Condiciones de trabajo de enfermería en tiempos de COVID ­ 19. Sincelejo, Sucre (Colombia) / Nursing work conditions in times of COVID ­ 19. Sincelejo, Sucre (Colombia)

INTRODUCCIÓN: el personal de enfermería se enfrenta a diversas situaciones en la práctica, debido a lo complejo que es cuidar de sí mismo y de los demás; la relevancia de este artículo de reflexión está en fortalecer la visibilidad de la disciplina de enfermería en la atención sanitaria. OBJETIVO: Reflexionar sobre la importancia de las condiciones de trabajo de enfermería, al brindar cuidado en tiempos de pandemia por Covid -19. DESARROLLO: la enfermería tiene consigo un camino recorrido a lo largo de la historia de la humanidad, donde el proceso salud - enfermedad, permite la presencia de enfermería con cada paciente. La trágica pandemia por Covid-19 que enfrenta el mundo, condujo a cambios para el ser humano, específicamente en la forma de brindar el cuidado de enfermería, en el cual se destacan aspectos positivos y otros no tan favorables para la profesión. CONCLUSIONES: el virus conocido como coronavirus, transformó la vida de muchos seres humanos, enfermería con su presencia ha desempeñado roles fundamentales al enfrentar un virus mortal, una vez más se ratifica que es una disciplina y profesión indispensable para el desarrollo de la sociedad, pero aspectos como condiciones laborales inadecuadas, el estrés, y el miedo ante cuidar la vida misma y la de los demás, han influido en la salud mental del personal de enfermería, que en la actualidad sigue en esfuerzo y búsqueda del verdadero reconocimiento de la profesión.

INTRODUCTION: Nursing staff face various situations in practice, due to how complex it is to take care of oneself and others; the relevance of this reflection article is to strengthen the visibility of the nursing discipline in health care. OBJECTIVE: To reflect on the importance of nursing working conditions, when providing care in times of the Covid-19 pandemic. DEVELOPMENT: Nursing has a path traveled throughout the history of humanity, where the health-disease process allows the presence of nursing with each patient. The tragic Covid-19 pandemic that the world is facing led to changes for the human being, specifically in the way of providing nursing care, in which positive aspects and others not so favorable for the profession stand out. CONCLUSIONS: the virus known as coronavirus, transformed the lives of many human beings, nursing with its presence has played fundamental roles in facing a deadly virus, once again it is ratified that it is an indispensable discipline and profession for the development of society, but Aspects such as inadequate working conditions, stress, and fear of caring for one's own life and that of others have influenced the mental health of nursing staff, who currently continue to strive and seek true recognition of the profession.

Fatores de estresse em estudantes de enfermagem na realização de atividades teórico-práticas da formação acadêmica / Factores de estrés en estudiantes de enfermería en la realización de actividades teórico-prácticas de la formación académica / Stress factors in nursing students in the realization of theoretical-practical activities of academic training

RESUMO Objetivo: verificar os fatores de estresse comumente vivenciados por estudantes do curso de Enfermagem na realização de atividades teóricas e práticas da formação acadêmica. Método: estudo descritivo, transversal, desenvolvido com 142 discentes do curso de Enfermagem de uma universidade pública localizada em Mato Grosso do Sul, Brasil. Os dados foram coletados em fevereiro de 2020 por meio de questionário sociodemográfico/acadêmico e da escala de Avaliação de Estresse em Estudantes de Enfermagem e, posteriormente, analisados de maneira descritiva, segundo a moda e percentis superiores e inferiores à moda das variáveis. Resultados: medo de cometer erros durante a assistência ao paciente (57,4%), sentimento de ter adquirido pouco conhecimento para fazer provas práticas (52,1%), insegurança ou medo de fazer provas teóricas (44,7%) e obrigatoriedade de realizar trabalhos extraclasse (41,5%) foram fatores que provocaram níveis muito altos de estresse entre os estudantes. Conclusão: os resultados podem auxiliar faculdades de Enfermagem no planejamento e fortalecimento de intervenções preventivas com foco no gerenciamento do estresse e seu enfrentamento.

