Efectividad de un programa de intervención psicosocial enfermera para potenciar la agencia de autocuidado y la salud mental positiva en personas con problemas crónicos de salud

[spa] INTRODUCCIÓN: El sistema sanitario está apostando por un cambio de paradigma que se orienta hacia la implicación activa de los pacientes en su proceso de salud y; se propone poner énfasis en los pacientes con enfermedades crónicas, grandes consumidores de servicios sanitarios. Por otro lado, la situación actual obliga a repartir los recursos disponibles y, por tanto, es necesario un cambio en el modelo de actuación fomentando la participación de la población y, en este sentido, el ciudadano puede aportar mucho en su autocuidado. Procurar una salud mental positiva se incluye en las acciones saludables y pensamos que el contexto de las consultas de enfermería puede ser un espacio idóneo para ello. Este trabajo se postula en base a las posibilidades de intervención psicosocial de enfermería con pacientes con problemas crónicos y en la relación entre los constructos Agencia de Autocuidado y Salud Mental Positiva. Se planteó una investigación estructurada en dos fases. OBJETIVOS: Fase I: Describir las características sociodemográficas y las condiciones de salud física en pacientes con problemas crónicos de salud y explorar los niveles de Agencia de Autocuidado y de Salud Mental positiva y la correlación entre ambos constructos. Fase II: Evaluar la efectividad de un programa de intervenciones psicosociales de enfermería para potenciar la agencia de autocuidado y la salud mental positiva en personas adultas con problemas crónicos de salud física e identificar la utilidad del programa y la satisfacción del mismo. METODOLOGÍA: Fase I se planteó un estudio transversal, descriptivo, y correlacional. Fase II quasi-experimental, pretest-posttest, con grupo de intervención y grupo control. La muestra estuvo configurada en la Fase I por n=259 y en la Fase II por n= 44 grupos: de intervención (n=22) y control (n=22). En la Fase I se realizó un análisis descriptivo, de todas las variables. Los datos se analizaron con el paquete estadístico PASW-18, con una significación p-valor de <0.05. En la Fase II, para la comparación entre las variables categóricas se utilizó el test exacto de Fisher y para las variables cuantitativas la U de Mann-Whitney. Para determinar si la intervención era significativa se realizó un análisis multivariante (MANOVA) con las diferencias pretest-posttest entre el grupo de intervención y el grupo de control. RESULTADOS: Los instrumentos utilizados, Escala de Agencia de Autocuidado (ASA) y Cuestionario de Salud Mental Positiva (CSM+) obtuvieron una α de Cronbach de 0.73 y 0.91 respectivamente. La correlación entre ambos constructos la correlación fue muy significativa y bidireccional. En el programa de intervención psicosocial de enfermería se comprobó la efectividad del mismo con un aumento significativo en la agencia de autocuidado (ASA) y en la salud mental positiva (CSM+) (F [7,36]=28,51, p<0,0001). CONCLUSIONES: El perfil es el de una mujer de 66-75 años, con una capacidad de agencia de autocuidado medio y una salud mental positiva moderada-alta. Existe una relación bidireccional estadísticamente significativa entre los constructos: agencia de autocuidado y salud mental positiva. El programa de intervención fue efectivo generando un incremento de la agencia de autocuidado y de la salud mental positiva en el grupo de intervención.[eng] INTRODUCTION: The health system is committed to a paradigm shift towards the active involvement of patients in their process of health, and the strong emphasis is placed in patients with chronic diseases, who are the large consumers of health services. Conversely, the current situation requires distributing the available resources and consequently a change is necessary in the performance model. Thus, encouraging population participation can be a pathway to achieve this goal, and in this sense, citizens can contribute much to their self-care. Ensure a positive mental health is included in wholesome actions. The hypothesis of this project is based on the possibilities of psychosocial nursing interventions in patients with chronic physical health problems, and the relationship between of Self-Care Agency and Positive Mental Health. A research structured in two phases was designed. OBJECTIVES: In Phase I objectives were: To describe the sociodemographic characteristics and physical health conditions in patients with chronic health problems and explore the levels of the Self-Care Agency and Positive Mental Health, and the positive correlation between the two constructs. In Phase II the objectives were: Evaluate the effectiveness of a program of psychosocial nursing interventions to enhance the Self-Care Agency and positive mental health in adults with chronic physical health problems and identify the program's usefulness and satisfaction. METHODS: For Phase I sectional, descriptive, correlational study and for Phase II quasi-experimental, pretest-posttest studies were proposed, with intervention group and control group. The sample in Phase I included 259 people with chronic health problems; Phase II included 44 people, divided between the intervention (n = 22) and control (n = 22) groups. In Phase I was conducted a descriptive analysis of all variables. Data were analyzed with SPSS-18 statistical package, with a significant p-value of <0.05. In Phase II, Fisher's exact test was used for comparison between categorical variables, and the Mann-Whitney U test for quantitative variables. To determine whether the intervention was significant, multivariate analysis (MANOVA) with pretest-posttest differences between the intervention group and the control group was performed. RESULTS: The instruments used, Appraisal of Self-Care Agency Scale (ASA) and Positive Mental Health Questionnaire (CSM +) obtained a Cronbach α of 0.73 and 0.91 respectively. Analyzing the correlation between both constructs, the correlation was highly significant and bidirectional. The effectiveness of nursing psychosocial intervention program demonstrated a significant increase in self-care agency (ASA) and positive mental health (CSM +) (F [7,36] = 28.51, p <0 , 0001). CONCLUSIONS: The following conclusions were obtained: The profile of the sample studied is that of a woman of 66-75 years, with a moderate capacity in the self-care agency and a moderate medium-high positive mental health. There is a statistically significant two-way relationship between the constructs: self-care agency and positive mental health , so that the more efficient self-care a higher level of positive mental health. The nursing psychosocial intervention program was effective in generating an increase in self-care agency and positive mental health in the intervention group. The usefulness of exercises carried out and participant satisfaction were very high

