Factores de protección y de riesgo para la salud mental de las mujeres después de un aborto espontáneo

Objetivo: examinar factores de protección y de riesgo personales y contextuales asociados a la salud mental de la mujer después de un aborto espontáneo. Método: se llevó a cabo un estudio transversal en el que 231 mujeres que habían sufrido un aborto espontáneo en los últimos 4 años respondieron a un cuestionario online de autoinforme para evaluar su salud mental (síntomas de depresión, ansiedad, duelo perinatal) y para recopilar características personales y contextuales. Resultados: las mujeres que habían sufrido un aborto espontáneo en los últimos 6 meses obtuvieron una puntuación más alta en lo que respecta a síntomas de depresión que las que lo habían sufrido entre 7 y 12 meses atrás, mientras que el nivel de ansiedad y el duelo perinatal no variaron según el tiempo transcurrido desde la pérdida. Además, la baja condición socioeconómica, el estado de inmigración y la falta de hijos se asociaron con una peor salud mental después de un aborto espontáneo. En cambio, la calidad de la relación conyugal y la satisfacción con la atención de la salud se asociaron positivamente con la salud mental de las mujeres. Conclusión: las mujeres en situaciones vulnerables, como las inmigrantes, las de baja condición socioeconómica o las mujeres sin hijos son especialmente vulnerables a problemas de salud mental después de un aborto espontáneo. Sin embargo, más allá de esos factores personales y contextuales, la calidad de la relación conyugal y la satisfacción con el cuidado de la salud podrían ser importantes factores de protección.Objetivo: examinar os fatores pessoais e contextuais de proteção e de risco associados à saúde mental das mulheres após aborto espontâneo. Método: foi realizado um estudo transversal, no qual 231 mulheres que sofreram aborto espontâneo nos últimos quatro anos responderam a um questionário on-line, cujo intuito era avaliar a saúde mental (sintomas de depressão, ansiedade, luto perinatal) e coletar informações pessoais, além de características contextuais. Resultados: mulheres que sofreram aborto espontâneo nos últimos seis meses apresentaram escores mais altos para sintomas depressivos do que mulheres que sofreram aborto espontâneo entre sete e 12 meses atrás, ao passo que o nível de ansiedade e o luto perinatal não variaram de acordo com o tempo transcorrido desde a perda. Além disso, baixo nível socioeconômico, status de imigrante e ausência de filhos foram associados a pior saúde mental após aborto espontâneo. Por outro lado, a qualidade do relacionamento conjugal e a satisfação com a assistência à saúde foram associadas positivamente à saúde mental das mulheres. Conclusão: mulheres em situação de vulnerabilidade, como as imigrantes, com baixo nível socioeconômico ou sem filhos estão particularmente vulneráveis a problemas de saúde mental após um aborto espontâneo. No entanto, além desses fatores pessoais e contextuais, a qualidade do relacionamento conjugal e a satisfação com a assistência à saúde podem ser importantes fatores de proteção.Objective: to examine personal and contextual protective and risk factors associated with women’s mental health after a spontaneous abortion. Method: a cross-sectional study was carried out where 231 women who had experienced spontaneous abortions in the past 4 years answered a self-reporting online questionnaire to assess their mental health (symptoms of depression, anxiety, perinatal grief) and to collect personal as well as contextual characteristics. Results: women who had experienced spontaneous abortions within the past 6 months had higher scores for depressive symptoms than those who had experienced spontaneous abortions between 7 and 12 months ago, while anxiety level and perinatal grief did not vary according to the time since the loss. Moreover, low socioeconomic status, immigrant status, and childlessness were associated with worse mental health after a spontaneous abortion. In contrast, the quality of the conjugal relationship and the level of satisfaction with health care were positively associated with women’s mental health. Conclusion: women in vulnerable situations, such as immigrants, women with a low socioeconomic status, or childless women are particularly vulnerable to mental health problems after a spontaneous abortion. However, beyond those personal and contextual factors, the quality of the conjugal relationship and the level of satisfaction with health care could be important protective factors

