Respuestas psicológicas disfuncionales en enfermeros de Unidades de Cuidados Intensivos: una revisión sistemática de la literatura

OBJETIVOBuscar evidencias de respuestas psicológicas disfuncionales en Enfermeros de Unidades de Terapia Intensiva, con enfoque en la ansiedad, síntomas depresivos y factores relacionados.MÉTODORevisión sistemática, con evaluación crítica y síntesis de datos de los estudios, llevada a cabo en las bases de datos CINAHL, PubMed y Scopus, en el período de 1999 hasta el presente, utilizándose los siguientes términos de investigación, individualmente o en combinación: "estado mental", "síntomas depresivos", "ansiedad", "enfermeros de UCI", "estrés post traumático", "burnout", "fatiga por compasión" y "estrés psicológico".RESULTADOFueron incluidos trece estudios cuantitativos en Inglés y Griego. Los resultados sugieren un incremento de la carga psicológica en los Enfermeros de UCI comparativamente con otras especialidades de enfermería, así como con la población en general.CONCLUSIÓNEstudios internacionales de investigación acerca de la respuesta psicológica son limitados. Estudios futuros, longitudinales y de intervención, contribuirán a una mejor comprensión del fenómeno.OBJECTIVETo systematically review evidence on dysfunctional psychological responses of Intensive Care Units nurses (ICUNs), with focus on anxiety and depressive symptoms and related factors.METHODA literature search was performed in CINAHL, PubMed and Scopus databases, from 1999 to present, along with a critical appraisal and synthesis of all relevant data. The following key words, separately and in combination, were used: "mental status" "depressive symptoms" "anxiety" "ICU nurses" "PTSD" "burnout" "compassion fatigue" "psychological distress".RESULTSThirteen quantitative studies in English and Greek were included. The results suggested increased psychological burden in ICUNs compared to other nursing specialties, as well as to the general population.CONCLUSIONSStudies investigating psychological responses of ICUNs are limited, internationally. Future longitudinal and intervention studies will contribute to a better understanding of the phenomenon.OBJETIVORever sistematicamente evidências de respostas psicológicas disfuncionais em Enfermeiros de Unidades de Cuidados Intensivos (EUCI), com foco na ansiedade, sintomas depressivos e fatores relacionados.MÉTODOFoi realizada uma pesquisa bibliográfica, com avaliação crítica e síntese de dados dos estudos, nas bases de dados da CINAHL, PubMed e Scopus, para o período de 1999 até ao presente. Foram utilizados os seguintes termos de pesquisa, individualmente ou em combinação: "estado mental" "sintomas depressivos" "ansiedade" "enfermeiros de UCI" "PTSD" "burnout" "fadiga da compaixão" "stress psicológico".RESULTADOForam incluídos treze estudos quantitativos em Inglês e Grego. Os resultados sugerem um aumento da carga psicológica nos EUCI comparativamente com outras especialidades de enfermagem, assim como com a população em geral.CONCLUSÕESEstudos internacionais de investigação sobre a resposta psicológica de EUCI são limitados. Estudos futuros, longitudinais e de intervenção, irão contribuir para uma melhor compreensão do fenômeno

Sintomas de ansiedade e qualidade da interacção entre equipes de enfermagem oncológica: um estudo correlacional e transversal