Programa d'Intervenció Psicosocial d’Infermeria (PIPsI) per a potenciar la Salut Mental Positiva i l’Autocura

El Programa d'Intervenció Psicosocial d’Infermeria (PIPsI) que es presenta, és un programa d'intervenció dirigit a potenciar la Salut Mental Positiva i l'Autocura de les persones, realitzant intervencions psicosocials extretes de la Classificació d’Intervencions d’Infermeria, NIC (Bulechek, Carnisser, Dochterman i Wagner, 2014)

Programa de Intervención Psicosocial de Enfermería (PIPsE) para potenciar la Salud Mental Positiva y el Autocuidado

El Programa de Intervención Psicosocial de Enfermería (PIPsE) que se presenta, es un programa de intervención dirigido a potenciar la Salud Mental Positiva y el Autocuidado de las personas, realizando intervenciones psicosociales extraídas de la Clasificación de Intervenciones de Enfermería NIC (Bulechek, Carnicero, Dochterman y Wagner, 2014)

Análisis de las complicaciones del acceso vascular en hemodiálisis. Una revisión sistemática.

Introducción: El acceso vascular sigue siendo uno de los retos más importantes en todas las unidades de diálisis, por todas las complicaciones derivadas de su uso y el gran impacto en la morbimortalidad del enfermo renal. Los tres tipos de acceso vascular más utilizados son la fístula arteriovenosa nativa, el injerto o fístula arteriovenosa protésica y el catéter venoso central. Objetivo: Analizar y evaluar la situación actual y la incidencia de las complicaciones relacionadas con los diferentes accesos vasculares en hemodiálisis. Metodología: Se realizó una revisión sistemática en las bases de datos PubMed, CINAHL, SCOPUS y SciELO. Se incluyeron todos los artículos originales de menos de 5 años de antigüedad en los que uno de sus objetivos fuera analizar la prevalencia o incidencia de las complicaciones de cualquier acceso vascular en hemodiálisis en población adulta. Resultados: El número de artículos para el análisis fueron 15. De ellos, 14 fueron estudios observacionales y uno, un ensayo clínico multicéntrico. Se analizaron datos demográficos de los pacientes, la prevalencia de complicaciones entre todos los accesos vasculares y la incidencia de complicaciones según fístula nativa/protésica/catéter venoso central. Conclusiones: La fístula arteriovenosa nativa es el acceso vascular de elección ya que tiene tasas de complicaciones muy bajas. De entre ellas, la trombosis, es la complicación con más incidencia. El uso de catéter venoso central todavía es muy habitual, pese a ser el acceso vascular que presenta mayores tasas de complicaciones como las infecciones y la bacteriemia, produciéndose en un 10%-17% de los pacientes portadores

