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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.

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Introducción: la intensa convivencia con la muerte en el ámbito sociosanitario puede alterar el nivel de ansiedad ante la muerte del profesional produciendo impacto emocional que repercuta en el cuidado y en su propia vida. Los objetivos de esta investigación son determinar el nivel de ansiedad ante la muerte y explorar los desencadenantes de temor y sus significados, en enfermeras de dicho ámbito. Método: diseño mixto cuantitativo/cualitativo. La población de estudio fueron las enfermeras de un centro sociosanitario en Tarragona, España. Respondieron los instrumentos seleccionados para la recogida de variables sociodemográficas y medición de la ansiedad ante la muerte, y realizaron entrevistas en profundidad. Análisis cuantitativo: medidas de tendencia central, dispersión y tablas de frecuencia (SPSS 15.0). El análisis cualitativo sigue la metodología de la teoría fundamentada. Resultados: la media de puntuación de ansiedad es de 114,36 [DT (Desviación Típica) 15,35]. Los valores más elevados corresponden al propio proceso de morir 30,09 (DT 3,96) y a la muerte de otros 29,64 (DT 3,47). Las enfermeras viven la muerte del otro, y piensan en la suya, influenciadas por emociones intensas que varían según la "aceptación" y evolución del proceso. Reconocen los temores, desencadenados por el cuidado, que les acompañan repercutiendo en su vida. Conclusiones: el ámbito asistencial sociosanitario acoge unos niveles altos de ansiedad ante la muerte para las enfermeras. La pérdida de personas queridas y el dolor asociado al proceso de morir, son las situaciones más ansiógenas. Identifican los temores de manera clara, sin alejarse del cuidado y ofreciendo el apoyo psicoemocional como signo de identidad profesional. Los resultados parciales de este trabajo fueron presentados en XXVIII Congreso Nacional de Enfermería de Salud Mental. 1a Conferencia Internacional de Enfermería de Salud Mental. Tarragona 2011 (AU)

Introduction: the intense presence of the death at the social health environment can disturb the level of death anxiety in the professional, producing in him an emotional impact leading to repercussions on the care and on his life. The objectives of this research are to determine the level of anxiety before the death and to explore the triggers of fear and their meanings, in nurses of this area. Method: mixed quantitative / qualitative design. The study population was nurses from a social and health care centre in Tarragona, Spain. They answered the selected scales and were interviewed in depth. Quantitative analysis: measures of central tendency, dispersion and frequency tables (SPSS 15.0). The qualitative analysis follows the methodology of grounded theory. Results: the anxiety average score is 114.36 [SD (Standar Deviation) 15.35]. The highest values correspond to the proper dying process 30.09 (SD 3.96) and to the deaths of others 29.64 (SD 3.47). Nurses live the death of the other and think of his own, influenced by strong emotions that vary according to the "acceptance" and to the process evolution. They recognize the fears unchained by the care, accompanied them and affected their lives. Conclusions: the Social and health care assistance receives high levels of death anxiety for nurses. The loss of loved people and the associated pain at the process of dying are the most anxiogenic situations. They identify clearly their fears, without moving away of the care and seeking psycho-emotional support as a sign of professional identity. Partial results of this work were presented at XXVIII Mental Health Nursing National Congress. 1st International Mental Health Nursing Conference. Tarragona 2011 (AU)

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Objetivo: Conocer la efectividad de la técnica de resolución de problemas en la reducción de la ansiedad y la depresión, y en el aumento del bienestar percibido en cuidadoras familiares de personas dependientes. Diseño: Ensayo clínico. Emplazamiento: Centros de atención primaria de Tarragona, España. Período 2007-2011. Participantes: Muestra 122 cuidadoras de pacientes incluidos en programa de atención domiciliaria, con síntomas de ansiedad, depresión o bienestar emocional comprometido. Se asignaron aleatoriamente al grupo control o de intervención. Intervenciones: En el grupo experimental las enfermeras aplicaban a la cuidadora, durante las visitas domiciliarias, la técnica según protocolo de 4 sesiones. En el grupo control la enfermera realizó la atención habitual. Al mes de finalizar la intervención, se realizó nuevamente la medición de las variables dependientes en ambos grupos. Mediciones principales: Las variables dependientes, ansiedad y depresión, se midieron mediante la escala Goldberg y el bienestar emocional mediante la escala de salud emocional del cuidador principal. Resultados: Se detecta una mejora estadísticamente significativa en el grupo intervención de los síntomas de ansiedad, depresión y bienestar percibido en relación con el grupo control. Conclusiones: La técnica de resolución de problemas es una herramienta terapéutica útil para la disminución de los síntomas de malestar emocional de las cuidadoras familiares de pacientes crónicos(AU)