RESUMEN Objetivo: verificar los factores de estrés comúnmente experimentados por estudiantes del curso de Enfermería en la realización de actividades teóricas y prácticas de la formación académica. Método: estudio descriptivo, transversal, desarrollado con 142 discentes del curso de Enfermería de una universidad pública ubicada en Mato Grosso do Sul, Brasil. Los datos fueron recogidos en febrero de 2020 a través de cuestionario sociodemográfico/académico y de la escala de Evaluación de Estrés en Estudiantes de Enfermería y, posteriormente, analizados de manera descriptiva, según la moda y percentiles superiores e inferiores a la moda de las variables. Resultados: miedo de cometer errores durante la atención al paciente (57,4%), sentimiento de haber adquirido poco conocimiento para hacer pruebas prácticas (52,1%), inseguridad o miedo de hacer pruebas teóricas (44,7%) y obligatoriedad de realizar trabajos extraclase (41,5%) fueron factores que provocaron niveles muy altos de estrés entre los estudiantes. Conclusión: los resultados pueden auxiliar facultades de Enfermería en la planificación y fortalecimiento de intervenciones preventivas con enfoque en el manejo del estrés y su enfrentamiento.

ABSTRACT Objective: to verify the stress factors commonly experienced by nursing students in carrying out theoretical and practical activities of academic training. Method: descriptive, cross-sectional study, developed with 142 students of the nursing course of a public university located in Mato Grosso do Sul, Brazil. Data were collected in February 2020 through a sociodemographic/academic questionnaire and the Stress Assessment scale in Nursing Students and, later, analyzed descriptively, according to fashion and upper and lower percentiles than the fashion of the variables. Results: fear of making mistakes during patient care (57.4%), feeling of having acquired little knowledge to take practical tests (52.1%), insecurity or fear of taking theoretical tests (44.7%) and mandatory to perform extra-class work (41.5%) were factors that caused very high levels of stress among students. Conclusion: the results can help nursing colleges in the planning and strengthening of preventive interventions focused on stress management and coping.

Music to reduce stress in hospitalized patients.

PURPOSE: To determine the impact of music on the physiologic and psychological stress experienced by hospital inpatients. METHODS: This pilot study monitored vital signs; utilized pain, anxiety, and agitation rating scales; and gathered verbal feedback from 50 participating inpatients at the authors' healthcare facility as they listened to music via an audiovisual interactive patient engagement technology system. RESULTS: After listening to music for 30 minutes, patients reported significantly lower pain and anxiety. CONCLUSION: Music offered a helpful tool to reduce pain and anxiety for patients in the ICU and telemetry units at the authors' healthcare facility. Future research may be geared toward incremental expansion and monitoring of this music intervention in other units.

Indicadores de calidad en el cuidado humanizado de personas con sufrimiento psíquico en etapa aguda / Quality indicators in the humanized care of users with psychic suffering in the acute stage / Indicadores de qualidade no atendimento humanizado a usuários com sofrimento psíquico na fase aguda

La práctica de enfermería, incorpora el cuidado humanizado como una vía para valorar además de aspectos físicos en las personas, los elementos mentales y emocionales implicados en el contexto de la enfermedad. Los indicadores de calidad han funcionado como aspectos que son objeto de evaluación sanitaria hacia el restablecimiento de la salud afectada. Estos indicadores suelen proveer información fundamental para el desarrollo de una práctica asistencial de calidad y al mismo tiempo refieren procesos para alcanzar los objetivos trazados en la atención de los centros sanitarios. La práctica de enfermería dirigida a superar el sufrimiento psíquico en etapa aguda, requiere la valoración holística, con lo cual alcanzar un mayor impacto en la salud de la persona. El cuidado humanizado de éstas personas que sufren de forma aguda, influye sobre el afrontamiento de esta realidad compleja, el sentirse escuchados, atendidos, e impulsando su participación y autonomía en el tratamiento, propicia un mejor afrontamiento a la realidad particular de cada persona. Aunque muchos profesionales de enfermería aplican un cuidado humanizado enmarcado en la religión o política, es fundamental redireccionar acciones para empoderar a la persona. El objetivo central del artículo está dirigido a efectuar un análisis reflexivo sobre los indicadores de calidad en el cuidado humanizado de las personas con sufrimiento psíquico en etapa aguda, para valorar el trabajo desarrollado de los profesionales de enfermería y su impacto en la salud de los mismos.

