Más allá de la COVID: los retos éticos de la reanudación de los servicios de salud mental

El objetivo de este trabajo de reflexión es establecer los valores éticos que deberían sustentar el restablecimiento de la asistencia sanitaria tras las primeras oleadas de la COVID-19, sabiendo que los brotes y las nuevas olas parecen inevitables hasta la masiva vacunación. Por ello, consideraremos diferentes cuestiones éticas a tener en cuenta en la fase de reanudación de la actividad de las unidades asistenciales de salud mental, tanto por gestores como por las y los profesionales de las mismas

Beyond COVID: the ethical challenges of restarting mental health services

El objetivo de este trabajo de reflexión es establecer los valores éticos que deberían sustentar el restablecimiento de la asistencia sanitaria tras las primeras oleadas de la COVID-19, sabiendo que los brotes y las nuevas olas parecen inevitables hasta la masiva vacunación. Por ello, consideraremos diferentes cuestiones éticas a tener en cuenta en la fase de reanudación de la actividad de las unidades asistenciales de salud mental, tanto por gestores como por las y los profesionales de las mismas.This reflection paper aims to establish the ethical values that should underpin the re-establishment of health care after the first waves of COVID-19, knowing that outbreaks and new waves seem inevitable until mass vaccination. To this end, we will consider different ethical issues to be taken into account in the phase of resumption of activity in mental health care units, both by managers and professionals

Continuity of care in minors with neuropsychiatric problems: A clinical case

Introducción: Hasta un tercio de los menores y adolescentes presentan algún tipo de trastorno mental, siendo el trastorno con déficit de atención e hiperactividad uno de los más prevalentes. Dicho trastorno aumenta el riesgo de comorbilidades neuropsiquiátricas que alteran el funcionamiento académico y social, dificultando la escolarización ordinaria ante la falta de recursos y programas de atención específicos. Objetivo: Evidenciar la falta de continuidad de cuidados integrales en menores con problemas neuropsiquiátricos y proponer un plan de cuidados: a propósito de un caso. Descripción del caso: Y. L., varón de 9 años con antecedentes de Trastorno con Déficit de Atención e Hiperactividad y síndrome 47XXX que presenta brote psicótico en centro escolar siendo remitido a la unidad de psiquiatría infantojuvenil para su ingreso. Resultados: A pesar de que Y. L. era usuario de salud mental y recibía atención multidisciplinar, no se identificó la sintomatología prodrómica previa al brote psicótico. Al alta, no se derivó a la enfermera de salud mental infantojuvenil, por lo que no se realizó un plan de cuidados individualizado que facilitara su proceso de recuperación. Conclusión: Para una adecuada recuperación de la salud mental es necesario planificar planes de cuidados desde la comunidad y la centralidad de la persona que garanticen la continuidad de cuidados integrales antes-durante y tras el alta hospitalaria. Dadas las posibilidades de la red asistencial de salud mental, la enfermera escolar se presenta como un nexo entre el equipo asistencial, el equipo docente, el menor y su familia, favoreciendo la identificación y derivación temprana a la enfermera de salud mental infantojuvenil y la monitorización del plan de cuidados diseñado por la enfermera especialista en el entorno natural del menor en pro de la inclusión en su entorno educativo ordinario.Introduction: Up to one third of children and adolescents have a mental disorder, with Attention Deficit Hyperactivity Disorder being one of the most prevalent. This disorder increases the risk of neuropsychiatric comorbidities that alter academic and social functioning, making regular schooling difficult due to the lack of resources and specific care programmes. Objective: to demonstrate the lack of continuity of comprehensive care in children with neuropsychiatric problems and to propose a care plan: a case study. Case description: Y. L., a 9-year-old boy with a history of attention deficit hyperactivity disorder and 47XXX syndrome who presented a psychotic outbreak at school and was referred to the child and adolescent psychiatry unit for admission. Results: Although Y. L. was a mental health user and received multidisciplinary care, the prodromal symptomatology before the psychotic break was not identified. He was not referred to the child and adolescent mental health nurse at discharge, so Any staff nurse made no individualised care plan to facilitate his recovery process.Conclusion: For an adequatemental health recovery, it is necessary to plan care plans from the community and person-centred care that guarantees the continuity of comprehensive care before, during and after hospital discharge. Given the possibilities of the mental health care network, the school nurse is presented as a link between the care team, the teaching team, the child and his/her family, favouring early identification and referral to the child and adolescent mental health nurse and the monitoring of the care plan designed by the specialist nurse in the child's natural environment in favour of inclusion in their familiar educational environment

Relationships between parent–infant bonding, dyadic adjustment and quality of life, in an intra-partner sample

