A nurse brings us the complaints of a person who had just been diagnosed with Chronic Obstructive Pulmonary Disease (COPD).
It was a retired 67-year-old woman, nurse of profession, to whom we will call Maria.
He was young, developed most of his professional practice in an intensive care unit.
He has been living for more than 20 years, with two dependent children; one is an engineer, now in unemployment and with an age of 40; the other is an adult with a syndrome;
She has a daughter married to three children who lives in the same city.
It also has three brothers, one senior already retired and two of them university professors with whom he maintains a good relationship and also live in the same city.
Maria had been a smoker until her respiratory crisis started admitting to the hospital.
I had always thought about quitting smoking but I hadn't done it; until a couple of weeks ago I felt I didn't breathe well, as she said, "I didn't breathe in a critical night", she began to have that feeling.
Once admitted, she had low oxygen saturation below 90.
The next day no doctor came to see him, the weekend came, and they continued without appearing.
Maria is a very discreet person and she was waiting to see her.
When Saturday and seeing that no one had asked him to go to his house, but no one cared for him, and the same family asked him to be patient, he felt quite ill.
About the delay of the medical visit, the nurses told him that he should "have patience since the clinic did not go through good times"; besides this information, the nurse intervention with Maria oxygen was limited to putting her on.
Monday, after four days of admission, the pulmonologists of the unit visited her and, after her successive complaints, the Tuesday sent her home, with the only scheme of 16 hours of oxygen at home.
Mary's brothers, who had often told him to quit smoking, because he had a lot of cough and would be scared any day, considered that he was pretty bad.
She, in addition, was very angry to see the family panorama she has with her child with Down syndrome, in July, vacations, since she usually spends a large part of her life on the street at a center.
The nurse who informed us about the case, to which we will call Beatriz, is the friend of the family, kept SMS messages with Maria in whom she realized she was very mad and did not want to talk.
She sought the opportunity to see her and at home, in the face-to-face encounter between Maria and her friend, she perceived that Maria had the opportunity to talk about dyspnea, but she didn't even want to see a hospital adequately 30 I didn't want to talk about dyspnea.
I understood that I was admitted with a magistrate at night, but my madman began when the next day and for days I did not suffer from any pneumologist.
When Monday they see me, they do not explain anything to me, and they only give me the regimen of the 16 hours followed by oxygen plus the bronchodilators and corticoids they already used.
The Tuesday, after a number of pits, sends me home.
The same indication of 16 hours of oxygen is repeated by the oxygen technician and another physician from the health center who came to see me at home".
Exp. ~~~ She's mad because she doesn't have any guidelines, nor reference to whether her condition improves or gets worse, when she doesn't find special changes.
"I never had dyspnea.
My saturation improved before leaving the clinic.
Now I don't know anything and I'm talking about it.
I know I have a smoker's COPD, and for now I only take the medication of bronchodilators and corticoids; I am not sure that the latter are continuously missing".
In the encounter of Beatriz with Maria, the latter continues to express her deep discomfort in the way she had been treated, due to the lack of explanations and because she felt that "they did not know anything".
He was now 16 hours of oxygen, but without having a reference to whether he was equal, better or worse.
The nurse-friend focused on Maria and was able to appreciate that she was not as bad as her brothers had told her, she talked to Maria herself and agreed to it.
In addition, the patient, because she was a nurse, knew what a COPD was, but as a patient, she lacked a reference measure to know whether she improved or made up.
In his condition he could not assess the changes and remained many days for medical review.
Beatriz explained the experience with the Pick-Flow very effective in patients with chronic constipation in order to measure lung capacity.
This gave him the idea of getting a pulse oximeter to control his oxygen saturation.
Your child sought it and requested it on the Internet.
A few days later, she felt much more anxious because the values oscillated around 94-96%, then she started to go out to the street to make small shopping, take the air and recover normal life.
He stopped smoking and, with the help of Beatriz, he adhered to natural care, including in his diet foods and diuretic infusions (alcachofa, sparragos, cola).
Their quality of life improved notably thanks to the performance of their nurse friend.
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Conceptual framework
For the analysis of the case and the interactions and reactions we will rely on the conceptual framework of the triangle of welfare care, clinical safety and autonomy5.
In this triangle, the three dimensions are closely related, so that if a person has pain or anxiety discomfort, he/she will not have confidence or security, which will increase his/her discomfort and hinder his/her recovery.
It may also tend to overestimate their discomfort and express symptoms of an exotic form.
In any case, it will not improve their autonomy or learn to know the process of their disease.
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In the Aurora Mas group and in the monthly seminars, we are consolidating the conceptual framework of care.
Contribute and caregiving as being with and waiting for people, sick or primary family caregiver (expression of being with and pending development within the framework of his doctoral thesis by Fabiola Hueso
Aurora Mas Group.
Not published, 2011).
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In this conceptual framework there are two parts: the lower part serves to analyze the educational and health context, the upper part corresponding to the family and nurses is the one that interests us at this moment.
In this part we see that numerous activities are developed versus care variables developed by family caregivers and professionals, that is, nurses.
All this, with a large dose of privacy, affection and serenity to achieve the greatest possible autonomy and quality of life.
The professional competences of being under are the monitoring of the disease symptoms and symptoms, but one can also see what for Henderson were supplemental care or the family of signs held by the nurse.
In short, helping skills are developed, care is personalized, achieving thus trustworthy, trustworthiness and autonomy by the people cared for, 6-8 that is to say in relation to the triangle of care explained.
En: Seminar on Care and Quality of Life.
March 10th, 2013, Jaundice, not published).