Nursing practice incorporates humanized care as a way to assess, in addition to physical aspects in people, the mental and emotional elements involved in the context of the disease. The quality indicators have functioned as aspects that are object of sanitary evaluation towards the reestablishment of the affected health. These indicators usually provide fundamental information for the development of a quality care practice and at the same time refer to processes to achieve the objectives set in the care of health centers. Nursing practice aimed at overcoming mental suffering in the acute stage requires holistic assessment, thereby achieving a greater impact on the health of the person. The humanized care of these people who suffer acutely, influences the coping with this complex reality, feeling heard, cared for, and promoting their participation and autonomy in the treatment, fosters a better coping with the particular reality of each person. Although many nursing professionals apply humanized care framed in religion or politics, it is essential to redirect actions to empower the person. The main objective of the article is aimed at carrying out a reflective analysis on the quality indicators in the humanized care of people with mental suffering in the acute stage, to assess the work carried out by nursing professionals and its impact on their health.

A prática de enfermagem incorpora o cuidado humanizado como forma de avaliar, além dos aspectos físicos nas pessoas, os elementos mentais e emocionais envolvidos no contexto da doença. Os indicadores de qualidade têm funcionado como aspectos que são objeto de avaliação sanitária para o restabelecimento da saúde afetada. Esses indicadores costumam fornecer informações fundamentais para o desenvolvimento de uma prática assistencial de qualidade e, ao mesmo tempo, referem-se a processos para atingir os objetivos traçados na assistência aos centros de saúde. A prática de enfermagem voltada para a superação do sofrimento mental na fase aguda requer avaliação holística, alcançando assim um maior impacto na saúde da pessoa. O cuidado humanizado a essas pessoas que sofrem agudamente, influencia no enfrentamento dessa realidade complexa, sentindo-se ouvido, cuidado e promovendo sua participação e autonomia no tratamento, favorece um melhor enfrentamento da realidade particular de cada pessoa. Embora muitos profissionais de enfermagem apliquem o cuidado humanizado enquadrado pela religião ou pela política, é fundamental redirecionar as ações para empoderar a pessoa. O objetivo principal do artigo é realizar uma análise reflexiva sobre os indicadores de qualidade no cuidado humanizado à pessoa com sofrimento mental na fase aguda, para avaliar o trabalho desenvolvido pelos profissionais de enfermagem e seu impacto na saúde.

Stress and coping among pregnant black women during the COVID-19 pandemic.

OBJECTIVE: This study explored stress and coping among pregnant Black women prior to and during the COVID-19 pandemic. DESIGN: Prospective, longitudinal, cohort study. SAMPLE: Thirty-three women enrolled in the Biosocial Impact on Black Births study prior to the COVID-19 pandemic and who were still pregnant during the pandemic. MEASUREMENTS: Questionnaires included the Perceived Stress Scale, Prenatal Coping Inventory, and questions related to sociodemographic characteristics, worry about COVID-19, and coping strategies used during the pandemic. RESULTS: Women reported very much being worried about my child getting COVID-19 (46%) and my family member getting COVID-19 (46%). Women reported specific active coping strategies very much reduced their feelings of discomfort during COVID-19: God, religion, or spirituality (24%), social media (24%), and following government advice (24%). Higher use of avoidance coping prior to the pandemic was associated with higher levels of stress both prior to (r = 0.60, p < .001) and during (r = 0.47, p < .01) the pandemic. CONCLUSION: Women reported worries about COVID-19 and used various strategies to cope with feelings of discomfort due to the pandemic. Nurses should assess the stress level of pregnant Black women and recommend active coping strategies during the pandemic.

