RESUMEN

Objective To assess the effectiveness of Problem-Solving Therapy (PST) on family caregivers through the use of scales to measure anxiety, depression and emotional distress; and to explore facilitating factors and obstacles for its use based on the narrative of nurses. Method A clinical trial and an exploratory focus group with the use of mixed analysis methodology. The study was conducted in a primary health care center in Tarragona, Spain, and the sample consisted of 122 family caregivers who were included in the home care service, and 10 nurses who participated in the intervention group. Family caregivers with evident symptoms of anxiety, depression and emotional distress received PST in the intervention group. The intervention group also consisted of a discussion with eight nurses, which was transcribed and submitted to content analysis. Conclusion Problem-Solving Therapy proved to be effective in reducing perceived anxiety, depression and emotional distress. We identified its strong points and obstacles as described by nurses.

RESUMEN

Objective To assess the effectiveness of Problem-Solving Therapy (PST) on family caregivers through the use of scales to measure anxiety, depression and emotional distress; and to explore facilitating factors and obstacles for its use based on the narrative of nurses. Method A clinical trial and an exploratory focus group with the use of mixed analysis methodology. The study was conducted in a primary health care center in Tarragona, Spain, and the sample consisted of 122 family caregivers who were included in the home care service, and 10 nurses who participated in the intervention group. Family caregivers with evident symptoms of anxiety, depression and emotional distress received PST in the intervention group. The intervention group also consisted of a discussion with eight nurses, which was transcribed and submitted to content analysis. Conclusion Problem-Solving Therapy proved to be effective in reducing perceived anxiety, depression and emotional distress. We identified its strong points and obstacles as described by nurses.

 .

Objetivo Avaliar a efetividade da Técnica de Resolução de Problemas (TRP) em cuidadores familiares mediante escalas positivas de ansiedade, depressão e stress emocional; explorar os fatores facilitadores e as barreiras para sua aplicação a partir das narrativas das enfermeiras. Método Ensaio clínico e grupo focal exploratório, com metodologia de análise mista. Realizado em centros de cuidados primários em Tarragona (Espanha), cuja amosta foi de 122 cuidadores familiares, incluindo atendimento domiciliar e 10 enfermeiros no grupo de intervenção. Grupo implementação experimental do TRP, cuidador familiar com sintomas de ansiedade, depressão e desconforto percebido. No grupo controle a enfermeira executa a intervenção habitual. Feita medição pré e pós intervenção em ambos os grupos. Grupo de discussão com oito enfermeiros do grupo de intervenção, transcrição e análise de conteúdo. Conclusão Ficou demonstrada a eficácia da TRP na redução da ansiedade, depressão e desconforto percebido. Foram identificados os pontos fortes e as barreiras na aplicação da técnica.
 .

Objetivo Evaluar la efectividad de la Técnica de Resolución de Problemas (TRP) en cuidadoras familiares mediante escalas positivas de ansiedad, depresión y malestar emocional; explorar los factores facilitadores y barreras en su aplicación a partir de la narrativa de las enfermeras. Método Ensayo clínico y grupo focal exploratorio y metodología de análisis mixta. Ilevado a cabo en el Centro de Atención Primaria de Tarragona (España), cuya muestra fue 122 cuidadoras familiares incluidas en el programa de atención domiciliaria y 10 enfermeras del grupo intervención. Grupo experimental aplicación de la TRP, a la cuidadora familiar con síntomas de ansiedad, depresión y malestar percibido. Grupo control la enfermera realiza la intervención habitual. Medición pre-post en ambos grupos. Grupo de discusión con ocho enfermeras del grupo intervención, trascripción y análisis del contenido. Conclusión Se demuestra la efectividad de la TRP en la reducción de ansiedad, depresión y malestar percibido. Se identifican los puntos fuertes y las barreras descritas por las enfermeras en la aplicación de la técnica.
 .

Asunto(s)

RESUMEN

AIMS AND OBJECTIVES: To evaluate the effectiveness of the problem-solving technique in reducing symptoms of anxiety and depression among primary caregivers and to describe and evaluate the process carried out by nurses to find strengths and areas of improvement. BACKGROUND: In Spain, home care for the chronically ill patients and their family caregivers should be a priority in health and social policies due to the increase in ageing population and the progressive increase in dependent individuals. One of the areas involved is home-based nursing and counselling for family caregivers. DESIGN: This is a clinical trial study (during 2007-2011) with a mixed analysis methodology. METHODS: Quantitative analysis was used to evaluate the effectiveness of the problem-solving technique in reducing symptoms of anxiety and depression. The clinical trial involved a control and experimental group and pre-post intervention measurements, using the Goldberg Scale. The practical application of the technique was evaluated by qualitative analysis. RESULTS: There was a statistically significant improvement in symptoms of anxiety and depression in the intervention group after application of the technique. Positive aspects and resistance factors in its implementation were noted. CONCLUSIONS: The problem-solving technique is a cost-effective intervention for reducing symptoms of anxiety and depression in family caregivers of the chronically ill patients. Positive aspects of the technique were satisfaction of the caregiver and nurse, and work done together based on reflection. Resistance factors identified were difficulty in maintaining written records and subjective perception of a lack of time in everyday practice for its consistent application. RELEVANCE TO CLINICAL PRACTICE: The problem-solving technique is an important tool to reduce the suffering of family caregivers of chronically ill patients and a prevention element of family claudication.

