The main aim of this article is to explore the experiences and life situations of people living with intestinal stomas. Previous studies indicated the need to investigate the concerns of ostomy patients and how these concerns can affect their quality of life and their approaches to the comprehensive conceptualization of the bodily changes. A qualitative systematic review and metasynthesis design was carried out by using the main scientific databases. Original articles from 2002 to 2015 were selected based on their qualitative methodology. Methodological quality was evaluated using the Critical Appraisal Skills Program. The findings were synthesized using the metasynthesis procedure of Sandelowski. The final number of articles included was 95 and 1,982 participants. Regarding the metasummary, the data generated 191 thematic statements that were organized into eight categories. The findings support an explanatory model of the experience of people with ostomy based on three aspects: Acceptance, Adaptation, and Autonomy.

Aim:to describe ostomy patient’s perception about health care received, as well as their needs and suggestions for healthcare system improvement. Method:qualitative phenomenological study was conducted, involving individual and semi-structured interviews on the life experiences of 21 adults who had a digestive stoma. Participants were selected following a purposive sampling approach. The analysis was based on the constant comparison of the data, the progressive incorporation of subjects and triangulation among researchers and stoma therapy nurses. The software Atlas.ti was used. Results:perception of health care received is closely related to the information process, as well as training for caring the stoma from peristomal skin to diet. It is worthy to point out the work performed by stoma care nurses ensuring support during all stages of the process. Conclusion:findings contribute to address the main patients’ needs (better prepared nurses, shorter waiting lists, information about sexual relation, inclusion of family members all along the process) and recommendations for improving health care to facilitate their adaptation to a new status of having a digestive stoma.

Objective:to describe the coping of stoma patients with the news about the ostomy, as well as to analyze the meaning and the experience of their new bodily reality. Method:qualitative phenomenological study undertaken through semistructured interviews with 21 stoma patients. The analysis was based on the constant comparison of the data, the progressive incorporation of subjects and triangulation among researchers and stomal therapy nurses. The software Atlas.ti was used. Results:two main categories emerge: "Coping with the news about receiving a stoma" and "Meaning and experience of the new bodily reality". The informants' answer varies, showing situations that range from the natural acceptance of the process to resignation and rejection. The previous experiences of other family members, the possible reconstruction of the stoma or the type of illness act as conditioning factors. Conclusions:the coping with the news about the stoma is conditioned by the type of illness, although the normalization of the process is the trend observed in most informants. Nursing plays a fundamental role in the implementation of cognitive-behavioral interventions and other resources to promote the patients' autonomy in everything related to care for the stoma.

RESUMENCon el objetivo de explorar la aplicación de la filosofía de Patricia Benner en el ámbito clínico se realizó una búsqueda de la literatura científica inicialmente con vigencia mínima de 5 años, encontrándose durante este proceso escasa literatura, por lo cual surgió la necesidad de ampliar el período e incluir desde 1984 hasta el 2010. Se encontraron 90 artículos, de los cuales se seleccionaron 52. En el desarrollo del presente artículo se establecen las competencias que requiere el profesional de enfermería durante la práctica clínica, partiendo de los planteamientos de Patricia Benner quien modifica los niveles de adquisición de habilidades de los hermanos Dreyfus con el fin de aplicarlos a enfermeria en el área clínica; adicionalmente se relacionan con los patrones del conocimiento descritos por Barbara Carper y el perfil que debe tener la enfermera(o) que cuida pacientes que por su edad o condición clinica se encuentran en las areas de urgencias, unidad de cuidados intensivos y pediatria. ABSTRACTIn order to explore how to apply Patricia Benner's philosophy on the clinical field, a research was done about the scientific literature, initially with a five year range. However, little material was found on that field and for this reason it was decided to increase the range to a period ranging from 1984 to 2010. 90 articles were found and 52 of them were selected.

Aim: To determine the effectiveness of a case management model for approaching multi-pathological people in a health promoting entity of the contributory healthcare scheme in Bogotá, Colombia between 2018 -2019. Design: Mixed methods research. Method: The study contemplates two components: a quantitative component using a quasi-experimental analytical design before and after longitudinal intervention to determine the effectiveness of the case management model and a qualitative descriptive design to understand the experience of the participants about the model. The Administrative Department of Science, Technology and Innovation of Colombia (Colciencias) funded this project by means of call 777-November 2017, under the financing agreement No. 848-December 2017.Discussion: Addressing problems deriving from the structure of the Colombian healthcare system is crucial for implementing case management models. Furthermore, the effectiveness of such models may be affected by power relations and market failures, but the proved potential of a model may represent a generalized benefit for the Colombian health system. Impact:In Colombia, considering complications and management of chronic noncommunicable diseases as isolated cases is considered as the highest cost events in healthcare provision, since an average of 12.8 million pesos is invested in each patient. This has led to rethink the management in these patients by means of a comprehensive model that guarantees the effectiveness of healthcare delivery, in the framework of a healthcare system heavily affected by payment capacity, where the market has a strong predominance, such as the case of Colombia. Trial registration number: RPCEC00000293 K E Y W O R D Scase management, multiple chronic conditions, nursing, quality of health care