The influence of psychological response and security sense on pregnancy stress during the outbreak of coronavirus disease 2019: A mediating model.

AIMS AND OBJECTIVES: To observe the psychological status of pregnant women during COVID-19 pandemic, and to test a hypothetical model that estimates the influence of psychological response to COVID-19 and security sense on pregnancy stress. BACKGROUND: COVID-19 advanced rapidly and then spread worldwide. Pregnant women were more susceptible to the COVID-19 infection. Furthermore, it is not clear whether this infection will increase the risk of congenital monstrosity, foetal growth restriction, premature delivery or cause other long-term adverse effects. DESIGN: A descriptive, cross-sectional survey. METHODS: A total of 331 pregnant women participated in this study. And this research adhered to the STROBE guideline. The psychological questionnaire for emergent events of public health, pregnancy stress scale and security questionnaire were used to collect data. The hypothetical path model was tested using the SPSS version 25.0 software and AMOS version 26.0 software. RESULTS: Fear and depression were the most common psychological responses among pregnant women during the COVID-19 pandemic. The hypothesis model of this study fitted the data well, and the results showed that psychological response positively affected pregnancy stress, while security sense negatively affected pregnancy stress; security sense mediated between psychological response and pregnancy stress. CONCLUSION: Nurses and midwives can help reduce the stress in pregnant women by alleviating their psychological response to the COVID-19 pandemic and by improving their security sense. RELEVANCE TO CLINICAL PRACTICE: It is essential for the health staff to build trust with pregnant women and their families, and communicate accurate information to them. Nurses should promptly conduct a psychological response evaluation and psychological guidance for pregnant women to alleviate their fears and hypochondria related to COVID-19.

Strategies and Barriers in Addressing Mental Health and Suicidality in Patients With Cancer.

PURPOSE: To identify how oncology nurses address mental health distress and suicidality in patients, what strategies they employ in treating this distress, and the barriers they face in addressing distress and suicidality in patients with cancer. PARTICIPANTS & SETTING: 20 oncology nurses at two cancer centers in Israel were interviewed. METHODOLOGIC APPROACH: The grounded theory method of data collection and analysis was employed. FINDINGS: Strategies used in addressing patients' mental health distress were being emotionally available, providing practical support, treating physical symptoms, and referring to counseling. Strategies in addressing suicidality were assessing the situation, offering end-of-life or palliative care, treating physical symptoms, and referring for assessment. Barriers to addressing distress were lack of training, stigma, workload or lack of time, and limited availability and accessibility of mental health resources. Barriers in addressing suicidality were lack of knowledge and training, patient reluctance to receive care, and lack of protocol. IMPLICATIONS FOR NURSING: Developing guidelines for addressing and responding to mental health distress and suicidality is essential to improving patients' quality of life and reducing disease-related morbidity and mortality. Reducing mental healthcare stigma for patients is critical.

Older Adults and Their Families: An Interactional Intervention That Brings Forth Love and Softens Suffering.

When assisting older adults and their families, the most useful family nursing conceptual skill is embracing the belief that "illness is a family affair." This illness belief summons a systemic or interactional focus specifically on relationship communication patterns. Uncovering maladaptive and distressing familial interactions, a family nurse can intervene and offer ideas for more loving and caring interactional patterns. Three brief and one detailed clinical case example, illustrating how to conceptualize interactional patterns and how to intervene, are offered. This article also presents the author's firsthand caregiving experience with its accompanying joys and pitfalls. Despite her decades of clinical practice and professional assistance to numerous elderly families, the caregiving and interactions with her father held no guarantee of being filled with consistent care and love. Although not easily applicable to one's own family, focusing on the interrelationships with the elderly and their families, the embedded interactional patterns become the crucial ingredient to facilitate more satisfying and loving relationships.