The transition to parenthood represents a moment of change and adaptation in which the dyadic marital relationship becomes a triadic relationship. Facilitating a positive transition requires a thorough understanding of the explanatory model of the relationship between parental–infant bonding, dyadic adjustment and quality of life (QoL) from an integrative perspective of the family unit. The aim of this work was to analyse the relationships between parent–infant bonding, dyadic adjustment and QoL from an intra-partner perspective, 6–12 months after the birth of a child. A cross-sectional observational study was performed in a convenience sample of 222 couples 6–12 months postpartum, enrolled from October 2013 to March 2016. The mean age of the mothers was 34.07 years (SD = 3.67), and for the fathers, it was 35.75 years (SD = 4.02). Mothers perceived better QoL and greater mother–infant bonding compared to fathers. The perception of an adequate dyadic adjustment, together with positive parent–infant bonding, had positively influenced the individual QoL of both members of the couple 6–12 months after birth. From an intra-partner perspective, the positive transition was influenced by the relationship between parent–infant bonding, dyadic adjustment and QoL. Positive parent–infant bonding in mothers and fathers, as well as promotion of the quality of the relationships between couples, can help promote a better QoL. Positive health results can be achieved in terms of individual and family well-being by designing healthcare interventions that encourage the presence and participation of the family unit.The present study was granted by the General Sub-Directorate for Evaluation and Promotion of Research (Institute of Health Carlos III, ISCIII) and co-funded by the European Regional Development Fund (FEDER) (No. PI14/01549)

The impact of volunteering in mental health settings on nursing students' attitudes

Nursing faculties are working to improve students’ attitudes towards mental illness and people with severe mental illness, given the repercussions a lack of knowledge and negative attitudes may have on the quality of care. Complementing undergraduate programmes with volunteering activities affords students the opportunity to interact with people with a severe mental illness, and allow them to develop positive attitudes and overcome prejudice. Aim: to explore and deepen in nursing students attitudes prior to and following volunteering on an Acute Mental Health Inpatient Unit. By means of mixed methods approach, students were assessed at two time points by questionnaires including “Community Attitudes to Mental Illness” and “Semantic Differential”, and by testimonies gathered from interviews. Positives changes in attitudes were identified and monitored over time capturing a destigmatizing tendency. The participation in educational strategies such as volunteering in Acute Mental Health Inpatient Unit, complementary to undergraduate programmes and clinical placements in mental health, allows nursing students to develop more diversified and positive attitudes towards mental illness and people with severe mental illness. The impact of an interventional education strategy is not as powerful in nursing students as it might be in students of other non-healthcare oriented university degrees due to their baseline attitudes.The present study received financial assistance via the ‘Programa de Redes-I 3CE’ research program for university training from the ‘Instituto de Ciencias de la Educación’ at the University of Alicante (2016-17); Reference No: 3720

El Document de Voluntats Anticipades com a instrument de planificació ètico-jurídic: especial atenció a la salut mental

La relación médico-paciente se encuentra en un proceso de cambio y evolución hacia un tratamiento más humano, sustentado sobre el principio de autonomía, con el objetivo de respetar los derechos del paciente y no sólo imponer la voluntad del médico. Un instrumento que salvaguarda esta situación es el Documento de Voluntades Anticipadas, como extensión del consentimiento informado. A pesar de su regulación internacional y nacional, en ciertos contextos, como el de la salud mental, el modelo hegemónico-paternalista sigue imperando y nos preguntamos por qué.The doctor-patient relations are undergoing a process of change and evolution towards a more humane approach, based on the principle of autonomy , with the aim of respecting the rights of patients and not just imposing the will of the phyisician. Advance Directives, as an extension of Informed Consent documents, can further safeguard such rights. Despite its international and national regulation, in certain contexts, such as mental health, the hegemonic-paternalistic model persists, and the authors question the underlying motive.La relació metge-pacient es troba en un procés de canvi i evolució cap a un tractament més humà basat en el principi d'autonomia, amb l'objectiu de respectar els drets del pacient i no només imposar la voluntat de metge. Un instrument que salvaguarda aquesta situació és el Document de Voluntats Anticipades, com a extensió del consentiment informat. Malgrat la seva regulació internacional i nacional, en certs contextos, com el de la salut mental, el model hegemònic-paternalista segueix imperant i ens preguntem per què.Este artículo ha recibido la ayuda técnica y económica del proyecto de investigación emergente GRE17-05 de la Universidad de Alicante, “Conocimientos y habilidades de los profesionales de Salud Mental hacia el Documento de Voluntades Anticipadas”, financiado por el Vicerrectorado de Investigación y Transferencia de Conocimiento para la promoción de la I +D de la Universidad de Alicante

Psychometric Properties of the Health Professionals Communication Skills Scale in University Students of Health Sciences