L’enseignement des enjeux de la paternité dans les universités canadiennes

Un nombre significatif de chercheurs et de cliniciens portent attention au développement du rôle du père dans la famille, particulièrement sous l’angle de l’engagement paternel. Pourtant, l’examen pancanadien des curriculums d’enseignement universitaire en soins infirmiers effectué en 2002 a révélé que dans 68 institutions offrant la formation de premier cycle en soins infirmiers, peu de cours portaient spécifiquement ou indirectement sur les pères ou la paternité. Une autre étude auprès de 30 étudiants de premier cycle en sciences infirmières, en pratiques sages-femmes et en travail social a révélé que ces étudiants se sentaient inconfortables à interagir avec les pères, surtout lors de situations plus critiques émotionnellement. Ces études ont conduit un groupe de chercheurs québécois à développer un cours interdisciplinaire de cycles supérieurs portant sur les enjeux de la paternité. Cet article vise à présenter brièvement les résultats des deux études citées, ainsi qu’à donner un aperçu de la structure du cours proposé. Les retombées pour le développement ultérieur de curriculums d’enseignement seront discutées.Fathers being important members of the family, a significant number of scholars have paid attention to the development of the father’s role in the family, particularly in regards to father involvement. However, an examination of the curricula in nursing carried out in 2002 by members of the Fathers’ Initiative in Educational Institutions (FI-EI) revealed that within 68 universities offering undergraduate nursing programs, very few courses referred specifically or even indirectly to fathers and fatherhood. Also, a qualitative study carried out from 2005-2007, with 30 undergraduate nursing, midwives and social work students revealed that students did not feel at ease in their interactions with fathers and required additional theory and models to sustain their feelings of adequacy. A group of researchers from Quebec have developed in 2007 an online graduate course pertaining to fatherhood, within an interdisciplinary perspective. This article will highlight the results of the two studies cited and an outline of the course developed. The implications for further curriculum development pertaining to fatherhood will be discussed

Multicountry study protocol of COCOON: COntinuing Care in COVID-19 Outbreak global survey of New, expectant, and bereaved parent experiences

Introduction Globally, the COVID-19 pandemic has significantly disrupted the provision of healthcare and efficiency of healthcare systems and is likely to have profound implications for pregnant and postpartum women and their families including those who experience the tragedy of stillbirth or neonatal death. This study aims to understand the psychosocial impact of COVID-19 and the experiences of parents who have accessed maternity, neonatal and bereavement care services during this time. Methods and analysis An international, cross-sectional, online and/or telephone-based/face-to-face survey is being administered across 15 countries and available in 11 languages. New, expectant and bereaved parents during the COVID-19 pandemic will be recruited. Validated psychometric scales will be used to measure psychosocial well-being. Data will be analysed descriptively and by assessing multivariable associations of the outcomes with explanatory factors. In seven of these countries, bereaved parents will be recruited to a nested, qualitative interview study. The data will be analysed using a grounded theory analysis (for each country) and thematic framework analysis (for intercountry comparison) to gain further insights into their experiences. Ethics and dissemination Ethics approval for the multicountry online survey, COCOON, has been granted by the Mater Misericordiae Human Research Ethics Committee in Australia (reference number: AM/MML/63526). Ethics approval for the nested qualitative interview study, PUDDLES, has been granted by the King's College London Biomedical & Health Sciences, Dentistry, Medicine and Natural & Mathematical Sciences Research Ethics Subcommittee (reference number: HR-19/20-19455) in the UK. Local ethics committee approvals were granted in participating countries where required. Results of the study will be published in international peer-reviewed journals and through parent support organisations. Findings will contribute to our understanding of delivering maternity care services, particularly bereavement care, in high-income, lower middle-income and low-income countries during this or future health crises

Adaptation of an existing measure to assess professionals’ attitudes regarding the importance of involving fathers in interventions with families