OBJETIVO Explorar a gravidade dos Sintomas de Ansiedade (SA) entre equipes de enfermagem Gregas, o grau de satisfação nas relações profissionais e a potencial associação entre estes indicadores. MÉTODO Estudo transversal e correlacional realizado em dois hospitais oncológicos Gregos, abrangendo 72 membros das equipes de enfermagem. A escala de ansiedade Hamilton foi utilizada para a avaliação da severidade dos Sintomas de Ansiedade, assim como a subescala do índice de Satisfação no Trabalho "Satisfação da Interação" para o grau de satisfação resultante das relações profissionais entre o pessoal de enfermagem (PE) e entre o pessoal de enfermagem e médicos (EM). RESULTADOS 11% da amostra revela SA clínicos [≥26, escala: 0-52]. Satisfação da interação profissional entre o PE [5.10 (SD: 1.04), SR: 1-7] e EM [4.21 (SD: 0.77), SR: 1-7], demonstrando que foi moderada em ambos os grupos. Significativas associações estatísticas foram observadas entre Sintomas de Ansiedade clínicos e a satisfação de interação profissional entre pessoal de enfermagem (p=0.014) e EM (p=0.013). CONCLUSÃO Ações para a redução da ansiedade e melhora das relações profissionais são essenciais de forma a reduzir o stress psicológico nas equipas de enfermagem em oncologia.OBJECTIVE To explore the severity of Anxiety Symptoms (AS) among Greek oncology nursing personnel, the degree of satisfaction from professional relationships, and potential association between them. METHOD A descriptive cross-sectional correlational study was performed in 2 Greek Oncology Hospitals, in 72 members of nursing personnel. Hamilton Anxiety Scale was used for the assessment of AS severity and the Index of Work Satisfaction subscale "Satisfaction from Interaction" for the degree of satisfaction from professional relationships among nursing personnel (NN) and between nursing personnel and physicians (NP). RESULTS 11% of the sample reported clinical AS [≥26, scale range (SR): 0-52]. Satisfaction from NN [5.10 (SD: 1.04), SR: 1-7], and NP [4.21 (SD: 0.77), SR: 1-7] professional interaction were both moderate. Statistically significantly associations were observed between clinical AS and satisfaction from NN (p=0.014) and NP (p=0.013) professional interaction. CONCLUSIONS Anxiety reduction interventions and improvement of professional relationships are essentials in order to reduce oncology nurses' psychological distress.OBJETIVO Explorar la gravedad de los Síntomas de Ansiedad (SA) entre los equipos de la enfermería oncológica Griega, el grado de satisfacción en las relaciones laborales y la potencial asociación entre estos indicadores. MÉTODO Estudio transversal y correlacional, se realizó en dos hospitales de Oncología Griegos, en 72 miembros de los equipos de enfermería. Fue utilizada la Escala de Ansiedad de Hamilton para la evaluación de la gravedad de SA y también la subescala del índice de Satisfacción en el Trabajo "Satisfacción de Interacción" para evaluar el grado de satisfacción de las relaciones laborales entre el personal de enfermería (PE) y entre el personal de la enfermería y los médicos (EM). RESULTADOS 11% de la muestra informó SA clínicos [≥26, escala: 0-52]. La satisfacción de la interacción profesional entre el PE [5.10 (SD: 1.04), SR: 1-7] y el EM [4.21 (SD: 0.77), SR: 1-7] fue moderada en ambos grupos. Significativas asociaciones estadísticas fueron notadas entre los SA clínicos y la satisfacción de la interacción profesional entre el PE (p=0.014) y el EM (p=0.013). CONCLUSIÓN Las técnicas de reducción de la ansiedad y del mejoramiento entre las relaciones laborales, son extremadamente importantes, con el fin de reducir el estrés psicológico en los equipos de enfermería de oncología

Φαινομενολογική διερεύνηση της βιωμένης εμπειρίας των ψυχικά πασχόντων από τη νόσο τους στην Κύπρο

