Family Caregivers' Experiences during the COVID-19 Pandemic: Qualitative Study.

Background: The COVID-19 pandemic imposed lockdown measures that affected caregiving. Understanding caregivers' context provides reveals their adaptive strategies to continue caring in this situation of uncertainty and isolation. Objective: To better understand the caregiving experiences of caregivers looking after dependent individuals living in the community during the pandemic. Design: Qualitative research, phenomenological approach. Setting: Primary healthcare centers in Madrid region (Spain). Participants: 21 family caregivers. Methods: Purposive and theoretical sampling was used to recruit caregivers across nurses from primary healthcare centers. Participants were interviewed using a semi-structured interview guide to explore the caring experience. Interview transcripts were evaluated using thematic analysis. Results: The findings were categorized into two themes: "Caregivers during lockdown-providing care in a time of adversity" and "Caregiving toward normality". The sub-themes identified were the re-structuring of before-care services and the introduction of new care approaches, managing the dependent person's health problems, looking after oneself, and dealing with adversity. To adapt to the new normal, strategies were put in place designed to recover confidence and trust, reincorporate assistance, and reconnect with others. Conclusions: Care intensified during the pandemic. Caregivers took on the task without assistance, focusing on preventing contagion and protecting themselves to be able to continue giving care.

Nursing Diagnoses of Individuals with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Research Protocol for a Qualitative Synthesis.

Although previously developed qualitative studies have explored the experience of illness of individuals with myalgic encephalomyelitis/chronic fatigue syndrome, these findings have not been undertaken for the purpose of enabling the identification of nursing care needs in such patients. This study aims to identify NANDA-I nursing diagnoses of adults with myalgic encephalomyelitis/chronic fatigue syndrome based on a qualitative literature review of their experience of illness. The protocol includes: searches in the electronic databases Medline, Embase, CINAHL, PsycINFO, SCI-EXPANDED, SSCI, SciELO, LILACS, and Cuiden; and manual searches in specialised journals and the references of the included studies. The authors will systematically search qualitative research studies published in databases from 1994 to 2021. Searches are limited to studies in Spanish and English. All stages of the review process will be carried out independently by two reviewers. Any disagreements shall be resolved through joint discussions, involving a third reviewer if necessary. The findings will be synthesised into a thematic analysis informed by the Domains and Classes of the NANDA-I Classification of Nursing Diagnoses, which will then serve to identify nursing diagnoses. This review will enable nursing professionals to identify the care needs of individuals with myalgic encephalomyelitis/chronic fatigue syndrome by taking into consideration their experience of illness in its entirety.

[Uncovering infertility: the experience of women undergoing assisted reproductive technologies.] / Descubrir la infertilidad: la experiencia de mujeres sometidas a técnicas de reproducción asistida.

OBJECTIVE: Infertility is a huge reproductive health problem in developed countries. The aim was to understand the infertility experience of women who have undergone assisted reproduction technologies. METHODS: Qualitative study using Grounded Theory. Through intentional sampling and theoretical sampling, 20 women who had undergone Assisted Reproduction Technologies in public hospitals and specialized private clinics in Spain were selected. Data were collected using semi-structured interviews and were analysed using the principles of Grounded Theory: initial coding and focused coding, memo writing, theoretical sampling and constant comparative method. RESULTS: "Uncovering infertility: unveiling the unknown" is the core category that explains the process which women go through. Four subcategories emerged and describe the temporal process from seeking pregnancy to reception and coping with the infertility diagnosis: "Seeking for a vital desire: being mothers/fathers", "Suspecting infertility: the absence of the natural", "In search of a diagnosis: knowing and understanding the problem" and "The impact of diagnosis: a vital grief". CONCLUSIONS: Uncovering infertility is a process that has an impact on the different areas of women's lives. This process produces different emotions and feelings such as guilt, frustration, sadness or anger. This process could be easier if women have the support of their partner, their social environment and if they share their problem with women who have the same situation.

