COVID-19 infection: Positive mental health, psychological vulnerability and sex: Cross-sectional study.

Since mid-March 2020, a state of emergency was decreed in Portugal due to the COVID-19 pandemic and, consequently, measures were implemented to protect public health, such as social isolation, which will certainly have a notable impact on the mental health of the population, especially in the most vulnerable groups. Positive Mental Health (PMH) is essential to deal with adversity, in this case with the pandemic, and to live better and with greater satisfaction. We consider it relevant to investigate how PMH was used as a resource to deal with the pandemic, depending on the level of vulnerability and sex. A, cross-sectional study was carried out whose the aim was to evaluate the levels of PMH and psychological vulnerability in people with COVOD-19 infection and analyze the association between PMH and psychological vulnerability among men and women. METHODS: The instruments used were a sociodemographic characterization questionnaire, the Positive Mental Health Questionnaire, and the Psychological Vulnerability Scale (PVS), that were sent and filled out online. A quantitative, cross-sectional, descriptive, and correlational study was carried out. RESULTS: After analyzing the results, it was found that approximately 50.4% of the respondents (n = 387) had global PMH values that place them in quartile 50. There was also a statistically significant difference between female and male PMH, with women showing greater psychological vulnerability and lower overall PMH. CONCLUSIONS: We conclude that the women present a greater psychological vulnerability and a lower level of PMH when compared to men. RELEVANCE TO CLINICAL PRACTICE: Considering the study's statistically significant results, when we talk about mental health, we should always consider the sex variable as a vulnerability factor, in a pandemic or non-pandemic phase.

The experiences of parents as caregivers of adolescents with mental illnesses, the impact of the crisis and the admission to a day hospital.

AIM: The aim of this study was to analyze the caregiving experience of parents whose adolescent children with a mental illness require admission to a day treatment hospital for mental health services. METHOD: The study used qualitative interpretative research methods. A total of 18 parents participated in the semi-structured interviews. Data were then transcribed and analyzed in accordance with established methods for the analysis of inductive thematic data. RESULTS: Seven themes were identified: questioning an unseen disease, abnormal behavior, a long road, truancy and loss of parental authority, internalized stigma on admission, regaining the meaning of life and an uncertain future. DISCUSSION: The experience of the parents was analyzed and various emotional, psychological and interpersonal barriers were found that influenced the help-seeking for the adolescent's treatment. IMPLICATIONS FOR PRACTICE: Nursing interventions should be based on detecting barriers and validating the experience of parents with mentally ill adolescents.

A method to determine a personalized set of online exercises for improving the positive mental health of a caregiver of a chronically ill patient.

BACKGROUND: Taking care of chronic or long-term patients at home is an arduous task. Non-professional caregivers suffer the consequences of doing so, especially in terms of their mental health. Performing some simple activities through a mobile phone app may improve their mindset and consequently increase their positivity. However, each caregiver may need support in different aspects of positive mental health. In this paper, a method is defined to calculate the utility of a set of activities for a particular caregiver in order to personalize the intervention plan proposed in the app. METHODS: Based on the caregivers' answers to a questionnaire, a modular averaging method is used to calculate the personal level of competence in each positive mental health factor. A reward-penalty scoring procedure then assigns an overall impact value to each activity. Finally, the app ranks the activities using this impact value. RESULTS: The results of this new personalization method are provided based on a pilot test conducted on 111 caregivers. The results indicate that a conjunctive average is appropriate at the first stage and that reward should be greater than penalty in the second stage. CONCLUSIONS: The method presented is able to personalize the intervention plan by determining the best order of carrying out the activities for each caregiver, with the aim of avoiding a high level of deterioration in any factor.

Efficacy of a multimodal nursing intervention strategy in the process of becoming a mother: A randomized controlled trial.