Εισαγωγή: Ερευνητικά δεδομένα δείχνουν ότι η κατανόηση των προβλημάτων των ατόμων με σοβαρή ψυχική νόσο είναι δύσκολο να επιτευχθεί από τους επαγγελματίες υγείας, με αποτέλεσμα οι ψυχικά πάσχοντες να μη δείχνουν εμπιστοσύνη σε αυτούς και στις παρεχόμενες υπηρεσίες. Σκοπός: Σκοπός της παρούσας μελέτης ήταν η διερεύνηση των αντιλήψεων και νοημάτων των ψυχικά πασχόντων σχετικά με: α) τη νόσο τους, συνολικά, β) την προσωπική τους εικόνα στο πλαίσιο της νόσου τους, γ) τις κοινωνικές επιπτώσεις που βιώνουν, λόγω της νόσου τους και δ) την ποιότητα των διαπροσωπικών θεραπευτικών σχέσεων με τους νοσηλευτές ψυχικής υγείας /επαγγελματίες υγείας. Υλικό & Μέθοδος: Εφαρμόστηκε ποιοτική μεθοδολογία βάσει φαινομενολογικής μεθόδου κατά van Manen. Το δείγμα, το οποίο επιλέχθηκε με σκόπιμη δειγματοληψία και βάσει του κριτηρίου του θεωρητικού κορεσμού, αποτέλεσαν 10 άτομα με παγιωμένη ψυχική νόσο, τα οποία χρησιμοποιούσαν κοινοτική υπηρεσία ψυχικής υγείας σε επαρχιακή πόλη της Κύπρου. Η συλλογή των δεδομένων έγινε μέσω ατομικών συνεντεύξεων. Οι συνεντεύξεις βασίστηκαν πάνω σε ημι-δομημένο οδηγό, ο οποίος αναπτύχθηκε βάση βιβλιογραφίας και ελέγχθηκε ως προς την καταλληλότητα της κάθε ερώτησης από ομάδα ειδικών. Αποτελέσματα: Ως πυρηνικό θέμα της βιωμένης εμπειρίας της σοβαρής ψυχικής νόσου, αναδύθηκε η επιγένεση της προσωπικότητας και η απόκτηση μιας νέας προοπτικής για τη ζωή. Αυτό φάνηκε να αφορά σε μια εσωτερική διαδικασία και να συνιστά το συνολικό αποτέλεσμα της πορείας του ατόμου στη νόσο και της μακρόχρονης προσπάθειάς του να αποδεχτεί: α) την αποτελεσματικότητα και αναγκαιότητα της φαρμακοθεραπείας και β) τη φύση και τους περιορισμούς της νόσου. Περαιτέρω, περιγράφηκαν έξι κύρια θέματα και αρκετά επιμέρους υποθέματά. Ως προς το νόημα της ψυχικής νόσου διατυπωθήκαν τα παρακάτω επιμέρους θέματα: α) η επιλογή του ψευδωνύμου, β) η ανυπόφορη ψυχική νόσος, γ) ψυχική νόσος: μία εξωτερική προς το άτομο οντότητα, δ) οι αιτίες της ψυχικής νόσου, ενώ ως προς τη φαρμακοθεραπεία: α) οι διαφορετικές φάσεις της νόσου στο χρόνο με σημείο αναφοράς τη θεραπεία και τη φαρμακευτική αγωγή, β) η αναγκαιότητα της φαρμακευτικής αγωγής, γ) οι αιτίες διακοπής της φαρμακευτικής αγωγής. Περαιτέρω, ως προς την αντίληψη της ατομικής εικόνας στο πλαίσιο της νόσου, ταυτοποιήθηκαν τα εξής: α) η αντίληψη της προσωπικής εικόνας στο πλαίσιο της νόσου, β) οι διαφορετικές πτυχές της ατομικής οντότητας στην πορεία της νόσου και η συνεπακόλουθη αλλαγή της αντίληψης της προσωπικής εικόνας, γ) η κατακερματισμένη υπόσταση του ατόμου στο πλαίσιο της νόσου, δ) η αντίληψη της προσωπικής αξίας και των προσωπικών ικανοτήτων στην πορεία της νόσου: η δυσάρεστη αλλαγή στην αντίληψη της ατομικής εικόνας. Αναφορικά με τις επιπτώσεις λόγω της νόσου, αυτές φάνηκε να προκύπτουν είτε λόγω κοινωνικού στιγματισμού (κοινωνική υποτίμηση της προσωπικής αξίας, πτώση αυτοεκτίμησης, περιορισμένη προσωπική και ρομαντική ζωή, περιορισμένη επαγγελματική ζωή και σταδιοδρομία, κοινωνική ζωή και οικονομική ζωή), ενώ οι απώλειες λόγω της φύσης της νόσου αφορούσαν κύρια σε διαστάσεις της: α) κοινωνικής ζωής, β) προσωπικής ζωής, γ) επαγγελματικής ζωής και εκπαίδευσης. Άλλα κύρια θέματα αφορούσαν στις Κοινοτικές Υπηρεσίες Ψυχικής Υγείας (ένα μέσο για την ευεξία & την ασφάλεια και η τραυματική εμπειρία της νοσηλείας στο νοσοκομείο Αθαλάσσας, στις σχέσεις με τους νοσηλευτές ψυχικής υγείας (η δυναμική της σχέσης με τους Νοσηλευτές Ψυχικής Υγείας, ο βαθμός ικανοποίησης από την παρεχόμενη νοσηλευτική φροντίδα) και στην ανάγκη των συμμετεχόντων να ακουστούν. Συμπεράσματα: Στην παρούσα μελέτη επισημαίνεται η σπουδαιότητα της αλλαγής του τρόπου με τον οποίο λειτουργούσε και υφίστατο η προσωπικότητα του ατόμου πριν από την έναρξη της σοβαρής ψυχικής νόσου και της θεραπείας της, προκειμένου ο πάσχων να αποκτήσει μία αντίληψη για την κανονικότητα. Το δεδομένο αυτό μπορεί να αποτελέσει εφαλτήριο για τη διαμόρφωση στοχευόμενων παρεμβάσεων ενδυνάμωσης των ψυχικά πασχόντων. Παράλληλα, στη μελέτη αυτή αναδύθηκε η σπουδαιότητα παρεμβάσεων ενδυνάμωσης της προσωπικής ταυτότητας, όπως φαίνεται να εκφράζεται αυτή στις διαφορετικές φάσεις της νόσου και της θεραπείας της. Επιπλέον, επισημαίνεται η ανάγκη περαιτέρω μελετών διερεύνησης του τρόπου αντίληψης της εικόνας του εαυτού στις διαφορετικές φάσεις της νόσου. Συνολικά, τα ευρήματα της μελέτης φαίνεται να συμβάλλουν στην ενίσχυση της ενσυναίσθησης των επαγγελματιών υγείας σε σχέση με τις εξατομικευμένες ανάγκες των ψυχικά πασχόντων, δεδομένου ότι αναδείχτηκαν νέες διαστάσεις της εμπειρίας αυτής. Επιπλέον, αναγκαίες θεωρούνται περαιτέρω μελέτες παρέμβασης περιορισμού του κοινωνικού στίγματος για τη ψυχική νόσο, τόσο σε