OBJETIVO: La infertilidad es uno de los grandes problemas de salud reproductiva en los países desarrollados. El objetivo de este estudio fue comprender la experiencia vivida de la infertilidad por mujeres que se han sometido a técnicas de reproducción asistida. METODOS: Estudio cualitativo de Teoría Fundamentada. Mediante muestreo intencional y muestreo teórico se seleccionaron 20 mujeres que habían sido sometidas a técnicas de reproducción asistida tanto en hospitales públicos como en clínicas privadas especializadas en España. La técnica de recogida de los datos fue la entrevista semiestructurada. El análisis siguió los procedimientos de la Teoría Fundamentada: codificación inicial y focalizada, escritura de memos analíticos, muestreo teórico y método de comparación constante. RESULTADOS: "Descubrir la infertilidad: desvelar lo desconocido" es la categoría principal que explica el proceso que viven las mujeres. Emergieron cuatro subcategorías que describen el proceso temporal desde el inicio de la búsqueda de embarazo hasta la recepción y afrontamiento del diagnóstico de infertilidad: "Buscar un deseo vital: ser madres/padres", "Sospechar la infertilidad: la ausencia de lo natural", "En busca de un diagnóstico: conocer y comprender el problema" y "El impacto del diagnóstico: un duelo vital". CONCLUSIONES: Descubrir la infertilidad es un proceso que afecta a los distintos ámbitos de la vida de las mujeres y en el que aparecen emociones y sentimientos como culpa, frustración, tristeza o rabia. Este proceso puede estar facilitado cuando se tiene el apoyo de su pareja, el entorno y se comparte el problema con mujeres que tienen su misma situación.

Nurses' perceptions and demands regarding COVID-19 care delivery in critical care units and hospital emergency services.

BACKGROUND: The COVID-19 pandemic is a public health challenge that puts health systems in a highly vulnerable situation. Nurses in critical care units (CCUs) and hospital emergency services (HESs) have provided care to patients with COVID-19 under pressure and uncertainty. OBJECTIVE: To identify needs related to safety, organisation, decision-making, communication and psycho-socio-emotional needs perceived by critical care and emergency nurses in the region of Madrid, Spain, during the acute phase of the epidemic crisis. METHODS: This is a cross-sectional study (the first phase of a mixed methods study) with critical care and emergency nurses from 26 public hospitals in Madrid using an online questionnaire. RESULTS: The response rate was 557, with 37.5% reporting working with the fear of becoming infected and its consequences, 28.2% reported elevated workloads, high patient-nurse ratios and shifts that did not allow them to disconnect or rest, while taking on more responsibilities when managing patients with COVID-19 (23.9%). They also reported deficiencies in communication with middle management (21.2%), inability to provide psycho-social care to patients and families and being emotionally exhausted (53.5%), with difficulty in venting emotions (44.9%). CONCLUSIONS: Critical care and emegency nurses may be categorised as a vulnerable population. It is thus necessary to delve deeper into further aspects of their experiences of the pandemic.

Acceptability and feasibility of a virtual community of practice to primary care professionals regarding patient empowerment: a qualitative pilot study.

BACKGROUND: Virtual communities of practice (vCoPs) facilitate online learning via the exchange of experiences and knowledge between interested participants. Compared to other communities, vCoPs need to overcome technological structures and specific barriers. Our objective was to pilot the acceptability and feasibility of a vCoP aimed at improving the attitudes of primary care professionals to the empowerment of patients with chronic conditions. METHODS: We used a qualitative approach based on 2 focus groups: one composed of 6 general practitioners and the other of 6 practice nurses. Discussion guidelines on the topics to be investigated were provided to the moderator. Sessions were audio-recorded and transcribed verbatim. Thematic analysis was performed using the ATLAS-ti software. RESULTS: The available operating systems and browsers and the lack of suitable spaces and time were reported as the main difficulties with the vCoP. The vCoP was perceived to be a flexible learning mode that provided up-to-date resources applicable to routine practice and offered a space for the exchange of experiences and approaches. CONCLUSIONS: The results from this pilot study show that the vCoP was considered useful for learning how to empower patients. However, while vCoPs have the potential to facilitate learning and as shown create professional awareness regarding patient empowerment, attention needs to be paid to technological and access issues and the time demands on professionals. We collected relevant inputs to improve the features, content and educational methods to be included in further vCoP implementation. TRIAL REGISTRATION: ClinicalTrials.gov , NCT02757781 . Registered on 25 April 2016.