Asunto(s)

RESUMEN

El análisis del caso parte de la Teoría de la Incertidumbre frente a la enfermedad de Merle H. Mishel, que aportó la idea de que aun sin haber una solución a la incertidumbre, el individuo debería aceptarla como parte de la realidad y reinterpretarla como una oportunidad que promueve un nuevo punto de vista de la vida regido por la probabilidad. La autora nos propone conceptos teóricos que permiten abordar los fenómenos que viven las cuidadoras familiares desde las perspectivas de sus vivencias y estrés. Plantea la incertidumbre y la indeterminación como contradicciones que no deberían crear angustia permanentemente. Esta puede liberarse, poco a poco, si creamos líneas de fuga a través del cuidado. Entre estas líneas se sitúa la técnica de resolución de problemas como estrategia útil en Atención Primaria para disminuir la incertidumbre de la cuidadora. El artículo describe la evolución de Isabel una mujer de 63 años cuidadora familiar de una madre dependiente y de una hija con anorexia. La enfermera de Atención Primaria en las visitas domiciliarias identifica un problema de cansancio del rol de cuidador y el de conflicto de decisiones. Se expone la valoración realizada a partir de los conceptos principales de la teoría y se trabaja con la cuidadora desde el Método de Resolución de Problemas con el objetivo de reducir su ansiedad y ayudarla a movilizar los recursos internos y aumentar su bienestar (AU)

This article describes the outcome of Isabel, a 63- year-old female family caregiver of her dependent mother and her daughter with anorexia. The primary care nurse identifies the problem of weariness of the care-givers role and that of conflict of decisions during home visits. It describes the assessment made from the main concepts of the theory and the work with the care-givers by the problem solving method in order to reduce anxiety and help to mobilize internal resources and increase their welfare. This case discussion starts from the Uncertainty Theory of illness of Merle Mishel, who raised the idea that even without a solution to the uncertainty, a person should accept it as a part of their life and reinterpret it as an opportunity to promote a new view of life governed by probability. The author proposes theoretical concepts that allow the phenomena experienced by family caregivers to be approached from the perspective of their experiences and stress. It establishes uncertainty and indecisiveness as contradictions that should not create anxiety permanently. This can be released gradually, if we create lines of flight though the care. Among these lines are located the Problem Solving Method as a strategy useful in primary health care to reduce the uncertainty of the caregivers (AU)

Asunto(s)

RESUMEN

This case discussion starts from the Uncertainty Theory of illness of Merle Mishel, who raised the idea that even without a solution to the uncertainty, a person should accept it as a part of their life and reinterpret it as an opportunity to promote a new view of life governed by probability. The author proposes theoretical concepts that allow the phenomena experienced by family caregivers to be approached from the perspective of their experiences and stress. It establishes uncertainty and indecisiveness as contradictions that should not create anxiety permanently. This can be released gradually, if we create lines of flight though the care. Among these lines are located the Problem Solving Method as a strategy useful in primary health care to reduce the uncertainty of the caregivers. This article describes the outcome of Isabel, a 63- year-old female family caregiver of her dependent mother and her daughter with anorexia. The primary care nurse identifies the problem of weariness of the care-givers role and that of conflict of decisions during home visits. It describes the assessment made from the main concepts of the theory and the work with the care-givers by the problem solving method in order to reduce anxiety and help to mobilize internal resources and increase their welfare.

Asunto(s)

RESUMEN

La elevada frecuencia de personas con trastornos depresivos en todos los niveles de atención y la complejidad de los cuidados, conlleva la necesidad, para la enfermera, de desarrollar nuevas habilidades y competencias en el abordaje integral de los pacientes y su familia. Para la comprensión de una persona con depresión es útil una mirada etnográfica que nos permita conocer la expresión subjetiva de la vivencia de la enfermedad. Un marco adecuado de referencia para ayudar en el cuidado de estos procesos es la teoría de Jean Watson sobre la Filosofía y Ciencia de los Cuidados Humanos, que a través de sus diez factores cuidativos enmarca el rol de la enfermera en “cómo tener cuidado de...”. Este artículo trata de analizar, a través de los factores cuidativos de Watson, las vivencias subjetivas relacionadas con la transformación del cuerpo y la mente de las personas con depresión: el sufrimiento y el dolor, la autoimagen y el reconocimiento, la falta de energía, la pérdida de la esperanza. Se concluye que no es posible controlar el cuerpo sin controlar la mente y para ello nos puede ayudar el análisis subjetivo de la experiencia y la aplicación de los factores cuidativos

The high frequency of people with depressive disorders in Primary Health Care as well as in Hospital and the complexity of care, carry for nurses the need to develop new skills and competences to deal with complete care of patiens and families. To understand a person suffering depressive disorders may be useful an ethnographic look that let us know the subjective expression of the experience of being ill. An appropriate framework to help care is Jean Watson’s Philosophy and Science of Human Caring, trough 10 caring factors that frame the nursing role “to take care of…”. This paper tries to analyze the subjective experience related to body and mind changes: suffering and pain, self-image and acceptance, lack of energy, loss of hope… in patients with depressive disorders. It is not possible to control body and not to control mind. To analyze the subjective experience trough Watson’s 10 caring factors, can be a good help

Asunto(s)