[Professional and psychological impact of second victims among hospital healthcare professionals]

OBJECTIVE

To analyze the occupational and psychological consequences suffered by healthcare workers who are considered second victims (SV).

MATERIAL AND METHODS

Observational, descriptive and cross-sectional study among the healthcare workers of a university hospital. The answers collected in a specifically designed questionnaire about psychological consequences at work and the result of a post-traumatic stress scale, "Impact of Event Scale-Revised (IES-R, spanish version)" were evaluated. The variables between the groups were compared using the Chi square test (or Fisher's exact test) when both were qualitative and with the Student's T (or the Mann-Whitney U test for independent data), when one of them was quantitative. The level of statistical significance was P<.05.

RESULTS

75.5% (148/207) of the participants in the study suffered some adverse event (AE) and, of these, 88.5% (131/148) were considered SV. Physicians had a 2.2 times higher risk of feeling SV than nurses (95% CI: 1.88-2.52). The impact on the patient related to the AE explained why the professionals involved in it felt SV (P=.037). 80.6% (N=104) of the SVs presented post-traumatic stress. Women were 2.4 times more likely to suffer from it (OR: 2.4; 95% CI: 1.5-4.0). Intrusive thoughts in the SV were almost three times more frequent when the damage suffered by the patient was permanent or death (OR: 2.5; 95% CI: 0.2-3.6).

CONCLUSIONS

Many healthcare workers, especially physicians, considered themselves to be SV, and many of them suffered from post-traumatic stress. The impact on the patient related to the AE was a risk factor for being SV and for suffering psychological consequences.

The factors that influence the adaptation process 6 months after a stroke: A path analysis

OBJECTIVE

The purpose of this study was to identify the determinant factors that influence the adaptation process and quality of life after a stroke.

METHODS

This study is an observational study using a cross-sectional design. Respondents were patients who were 6 months post-discharge after non-hemorrhagic strokae and their family caregivers. Information about respondents was taken from medical record data at two regional general hospitals in West Kalimantan Province, Indonesia. A total of 80 patients were selected using a consecutive sampling method. Theoretical models of patient and caregiver factors that influence adaptation responses and post-stroke quality of life were tested using path analysis.

RESULT

Caregiver coping, self-efficacy, and illness acceptance had a direct effect on the post-stroke psychosocial adaptation response by 58.1%, with self-efficacy contributing the most (β = 0.668, P < .0001). Self-efficacy, illness acceptance, and healthy behavior had a direct effect on the physiological adaptation response by 24.3%, where self-efficacy also contributed the most (β = 0.272, P < .014). Psychosocial adaptation and physiological adaptation had a direct effect on the quality of life by 54.6%, where psychosocial adaptation showed the largest contribution (β = 0.63, P < .0001).

CONCLUSION

Self-efficacy contributes the most to both psychosocial and physiological adaptations 6 months after stroke. Psychosocial adaptation and self-efficacy have been proven to be the determinant factors that contribute the most to the quality of life of patients 6 months after stroke.

[The effective post-stroke adaptation behavior model requires a family support system]

PURPOSE

This study aimed to explain the effective post-stroke adaptation behavior based on the Roy's adaptation model (RAM) through the patient experiences when undergoing the adaptation process after stroke.

METHODS

This study was qualitative used a phenomenological approach. The participants were patients undergoing post-stroke recovery at home with the following inclusion criteria: post-discharge from the hospital 2-3 months, and in stable medical condition. The data were collected through in-depth interviews. The data analysis was performed through content analysis. We used Lincoln and Guba's criteria to establish the trustworthiness of the study.

RESULTS

Three thematic categories structured the meaning of the stroke survivor's experience: (1) Problems after stroke; (2) Adaptive coping strategies and (3) Effective adaptation response.

CONCLUSION

A thematic analysis integrated with Roy's adaptation model generated an effective post-stroke adaptation model. We recommend the development of a family empowerment intervention framework to improve the adaptation behavior of stroke survivors.

Experiences and needs of patients undergoing clinical isolation. Phenomenological-hermeneutic study

OBJECTIVE

To know the experience lived by people subjected to hospital isolation, as well as to recognize the most significant needs expressed during this process.

METHOD

Qualitative study from a phenomenological-hermeneutical approach. The study participants were patients subjected to hospital isolation during their admission to the trauma ward of the Vall d'Hebron University Hospital. Six in-depth interviews were conducted and recorded by audio. The data was analyzed using a thematic content analysis.

