No abstract

OBJECTIVE: To describe the implementation status of the Community-Based Rehabilitation in Chile. METHODS: Quantitative, transversal and descriptive study. The scope was constituted by the 66 community-based rehabilitation centers in the Chilean Metropolitan Region that implemented Community-Based Rehabilitation until December 2016. The sampling was based on a census method, so all the community centers were contacted. A self-administered questionnaire designed based on the Community-Based Rehabilitation matrix defined by the World Health Organization was applied. The questionnaire was answered on-line by the coordinators of the strategy in their respective centers. The data analysis was performed using descriptive statistics. RESULTS: A heterogeneous level of implementation of Community-Based Rehabilitation was identified, specifically in terms of the components of the matrix described by the World Health Organization. The most implemented component was Health; the Social, Livelihood and Empowerment components were moderately implemented; and the Education component was the least implemented. CONCLUSION: The implementation of Community-Based Rehabilitation is mainly based on the Health component. The level implementation of the other components of the matrix needs to be increased, as well as interdisciplinary and intersectoral strategies to achieve greater social inclusion of people with disabilities.

Resumen Este estudio busca describir experiencias y percepciones sobre discapacidad y participación social de personas con discapacidad y profesionales sanitarios de centros de rehabilitación comunitaria de la Región Metropolitana de Chile. Se realizó un estudio cualitativo con muestreo teórico de actores claves en cuatro centros. Se realizaron 16 grupos focales y análisis de contenido semántico. Las experiencias de personas con discapacidad son diversas, existen elementos comunes como la homologación de la dependencia con la discapacidad y el reconocimiento de barreras sociales. Las percepciones sobre discapacidad representan los modelos individual y social, esto último se evidencia en las injusticias y discriminaciones. La participación social es intensa y afectiva en el centro de salud, sin embargo, otros espacios de participación son escasos. Las concepciones sobre discapacidad y niveles de participación señalan la necesidad de más lineamientos, capacitación y recursos para la efectiva implementación de la rehabilitación comunitaria.

Background Deaths in the intensive care unit (ICU) represent an experience of suffering for patients, their families, and professionals. End-of-life (EOL) care has been added to the responsibilities of the ICU team, but the evidence supporting EOL care is scarce, and there are many barriers to implementing the clinical recommendations that do exist. Objectives To explore the experiences and perspectives of the various members of an ICU care team in Chile regarding the EOL care of their patients. Methods A qualitative study was performed in the ICU of a high-complexity academic urban hospital. The study used purposive sampling with focus groups as a data collection method. A narrative analysis based on grounded theory was done. Results Four discipline-specific focus groups were conducted; participants included 8 nurses, 6 nursing assistants, 8 junior physicians, and 6 senior physicians. The main themes that emerged in the analysis were emotional impact and barriers to carrying out EOL care. The main barriers identified were cultural difficulties related to decision-making, lack of interprofessional clinical practice, and lack of effective communication. Communication difficulties within the team were described along with lack of self-efficacy for family-centered communication. Conclusion These qualitative findings expose gaps in care that must be filled to achieve high-quality EOL care in the ICU. Significant emotional impact, barriers related to EOL decision-making, limited interprofessional clinical practice, and communication difficulties were the main findings cross-referenced.

No abstract