Nursing intervention to improve positive mental health and self-care skills in people with chronic physical health conditions

The exponential increase in the number of people suffering chronic illness has become a problem for which healthcare services need a response. The inclusion of self-care and positive mental health as part of a strategy to promote health offers an opportunity for a reorganization oriented towards community spaces and group interventions. This study undertook the assessment of an intervention designed to optimize the agency of and capacity for self-care and positive mental health by utilizing activities drawn from the Nursing Intervention Classification (NIC), specifically from Field 3 (Behavioral), and organized as a program called PIPsE. A quasi-experimental design was prepared with an intervention group (n = 22) and a control group (n = 22), in a primary care center in the Barcelona metropolitan area. The instruments used were two ad hoc questionnaires to collect sociodemographic and satisfaction information and two scales: the Appraisal of Self-care Agency Scale (ASA) and the Positive Mental Health Questionnaire (PMHQ). The results obtained showed a significant increase in self-care capacity and both overall positive mental health and mental health by factors in the intervention group

Effectiveness of the online 'Dialogue Circles' nursing intervention to increase positive mental health and reduce the burden of caregivers of patients with complex chronic conditions. Randomized clinical trial

The personal demands involved in caring for a chronically ill person can lead to emotional and physical exhaustion in caregivers. The aim of this study was to evaluate the effectiveness of an online nursing intervention called 'dialogue circles' designed to reduce caregiver overload and enhance positive mental health (PMH) in family caregivers. We used a pre-post design. The sample consisted of 86 family caregivers of patients with complex chronic conditions, randomly assigned to the intervention group (n = 43) or the control group (n = 43). All participants completed the Zarit scale and the Positive Mental Health Questionnaire 15 days before starting the intervention and 30 days after its completion. Comparison of the post-test changes revealed statistically significant differences between the two groups in PMH and overload, with the intervention group showing greater positive changes in all dimensions of PMH after the intervention and lower scores on overload. In conclusion, the results suggest that incorporating dialogue circles as an online nursing intervention in the caregivers of patients with complex chronic conditions can enhance PMH and decrease caregiver overload, especially in settings where face-to-face encounters are not possible

Rúbrica d’avaluació de l’activitat Pla d’Autocures

La rúbrica que es presenta és l’instrument per avaluar la pràctica del Pla d’Autocures que es realitza com activitat d’avaluació continuada en l’assignatura de Ciències Psicosocials Aplicades a la Salut, en el primer curs del Grau d’Infermeria

The experiences of family members of persons with intellectual disabilities who used residential care homes during the COVID-19 pandemic

Background: The global COVID-19 pandemic has shown the vulnerability of some population groups, including persons with intellectual and developmental disabilities (IDD). Aim: The present paper will provide more clarity and understanding of the experiences of family members of persons with IDD housed in residential facilities in Catalonia within the period of maximum restrictions during the COVID-19 pandemic. Methods and procedures: Semi-structured interviews were conducted using an interpretive phenomenological qualitative approach. Study participants consisted of 14 relatives of IDD individuals who were institutionalized in residence facilities or homes. The guiding questions emerged from group discussions with relatives of those with IDD who did not participate in the subsequent interviews. Drawing from this group, the factors that were identified to have had the greatest impact on their lives were later used to guide the interviews. Data collection was carried out in face-to-face individual interviews that were recorded together with the observations of two researchers between February and October 2022. Results: Our analysis identified 4 main themes that developed into additional factors: the decision to stay at home or in the residence, fear, illness, and protocol. Individuals with IDD lost their daily routines, suffered from social isolation, and did not understand the situation. Conclusion: The results of this study allow for a better understanding of the experiences of families of persons with IDD in residential centres during the lockdown by identifying their needs and how to better support them in the future. Outcomes and results: Knowledge and understanding of these events should allow for better management of similar situations in the future

