialist did what was considered appropriate.

At this stage, he was confused, and he hated that people treated him like a sick person. But when he met a sick girl with brain cancer but eager to fight and live, he changed his attitude thanks to this girl's friendship. Because of his illness, the doctor realized how important life was, and this was reflected in his own doctor when observing the coldness with which she treated her patients. The doctor is able to change his view of life by seeing system crashes. Now he truly knows what it feels like to be ill and to be afraid for his life.