{"id":116415,"date":"2014-02-10T00:00:00","date_gmt":"2014-02-10T00:00:00","guid":{"rendered":"https:\/\/www.deberes.net\/tesis\/sin-categoria\/la-facilitacion-como-herramienta-basica-de-planificacion-anticipada-de-la-asitencia-sanitaria-fundamentos-del-programa-kayros-conversaciones-que-ayudan-inspirado-en-respecting-choicesr\/"},"modified":"2014-02-10T00:00:00","modified_gmt":"2014-02-10T00:00:00","slug":"la-facilitacion-como-herramienta-basica-de-planificacion-anticipada-de-la-asitencia-sanitaria-fundamentos-del-programa-kayros-conversaciones-que-ayudan-inspirado-en-respecting-choicesr","status":"publish","type":"post","link":"https:\/\/www.deberes.net\/tesis\/ciencias-clinicas\/la-facilitacion-como-herramienta-basica-de-planificacion-anticipada-de-la-asitencia-sanitaria-fundamentos-del-programa-kayros-conversaciones-que-ayudan-inspirado-en-respecting-choicesr\/","title":{"rendered":"La facilitaci\u00f3n como herramienta b\u00e1sica de planificaci\u00f3n anticipada de la asitencia sanitaria. fundamentos del programa \u00abkayr\u00f3s-conversaciones que ayudan\u00bb (inspirado en respecting choices(r))"},"content":{"rendered":"<h2>Tesis doctoral de <strong> Francisco Javier J\u00fadez Guti\u00e9rrez <\/strong><\/h2>\n<p>Resumen   objetivos principales: * fundamentar adecuadamente la planificaci\u00f3n anticipada de la asistencia sanitaria (paas) para poder desplegar programas integrales eficaces y \u00fatiles a lo largo de todo el proceso de enfermedad de un paciente. * traducir, adaptar, validar y aplicar a diversas trayectorias de enfermedad, para el programa kayr\u00f3s-conversaciones que ayudan, el proceso de capacitaci\u00f3n de facilitadores, pieza clave imprescindible de un programa de paas. objetivos espec\u00edficos: 1. Revisar cr\u00edticamente los fundamentos y referencias de un programa de paas 2. Obtener la capacitaci\u00f3n como facilitador e instructor del programa respecting choices\u00c2\u00bf (referente internacional). 3. Adaptar los contenidos de conocimientos b\u00e1sicos en comunicaci\u00f3n y bio\u00e9tica que deben tener los &quot;facilitadores&quot; de un programa de paas. 4. Adaptar el proceso de capacitaci\u00f3n (formaci\u00f3n \/ entrenamiento \/ certificaci\u00f3n) de facilitadores y las habilidades b\u00e1sicas necesarias. 5. Explorar complementariamente las actitudes, necesidades y expectativas de los pacientes, familiares y profesionales frente a las decisiones, vivencias, objetivos y temores en la atenci\u00f3n sanitaria a enfermos con procesos cr\u00f3nicos avanzados de enfermedad. 6. Desarrollar herramientas para la difusi\u00f3n (web kayr\u00f3s-conversaciones que ayudan) y definir indicadores de evaluaci\u00f3n adecuados para el proceso de capacitaci\u00f3n y futuros programas de paas. metodolog\u00eda:  metodolog\u00edas mixtas con dos componentes: a) revisi\u00f3n cr\u00edtica de los &quot;antecedentes y el estado actual del tema&quot; (metodolog\u00eda de humanidades m\u00e9dicas con revisi\u00f3n cr\u00edtica de la literatura y an\u00e1lisis de buenas pr\u00e1cticas en servicios de salud); b) adaptaci\u00f3n cultural y desarrollo del proceso de capacitaci\u00f3n (formaci\u00f3n y entrenamiento) de facilitadores de paas (a trav\u00e9s de paneles de expertos y talleres pr\u00e1cticos, complementado con metodolog\u00eda cualitativa con grupos de discusi\u00f3n\/focales y entrevistas en profundidad). conclusiones:  &quot;\tel enfoque predominante en espa\u00f1a en torno a las instrucciones previas o voluntades anticipadas (ips) es inadecuado, desenfocado e insuficiente, resultando una realidad marginal. &quot;\tla mera promoci\u00f3n, mediante la informaci\u00f3n, campa\u00f1as de educaci\u00f3n sanitaria y entrega de folletos, de los documentos de ips no va a cambiar esta tendencia a la irrelevancia en la pr\u00e1ctica (enfoque centrado en los papeles y los derechos). &quot;\tun enfoque m\u00e1s completo, incorpora el objetivo de las ips como resultado de un proceso comunicativo y participativo a lo largo de la trayectoria de enfermedad del paciente. Esto da lugar a un nuevo concepto de &quot;planificaci\u00f3n anticipada de la asistencia sanitaria&quot; (paas), m\u00e1s all\u00e1 de los documentos, ya