BiFiSo-CSIC: balance de una lucha multidisciplinar contra la pandemia

En marzo de 2020 se declaró el estado de emergencia en España a raíz de una pandemia causada por el virus llamado SARS-CoV-2. La enfermedad, denominada COVID-19, produce una gran letalidad en personas de edad avanzada. Estas excepcionales circunstancias dictaron medidas inéditas en nuestro país: confinamiento domiciliario, cierre de colegios y comercios no esenciales. El Consejo Superior de Investigaciones Científicas (CSIC) reaccionó de inmediato: recién iniciado el confinamiento todos los investigadores de esta institución fueron convocados para dedicar parte de su tiempo a investigar sobre la pandemia. La respuesta fue instantánea y personas de todas las áreas de investigación se brindaron a contribuir con su granito de arena. Lo que al principio iba a suponer una media del 20% del tiempo de cada investigador pasó a ocupar toda la jornada: y así hasta hoy. En este contexto surge el proyecto BiFiSo, en el cual desde la biología, la filosofía o la antropología hemos estudiado y explicado la pandemia, complementando mutuamente la visión de nuestras respectivas especialidades.Consejo Superior de Investigaciones Científicas aporta financiación como institución fundacional de The Conversation ES. Universidad de Málaga aporta financiación como institución colaboradora de The Conversation ES.Peer reviewe

Assessing positive mental health in people with chronic physical health problems: correlations with socio-demographic variables and physical health status

Background: A holistic perspective on health implies giving careful consideration to the relationship between physical and mental health. In this regard the present study sought to determine the level of Positive Mental Health (PMH) among people with chronic physical health problems, and to examine the relationship between the observed levels of PMH and both physical health status and socio-demographic variables. Methods: The study was based on the Multifactor Model of Positive Mental Health (Lluch, 1999), which comprises six factors: Personal Satisfaction (F1), Prosocial Attitude (F2), Self-control (F3), Autonomy (F4), Problem-solving and Self-actualization (F5), and Interpersonal Relationship Skills (F6). The sample comprised 259 adults with chronic physical health problems who were recruited through a primary care center in the province of Barcelona (Spain). Positive mental health was assessed by means of the Positive Mental Health Questionnaire (Lluch, 1999). Results: Levels of PMH differed, either on the global scale or on specific factors, in relation to the following variables: age: global PMH scores decreased with age (r=-0.129; p=0.038); b) gender: men scored higher on F1 (t=2.203; p=0.028) and F4 (t=3.182; p=0.002), while women scored higher on F2 (t -3.086; p=0.002) and F6 (t=-2.744; p=0.007); c) number of health conditions: the fewer the number of health problems the higher the PMH score on F5 (r=-0.146; p=0.019); d) daily medication: polymedication patients had lower PMH scores, both globally and on various factors; e) use of analgesics: occasional use of painkillers was associated with higher PMH scores on F1 (t=-2.811; p=0.006). There were no significant differences in global PMH scores according to the type of chronic health condition. The only significant difference in the analysis by factors was that patients with hypertension obtained lower PMH scores on the factor Autonomy (t=2.165; p=0.032). Conclusions: Most people with chronic physical health problems have medium or high levels of PMH. The variables that adversely affect PMH are old age, polypharmacy and frequent consumption of analgesics. The type of health problem does not influence the levels of PMH. Much more extensive studies with samples without chronic pathology are now required in order to be able to draw more robust conclusions