Introduction. Despite greater father participation in child care/rearing nowadays and the challenge of involving fathers in nursing interventions, no instrument exists to measure professional attitudes toward father involvement in family interventions. Objectives. The aim of this study was to adapt an existing measure that assesses nurse attitudes regarding the importance of including families in nursing care into a measure that assesses professionals’ attitudes towards the importance of involving fathers in interventions with families. Method. The Professionals’ Attitudes towards Father Involvement (PAFI) scale was adapted from the Families’ Importance in Nursing Care – Nurse Attitudes (FINC-NA) scale. A total of 297 professionals in family care completed the 26 items of the PAFI. Results. Items analysis indicated three items had low variability and abnormal distribution. Principal component analysis was conducted with the 23 remaining items. Results revealed a solution with four factors reproducing the structure of the original scale: Father as conversational partner, Father as resource, Father as burden, and Father as own resource. Most items loaded on their original factor. The four subscales and the global scale showed good internal consistency. Discussion and conclusion. Even though further studies are needed, this adapted scale now enables researchers and practitioners to assess professionals’ attitudes towards the importance of involving fathers in interventions with families.Introduction. Les pères sont de plus en plus engagés auprès de leurs enfants. Plusieurs professionnels, dont les infirmières, peinent à s’adapter à cette nouvelle réalité. Aucune échelle n’existe pour mesurer l’attitude des professionnels par rapport à l’importance d’inclure les pères dans leurs interventions. Objectifs. Le but de cette étude est d’adapter une échelle qui mesure les attitudes des infirmières quant à l’importance d’inclure les familles dans leurs soins pour en faire un instrument permettant de mesurer les attitudes des professionnels envers l’importance d’inclure les pères dans leurs interventions auprès des familles. Méthodes. L’échelle Attitudes des professionnels envers l’inclusion des pères (APIP) a été adaptée à partir de l’échelle Importance des familles dans les soins infirmiers – Attitudes des infirmières. Au total, 297 professionnels ont répondu aux 26 items de l’échelle APIP. Résultats. L’analyse des items révèle que trois d’entre eux présentaient une faible variabilité et une distribution anormale. L’analyse à composantes principales a été effectuée avec les 23 items restants. Les résultats confirment quatre facteurs, reproduisant la structure de l’échelle originale : le père comme partenaire de conversation, le père comme ressource, le père comme fardeau et le père comme ayant ses propres ressources. Les quatre sous-échelles et l’échelle globale ont montré une bonne cohérence interne. Discussion et conclusion. Même si d’autres études sont nécessaires, cette échelle adaptée permet maintenant aux chercheurs et aux praticiens de mesurer les attitudes des professionnels quant à l’importance d’impliquer les pères dans leurs interventions auprès des familles

NECESSIDADES PRIORITÁRIAS REFERIDAS PELAS FAMÍLIAS DE PESSOAS COM DOENÇAS RARAS

Las enfermedades raras provocan fuerte impacto en las familias, generando necesidades más allá de los relacionados con las enfermedades más frecuentes. La incorporación de nuevas responsabilidades y la relación con los servicios sociales y de salud, son algunas de ellas. Este estudio tiene como objetivo identificar las necesidades prioritarias de las familias de las personas con enfermedades raras, percibidas desde el diagnóstico. Se trata de un estudio cualitativo realizado con 16 miembros de la familia de las personas con enfermedades raras, los residentes de Rio Grande do Sul, cuyos datos fueron recolectados entre noviembre/2012 y marzo/2013, a través de entrevistas semiestructuradas y sometido a análisis de contenido, impulsado por La teoría bio-ecológica del desarrollo humano. Los resultados indican como prioridad las necesidades de: acceso a los servicios sociales y de salud; conocimiento sobre las enfermedades raras; estructuras de apoyo social; la aceptación y la integración social; preservación de la vida personal y familiar. Llegamos a la conclusión de que (re)organizar los servicios y satisfacer las necesidades específicas son condiciones previas para calificar la atención de enfermería y amortiguar el impacto de las causas de enfermedades raras en la família