The lack of knowledge and skills for transitioning to motherhood places first-time mothers at greater risk of depression and stress, may lower their perceived self-efficacy and satisfaction with the maternal role, and potentially affects the mother-infant bond. The purpose of this study was to test the efficacy of a multimodal nursing intervention (AMACOMPRI), based on Mercer's Becoming a Mother Theory, in supporting the process of becoming a mother in first-time mothers of term infants. This study was a parallel-group, double-blind, randomized, controlled trial with a 4-month postpartum follow-up. The outcome measures were the process of becoming a mother, functional social support, mother-infant bond, and perceived maternal self-efficacy. Sixty-six first-time mothers completed the study: 33 in the intervention group and 33 in the control group. The intervention was effective in supporting the process of becoming a mother, with a large effect size (Cohen's d = 1.50) and higher scores on the Becoming-a-Mother Scale in the intervention group compared with the control group (intergroup difference 13.04 points; 95% confidence interval: 8.72-17.34). Participants in the intervention group demonstrated higher scores in functional social support, perceived maternal self-efficacy, and mother-infant bond. This study provides evidence for the efficacy of an innovative nursing intervention that supports the process of becoming a mother. Further testing of the intervention is required in different settings and first-time mothers of low and high risk newborns.

Association of Nursing Practice Environment on reported adverse events in private management hospitals: A cross-sectional study.

AIMS AND OBJECTIVES: To examine the relationships between nurses' perceptions of their practice environment, other working conditions and reported adverse events in two private management hospitals. BACKGROUND: Patient safety is influenced by knowledge, available resources and the context in which nursing care is provided. In this sense, it has been found that certain work environments (e.g., workload, nurse turnover level, patient-to-nurse ratio, nurse staffing, nurse manager ability) influence patient outcomes. The association between nursing practice environment and reported adverse events has not been explored in private management hospitals. DESIGN: A cross-sectional study. The STROBE was selected as the checklist in this study. METHODS: A total of 219 nurses were included in the study. This study was conducted from June 2018-June 2019 in Spain. Data were collected through questionnaires focusing on work conditions, reported adverse events (falls, medication errors, catheter-related sepsis and pressure ulcer) and Practice Environment Scale of the Nursing Work Index. Binary logistic regression analysis was performed to determine the factors influencing the occurrence of errors. RESULTS: Nurses reported poor perception of the professional environment, and 62.1% reported having made at least one error in the previous year. Manager support and leadership and nurse-physician relations were the most favourable aspects of work environment. Medical-surgical units, rotating in the same shift and favourable work environment, were associated with more reporting of adverse events. CONCLUSION: The factors of nursing practice (hospital area workload, staff rotating and perception of work environment) associated with reporting adverse events can be worked upon from the organisation and provided an opportunity for safety culture improvement and safer healthcare services. RELEVANCE TO CLINICAL PRACTICE: Improving the nurse work environment may reduce adverse patient events in private management hospitals.

'Living Together With Dementia': preliminary results of a training programme for family caregivers.

The aim of this article was to present the preliminary results of a training programme for family caregivers of people with dementia at an early to moderate stage living at home - 'Living Together With Dementia'. In this randomised controlled trial, 27 family caregivers who met the inclusion criteria were recruited from the neurology outpatient consultation clinic of a hospital in the north of Portugal and randomised into two groups (control and experimental) between October 2015 and March 2016. The programme 'Living Together With Dementia' was applied to the participants of the experimental group. The strategies used, overload, difficulties and satisfaction of the caregivers were assessed at three different stages (at the beginning and end of the intervention, as well as at follow-up). For the data analysis, quantitative parametric measures were applied. The Health Ethical Commission of the Hospital Centre approved the study, and its protocol and Helsinki Declaration ethical principles were considered throughout the process. In the final assessment, an improvement in the overload and difficulties was confirmed, as was an increase in the caregivers' satisfaction level and an improvement in coping/problem-solving strategies. In the follow-up stage, the results tended to revert towards those of the initial assessment. The programme 'Living Together With Dementia' appeared to be a major contribution enabling family caregivers of people with dementia, although there is a need to develop an efficacy study using a more substantial sample. The programme contributed to a reduction in the overload and difficulties borne by the family caregivers of people with dementia at an early to moderate stage living at home and to increased caregiver satisfaction.

Psychometric Properties of the Spanish Version of the Perceived Maternal Parenting Self-efficacy (PMP S-E) Tool for Primiparous Women.