κοινωνικό επίπεδο, όσο και αναφορικά με τους επαγγελματίες υγείας συνολικά.Background: research shows that understanding the problems of people with serious mental illness (SMI) is difficult for health professionals to achieve. As a result, people with mental health problems do not show confidence in healthcare professionals and in the provided services. Aim: The exploration of mentally ill patients’ perceptions and meanings regarding: a) their illness, in total, b) their self-image throughout their illness, c) the lived social implications following their illness and d) the quality of the inter personal therapeutic relationship with mental health nurses/health professionals. Design & Method: A qualitative methodological approach based on Van Manen was employed. The sample which was selected through purposive sampling and based on theoretical saturation, consisted with 10 people with serious mental illness, that they were recruited from a Day Center in a district of Cyprus. Data collection was conducted via personal interviews. Interviews were based on a semi structured interview guide, which was based on literature and was tested for the suitability of each question by a panel of experts. Results: As the core theme of the lived experience of serious mental illness epi-genesis of the personality and of gain of a new prospective of life, was revealed. This seemed to relate to an internal process and to propose the result of the totality of the individual’s disease course and the lengthy period of trying to accept the effectiveness and the necessity of medication, as well as the nature of the disease and its limitations. In addition, six main themes and several subthemes were described. As far as the meaning of mental illness, the following subthemes were defined: a) the selection of pseudonym, b) the unbearable mental illness, c) mental illness as an external entity towards the person, d) the causes of mental illness, while as far as the pharmacotherapy: a) the different phases of illness in time with pharmacotherapy as a bookmark, b) the necessity of pharmacotherapy, c) reasons for stopping pharmacotherapy. In addition, as far as the perception of personal image through the continuum of illness, the following were identified: a) the perception of personal image within the context of illness, b) the different aspects of the individual’s entity through the continuum of illness and the consequent change of it’s personal image, c) the fragmented individuals status within the context of the illness, d) the perception of personal value and personal abilities through the continuum of the illness: the unpleasant change in the perception of one’s personal image. As far as the consequences due to the illness, those seemed to be the result, either of the social stigma (social devaluation of the personal value, due to low self-esteem, due to deteriorating personal and romantic life, due to deteriorating professional and career life, social life and financial life), while other losses due to the nature of the illness were mainly referred to the dimensions of a) social life, b) personal life and c) professional life and education. Other main themes concerned the Community Mental Health Services (a means for happiness and safety and the traumatic experience of hospitalization (Athalassa Hospital), and the relationship with mental health nurses (a dynamic relationship with Mental Health Nurses, the degree of satisfaction of the provided nursing care) and participants need to be heard. Conclusions: This study highlights the importance of changing the way in which the personality of the person was functioning and existed before the onset of serious mental illness and its treatment, in order for the sufferer to obtain a notion of normality. This data could enhance the formation of targeted Cognitive Behavioral Intervention for the mentally ill. Furthermore, within the current study, the importance of empowerment interventions of the self-identity emerged, which seems to express the different phases of illness and its therapy. Additionally, it has emerged the way a person perceives his personal image throughout the different phases of the illness. Overall, the findings appeared to contribute to the enhancement of the health professional’s empathy in relation to the individual’s needs, based on the fact that new perspectives of such experience. In addition, further intervention studies of limiting mental illness stigma, both in social level and in relation to health professionals in total, are considered to be essential.Κωνσταντίνος Ν. Φελλάς (Πρόεδρος) Νίκος Μίτλεττον (Μέλος)Complete

