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Thompson CM, Babu S, Makos S. Women's Experiences of Health-Related Communicative Disenfranchisement. HEALTH COMMUNICATION 2023; 38:3135-3146. [PMID: 36281957 DOI: 10.1080/10410236.2022.2137772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Women's inequitable healthcare experiences are epistemic injustices by which women are discredited and harmed in their position as knowers of their health and their bodies. Drawing on the theory of communicative disenfranchisement (TCD), we sought to amplify voices of women experiencing communicative disenfranchisement (CD) and to unify their stories according to theoretical premises, namely, attention to power, material conditions, discourse, identities and relationships, and process. We interviewed 36 women living in the United States whose health issues have not been taken seriously by health care providers, friends, and family - pervasive sources of disenfranchising talk surrounding health. Mapping onto the TCD framework, our findings explicate the process of CD, including the material and immaterial consequences of disenfranchising talk and women's responses to such talk. CD unfolded as a protracted and often circular process of women seeking care but encountering health dismissals and minimalizations, blaming and shaming, normalizing of their pain, and psychologizing. We unpack how disenfranchising talk rendered women crazy and dehumanized them and inflicted shame and loss. Women responded to disenfranchising talk with silence, and they (re)claimed their voice by resisting psychogenic explanations for their problems, critiquing women's healthcare, asserting their needs, and advocating for others. We discuss the implications of this research for theory and praxis.
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Hempel S, Danz M, Robinson KA, Bolshakova M, Rodriguez J, Mears A, Pham C, Yagyu S, Motala A, Tolentino D, Akbari O, Johnston J. Multiple chemical sensitivity scoping review protocol: overview of research and MCS construct. BMJ Open 2023; 13:e072098. [PMID: 37739463 PMCID: PMC10533706 DOI: 10.1136/bmjopen-2023-072098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 08/16/2023] [Indexed: 09/24/2023] Open
Abstract
INTRODUCTION Multiple chemical sensitivity (MCS) has been characterised by reported adverse responses to environmental exposures of common chemical agents (eg, perfumes, paint, cleaning products and other inhaled or ingested agents) in low doses considered non-toxic for the general population. There is currently no consensus on whether MCS can be established as a distinct disorder. METHODS AND ANALYSIS The scoping review of the literature will be guided by five questions: How is MCS defined and which diagnostic criteria have been proposed? What methods are used to report prevalence and incidence estimates of MCS? What are the characteristics of the body of scientific evidence that addresses whether MCS is a distinct disorder or syndrome? What underlying mechanisms for MCS have been proposed in the scientific literature? Which treatment and management approaches for MCS have been evaluated in empirical research studies? We will conduct a comprehensive search in 14 research databases. Citation screening will be supported by machine learning algorithms. Two independent reviewers will assess eligibility of full-text publications against prespecified criteria. Data abstraction will support concise evidence tables. A formal consultation exercise will elicit input regarding the review results and presentation. The existing research evidence will be documented in a user-friendly visualisation in the format of an evidence map. ETHICS AND DISSEMINATION Determined to be exempt from review (UP-22-00516). Results will be disseminated through a journal manuscript and data will be publicly accessible through an online data repository. REGISTRATION DETAILS The protocol is registered in Open Science Framework (osf.io/4a3wu).
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Affiliation(s)
- Susanne Hempel
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Margie Danz
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Karen A Robinson
- Division of Health Science Informatics, John Hopkins Medicine, Baltimore, Maryland, USA
| | - Maria Bolshakova
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Jesus Rodriguez
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Alanna Mears
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Cindy Pham
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Sachi Yagyu
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Aneesa Motala
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Danica Tolentino
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Omid Akbari
- Molecular Microbiology and Immunology, University of Southern California, Los Angeles, California, USA
| | - Jill Johnston
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Oter-Quintana C, Esteban-Hernández J, Cuéllar-Pompa L, Gil-Carballo MC, Brito-Brito PR, Martín-García A, Alcolea-Cosín MT, Martínez-Marcos M, Alameda-Cuesta A. Nursing Diagnoses of Individuals with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Research Protocol for a Qualitative Synthesis. Healthcare (Basel) 2022; 10:healthcare10122506. [PMID: 36554030 PMCID: PMC9777975 DOI: 10.3390/healthcare10122506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 12/05/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022] Open
Abstract
Although previously developed qualitative studies have explored the experience of illness of individuals with myalgic encephalomyelitis/chronic fatigue syndrome, these findings have not been undertaken for the purpose of enabling the identification of nursing care needs in such patients. This study aims to identify NANDA-I nursing diagnoses of adults with myalgic encephalomyelitis/chronic fatigue syndrome based on a qualitative literature review of their experience of illness. The protocol includes: searches in the electronic databases Medline, Embase, CINAHL, PsycINFO, SCI-EXPANDED, SSCI, SciELO, LILACS, and Cuiden; and manual searches in specialised journals and the references of the included studies. The authors will systematically search qualitative research studies published in databases from 1994 to 2021. Searches are limited to studies in Spanish and English. All stages of the review process will be carried out independently by two reviewers. Any disagreements shall be resolved through joint discussions, involving a third reviewer if necessary. The findings will be synthesised into a thematic analysis informed by the Domains and Classes of the NANDA-I Classification of Nursing Diagnoses, which will then serve to identify nursing diagnoses. This review will enable nursing professionals to identify the care needs of individuals with myalgic encephalomyelitis/chronic fatigue syndrome by taking into consideration their experience of illness in its entirety.