OBJECTIVE: The objective of this study was to determine the validity and the reliability of the Perceived Maternal Parenting Self-Efficacy tool translated into Spanish and adapted to be used among primiparous women of term babies. METHODS: Validation study. A total of 210 women participated in the survey to establish construct validity and reliability. The questionnaire has 20 items and four subscales. The higher the score, the higher the self-efficacy. A process of translation/back-translation and cultural adaptation in accordance with international standards and an expert review were conducted to test face and content validity. The Validity Content Index and an exploratory factor analysis were used to identify the structure of the questionnaire. Reliability was estimated using Cronbach's alpha coefficient. RESULTS: Linguistic and cultural adaptation, validation and reliability were performed. Face validity for women was as follows: high comprehension (99%); and for experts: medium comprehension (84.1%), medium clarity (83.9%) and medium precision (80%). Concerning pertinence, the content validity index was 0.93 (i.e., highly pertinent). Concerning relevance, the content validity index was 0.96 (i.e., highly relevant). Factor validation identified four factors that accounted for 91% of the variance. Overall Cronbach's alpha value was 0.98 (IC 95 0.97-0.98). CONCLUSIONS FOR PRACTICE: Given the robust properties of the Spanish version of the Perceived Maternal Parenting Self-efficacy, it may be used to identify women with low self-efficacy and to assess the effectiveness of health-based interventions.

Affectivity in schizophrenia: Its relations with functioning, quality of life, and social support satisfaction.

OBJECTIVE: To evaluate the relationship between affectivity and sociodemographic and clinical characteristics, quality of life, functioning, and social support satisfaction in schizophrenia. METHOD: Cross-sectional study of a sample of 282 schizophrenic patients. An interview was performed using a sociodemographic and clinical questionnaire and scales to evaluate positive and negative affect, quality of life, social support satisfaction, and functioning. RESULTS: Participants' employment status, gender, whether they smoked, hospitalization in the last year, antidepressant medication and benzodiazepines, quality of life, functioning, and satisfaction with social support had relationships with positive or negative affect. CONCLUSION: This study provides further understanding of the factors related to affectivity in schizophrenia. More studies are needed to prove these relations and their effects on rehabilitation in people with schizophrenia.

A multi-centre, randomized, 3-month study to evaluate the efficacy of a smartphone app to increase caregiver's positive mental health.

BACKGROUND: To assess the effectiveness of a smartphone app-based intervention compared to a regular intervention of caregivers in primary health care institutions. The intervention is aimed at increasing positive mental health and decreasing caregiver's burden. METHODS/DESIGN: Randomized and controlled trial with an experimental group and a control group. SUBJECTS: 108 caregivers over 18, with a minimum of 4 months of experience as caregivers. Description of the intervention: an intervention with a smartphone app (n = 54) or a regular intervention for caregivers (n = 54). Each caregiver installs a smartphone app and uses it for 28 days. This app offers them a daily activity (Monday-Friday). These activities are related to the Decalogue of Positive Mental Health, which was designed ad hoc by a group of experts. The outcomes will be the score of caregiver burden, the positive mental health and participant satisfaction. These results will be assessed after the first, third and sixth month. DISCUSSION: The results of this study will offer evidence of the effectiveness of an intervention using a free smartphone app. If its effectiveness is proven and the results are acceptable, this could lead to a rethinking of the intervention offered to caregivers in primary care. TRIAL REGISTRATION: Clinical Register ISRCTN14818443 (date: 24/05/2019).

Exploring family members' experiences during a death process in the emergency department: A grounded theory study.