Overweight and obesity: effectiveness of interventions in adults. / Sobrepeso y obesidad: eficacia de las intervenciones en adultos.

OBJECTIVE: To identify the most effective interventions in overweight and obese adults. METHOD: A narrative review through a search of the literature in databases PubMed, Cochrane, Joanna Briggs Institute, EMBASE, Cuiden y Cinahl with free and controlled language (MeSH terms) using Boolean operators AND and NOT. The research was limited to articles published between 2007 and 2015. Eighteen articles were selected based on the established inclusion and exclusion criteria. RESULTS: Different types of interventions were identified based on the modification of lifestyles, mainly diet, physical activity and behavior. Major differences were found in specific content, degree of intensity of interventions, time tracking and elements evaluated. Most of studies found statistically significant weight loss but this was limited in terms of weight and number of people. Web-based interventions have no uniform effect on weight loss but achieve similar levels to face-to-face interventions in maintaining weight loss. CONCLUSIONS: The combination of personalised diet, exercise and cognitive behavioural therapy is the most effective form of intervention in overweight and obesity. There is insufficient data to indicate whether group or individual interventions are more effective. Online intervention allows greater accessibility and lower cost.

Factors associated to clinical learning in nursing students in primary health care: an analytical cross-sectional study.

OBJECTIVE: to identify the students' perception about the quality of clinical placements and asses the influence of the different tutoring processes in clinical learning. METHODS: analytical cross-sectional study on second and third year nursing students (n=122) about clinical learning in primary health care. The Clinical Placement Evaluation Tool and a synthetic index of attitudes and skills were computed to give scores to the clinical learning (scale 0-10). Univariate, bivariate and multivariate (multiple linear regression) analyses were performed. RESULTS: the response rate was 91.8%. The most commonly identified tutoring process was "preceptor-professor" (45.2%). The clinical placement was assessed as "optimal" by 55.1%, relationship with team-preceptor was considered good by 80.4% of the cases and the average grade for clinical learning was 7.89. The multiple linear regression model with more explanatory capacity included the variables "Academic year" (beta coefficient = 1.042 for third-year students), "Primary Health Care Area (PHC)" (beta coefficient = 0.308 for Area B) and "Clinical placement perception" (beta coefficient = - 0.204 for a suboptimal perception). CONCLUSIONS: timeframe within the academic program, location and clinical placement perception were associated with students' clinical learning. Students' perceptions of setting quality were positive and a good team-preceptor relationship is a matter of relevance. OBJETIVO: identificar a percepção dos estudantes de enfermagem sobre a qualidade das Práticas Clínicas em Atenção Primária à Saúde e avaliar a influência dos diferentes processos de tutoria na aprendizagem clínica. MÉTODOS: um estudo analítico transversal realizado com alunos do segundo e do terceiro ano de enfermagem (n = 122) na aprendizagem clínica nos serviços de Atenção Primária à Saúde. A Ferramenta de Avaliação de Práticas Clínicas (Clinical Placement Evaluation Tool) e um índice sintético de atitudes e habilidades (escala de 0 a 10) foram calculados para marcar a aprendizagem clínica. Foram realizadas análises univariadas, bivariadas e multivariadas (regressão linear múltipla). RESULTADOS: a taxa de resposta foi de 91,8%. O processo de tutoria mais indicado foi o de "preceptor-professor" (45,2%). As Práticas Clínicas foram avaliadas como "ótimas" por 55,1%, o relacionamento com a equipe-preceptor foi considerado bom por 80,4% dos casos e a