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Affiliation(s)
- Cristina Oter-Quintana
- Member of the Nursing and Health Care Research Group IDIPHISA, 28222 Majadahonda, Spain
- Nursing Department, Faculty of Medicine, Autonomous University of Madrid, 28029 Madrid, Spain
- Faculty of Health Sciences, Rey Juan Carlos University, 28922 Alcorcón, Spain
- Correspondence: ; Tel.: +34-914-975-855
| | - Jesús Esteban-Hernández
- Medical Specialties and Public Health Department, Faculty of Health Sciences, Rey Juan Carlos University, 28922 Alcorcón, Spain
| | - Leticia Cuéllar-Pompa
- Care Research Institute, Illustrious Professional Association of Nurses of Santa Cruz de Tenerife, 30001 Santa Cruz de Tenerife, Spain
| | | | - Pedro Ruymán Brito-Brito
- Primary Care Management of Tenerife, The Canary Islands Health Service, 38204 La Laguna, Spain
- Nursing Department, La Laguna University, 38200 La Laguna, Spain
| | - Angel Martín-García
- Health Care Directorate (Southern District), Primary Care, Madrid Health Service, 28981 Parla, Spain
| | | | - Mercedes Martínez-Marcos
- Member of the Nursing and Health Care Research Group IDIPHISA, 28222 Majadahonda, Spain
- Nursing Department, Faculty of Medicine, Autonomous University of Madrid, 28029 Madrid, Spain
| | - Almudena Alameda-Cuesta
- Nursing and Oral Medicine Department, Faculty of Health Sciences, Rey Juan Carlos University, 28922 Alcorcón, Spain
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4
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Wurz A, Culos-Reed SN, Franklin K, DeMars J, Wrightson JG, Twomey R. "I feel like my body is broken": exploring the experiences of people living with long COVID. Qual Life Res 2022; 31:3339-3354. [PMID: 35816258 PMCID: PMC9272651 DOI: 10.1007/s11136-022-03176-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE Long COVID, an illness affecting a subset of individuals after COVID-19, is distressing, poorly understood, and reduces quality of life. The objective of this sub-study was to better understand and explore individuals' experiences with long COVID and commonly reported symptoms, using qualitative data collected from open-ended survey responses. METHODS Data were collected from adults living with long COVID who participated in a larger observational online survey. Participants had the option of answering seven open-ended items. Data from the open-ended items were analyzed following guidelines for reflective thematic analysis. RESULTS From 213 participants who were included in the online survey, 169 participants who primarily self-identified as women (88.2%), aged 40-49 (33.1%), who had been experiencing long COVID symptoms for ≥ 6 months (74%) provided open-ended responses. Four overlapping and interconnected themes were identified: (1) Long COVID symptoms are numerous and wearing, (2) The effects of long COVID are pervasive, (3) Physical activity is difficult and, in some cases, not possible, and (4) Asking for help when few are listening, and little is working. CONCLUSION Findings reaffirm prior research, highlighting the complex nature of long COVID. Further, results show the ways individuals affected by the illness are negatively impacted and have had to alter their daily activities. Participants recounted the challenges faced when advocating for themselves, adapting to new limitations, and navigating healthcare systems. The varied relapsing-remitting symptoms, unknown prognosis, and deep sense of loss over one's prior identity suggest interventions are needed to support this population.
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Affiliation(s)
- Amanda Wurz
- School of Kinesiology, University of the Fraser Valley, Chilliwack, BC, Canada
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - S Nicole Culos-Reed
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- Department of Oncology, Cumming School of Medicine, Calgary, AB, Canada
- Department of Psychosocial Resources, Tom Baker Cancer Centre, Alberta Health Services, Calgary, AB, Canada
| | | | | | - James G Wrightson
- Department of Clinical Neurosciences, University of Calgary and Alberta Children's Hospital, Calgary, AB, Canada
| | - Rosie Twomey
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada.