RESULTS

The feedback from the participants in this study was essential to understand the experience lived by people subjected to hospital isolation. These perceptions were listed in the format of 5 categories related to the following experiences: loneliness, perception of "feeling like the last one", lack of communication, resilience and lack of attention and 3 categories related to their needs.

CONCLUSIONS

The findings suggest that isolation requires compliance with a series of rules and restrictions in the hospital setting that, despite its therapeutic purposes, can promote negative feelings. Based on the results of our research, we conclude that an effort should be made to improve actions aimed at minimizing these feelings in situations of isolation.

[Influence of the caregiver on the cognitive and functional decline of people with dementia: A systematic review]

Dementia is a neurodegenerative disease that requires the accompaniment of a caregiver who is in charge of assisting and supervising basic and psychosocial needs. The objective of this article was to determine the influence of the caregiver on the cognitive and functional decline of patients with dementia. The method was a systematic review by searching the Scopus, Pubmed and Science Direct databases between the years 2010-2020. In conclusion, the informal caregiver condition was the most reported by the investigations, generally assumed by wives and children; Caregiver characteristics such as personality, subjective interpretations of the functional status of adults with dementia, and caregivers' coping strategies were associated with a decrease in the rate of cognitive and functional impairment of people with dementia.

The effective post-stroke adaptation behavior model requires a family support system

PURPOSE

This study aimed to explain the effective post-stroke adaptation behavior based on the Roy's adaptation model (RAM) through the patient experiences when undergoing the adaptation process after stroke.

METHODS

This study was qualitative used a phenomenological approach. The participants were patients undergoing post-stroke recovery at home with the following inclusion criteria: post-discharge from the hospital 2-3 months, and in stable medical condition. The data were collected through in-depth interviews. The data analysis was performed through content analysis. We used Lincoln and Guba's criteria to establish the trustworthiness of the study.

RESULTS

Three thematic categories structured the meaning of the stroke survivor's experience: (1) Problems after stroke; (2) Adaptive coping strategies and (3) Effective adaptation response.

CONCLUSION

A thematic analysis integrated with Roy's adaptation model generated an effective post-stroke adaptation model. We recommend the development of a family empowerment intervention framework to improve the adaptation behavior of stroke survivors.

Living with chronic obstructive pulmonary disease: A story conditioned by the symptoms

OBJECTIVE

To determine the meaning of the experience of people with chronic obstructive pulmonary disease.

METHOD

A qualitative approach study rooted in hermeneutic phenomenology. In-depth interviews were conducted with 10 people with critical and severe chronic obstructive pulmonary disease.

RESULTS

The findings obtained are described in three emerging topics and their consequent subtopics, which describe the process of the disease focusing on five subtopics related to awareness of the disease, the choking characteristic of the disease and tiredness as daily unpleasant symptoms, as well as choking as a death threat, rejection of oxygen dependency and coping systems to control the disease. In the second topic, family support with two subtopics are described: the loss of the patient's role, the burden of care; and the third topic concerns the support of health system on two subtopics: medical care and nursing care.

CONCLUSION

The symptoms and functional changes in general, denote a different meaning not only in everyday life, but also in times of exacerbation of the condition. Likewise, changes in lifestyle due to the loss of roles and health care processes are revealed, as experiences that do not allow effective coping and adaptation.

Hospitalization due to bronchiolitis: factors influencing parents' experience

AIM

To describe the experience of the parents of children hospitalized due to bronchiolitis.

METHOD

Phenomenological qualitative study. Purposeful sampling was undertaken of parents with children diagnosed with bronchiolitis, from December 7, 2015 to January 8, 2016, and admitted to the paediatric department of a public hospital of the Madrid Health Service. Data collection strategies included focus groups and researchers' field notes. Afterwards, the data were analyzed using thematic analysis. We included 10 parents, aged between 30 and 39 years. Five themes were explored: perception of monitoring, need to know, perception of child fragility, coping strategies, and reorganization of the family environment.

RESULTS

Oxygen saturation monitoring through devices produced dependence and uncertainty in the parents. In addition, there was a need to know and understand the technical language, which encouraged searching for information on the Internet. The parents perceived the fragility of the hospitalized child through their appearance and physical state. In addition, they developed different coping strategies to seek and confirm information, to approach professionals and be present with their children. Finally, the family was reorganised to maintain the constant presence of the parents during hospitalization.