AIMS AND OBJECTIVES: To identify which are the needs arised from feelings, perceptions and experiences of the family members during any time within the death process in an emergency service of an acute care hospital, with regard to the assistance received. BACKGROUND: The publications refer to the needs expressed by bereaved families, who explain the support they received right after the death of a relative in an emergency service, and during the months after the tragedy. DESIGN: Qualitative study drawing on grounded theory based on Charmaz (2006). METHODS: Ten interviews were conducted to a member of each family, who had been in an emergency service with a relative during any of the stages of the dying process. Data were collected from September 2015-June 2016. The analysis was made while data were being collected. Three types of codification were carried out: open, axial and selective. Theoretical saturation was achieved after data collection and analysis. RESULTS: Three thematic categories emerged: the power of information/communication (a), decisions taken by professionals within the dimension of caring (b) and the humanisation of death in emergency services (c). CONCLUSIONS: The quality of the information given to families in the process of death in an emergency service affects to their satisfaction. Family support must be essential in a situation of death. Institutions must guarantee standards of practice, which include orientation on the care of people in bereavement, and the commitment to provide specialised attention those families. RELEVANCE TO CLINICAL PRACTICE: Research findings reveal the need to create changes within clinical practice, regarding how to take care of the family involved in a death process in an emergency service. From the needs detected by the participants, it could be possible to implement an interventional programme, which offers the relatives the emotional support they may need.

The emotion: A crucial component in the care of critically ill patients.

BACKGROUND: The acquisition of experience is a major concern for nurses in intensive care units. Although the emotional component of the clinical practice of these nurses has been widely studied, greater examination is required to determine how this component influences their learning and practical experience. OBJECTIVE: To discover the relationships between emotion, memory and learning and the impacts on nursing clinical practice. RESEARCH DESIGN: This is a qualitative phenomenological study. The data were collected from open, in-depth interviews. A total of 22 intensive care unit nurses participated in this research between January 2012 and December 2014. Ethical considerations: The School of Nursing Ethics Committee approved the study, which complied with ethical principles and required informed consent. FINDINGS: We found a clear relationship between emotion, memory and the acquisition of experience. This relationship grouped three dimensions: (1) satisfaction, to relieve the patient's pain or discomfort, give confidence and a sense of security to the patient, enable the presence of family members into the intensive care unit and provide family members with a realistic view of the patient's situation; (2) error experience, which nurses feel when a patient dies, when they fail to accompany a patient in his or her decision to abandon the struggle to live or when they fail to lend support to the patient's family; and (3) the feel bad-feel good paradox, which occurs when a mistake in the patient's care or handling of his or her family is repaired. CONCLUSION: Emotion is a capacity that impacts on nurses' experience and influences improvements in clinical practice. Recalling stories of satisfaction helps to reinforce good practice, while recalling stories of errors helps to identify difficulties in the profession and recognise new forms of action. The articulation of emotional competencies may support the development of nursing ethics in the intensive care unit to protect and defend their patients and improve their relationships with families in order to maximise the potential for patient care.

Violence and depression in a community sample.

AIMS AND OBJECTIVES: To understand the relation between the experience of violence and sociodemographic and clinical factors, and to determine whether diagnosed depression and the presence of anxiety and stress are related to having experienced workplace and domestic violence in different genders and age groups. BACKGROUND: Previous studies indicate that domestic and workplace violence increase the risk of suffering from depression. However, no studies have evaluated these two types of violence in a same cohort. DESIGN AND METHODS: We designed a descriptive cross-sectional study from 317 individuals randomly selected from the population in southern Catalonia (Spain). Sociodemographic and Goldberg anxiety-depression questionnaires were administered by telephone survey to 160 men and 157 women in December 2008. The data obtained were analysed by a logistic regression model. RESULTS: A quarter of the individuals had suffered from violence: 48·29% of them had experienced domestic violence and 32·9% had experienced workplace violence. Nearly half of the individuals with depression had experienced violence. No statistical difference has been observed between domestic and workplace violence regarding diagnosed depression. Women were twice as likely as men to have suffered from violence. People working outside their home and those who claimed to have no social support had a greater risk of suffering from violence. A greater consumption of medication, above all of psychotropic drugs, is associated with experiencing violence and with greater comorbidity. Predictive factors for suffering from depression are being women, having experienced violence, having suffered stress or anxiety, having little or no social support, having overload of task or having no secondary education and no tertiary education. CONCLUSIONS: This study suggests that when considering depression, anxiety and stress, especially in women, we must take into account whether an individual has suffered violence. RELEVANCE TO CLINICAL PRACTICE: Identifying violence can help health professionals, managers and researchers improve care and reduce suffering in families and communities.