Perspectives of Childhood Cancer Symptom-Related Distress: Results of the State of the Science Survey.

Management of symptom-related distress is an important area of pediatric oncology nursing. Participants who attended the Children's Oncology Group (COG) State of the Science Symposium on symptom distress completed an anonymous survey. The purpose was to explore participant perceptions of symptom distress experienced by children receiving cancer treatment on clinical trials, determine how symptom distress is currently assessed at COG institutions, and to identify what interventions are used to reduce symptom distress for these children. Among the 90 symposium attendees, 72% completed the survey, the majority (92%) of whom were nurses. The five most distressing symptoms in children with cancer enrolled on clinical trials identified by survey respondents were nausea/vomiting, fatigue, pain, anxiety, and sleep disturbances. Results from our survey also suggest that symptom distress may differ by disease type. For example, symptoms associated with leukemia/lymphoma included steroid side effects, procedural pain, and neuropathy. The majority of respondents (90%) also reported that symptoms go unrecognized by health care providers. The most commonly described unrecognized symptoms were behavioral (i.e., sadness, anxiety, fear, depression, and emotional needs; 45%) and fatigue (19%). Key focus areas reported by respondents included informal and inconsistent symptom assessment, the need for uniform measurement tools, and improved documentation of symptom-related distress. Management of symptom-related distress is an important aspect of pediatric oncology nursing. Further exploration of symptom distress experienced by children with specific types of cancers, and the development of standardized symptom assessment processes, will provide a foundation for developing future interventions aimed at alleviating symptom-related distress.

How specialist palliative care nurses identify patients with existential distress and manage their needs.

BACKGROUND: Existential distress is a term used when patients who are coming towards the end of their lives exhibit profound suffering, related particularly to their thoughts on life and existence. The clinical expression of this phenomenon has not been widely researched, and so specialist palliative care nurses were asked how they identify and manage this patient cohort. AIMS: To explore how palliative-care nurses identify patients with existential distress and manage their needs. METHODS: A qualitative descriptive design with thematic content analysis of transcribed interviews. FINDINGS: Behavioural changes, agitation, social withdrawal and communication difficulties are identified as indicators of possible existential distress. Susceptible patient groups are identified. Nurses acknowledged that caring for patients with existential distress can be emotionally demanding. Being present and building relationships with patients are identified as enabling meaning-making. Sedation for refractory distress is seen as a last resort. CONCLUSION: Early identification of existential distress by carers could enable timely intervention (counselling, psychotherapy and or spiritual guidance) to improve the patients' quality of life in the terminal phase of their illness and avoid intractable or refractory existential distress that may necessitate palliative sedation.

Realist Review: Understanding Effectiveness of Intervention Programs for Dementia Caregivers.

PURPOSE: Caring for patients with dementia is a challenging issue entailing heavy responsibility. Many interventions for caregivers have been developed, but their effectiveness is not clear. This study aimed to examine how, why, and under what circumstances interventions for dementia caregivers affected their burden of caring. METHODS: Authors used a realist review approach to explore the evidence for how different interventions reduce the burden of dementia caregivers. We completed the literature review about the burden of dementia caregivers and extracted the theoretical concepts to explain context-mechanism-outcome configuration why an intervention may be effective in some situations and not others. Six databases were searched for experimental or quasi-experimental studies conducted from 2008 to 2017. Of 1,225 screened studies, 10 studies were eligible for inclusion. RESULTS: None of the studies included all the derived contexts while explaining in detail the mechanism of the intervention effectiveness. Among contexts, the variable of other family members requiring care was not included in all studies. Among the analyzed studies, no studies have applied repeated intervention. Most studies included only some variables of context and mechanism, and these variables did not directly explain the effectiveness of intervention. The effect of outcome variables was significant for each study, and the effects of research intervention and national services could not be separately described. CONCLUSION: Authors conclude that Korean culture's emphasis on relationships with others increases the burden of care. In context, Confucian norms and traditional femininity of Korea were reflected in the core. It is necessary to check the homogeneity of participants and the design of intervention to verify the effectiveness of the outcome variable of psychological burden.