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Jahanbani F, Maynard RD, Sing JC, Jahanbani S, Perrino JJ, Spacek DV, Davis RW, Snyder MP. Phenotypic characteristics of peripheral immune cells of Myalgic encephalomyelitis/chronic fatigue syndrome via transmission electron microscopy: A pilot study. PLoS One 2022; 17:e0272703. [PMID: 35943990 PMCID: PMC9362953 DOI: 10.1371/journal.pone.0272703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 07/25/2022] [Indexed: 01/06/2023] Open
Abstract
Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a complex chronic multi-systemic disease characterized by extreme fatigue that is not improved by rest, and worsens after exertion, whether physical or mental. Previous studies have shown ME/CFS-associated alterations in the immune system and mitochondria. We used transmission electron microscopy (TEM) to investigate the morphology and ultrastructure of unstimulated and stimulated ME/CFS immune cells and their intracellular organelles, including mitochondria. PBMCs from four participants were studied: a pair of identical twins discordant for moderate ME/CFS, as well as two age- and gender- matched unrelated subjects-one with an extremely severe form of ME/CFS and the other healthy. TEM analysis of CD3/CD28-stimulated T cells suggested a significant increase in the levels of apoptotic and necrotic cell death in T cells from ME/CFS patients (over 2-fold). Stimulated Tcells of ME/CFS patients also had higher numbers of swollen mitochondria. We also found a large increase in intracellular giant lipid droplet-like organelles in the stimulated PBMCs from the extremely severe ME/CFS patient potentially indicative of a lipid storage disorder. Lastly, we observed a slight increase in platelet aggregation in stimulated cells, suggestive of a possible role of platelet activity in ME/CFS pathophysiology and disease severity. These results indicate extensive morphological alterations in the cellular and mitochondrial phenotypes of ME/CFS patients' immune cells and suggest new insights into ME/CFS biology.
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Affiliation(s)
- Fereshteh Jahanbani
- Department of Genetics, Stanford University School of Medicine, Stanford, California, United States of America
| | - Rajan D. Maynard
- Department of Genetics, Stanford University School of Medicine, Stanford, California, United States of America
| | - Justin Cyril Sing
- Department of Molecular Genetics, Donnelly Centre, University of Toronto, Toronto, Ontario, Canada
| | - Shaghayegh Jahanbani
- Division of Immunology and Rheumatology, Stanford University School of Medicine, and VA Palo Alto Health Care System, Palo Alto, California, United States of America
| | - John J. Perrino
- Stanford Cell Sciences Imaging Facility (CSIF), Stanford University School of Medicine Stanford, Stanford, California, United States of America
| | - Damek V. Spacek
- Karius Incorporated, Redwood City, California, United States of America
| | - Ronald W. Davis
- ME/CFS Collaborative Research Center at Stanford, Stanford Genome Technology Center, Stanford University School of Medicine, Palo Alto, California, United States of America
| | - Michael P. Snyder
- Department of Genetics, Stanford University School of Medicine, Stanford, California, United States of America
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Brown N. The Social Course of Fibromyalgia: Resisting Processes of Marginalisation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:333. [PMID: 35010593 PMCID: PMC8751202 DOI: 10.3390/ijerph19010333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/16/2021] [Accepted: 12/20/2021] [Indexed: 06/14/2023]
Abstract
This sociological article reports an empirical study into the lived experience of fibromyalgia. It includes 28 participants (26 women, 2 men) with a formal diagnosis of fibromyalgia. Data collection consisted of the completion of an identity box project and subsequent interviews. Data analysis followed the principles of iterative, inductive, semantic thematic analysis, and led to the identification of four major themes: the role of the social in making sense of the experience, the process of redefining lifegoals, the refusal to accept fibromyalgia as a diagnosis, and the consideration of identifying as a patient. These themes in turn demonstrate four forms of resistance against processes of marginalisation amongst those who have been diagnosed with fibromyalgia: (1) the incorporation of societal expectations and norms into their life-stories; (2) the re-making the lifeworld at a cerebral level through redefining reality and creating a new, socially acceptable reality; (3) the active rejection of the fibromyalgia diagnosis; and (4) the employment of active and pro-active countermeasures to assuming the sick role.