classificação média para a aprendizagem clínica foi de 7,89. O modelo de regressão linear múltipla, com mais capacidade explicativa incluiu as variáveis "ano acadêmico" (coeficiente de beta = 1.042 para alunos do terceiro ano), "área de cuidados de saúde primários" (coeficiente de beta = 0,308 para a Área B) e "percepção de práticas clínicas" (beta coeficiente = - 0,204 para uma percepção menos que ótima). CONCLUSÕES: O momento dentro do programa acadêmico, a localização e percepção das Práticas Clínicas foram associados com a aprendizagem clínica dos alunos. A percepção dos alunos sobre a qualidade do lugar das Práticas Clínicas foi positiva e um bom relacionamento da equipe-preceptor é uma questão de relevância. OBJETIVO: identificar la percepción del alumnado de enfermería sobre la calidad de las Prácticas Clínicas y evaluar la influencia de los diferentes procesos de tutoría en el aprendizaje clínico. MÉTODOS: estudio analítico transversal realizado con estudiantes de segundo y tercer año de enfermería (n = 122) en el aprendizaje clínico en los servicios de atención primaria de salud. La Herramienta de Evaluación de Prácticas Clínicas (Clinical Placement Evaluation Tool) y un índice sintético de las actitudes y habilidades (escala de 0 a 10) se calcularon para puntuar el aprendizaje clínico. Se realizaron análisis univariados, bivariados, multivariados (regresión lineal múltiple). RESULTADOS: la tasa de respuesta fue del 91,8%. El proceso de tutoría más comúnmente identificado fue "preceptor-profesor" (45,2%). Las Prácticas Clínicas se evaluaron como "óptimas" en un 55,1%, la relación equipo-preceptor fue considerada buena por el 80,4% de los casos y la calificación media para el aprendizaje clínico fue de 7.89. El modelo de regresión lineal múltiple con mayor capacidad explicativa incluyó las variables "año académico" (coeficiente beta = 1.042 para los estudiantes de tercer año), "Área de Atención Primaria de la Salud" (coeficiente beta = 0,308 para el Área B) y la "percepción de las Prácticas Clínicas" (coeficiente beta = - 0,204 para una percepción subóptima). CONCLUSIONES: el momento dentro del programa académico, la ubicación y la percepción de las Prácticas Clínicac se asociaron con el aprendizaje clínico de los estudiantes. La percepción de los estudiantes de la calidad del lugar de las Prácticas Clínicas fue positiva y la buena relación equipo-preceptor es una cuestión de relevancia.

[The experience of women care cargivers with chronic conditions of dependent relatives]. / La experiencia del cuidado de las mujeres cuidadoras con procesos crónicos de salud de familiares dependientes.

OBJECTIVE: To describe the experience of women caregivers with chronic conditions who care for a dependent relative. DESIGN: Qualitative study based on constructivist grounded theory. LOCATION: Study conducted on two Health Areas urban of the Community of Madrid. PARTICIPANTS: Thirty nine women with a chronic condition who take care of dependent relatives were selected by means of purposive sampling. METHOD: Data were collected through 23 semi-structured interviews and 2 focus groups between April 2010 and December 2011. Grounded theory procedures were used in the data analysis. RESULTS: To feel their life hampered describes the subjective experience of family caregivers with chronic conditions who take care of a dependent relative. When comparing their past life with the current life they become aware of the losses they have suffered over time. They feel less strong, sadder and less free; they worry about how to meet the demands of family care. The life they are leading makes them question the meaning of their own lives. CONCLUSIONS: This study shows the losses realized day by day by women caregivers with a chronic illness, which lead them to lose the meaning of their own lives. To know the experience of these women caregivers will help develop interventions and specific services that compensate for the losses they feel and help improve their quality of living.