Objective: To determine the effectiveness of Problem Solving Technique in reducing anxiety and depression, and increased perceived well-being in women family caregivers of chronic patients. Design: A clinical trial. Field of study: Health centres in Tarragona, Spain, during 2007-2011. Participants: A sample 122 caregivers of patients in home care programs that met the inclusion criteria, were assigned to intervention or control group according to a simple random process. Interventions: In the experimental group, the nurses applied the Problem Solving Technique to the caregiver according to a four-session protocol. The nurses provided the usual care to the caregivers In the control group. One month after intervention, the dependent vriables were measured again in both groups. Principal measurement: The dependent variables of anxiety and depression were measured using the Goldberg scale, and the emotional well-being variable by the scale of emotional health of the primary caregiver. Results: A statistically significant improvement was detected in the anxiety and depression symptoms, as well as the perceived well-being in the intervention group compared to the control group. Conclusions: Implementation of the Problem Solving Technique is a useful therapeutic tool for reducing symptoms of distress in family caregivers of chronic patients(AU)

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OBJECTIVE: The aim of this research is to determine the relationship between professional experience in palliative care, and the assistance area in which that palliative care occurs, and the degree of anxiety before the death in professional nursing. We also explored the relationships between demographic and work variables with death anxiety, replicating existing studies. METHOD: Is a quantitative and descriptive and comparative study in 2009 in La Xarxa Sanitaria Santa Tecla in Tarragona. The study's sample population was nurses of different levels of assistance (n=105) who answered the selected means for the collection of socio-demographic variables and the measurement of the degree of death anxiety (Spanish version of CL-FODS). RESULTS: We found significant statistic difference on the points of scale anxiety in the presence of the death with the nurses belonging to several assistance areas. The care frequency to moribund people is shown definitely of fear levels to the proper death as well as the assiduity in which professionals talk about death in private surroundings. CONCLUSIONS: The assistance area as scene of care moments to moribund people which theses professionals share, and the frequency of the fulfilment of theses cares constitute definite elements to their fear or anxiety to the death.

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Objetivo: conocer el nivel de ansiedad ante la muerte en los profesionales de enfermería teniendo en cuenta la experiencia en cuidados paliativos así como el ámbito asistencial donde desarrollan su actividad. También se estudiarán las relaciones entre variables sociodemográficas y laborales con la ansiedad ante la muerte, como réplica de estudios ya existentes. Método: estudio cuantitativo, descriptivo y comparativo realizado en 2009 en La Xarxa Sanitaria Santa Tecla en Tarragona. La población de estudio fueron las enfermeras (n=105) de los diversos niveles asistenciales que respondieron los instrumentos seleccionados para la recogida de variables sociodemográficas y medición de la ansiedad ante la muerte (versión española de CL-FODS). Resultados: se detectan diferencias estadísticamente significativas en las puntuaciones de la escala de ansiedad ante la muerte en las enfermeras correspondientes a diversos ámbitos asistenciales. La frecuencia de cuidados a personas moribundas se muestra como determinante de los niveles de miedo ante la propia muerte, así como de la asiduidad con que los profesionales hablan del morir en su entorno privado. Conclusiones: el ámbito asistencial, como escenario de los momentos de cuidados a personas moribundas que estos profesionales comparten, y la frecuencia de realización de los mismos, constituyen elementos determinantes de su miedo o ansiedad ante la muerte(AU)

Objective: The aim of this research is to determine the relationship between professional experience in palliative care, and the assistance area in which that palliative care occurs, and the degree of anxiety before the death in professional nursing. We also explored the relationships between demographic and work variables with death anxiety, replicating existing studies. Methods: Is a quantitative and descriptive and comparative study in 2009 in La Xarxa Sanitaria Santa Tecla in Tarragona. The study's sample population was nurses of different levels of assistance (n=105) who answered the selected means for the collection of socio-demographic variables and the measurement of the degree of death anxiety (Spanish version of CL-FODS). Results. We found significant statistic difference on the points od scale ansiety in the presence of the death with the nurses belonging to several assistance areas. The care frequency to moribund people is shown definitely of fear levels to the proper deaths as well as the assiduity in which professionals talk about death in private surroundings. Conclusions. The assistance area as scene of care moments to moribund people which theses proffesionals share, and the frequency of the fulfillment of these cares constitute definite elements to their fear or anxiety to the death(AU)

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OBJECTIVE: To determine the effectiveness of Problem Solving Technique in reducing anxiety and depression, and increased perceived well-being in women family caregivers of chronic patients. DESIGN: A clinical trial FIELD OF STUDY: Health centres in Tarragona, Spain, during 2007-2011. PARTICIPANTS: A sample 122 caregivers of patients in home care programs that met the inclusion criteria, were assigned to intervention or control group according to a simple random process. INTERVENTIONS: In the experimental group, the nurses applied the Problem Solving Technique to the caregiver according to a four-session protocol. The nurses provided the usual care to the caregivers In the control group. One month after intervention, the dependent vriables were measured again in both groups. PRINCIPAL MEASUREMENT: The dependent variables of anxiety and depression were measured using the Goldberg scale, and the emotional well-being variable by the scale of emotional health of the primary caregiver. RESULTS: A statistically significant improvement was detected in the anxiety and depression symptoms, as well as the perceived well-being in the intervention group compared to the control group. CONCLUSIONS: Implementation of the Problem Solving Technique is a useful therapeutic tool for reducing symptoms of distress in family caregivers of chronic patients.

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