Undergraduate nursing students caring for cancer patients: hermeneutic phenomenological insights of their experiences

Background: The care of patients suffering from cancer and especially those facing the death trajectory appears to be complex and demanding not only for student nurses but for professional nurses as well. The educational models often used in nursing require students to face challenging care scenarios, sometimes with minimal or no supervision and guidance. These "worst case scenarios" can be traumatic experiences that can leave the student hopeless and disappointed of themselves and in many cases can "scar" their subsequent professional career. The literature demonstrates that this can be the result of the students' ill-preparation to care for cancer patients and deal with death and dying. The purpose of this study was to interpret the students' experiences of coming face-to-face with cancer care during their clinical placements. Methods. This is a hermeneutic phenomenological study influenced by the ideas of the French Philosopher Paul Ricoeur. Based on this philosophical enquiry the interpretation process included three stages: 1) naïve reading, 2) structural analysis and 3) comprehensive understanding. Data were collected through reflective/narrative diaries from the 4th grade undergraduate (pre-registration) nursing students practicing at oncology, hematology, pediatric oncology departments and hospices. Diaries of twelve students met the inclusion criteria and were included in the interpretation process. The study took place during January and May 2011. Results: The interpretation yielded the following themes: a) Being part of the center's life, b) Being sympathetic, c) Being confronted by others, d) Being self-reflective, e) Being trapped in the system, f) Being caring towards the family and g) Being better in clinical practice. Conclusions: The students emphasized the need for appropriate preparation both at a theoretical and at a clinical level, as to better confront situations involving death and dying as well as learning techniques for crisis management. The students perceived the importance of adopting a policy that is both patient and family-centered in order to provide better care

Greek-Cypriot mental health nurses' professional satisfaction and association with mild psychiatric symptoms

The present descriptive correlational study aims to explore among Greek-Cypriotmental health nurses (MHNs) the level of professional satisfaction, potential differences with regardto vocational characteristics, and associations with anxiety and depressive symptoms. A random sampleof 225 Greek-Cypriot MHNs employed in hospital and community settings completed Hamilton’sAnxiety Scale, Beck’s Depression Inventory, and Stamps’s Index of Work Satisfaction. Moderate levelsof overall professional satisfaction of 4.38 (Ϯ0.58) were detected. Work experience was positivelycorrelated with satisfaction from payment (t = 0.230, P < 0.0001). Men seemed to be more satisfied withorganizational policies (P = 0.0043) and performed tasks (P = 0.027) than women. Nurses working inpsychiatric clinics of general hospitals experienced higher levels of professional satisfaction in general,and more satisfaction from organizational policies, autonomy, and task requirements than nursesworking in community settings, substance misuse programs, and community mental health centres(P = 0.001). Nurses working in acute/admission settings were the less satisfied, compared to nursesworking in rehabilitation wards (P = 0.017). Professional satisfaction was associated with anxiety(t = 0.280, P < 0.0001) and depressive (t = 0.246, P < 0.0001) symptoms. Greek-Cypriot MHNs seem toget moderate satisfaction from their work, whilst professional satisfaction is associated with theirpsychological well-being. Targeted managerial interventions and longitudinal research are warranted