Factors associated to clinical learning in nursing students in primary health care: an analytical cross-sectional study / Fatores associados à aprendizagem clínica dos alunos de enfermagem nos cuidados de saúde primários: um estudo analítico transversal / Factores asociados al aprendizaje clínico de los estudiantes de enfermería en la atención primaria de salud: un estudio transversal analítico

ABSTRACT Objective: to identify the students' perception about the quality of clinical placements and asses the influence of the different tutoring processes in clinical learning. Methods: analytical cross-sectional study on second and third year nursing students (n=122) about clinical learning in primary health care. The Clinical Placement Evaluation Tool and a synthetic index of attitudes and skills were computed to give scores to the clinical learning (scale 0-10). Univariate, bivariate and multivariate (multiple linear regression) analyses were performed. Results: the response rate was 91.8%. The most commonly identified tutoring process was "preceptor-professor" (45.2%). The clinical placement was assessed as "optimal" by 55.1%, relationship with team-preceptor was considered good by 80.4% of the cases and the average grade for clinical learning was 7.89. The multiple linear regression model with more explanatory capacity included the variables "Academic year" (beta coefficient = 1.042 for third-year students), "Primary Health Care Area (PHC)" (beta coefficient = 0.308 for Area B) and "Clinical placement perception" (beta coefficient = - 0.204 for a suboptimal perception). Conclusions: timeframe within the academic program, location and clinical placement perception were associated with students' clinical learning. Students' perceptions of setting quality were positive and a good team-preceptor relationship is a matter of relevance.

RESUMO Objetivo: identificar a percepção dos estudantes de enfermagem sobre a qualidade das Práticas Clínicas em Atenção Primária à Saúde e avaliar a influência dos diferentes processos de tutoria na aprendizagem clínica. Métodos: um estudo analítico transversal realizado com alunos do segundo e do terceiro ano de enfermagem (n = 122) na aprendizagem clínica nos serviços de Atenção Primária à Saúde. A Ferramenta de Avaliação de Práticas Clínicas (Clinical Placement Evaluation Tool) e um índice sintético de atitudes e habilidades (escala de 0 a 10) foram calculados para marcar a aprendizagem clínica. Foram realizadas análises univariadas, bivariadas e multivariadas (regressão linear múltipla). Resultados: a taxa de resposta foi de 91,8%. O processo de tutoria mais indicado foi o de "preceptor-professor" (45,2%). As Práticas Clínicas foram avaliadas como "ótimas" por 55,1%, o relacionamento com a equipe-preceptor foi considerado bom por 80,4% dos casos e a classificação média para a aprendizagem clínica foi de 7,89. O modelo de regressão linear múltipla, com mais capacidade explicativa incluiu as variáveis "ano acadêmico" (coeficiente de beta = 1.042 para alunos do terceiro ano), "área de cuidados de saúde primários" (coeficiente de beta = 0,308 para a Área B) e "percepção de práticas clínicas" (beta coeficiente = - 0,204 para uma percepção menos que ótima) Conclusões: O momento dentro do programa acadêmico, a localização e percepção das Práticas Clínicas foram associados com a aprendizagem clínica dos alunos. A percepção dos alunos sobre a qualidade do lugar das Práticas Clínicas foi positiva e um bom relacionamento da equipe-preceptor é uma questão de relevância.

RESUMEN Objetivo: identificar la percepción del alumnado de enfermería sobre la calidad de las Prácticas Clínicas y evaluar la influencia de los diferentes procesos de tutoría en el aprendizaje clínico. Métodos: estudio analítico transversal realizado con estudiantes de segundo y tercer año de enfermería (n = 122) en el aprendizaje clínico en los servicios de atención primaria de salud. La Herramienta de Evaluación de Prácticas Clínicas (Clinical Placement Evaluation Tool) y un índice sintético de las actitudes y habilidades (escala de 0 a 10) se calcularon para puntuar el aprendizaje clínico. Se realizaron análisis univariados, bivariados, multivariados (regresión lineal múltiple). Resultados: la tasa de respuesta fue del 91,8%. El proceso de tutoría más comúnmente identificado fue "preceptor-profesor" (45,2%). Las Prácticas Clínicas se evaluaron como "óptimas" en un 55,1%, la relación equipo-preceptor fue considerada buena por el 80,4% de los casos y la calificación media para el aprendizaje clínico fue de 7.89. El modelo de regresión lineal múltiple con mayor capacidad explicativa incluyó las variables "año académico" (coeficiente beta = 1.042 para los estudiantes de tercer año), "Área de Atención Primaria de la Salud" (coeficiente beta = 0,308 para el Área B) y la "percepción de las Prácticas Clínicas" (coeficiente beta = - 0,204 para una percepción subóptima). Conclusiones: el momento dentro del programa académico, la ubicación y la percepción de las Prácticas Clínicac se asociaron con el aprendizaje clínico de los estudiantes. La percepción de los estudiantes de la calidad del lugar de las Prácticas Clínicas fue positiva y la buena relación equipo-preceptor es una cuestión de relevancia.