Self-care of patient and caregiver DyAds in multiple chronic conditions: A LongITudinal studY (SODALITY) protocol.

AIM: To describe a research protocol for a study designed to examine self-care in patient and caregiver dyads in coping with multiple chronic conditions, to evaluate the influence of dyad self-care on: (a) patient mortality, quality of life, hospital admissions, and the unplanned access of care; and (b) the positive aspects of caregiving. The specific conceptual framework that we developed for this study considers the predictors of self-care (at patient, caregiver, and dyadic levels), the process of self-care and the outcomes of self-care in patient and caregiver dyads with multiple chronic conditions. These elements in patient and caregiver dyads have not been well-studied to date. DESIGN: This is a multicentre longitudinal study with data collection at 0, 6, and 12 months. METHODS: We will use generic and specific tools to assess the predictors of self-care, the process of self-care and the outcomes of self-care in the dyads. The data will be analysed with descriptive and inferential statistics and multilevel modelling to control for the interdependent nature of dyadic data. The study was approved by an ethics committee and was funded by a grant from the Centre of Excellence for Nursing Scholarship Rome, in November 2015. DISCUSSION: This study seeks to determine the predictors and outcomes of self-care in patient and caregiver dyads within the context of multiple chronic conditions. IMPACT: The results of this study will inform clinical practice and research by identifying variables that are modifiable and therefore amenable to interventions.

The effectiveness of a structured nursing intervention program on maternal stress and ability among mothers of premature infants in a neonatal intensive care unit.

AIMS AND OBJECTIVES: To investigate the effectiveness of a structured nursing intervention program on maternal stress and NICU-related maternal ability after the admission of premature infants to a neonatal intensive care unit (NICU). BACKGROUND: Mothers of premature infants may face stress having premature infants, and their infants may be admitted to the NICU for a few weeks or months. The mothers' experience of stress would be worse if they have low knowledge and poor NICU-related maternal ability. Mothers of infants admitted to the NICU require well-planned interventions to cope with psychological matters arising after an infant hospitalisation. DESIGN: Quasi-experimental design. METHODS: A total of 216 mothers were consecutively assigned to control and intervention groups. Each group consisted of 108 mothers. The mothers in both groups received questionnaire concerning maternal stress and NICU-related ability during their first visit to NICU (within 48 hr of admission). A structured nursing intervention was implemented for 10 days on mothers in the intervention group. The control group continued to receive existing practice nursing care. Mothers of both groups were again given the questionnaire on maternal stress and NICU-related ability after 14 days of admission. RESULTS: In the intervention group, the difference between the mean total score of maternal stress and parental role and relationship subscale decreased significantly, compared to the control group (p = 0.04; p = 0.01) respectively. Maternal ability improved significantly in mothers in the intervention group 2 weeks postintervention, p < 0.001. CONCLUSION: A structured nursing intervention for mothers could significantly reduce maternal stress and promote maternal NICU-related abilities. RELEVANCE TO CLINICAL PRACTICE: The results of the study could help neonatal nurses to develop an appropriate nursing intervention for parents with premature infants in the NICU.

Psychological processes of suffering of palliative care patients in Malaysia: a thematic analysis.

Although suffering in palliative care has received increasing attention over the past decade, the psychological processes that underpin suffering remain relatively unexplored. OBJECTIVE: To understand the psychological processes involved in the experiencing of suffering at the end phase of life. METHODS: Semistructured interviews were conducted with 20 palliative care inpatients from an academic medical centre in Kuala Lumpur, Malaysia. The transcripts were thematically analysed with NVIVO9. RESULTS: 5 themes of psychological processes of suffering were generated: (1) perceptions, (2) cognitive appraisals, (3) hope and the struggles with acceptance, (4) emotions and (5) clinging. A model of suffering formation was constructed. CONCLUSION: The findings may inform the development of mechanism-based interventions in the palliation of suffering.