CONCLUSIONS

The results obtained can help paediatric professionals manage the information given to parents and thus empower them.

Transition to parenthood: consequences on health and well-being. A qualitative study

OBJECTIVE

Parenthood is one of the most dramatic developmental transitions in the family life cycle. It requires profound changes in lifestyle, roles and relationships, can increase stress levels and affects both men and women's quality of life. This study aimed to explore the effects on the health and well-being of parents during the first six months of transition to the parental role.

METHOD

A qualitative study using the grounded theory approach. Data collection was from semi-structured interviews (total of 60 interviews). The constant comparative method was used and theoretical sampling in the process of data collection and analysis, and the study was undertaken in a simultaneous and cyclical way. Five fathers and five mothers (couples) participated.

RESULTS

The category "living on the edge of one's capacities" was described, which is composed of the subcategories "feeling exhaustion", "perceiving exhaustion in the mother", "overflowing emotions" and "feeling less exhaustion", to explain the impact that the birth of a child had on the parents' lives, when taking on all the tasks and responsibilities of parenthood.

CONCLUSIONS

Adapting to parenthood is not easy, linear or fast. It involves numerous situations that generate stress and emotional disturbance, linked to tiredness, sleep disturbance, work overload and readjustments of the dynamics of life, which especially affect the mother. Antenatal and postnatal preparation for this impact should, therefore, be encouraged and effective, as a focus of nursing intervention.

[Caregiver's health: adaption and validation in a Spanish population of the Experience of Caregiving Inventory (ECI)]

OBJECTIVE

To adapt and to validate the Experience of Caregiving Inventory (ECI) in a Spanish population, providing empirical evidence of its internal consistency, internal structure and validity.

METHOD

Psychometric validation of the adapted version of the ECI. One hundred and seventy-two caregivers (69.2% women), mean age 57.51 years (range: 21-89) participated. Demographic and clinical data, standardized measures (ECI, suffering scale of SCL-90-R, Zarit burden scale) were used. The two scales of negative evaluation of the ECI most related to serious mental disorders (disruptive behaviours [DB] and negative symptoms [NS]) and the two scales of positive appreciation (positive personal experiences [PPE], and good aspects of the relationship [GAR]) were analyzed. Exploratory structural equation modelling was used to analyze the internal structure. The relationship between the ECI scales and the SCL-90-R and Zarit scores was also studied.

RESULTS

The four-factor model presented a good fit. Cronbach's alpha (DB: 0.873; NS: 0.825; PPE: 0.720; GAR: 0.578) showed a higher homogeneity in the negative scales. The SCL-90-R scores correlated with the negative ECI scales, and none of the ECI scales correlated with the Zarit scale.

CONCLUSIONS

The Spanish version of the ECI can be considered a valid, reliable, understandable and feasible self-report measure for its administration in the health and community context.

[Problems in the process of adapting to change among the family caregivers of elderly people with dementia]

OBJECTIVE

To identify and analyse problems in adapting to change among the family caregivers of relatives with dementia.

METHOD

Qualitative study based on the methodology of Charmaz's Constructivist Grounded Theory. Seven focus groups were conducted in different primary health care centres in the province of Jaen (Spain). Eighty-two primary family caregivers of relatives with dementia participated by purposeful maximum variation sampling and theoretical sampling. Triangulation analysis was carried out to increase internal validity.

RESULTS

We obtained three main categories: 'Changing Care', 'Problems in the process of adapting to change' and 'Facilitators of the process of adapting to change'. Family caregivers perform their role in a context characterized by personal change, both in the person receiving the care and in the social and cultural context. The challenge of adaptation lies in the balance between the problems that hamper adaptation of the caregiver to new situations of care and the factors that facilitate the caregiver role.

CONCLUSIONS

The adaptation of family caregivers to caring for a person with dementia is hindered by the lack of formal support and under-diagnosis of dementia. The adaptation process could be improved by strengthening formal support in the early stages of care to reduce the stress of family caregivers who must teach themselves about their task and by interventions adapted to each phase in the development of the caregiver role.