Women's self-management of chronic illnesses in the context of caregiving: a grounded theory study.

AIMS AND OBJECTIVES: Uncover how women self-manage their own chronic illness while taking care of a dependent relative. BACKGROUND: International policies place special emphasis in promoting interventions addressed to control, prevent and care for people with chronic health conditions. Self-management is a crucial part of this care. Caregivers are more prone to have chronic illness than non-caregivers. They are confronted with dilemmas about taking care of themselves while taking care of their dependent relative and the rest of their families. Caregivers articulate strategies to enable them to focus their energy on caring. DESIGN: Qualitative study using constructivist grounded theory. METHODS: Thirty-nine women caregivers with a chronic illness participated in the study. Twenty-three semi-structured interviews and two focus groups were carried out between April 2010-December 2011. Data were analysed using grounded theory procedures. FINDINGS: Self-management helps women caregivers with a chronic illness to balance the demands of their own illness and those of the dependent relative. They self-manage their illness by self-regulating the treatment, by regulating their strength and by controlling their emotions. CONCLUSIONS: Women caregivers integrate effectively and creatively the management of their chronic illnesses within the complexities of family care. This renders their health needs invisible and reaffirms them as capable caregivers. RELEVANCE TO CLINICAL PRACTICE: Identifying self-management strategies of women caregivers allow health professionals to acknowledge and reinforce effective self-care measures and to deter those that are ineffective and lessen their quality of life.

How women caregivers deal with their own long-term illness: a qualitative study.

AIM: To explore the strategies used by women caregivers to deal with their own chronic health conditions. BACKGROUND: Providing care has a negative impact on the physical and mental health of caregivers. When caregivers suffer chronic health problems, it increases the burden of caring, making them more vulnerable and less likely to look after their own health. DESIGN: Qualitative study carried out between April 2010-December 2011. METHOD: Thirty-nine women with long-term illness who care for dependent family members took part in the study, 23 in semi-structured interviews and 16 in two focus groups. The data were analysed using the grounded theory method. FINDINGS: Women caregivers feel that they cannot let their own chronic health problems prevent them from caring for others. Dealing with their health problems enables them to provide the time and effort their family member requires. They do this by: (1) normalizing their chronic conditions; (2) neutralizing the effects of their long-term illness; and (3) forgetting that they are chronic sufferers. CONCLUSIONS: This study analyses the strategies that family caregivers use to deal with their own chronic health problems, so that they can continue to provide family care. It shows that, to forget about their own illnesses, these women must take charge of them. Nurses need to recognize and value the strategies that caregivers use to deal with their own health problems. They also need to encourage them to use the most effective strategies, to improve their quality of life.

[Another way to view the nursing profession: an experience in deconstruction]. / Otra forma de mirar enfermería. Una experiencia de deconstrucción.

The authors present a personal process to search for new meanings and ways to approach the reality how nurses exercise their profession by means of exploring, reviewing and analyzing active nursing practice, care and teaching. All this investigation permitted the authors to construct a reflexive, inquisitive and critical view, leading to a position change regarding education and the concept we hold about people and about ourselves. This method deals with listening to theory by telling one's experiences.