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Affiliation(s)
- Nicole Brown
- UCL Institute of Education, College London, London WC1H 0AL, UK
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7
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Arfuch VM, Queiroga Gonçalves A, Caballol Angelats R, Aguilar Martín C, Carrasco-Querol N, Sancho Sol MC, González Serra G, Fusté Anguera I, Berenguera A. Patients' appraisals about a multicomponent intervention for fibromyalgia syndrome in primary care: a focus group study. Int J Qual Stud Health Well-being 2021; 16:2005760. [PMID: 34839810 PMCID: PMC8843386 DOI: 10.1080/17482631.2021.2005760] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Abstract
PURPOSE To assess fibromyalgia patients' experiences and appraisals about a multidisciplinary intervention programme, in Catalonia's primary care, regarding its format and contents, benefits, and health impact in the short and long term. METHOD Qualitative interpretative research design through hermeneutic phenomenology perspective. Two focus groups discussions were conducted in February and July 2020. The purposive heterogeneous sample included 19 fibromyalgia patients who attended a multicomponent programme. In addition, thematic analysis on the verbatims was performed. RESULTS Findings were organized into five main domains with an explanatory theme each. Overall, the informants valued the programme as a positive experience due to its holistic approach, health benefits, suffering relief, group effect, and fibromyalgia legitimacy promotion. Detected improvable aspects focused on extending the timeframe, including family members as beneficiaries, deepening the thematic contents, and getting regular access to this healthcare service. Furthermore, the intervention was considered feasible to be incorporated into usual clinical care. CONCLUSION the programme fulfilled users' expectations about results and procedure and showed promise as a treatment strategy to reinforce the usual practice. Our findings suggest a broad perspective on fibromyalgia patients' suffering, which urges us to adjust the intervention programme to their real health needs.
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Affiliation(s)
- Victoria Mailen Arfuch
- Unitat de Suport a La Recerca Terres de l'Ebre, Institut Universitari d'Investigació En Atenció Primària Jordi Gol (Idiap Jordi Gol), Tortosa, Spain.,Department of Pediatrics, Obstetrics and Gynecology, and Preventive Medicine, Universitat Autònoma de Barcelona, Spain.,Insurance Medicine Division, Department of Neuroscience, Karolinska Institutet, Sweden
| | - Alessandra Queiroga Gonçalves
- Unitat de Suport a La Recerca Terres de l'Ebre, Institut Universitari d'Investigació En Atenció Primària Jordi Gol (Idiap Jordi Gol), Tortosa, Spain.,Unitat Docent de Medicina de Família I Comunitària Tortosa-Terres de L'Ebre, Institut Català de La Salut (Ics), Spain
| | - Rosa Caballol Angelats
- Centre d'Atenció Primària Baix Ebre Tortosa Est, Gerència Territorial de Terres de l'Ebre, Institut Català de La Salut (Ics), Tortosa, Spain.,Unitat d'Expertesa En Sindromes de Sensibilització Central Terres de l'Ebre, Gerència Territorial de Terres de l'Ebre, Institut Català de La Salut (Ics), Tortosa, Spain
| | - Carina Aguilar Martín
- Unitat de Suport a La Recerca Terres de l'Ebre, Institut Universitari d'Investigació En Atenció Primària Jordi Gol (Idiap Jordi Gol), Tortosa, Spain.,Unitat d'Avaluació, Direcció d'Atenció Primària Terres de l'Ebre, Gerència Territorial de Terres de l'Ebre, Institut Català de La Salut (Ics), Tortosa, Spain
| | - Noèlia Carrasco-Querol
- Unitat de Suport a La Recerca Terres de l'Ebre, Institut Universitari d'Investigació En Atenció Primària Jordi Gol (Idiap Jordi Gol), Tortosa, Spain
| | - Maria Cinta Sancho Sol
- Unitat d'Expertesa En Sindromes de Sensibilització Central Terres de l'Ebre, Gerència Territorial de Terres de l'Ebre, Institut Català de La Salut (Ics), Tortosa, Spain.,Centro de Salut Mental Adultos (Csma) de Fundació Pere Mata Terres de l'Ebre, Tortosa, Spain
| | - Gemma González Serra
- Unitat d'Expertesa En Sindromes de Sensibilització Central Terres de l'Ebre, Gerència Territorial de Terres de l'Ebre, Institut Català de La Salut (Ics), Tortosa, Spain.,Servei de Rehabilitació I Medicina Física, Hospital Verge de La Cinta, Gerència Territorial de Terres de l'Ebre, Institut Català de La Salut (Ics), Tortosa, Spain
| | - Immaculada Fusté Anguera
- Centre d'Atenció Primària Baix Ebre Tortosa Est, Gerència Territorial de Terres de l'Ebre, Institut Català de La Salut (Ics), Tortosa, Spain.,Unitat d'Expertesa En Sindromes de Sensibilització Central Terres de l'Ebre, Gerència Territorial de Terres de l'Ebre, Institut Català de La Salut (Ics), Tortosa, Spain