apuntado desde mediados de los a\u00f1os 90. &quot;\teste enfoque de la paas, que llamaremos paas-tipo 1, aunque refuerza la figura del representante, sigue centrado en la eventual preparaci\u00f3n para la defensa de una autonom\u00eda prospectiva (cumplimentaci\u00f3n de ips) quedando los procesos de interacci\u00f3n a la discreci\u00f3n del profesional sanitario que atiende al paciente. &quot;\tel concepto de paas ha evolucionado a una visi\u00f3n de la paas (tipo 2) que se concibe como un proceso de comunicaci\u00f3n y relaci\u00f3n que ayuda a activar las capacidades relacionales de todos los implicados cuando alguien est\u00e1 enfermo. Si bien su fundamento \u00faltimo descansa en la autonom\u00eda del paciente, \u00e9sta se encarna en su realidad humana, de relaciones y asistencial, que es como se entiende el enfermar y morir de los seres humanos, incluyendo su adaptaci\u00f3n a la demograf\u00eda y epidemiolog\u00eda del enfermar contempor\u00e1nea con diferentes patrones o trayectorias de enfermedad caracter\u00edsticas y como se da sentido a los fines de la medicina\/asistencia sanitaria. Esta paas-tipo 2 ayuda a pacientes y su entorno de cuidados a tomar decisiones a lo largo del propio proceso o trayectoria de enfermedad, y no s\u00f3lo como preparaci\u00f3n para una eventual falta de capacidad futura. &quot;\tel rol central sobre el que pivota el proceso de la paas-tipo 2 es el del facilitador. Se articula con otros componentes: a) el dise\u00f1o de sistemas en la provisi\u00f3n de servicios de salud; b) la educaci\u00f3n e implicaci\u00f3n comunitaria; c) los procesos de mejora de la calidad. &quot;\tel facilitador necesita unos conocimientos, unas aptitudes (habilidades) y unas actitudes que ser\u00e1n desarrolladas en un proceso de capacitaci\u00f3n que incluye formaci\u00f3n, entrenamiento y certificaci\u00f3n (al menos la propia de una organizaci\u00f3n de salud). &quot;\tel programa kayr\u00f3s-conversaciones que ayudan se fundamenta en esta filosof\u00eda de paas-tipo 2 y ha validado el proceso de capacitaci\u00f3n de facilitadores (tipo respecting choices\u00c2\u00bf), por lo que est\u00e1 a disposici\u00f3n de las organizaciones del sistema nacional de salud para proceder a la capacitaci\u00f3n de facilitadores en el marco del desarrollo de programas integrales multi-componente de paas-tipo 2.   abstract   main objectives:  * set the adequate basis of advance care planning (acp) in order to deploy effective and helpful comprehensive programs throughout the entire process of a patient&apos;s disease trajectory. * translate, adapt, validate and apply the facilitator training process, a key component of an acp program, to different illness trajectories for kayr\u00f3s-conversations that help program. specific objectives:  1.\tCritically review the basis and references of an acp program. 2.\tObtain a facilitator and instructor certification from respecting choices\u00c2\u00bf (international beacon program). 3.\tAdapt the content of basic knowledge in communication and bioethics that acp&apos;s facilitators should have. 4.\tAdapt the facilitator&apos;s training process (education \/ hands-on training \/ certification) and the necessary basic skills. 5.\tAdditionally explore attitudes, needs and expectations of patients, families and health care professionals facing decisions, experiences, goals and fears while caring for patients with advanced chronic disease processes. 6.\tDevelop tools for dissemination (web kayr\u00f3s-conversations that help) and define appropriate assessment indicators for the training process and future acp programs. methodology: mixed methodologies with two components: a) critical review of the &quot;history and current status of the subject&quot; (methodology from medical humanities with critical review of the literature and analysis of best practices in health services); b) cultural adaptation and development of the training process of acp facilitators (practice and coaching) (through expert panels and workshops, supplemented with qualitative methodology with focus groups \/ in-depth interviews).  