Evaluation of the adherence of distress screening with the distress thermometer in cancer patients 4 years after implementation.

PURPOSE: Identifying and assessing psychosocial distress with an appropriate screening instrument is essential when caring for cancer patients. Since 2012, the distress thermometer (DT) has been used by nurses for all cancer inpatients at the Comprehensive Cancer Center Zurich. We wanted to identify nurses' adherence to the screening protocol, differences between screened and not screened patients and the relationship between screening rate and productivity. METHODS: This retrospective descriptive study used screening and referral data as well as socioeconomic and disease-related data of inpatients at the Comprehensive Cancer Center Zurich. This was collected from the electronic patient documentation system. Additionally, data showing the productivity of all wards was used. All data were analyzed descriptive. RESULTS: Since 2012, 40.6% (4541) of the 11,184 patients have been screened. The screening rate was initially significantly lower but settled at 40% after 2 years. There was a higher screening rate among Swiss, married, male, and emergency patients and patients with hematology diseases, brain tumors, or head and neck cancer (p < 0.001). Every fourth patient with a moderate to severe distress level requested referral to a psychosocial service. Significantly more screened patients were referred to the social service (44.7%) than to the psycho-oncology service (9.4%). Only 22.9% of all referrals were made on the day of screening or a day later. There were only two wards of 15 with a significant relationship between productivity and screening rate. CONCLUSIONS: Screening is useful in recognizing distress among patients, but screening practice needs to be reconsidered.

A 3-Item Screening Scale for Caregiver Burden in Dementia Caregiving: Scale Development and Score Mapping to the 22-Item Zarit Burden Interview.

OBJECTIVES: Brief screening scales for caregiver burden are much needed in routine dementia services to efficiently identify caregivers of persons with dementia (PWD) for further intervention. Although the 22-item Zarit Burden Interview (ZBI) is often used, its available screening versions have not performed as well as the full version in distinguishing significant burden. We developed a brief screening scale that is valid and comparable to ZBI in distinguishing caregiver burden. DESIGN AND SETTING: Baseline data of an ongoing cohort study. PARTICIPANTS: Family careivers of community-dwelling PWD (n = 394). MEASURES: Participants completed questionnaires containing ZBI and other caregiving scales. Initially, we split the study samples into 2-the derivation sample (n = 215) was used to develop a brief scale that best distinguishes significant burden (using the best-subset approach with 10-fold cross-validation), whereas the validation sample (n = 179) verified its actual performance in distinguishing significant burden. We then evaluated the derived scale in its internal consistency reliability, factorial validity, known group validity, and construct validity, and mapped the scores between the brief scale and ZBI using the equipercentile equating method. RESULTS: We derived a 3-item scale which had comparable performance to ZBI in distinguishing significant burden (area under the receiver operating characteristic curve 0.86, 95% confidence interval 0.81-0.92). It had a single dimension in exploratory factor analysis and maintained good psychometric properties similar to those of ZBI. It also explained 77.8% of the variability in ZBI, and had scores that could be mapped to ZBI with reasonable precision. CONCLUSIONS AND IMPLICATIONS: We have derived a highly accessible tool to screen for caregiver burden, which can have a wider health system effect of expanding the reach of caregiver-focused interventions to services involved in the care of PWD. Notably, this screening tool was developed using rigorous methods and demonstrated comparability to ZBI in its validity, reliability, and total scores.