| | - Anna Berenguera
- Department of Pediatrics, Obstetrics and Gynecology, and Preventive Medicine, Universitat Autònoma de Barcelona, Spain.,Central Research Unit, Institut Universitari per a La Recerca a l'Atenció Primària de Salut Jordi Gol I Gurina (Idiapjgol), Barcelona, Spain.,Departament d'Infermeria, Universitat de Girona, Girona, Spain
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Hausteiner-Wiehle C, Henningsen P. [Body Experience and Body Interaction in Psychotherapeutic Diagnostics]. Psychother Psychosom Med Psychol 2021; 72:216-224. [PMID: 34781383 DOI: 10.1055/a-1641-0400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Since they are core features of many mental and psychosomatic disorders, disturbances of body experience and body interaction are relevant to understand and treat a particular patient. There are several body-related constructs, standardized psychometric instruments and experiments, focusing on single facets and following categorized evaluation. However, there is a lack of terminology and methods to individually and situationally understand and use body experience and body interaction in everyday clinical psychotherapeutic diagnostics. Based on clinical experience and a broad, topic-focused literature research, this discussion agenda delineates their core dimensions - bodily perception, body language, bodily changes, body-related narratives and actions, bodily resonance - and how to approach them by observation, mentalization, and relatedness.
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Affiliation(s)
- Constanze Hausteiner-Wiehle
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Klinikum rechts der Isar, Technische Universität München, Deutschland.,Psychosomatischer Konsil- und Liaisondienst, Neurologie, Klinische Neurophysiologie und Stroke Unit, Berufsgenossenschaftliche Unfallklinik Murnau, Deutschland
| | - Peter Henningsen
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Klinikum rechts der Isar, Technische Universität München, Deutschland
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Fernandez-Araque A, Gomez-Castro J, Giaquinta-Aranda A, Verde Z, Torres-Ortega C. Mishel's Model of Uncertainty Describing Categories and Subcategories in Fibromyalgia Patients, a Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3756. [PMID: 32466421 PMCID: PMC7312620 DOI: 10.3390/ijerph17113756] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/17/2020] [Accepted: 05/19/2020] [Indexed: 12/14/2022]
Abstract
The aim of this review was to demonstrate the presence of categories and subcategories of Mishel's model in the experiences of patients with fibromyalgia by reviewing qualitative studies. Uncertainty is defined as the inability to determine the meaning of disease-related events. A scoping review of qualitative studies was carried out. Twenty articles were included, with sample sizes ranging from 3 to 58 patients. Articles from different countries and continents were included. Three categories of the model and eight subcategories could be shown to be present in the experiences of fibromyalgia patients through the scoping review. The first category, concerning antecedents of uncertainty in patients with fibromyalgia, is constituted by the difficulty in coping with symptoms, uncertainty about the diagnosis and uncertainty about the complexity of the treatment. The second concerns the cognitive process of anxiety, stress, emotional disorder and social stigma. The third category refers to coping with the disease, through the management of social and family support and the relationship with health care professionals.
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Affiliation(s)
- Ana Fernandez-Araque
- Department of Nursing, Faculty of Health Sciences, University of Valladolid, 42004 Soria, Spain; (J.G.-C.); (A.G.-A.); (C.T.-O.)
| | - Julia Gomez-Castro
- Department of Nursing, Faculty of Health Sciences, University of Valladolid, 42004 Soria, Spain; (J.G.-C.); (A.G.-A.); (C.T.-O.)
| | - Andrea Giaquinta-Aranda
- Department of Nursing, Faculty of Health Sciences, University of Valladolid, 42004 Soria, Spain; (J.G.-C.); (A.G.-A.); (C.T.-O.)
- Haemodialysis Service, Santa Bárbara Hospital, 42005 Soria; Spain
| | - Zoraida Verde
- Department of Biochemistry, Molecular Biology and Physiology, University of Valladolid, 42004 Soria, Spain;
| | - Clara Torres-Ortega
- Department of Nursing, Faculty of Health Sciences, University of Valladolid, 42004 Soria, Spain; (J.G.-C.); (A.G.-A.); (C.T.-O.)
- Emergency Service of the Hospital Santa Bárbara, 42005 Soria, Spain
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