conclusions:  o the prevailing approach in spain about advance directives or living wills (ads) is inadequate, misguided, and unsatisfactory resulting in being a marginal reality. o simple promotion of ads documents through information, campaigns and delivery of health education brochures will not change this trend to irrelevance in practice (approach focused on documents and rights).  o a more comprehensive approach incorporates the objective of ads as a result of a participatory and communicative process throughout the course of the patient&apos;s illness trajectory. This leads to a new concept of &quot;advance care planning&quot; (acp), beyond the documents, and pointed since mid 90s.  o this acp approach, which we will call acp-type 1, although it reinforces the figure of the surrogate, remains focused on the possible preparation for the protection of prospective autonomy (filling in ads) interaction processes running at the discretion of the healthcare professional caring for the patient. o the concept of acp has evolved towards a vision of acp (type 2) conceived as a process of communication and relationship that helps activate the relational capabilities of all those involved when someone is sick. While its ultimate foundation rests on patient autonomy, this acp-type 2 is embodied in human reality, that of relationships and health care, which is how becoming ill and dying is understood by human beings, including the adaptation to demography and epidemiology of contemporary illness with different patterns or illness trajectories and how goals of medicine maintain their sense-making. This acp-type 2 helps patients and their care environment make decisions throughout the process itself or trajectory of illness, and not just as preparation for possible future lack of capacity. o the central role around which acp-type 2 process revolves is the facilitator. It assembles with other components: a) the design of systems in the provision of health services; b) education and community engagement; c) quality improvement processes.  o the facilitator needs some knowledge, some aptitudes (skills) and some attitudes to be developed in a training process that includes education, practice and certification (at least the one that a health organization sets in place for delivery of services). o kayr\u00f3s-conversations that help program is based on this philosophy of acp-type 2 and has validated the training process of facilitators (respecting choices\u00c2\u00bf type), so it is available to organizations of the national health system in order to proceed to the training of facilitators under the development of comprehensive multi-component programs acp-type 2.<\/p>\n<p>&nbsp;<\/p>\n<h3>Datos acad\u00e9micos de la tesis doctoral \u00ab<strong>La facilitaci\u00f3n como herramienta b\u00e1sica de planificaci\u00f3n anticipada de la asitencia sanitaria. fundamentos del programa \u00abkayr\u00f3s-conversaciones que ayudan\u00bb (inspirado en respecting choices(r))<\/strong>\u00ab<\/h3>\n<ul>\n<li><strong>T\u00edtulo de la tesis:<\/strong>\u00a0 La facilitaci\u00f3n como herramienta b\u00e1sica de planificaci\u00f3n anticipada de la asitencia sanitaria. fundamentos del programa \u00abkayr\u00f3s-conversaciones que ayudan\u00bb (inspirado en respecting choices(r)) <\/li>\n<li><strong>Autor:<\/strong>\u00a0 Francisco Javier J\u00fadez Guti\u00e9rrez <\/li>\n<li><strong>Universidad:<\/strong>\u00a0 Murcia<\/li>\n<li><strong>Fecha de lectura de la tesis:<\/strong>\u00a0 02\/10\/2014<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h3>Direcci\u00f3n y tribunal<\/h3>\n<ul>\n<li><strong>Director de la tesis<\/strong>\n<ul>\n<li>Luis Fernando Carballo Alvarez<\/li>\n<\/ul>\n<\/li>\n<li><strong>Tribunal<\/strong>\n<ul>\n<li>Presidente del tribunal: Francisco javier Tebar masso <\/li>\n<li>lydia Feito grande (vocal)<\/li>\n<li>abel Jaime Novoa jurado (vocal)<\/li>\n<li>diego Miguel Gracia guill\u00e9n (vocal)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Tesis doctoral de Francisco Javier J\u00fadez Guti\u00e9rrez Resumen objetivos principales: * fundamentar adecuadamente la planificaci\u00f3n anticipada de la asistencia sanitaria [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center 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