Communication is one of the determining factors of healthcare quality; however, a health model that prioritizes clinical over non-technical skills remains prevalent. The aims of this article were: (a) to validate a communication skills scale in a sample of fourth-year nursing degree students from two Spanish universities and (b) determine their perception of communication skills. The study included 289 fourth-year nursing undergraduate students with a mean age of 22.7 (SD = 4.87) years; 81.7% were female. The Health Professionals Communication Skills Scale (HP-CSS) questionnaire was adapted for use among nursing students. We analysed the psychometric properties and relationships with the variable attitudes toward communication skills. The HP-CSS showed a high internal consistency (0.88) and good fit of data to the model (TLI = 0.98; CFI = 0.97; RMSEA = 0.05 [95% CI = 0.04–0.06]). The total score and subscale scores correlated with the variable attitude towards communication skills. High scores were obtained for the students’ perception of communication skills. The HP-CSS is a valid and reliable tool to assess the communication skills in nursing students. This scale provides university teachers with a rapid and easily applied instrument to assess the level of communication skills and relationship with patients.This research was funded by Program Redes-I 3CE for Research in University Teaching of the Institute of Education Science (Vice-chancellorship of Quality and Educational Innovation) of the University of Alicante, edition 2018-19

Efficacy of a Standardised Patient Simulation Programme for Chronicity and End-of-Life Care Training in Undergraduate Nursing Students

Background: Standardised patient simulations seem to be useful for improving the communication skills of health sciences students. However, it is important to define the effectiveness of these types of interventions in complex scenarios linked to disease chronicity and end-of-life contexts. Methods: A quasi-experimental study with pre- and post-intervention measures was carried out in a single group. A total of 161 nursing students completed different assessment instruments to measure their attitudes towards communication (Attitude Toward Communication Scale), self-efficacy (Self-Efficacy of Communication Skills, SE-12), and communication skills (Health Professionals Communication Skills Scale, EHC-PS) before and after simulation training with standardised patients. The objective of the program was to train students in non-technical skills for complex situations involving chronicity and end-of-life care. It comprised eight sessions lasting 2.5 h each. Results: The results showed notable baseline gender differences in attitudes towards communication and in the informative communication dimension, with women obtaining higher scores. The participants’ self-efficacy and communication skills significantly improved after completing the intervention, with no significant differences being found for the attitudes towards communication variable. Conclusion: The standardised patient simulation programme for complex scenarios related to chronicity and end-of-life contexts improved communication self-efficacy and communication skills in these nursing students. In future work it will be important to analyse the influence of gender and attitudes towards communication as variables in the learning of communication skills in nursing students.Program Redes-I 3CE for Research in University Teaching of the Institute of Education Science (Vice-Chancellorship of Quality and Educational Innovation) of the University of Alicante, edition 2018-19 (No. XARXES-I3CE-20184344)

Estigma social hacia personas con trastornos mentales en adolescentes españoles: un estudio transversal

Introduction: Stigma and mental health literacy play an important role in individuals' trajectories with mental disorders who are often stigmatised and suffer adverse consequences such as social isolation and limited life chances. Stigma towards people with mental disorders can occur in adults but also in adolescents. Objective: We aimed to determine the social stigma towards people with mental disorders in a group of adolescents and to establish any possible relationships with personal variables. Methods: We conducted a cross-sectional study. A total of 144 adolescents were recruited from a secondary school in Spain by the convenience sampling method and completed a demographic questionnaire and the Community Attitudes toward the Mentally Ill scale. Results: Female adolescents had fewer stigmatising attitudes (p= 0.003). Females and Higher academic year students scored less in the Authoritarianism subscale (p< 0.001 and p= 0.001, respectively). Differences in scores of the Benevolence subscale were found depending on the academic level of the mother (p= 0.013). Discussion: Gender, age and academic year are factors related to social stigma in the adolescent population. Mothers’ academic level is related. Implications to clinical practice: Our results can contribute in focusing anti-stigma interventions in those adolescents with more stigma levels.Introducción: El estigma y la alfabetización en salud mental juegan un papel importante en las trayectorias de los individuos con trastornos mentales, que a menudo son estigmatizados y sufren consecuencias adversas como el aislamiento social y la limitación de sus oportunidades vitales. El estigma hacia las personas con trastornos mentales puede darse en personas adultas pero también en adolescentes. Objetivo: Nos propusimos determinar el estigma social hacia las personas con trastornos mentales en un grupo de adolescentes y establecer las posibles relaciones con variables personales. Métodos: Realizamos un estudio transversal. Un total de 144 adolescentes fueron reclutados en un centro de enseñanza secundaria de España por el método de muestreo de conveniencia y completaron un cuestionario demográfico y la escala denominada Community Attitudes toward the Mentally Ill. Resultados: Las adolescentes tenían menos actitudes estigmatizantes (p = 0,003). Las adolescentes y los estudiantes de cursos académicos superiores puntuaron menos en la subescala de Autoritarismo (p < 0,001 y p = 0,001, respectivamente). Se encontraron diferencias en las puntuaciones de la subescala de Benevolencia en función del nivel académico de la madre (p= 0,013). Discusión: El género, la edad y el curso académico son factores relacionados con el estigma social en la población adolescente, así como el nivel académico de las madres. Implicaciones para la práctica clínica: Nuestros resultados pueden contribuir a focalizar las intervenciones antiestigma en aquellos adolescentes con más niveles de estigma