[Cultural scale adaptation and validation of the Spanish version of the BRCA Self-Concept Scale in women carriers at high risk for hereditary breast and ovarian cancer]

BACKGROUND AND OBJECTIVE

Having an inherited predisposition to cancer may have a psychological impact, and one goal of genetic counseling is to promote psychological adjustment to the new situation. Thus, in the genetic context, validated measures of adjustment are required. Given that self-concept is a good indicator of adjustment to the disease or to the risk for it, and a relevant variable in oncology, the goal of the study is to culturally adapt and validate the BRCA Self-Concept Scale.

MATERIAL AND METHOD

One hundred and sixty-five BRCA carriers' women answered to the questionnaire, previously adapted through a process of forward/back-translation, and to the Cancer Worry Scale (CWS) as a measure of convergent validity. Theoretical structure of BRCA Self-Concept Scale was assessed by expert judges, and submitted to a confirmatory factor analysis (CFA). Cronbach's α was calculated for each subscale (Stigma, Vulnerability and Control), and correlations with CWS were performed.

RESULTS

Expert judges' structure and CFA do not support the original structure of the questionnaire. The respecificity model (with items 10 and 13 loading on Vulnerability factor) show a better fit: comparative fit index 0.973; Tucker-Lewis index 0.968; root mean square error of approximation 0.067. The Cronbach's α is 0.83 for Stigma, 0.84 for Vulnerability, and 0.61 for Control. Evidence of convergent validity with CWS has been obtained (Spearman's rho 0.631 for Stigma, 0.683 for Vulnerability, and -0.363 for Control; P<.001).

CONCLUSIONS

Results support the validity of the modified Spanish BRCA Self-Concept Scale, which is a potentially useful measure for the study of psychological adjustment to high risk for hereditary breast and ovarian cancer.

Reliability and validity of the Spanish version of the modified Yale Preoperative Anxiety Scale

INTRODUCTION AND OBJECTIVE

To minimise preoperative stress and increase child cooperation during induction of anaesthesia is one of the most important perioperative objectives. The modified Yale Preoperative Anxiety Scale was developed to evaluate anxiety. The aim of this study was to translate into Spanish, and validate the psychometric properties of the Spanish version of this scale.

MATERIAL AND METHODS

The Spanish translation of the scale was performed following the World Health Organisation guidelines. During induction of anaesthesia, 81 children aged 2 to 12 years were recorded. Two observers evaluated the recordings independently. Content validity index of modified Yale Preoperative Anxiety Scale Spanish version was assessed. Weighted Kappa was calculated to measure interobserver agreement, and the Pearson correlation between the Induction Compliance Checklist and the modified Yale Preoperative Anxiety Scale was determined.

RESULTS

The Spanish version obtained high content validity (0.91 to 0.98). Reliability analysis using weighted Kappa statistics revealed that interobserver agreement ranged from 0.54 to 0.75. Concurrent validity was high (r=0.94; P<.001).

CONCLUSIONS

Validated assessment tools are needed to evaluate interventions to reduce child preoperative anxiety. The Spanish version of the modified Yale Preoperative Anxiety Scale evaluated in this study has shown good psychometric properties of reliability and validity.

[Somatic complaints, emotional awareness and maladjustment in schoolchildren]

INTRODUCTION

Somatic complaints are common in childhood. Research has shown their relationship with emotional awareness and maladjustment. The study had three objectives: 1) to analyze the prevalence of somatic complaints; 2) To explore the relationships between the variables evaluated: somatic complaints, differentiating emotions, verbal sharing of emotions, not hiding emotions, body awareness, attending to others' emotions, analysis of emotions, and personal, social, family, and school maladjustments; and 3) To identify predictors of somatic complaints.

PATIENTS AND METHODS

The study included a total of 1,134 randomly selected schoolchildren of both sexes between 10-12 years old (M=10.99; SD=0.88). The Somatic Complaint List, Emotional Awareness Questionnaire, and Self-reported Multifactor Test of Childhood Adaptation were used to gather information.

RESULTS

The results showed that the prevalence of somatic complaints was 90.2%, with fatigue, headache and stomachache being the most frequently. Dizziness and headache were more common in girls, and the frequency of complaints decreases with age. Somatic complaints are negatively related to emotional awareness, and positively related to maladjustment. The variables that contribute the most to the prediction of somatic complaints are personal maladjustment (25.1%) and differentiating emotions (2.5%).

CONCLUSIONS

The study shows that personal maladjustment is the best predictor of somatic complaints; the more emotional awareness and better adapted the child, the fewer somatic complaints they lodge. Childhood is a stage with significant physical discomfort.