Waves of family hope: narratives of families in the context of pediatric chronic illness

Objetivo: analizar las narrativas sobre la experiencia deesperanza de las familias en el contexto de la enfermedadcrónica pediátrica. Método: investigación narrativa que utilizó laEnfermería de Sistemas Familiares como marco conceptual. Eneste estudio participaron tres familias de niños y adolescentesdiagnosticados con enfermedades crónicas complejas, con untotal de 10 participantes. La recogida de datos se desarrollómediante entrevistas familiares con foto-elicitación. Seconstruyeron y analizaron narrativas familiares siguiendo elanálisis temático inductivo con triangulación teórica de losde datos. Resultados: el tema analítico - Olas de esperanzafamiliar en el contexto de la enfermedad crónica pediátrica - secompone de cuatro tipos diferentes de esperanza: esperanzaincierta, esperanza cuidadora, esperanza latente y esperanzaexpectante. El movimiento a través de estas esperanzasgenera una fuerza motriz y dependiente de varios factores:apoyo, información, búsqueda de la normalidad, pensamientosy comparaciones. Conclusión: los resultados destacan lainteracción y reciprocidad de los miembros de la unidad familiar,la dinámica de la esperanza, e ilustran los diferentes tipos deesperanza y los factores que los influyen. Este estudio destacala experiencia de la esperanza como un recurso familiar, envez de un recurso individual, y apoya a los profesionales de lasalud en la planificación del cuidado familiar considerando laesperanza como un recurso familiar esencial y dinámico.Objective: to analyze narratives about the experience of hopeof families in the context of pediatric chronic illness. Method: anarrative research using Family Systems Nursing as a conceptualframework. Three families of children and adolescents diagnosedwith complex chronic illness participated in this study, totaling10 participants. Data collection was developed using familyphoto-elicitation interviews. Family narratives were constructedand analyzed according to inductive thematic analysis withtheoretical data triangulation. Results: the analytical theme– Waves of Family Hope in the Context of Pediatric ChronicIllness – is composed of four different types of hope: uncertainhope, caring hope, latent hope, and expectant hope. Movementthrough these hopes generates a driving energy and dependson a number of factors: support, information, searching fornormality, and thoughts and comparisons. Conclusion: theresults highlight the interaction and reciprocities of the membersof the family unit, and the dynamics of hope, and illustrate thedifferent types of hope and the factors that influence them. Thisstudy highlights the experience of hope as a family resourcerather than just an individual resource, and supports healthprofessionals in the planning of family care considering hopeas an essential and dynamic family resource.Objetivo: analisar as narrativas de famílias sobre suasexperiências de esperança no contexto da doença crônicapediátrica. Método: pesquisa narrativa, que utilizou a teoriade sistemas familiares aplicada à enfermagem como referencialteórico. Compuseram a amostra deste estudo três famílias decrianças e adolescentes diagnosticados com doenças crônicascomplexas, em um total de 10 participantes. Os dados coletadospor meio de entrevistas com foto-elicitação permitiram aconstrução de narrativas familiares, as quais foram analisadasde acordo com a análise temática indutiva e triangulaçãoteórica dos dados. Resultados: o tema analítico – Ondas deesperança familiar no contexto da doença crônica pediátrica –está composto por quatro diferentes tipos: esperança incerta,esperança cuidativa, esperança latente e esperança expectante.O movimento suscitado por essas esperanças gera umaenergia motriz e depende de uma série de fatores, tais comoapoio, informação, busca pela normalidade, pensamentos ecomparações. Conclusão: os resultados evidenciam a interaçãoe reciprocidades dos membros da unidade familiar, bem comoa dinâmica da esperança, os diferentes tipos de esperança e osfatores que os influenciam. Este estudo destaca a experiênciade esperança como um recurso familiar e não apenas individual,além de auxiliar os profissionais de saúde no planejamento docuidado familiar considerando a esperança como um recursofamiliar essencial e dinâmico