We have read with interest the work of Bozzalla-Cassione et al 1 published recently in your journal regarding the implementation of a telemedicine programme for patients with lupus in northern Italy. It is logical to suppose that the risk of patients with rheumatic diseases of having a more severe clinical course if they become infected with the COVID-19 infection is very high; however, although some of the reports show that there seems to be a low incidence of COVID-19 infection in patients with rheumatic disease, collaborative work with large cohorts is needed, which could show us the real incidence of COVID-19 infection in these patients and what happens with the establishment of telemedicine programmes. [2][3][4][5][6] We show an experience in a specialised centre in Bogota, Colombia; currently, we have a cohort of 5597 patients with rheumatoid arthritis (RA) in exclusively ambulatory care. On 12 March 2020, in Colombia, the health emergency by COVID-19 was established and a week later the Ministry of Health ordered the outpatient care procedure for the population in isolation. From that moment on, our institution, carrying out the proper logistical and legal processes, proceeded to convert its ambulatory care services into care through telemedicine.By telecounselling, patients were offered consultation by telemedicine due to the high epidemiological risk of COVID-19; the patient gave informed consent to accept it or otherwise to request a face-to-face consultation despite the epidemiological risk warning; a third option was that the patient did not accept telemedicine or face-to-face consultation for personal reasons.Here, we report the outcomes since 21 March-16 May (8 weeks later). For rheumatology care, the doctor must request informed consent for the consultation; then a standardised protocol was applied both for RA and also for suspected symptoms of COVID-19; as a measure of disease activity Patient Activity Score (PAS) was applied, and Health Assessment Questionnaire (HAQ) was also evaluated. When during the consultation the doctor finds that there is potentially high activity of the disease, a face-to-face consultation was ordered. In case of need, patients are sent to telemedicine consultation with the physiatrist or psychologist. For face-to-face consultation, standardised clinimetry instruments are used.Until May the 16 (8 weeks later), 3503 patients have been followed up; 3228 (92%) have been seen by telemedicine and 275 (8%) by conventional face-to-face consultation; of these patients, 55 (20%) men and 220 (80%) women attended the face-to-face consultation; of patients attended by telemedicine, 567 (17.5%) were men and 2661 (82.5%) were women. Regarding COVID-19 infection, in 3 of the 275 patients who attended an in-person consultation, COVID-19 infection was suspected due to respiratory symptoms, but was finally ruled out. None of the patients seen so far by telemedicine had suspected COVID-19 by clinic or had contact with COVID-19 confirmed patients.At first glance, these results seem surprisin...

Objective: To measure the self-care capability and its relation with the socio-demographic and clinical characteristics in a group of patients from the peritoneal dialysis program according to their self-care capability. Methodology:A prospective-descriptive cross-sectional study was performed. Three data collection instruments were applied: A socio-demographic and clinical characteristics form, the Morisky-Green test and the Appraisal of Self-care Agency Scale (ASA) were used with 87 patients, male and female alike. They were all over 18 years old and they were going through a peritoneal dialysis treatment having been over a month in the program. A descriptive analysis was done which included absolute and relative frequencies, central tendency and dispersion measures for the Morisky-Green test and for the socio-demographic and clinical tendencies. A multiple correspondence analysis was also done, using as the illustrative variable the self-care capability and as the control differences the sociodemographic and clinical variables.Results: 60% of subjects reported sufficient self-care capability and the remaining 40% reported an insufficient self-care capability. In addition, the self-care activities that the subjects perform the most were defined.

Introducción: La calidad de vida es un indicador de bienestar percibido por personas diagnosticadas con Enfermedad Renal Crónica Avanzada (ERCA), al respecto la literatura reporta diferentes instrumentos para su medición y de algunos de ellos describe las características psicométricas y adaptación transcultural. Objetivo: Identificar los instrumentos reportados por la literatura para evaluar la calidad de vida en la persona con ERCA y describir las características psicométricas y validación transcultural de los mismos. Material y Método: Se realizó una revisión integrativa de la literatura científica publicada en el periodo 2013 a 2018, en español, inglés y portugués. La búsqueda se realizó en 2 etapas, utilizando los operadores booleanos AND y OR, y los términos DeCS y MeSH para identificar escalas que evalúan la calidad de vida de los pacientes con ERCA, posteriormente se realizó una búsqueda focalizada para identificar cuales contaban con adaptación transcultural y las características psicométricas de las mismas. Resultados: La búsqueda inicial reportó 364 títulos elegibles, se seleccionaron 20, que comprendían instrumentos genéricos y específicos, de ellos 5 escalas se han usado en pacientes con ERCA: SF-12, SF-36, KDQOL 36, WHOQOL BREF, WHOQOL OLD. Conclusión: La escala KDQOL 36, posee dimensiones específicas para evaluar al paciente con ERCA , se encuentra adaptada transculturalmente en varios países de habla hispana y sus características psicométricas son confiables, el Alfa de Cronbach es >0.7, y su utilidad es adecuada porque es de fácil aplicación, poco compleja y a un bajo costo.