Avaliação da dor, estresse e coping em puérperas no pós operatório de cesárea / Evaluation of pain, stress and coping in puerperal women after cesarean section / Evaluación del dolor, el estrés y afrontamiento en las madres en la sección cesárea postoperatoria

Objetivo: Avaliar dor, estresse percebido e coping em puérperas pós cesárea. Métodos: Estudo transversal, quantitativo, com 65 puérperas em um hospital geral. Foram incluídas puérperas no Pós Operatório de cesárea, com queixas e/ou sinais de dor nas últimas 24 horas. Coleta de dados de abril a julho de 2014, com Formulário de caracterização sociodemográfica/clínica, Questionário McGill de Dor, Escala de Estresse Percebido e Inventário de Estratégias de Coping. Foi realizada análise estatística. Projeto aprovado pelo Comitê de Ética e Pesquisa da Unijuí, CAAE nº 26726014.0.0000.5350. Resultados: 46,4% referiram dor severa; 64,6% dor "enjoada". Dentre as puérperas, 83,1% foram classificadas em médio estresse e, a Reavaliação Positiva foi o fator de coping mais utilizado. Conclusão: Pelo procedimento cirúrgico a saúde biopsicossocial da puérpera pode ficar comprometida pela presença da dor, entretanto a utilização de estratégias de coping focadas no problema pode favorecer o enfrentamento dos estressores de forma positiva

Objetivo: Cevaluar dolor, estrés percibido y afrontamiento en madres postoperatoria cesárea. Métodos: Estudio transversal, cuantitativo, con 65 madres en un hospital general. Fueron incluidas madres en post cesárea con quejas y/o signos de dolor en las últimas 24 horas. La recolección de datos, de abril a julio de 2014, con el McGill Pain Questionnaire, Formulario de caracterización sociodemográfica/clínica, Escala de estrés percibido y Inventario de Estrategias de adaptación. Se realizó análisis estadístico. Proyecto aprobado por Comité Ético de Investigación de UNIJUI, CAAE Nº 26726014.0.0000.5350. Resultados: 46.4% reportaron dolor severo; 64,6% dolor "enfermo". El 83,1% fueron clasificados como medio estrés y reevaluación positiva fue factor de afrontamiento más utilizado. Conclusión: En la cirugía, la salud biopsicosocial de mujeres después del parto puede verse comprometida por presencia de dolor, sin embargo, el uso de estrategias de afrontamiento centradas en el problema puede favorecer positivamente para hacer frente a los factores de estrés

Objective: The study's purpose has ben to assess pain, perceived stress and coping in puerperal women during their cesarean postoperative periods. Methods: It is a cross-sectional study with a quantitative approach, which was carried out with 65 postpartum women admitted to a general hospital. The puerperal women during their cesarean postoperative period showing complaints and/or signs of pain in the last 24 hours were included. Data collection took place from April to July 2014 by using a Socio-demographic/Clinical Characterization Form, the McGill Pain Questionnaire, the Perceived Stress Scale, and an Inventory of Coping Strategies. Considering data analysis, Statistical analysis was performed. The project was approved by the Ethics and Research Committee from the Universidade Regional do Nororeste do Estado do Rio Grande do Sul (UNIJUÍ), CAAE No. 26726014.0.0000.5350. Results: 46.4% reported severe pain; 64.6% "nauseous" pain. Among the puerperal women, 83.1% were classified as medium stress, and Positive Reassessment was the most used coping factor. Conclusion: Through the surgical procedure the biopsychosocial health of the puerperal women can be compromised due to the presence of pain. Nevertheless, the use of coping strategies focused on the problem might favor the confrontation of the stressors in a positive way

Mitigating Infant Medical Trauma in the NICU: Skin-to-Skin Contact as a Trauma-Informed, Age-Appropriate Best Practice.

Infant medical trauma in the NICU is associated with serious and lasting consequences. Skin-to-skin contact (SSC) of infants with their parents is a nursing intervention that provides significant benefits and can mitigate the negative consequences of the infant's traumatic experiences in the NICU. The purpose of this article is to explain how SSC aligns with the concept of trauma-informed age-appropriate care (TIAAC) in the NICU. The evidence supporting SSC will be reviewed and discussed using TIAAC as a framework. SSC is an effective and evidence-based care strategy that reduces the infant's traumatic NICU experiences by improving parental proximity, attachment, and lactation; decreasing stress and pain; improving physiologic stability; supporting sleep; and enhancing neurologic outcomes.