Training programmes for family caregivers of people with dementia living at home: integrative review.

AIMS AND OBJECTIVES: To establish primary features of training programmes designed to assist family caregivers of people with dementia living at home and to propose a model programme based on literature findings. BACKGROUND: Due to dementia's distinctive progression, there is a widely felt need to train family members who undertake the responsibility of caring for relatives diagnosed with this condition to provide positive care, particularly during the early and middle stages of the disease. DESIGN: Integrative review. METHODS: Literature reviews were carried out in the Pubmed, CINAHL, Mediclatina and Medline databases, using the following describers: training programme, family caregivers, dementia and aged. Such searches encompassed publications between 2004-2014, together with eight articles for review due to their positive identification with the inclusion criteria. Relevant results were extracted, the subsequent analysis performed and the presentation carried out in a descriptive manner. RESULTS: The prevailing length of a training programme for a family caregiver of people with dementia is of six sessions over a six-week period, with one weekly session load, and an average duration of 100 minutes each. Methodologies most commonly used include discussion, problem-solving models as well as skills and strategies training. The themes discussed comprehend caring for the individual with dementia, information about the illness and the use of health and community resources. Regarding the assessment of the family caregiver, the most widely used instruments are demographic assessment questionnaires, self-efficiency and caregiver's burnout scales, as well as depression and quality of life measures. Three assessment instances of family caregivers' needs during the training programme are commonly encountered: initial, final and follow-up. CONCLUSIONS: This review has identified a set of features transversal to training programmes for family members who undertake the care for individuals with dementia living at home, which will bolster the construction and validation of other programmes in the area. More studies about such programmes need to be implemented, particularly engaged in their conceptual and experimental validation. RELEVANCE TO CLINICAL PRACTICE: The results of this review assist nurses by increasing their awareness of the basic assumptions supporting training programmes for family members responsible for individuals with dementia living at home and subsequently enforce them during their interventions with such population.

Analysis of the transition process among family caregivers in a hospital in the region of Catalonia in Spain.

PURPOSE: The aim of this study is to explore and understand the experience of the adaptation process among family caregivers in hospitals, who have an active presence in hospital and are essential in ensuring proper patient care. METHODS: A qualitative phenomenological approach was used to gain a deeper understanding of caregivers' lived experiences. Data were collected using in-depth interviews to explore six caregivers' experiences of hospitalization. RESULTS: The caregivers' accounts highlight the different determining factors in the transition process of a chronically ill patient's family caregiver during the patient's time in hospital. The most important themes emerging from the analysis were the importance of cultural beliefs and attitudes, meaning of the situation, caregiver's training and knowledge, socio-economic status and the hospital as a community. These categories can be analyzed using transitions theory. CONCLUSIONS: The most important conclusion is that the hospital in this study was not designed to accommodate caregivers, and the mechanisms used to meet caregivers' needs endanger their privacy, health, and coexistence in the hospital's rooms. Transitions theory provides a holistic understanding of the experience of the family caregiver.

Effectiveness of a Smartphone application and wearable device for weight loss in overweight or obese primary care patients: protocol for a randomised controlled trial.

BACKGROUND: To evaluate the effectiveness of an experimental intervention based on standard diet recommendations plus free Smartphone application (app) and wearable device for weight loss, compared with the standard diet intervention alone, in primary care patients aged 18 years or older who are overweight or obese. METHODS/DESIGN: Multicentre randomized, controlled clinical trial. LOCATION: Primary health care centres in the city of Tarragona and surrounding areas. SUBJECTS: 70 primary care patients, aged 18 years or older, with body mass index of 25 g/m2 or greater who wish to lose weight. Description of the intervention: 12 months of standard diet recommendations without (n = 35) or with (n = 35) assistance of a free Smartphone app that allows the participant to maintain a record of dietary intake and a bracelet monitor that records physical activity. The outcomes will be weight loss at 12 months (primary outcome), changes in physical activity and cardiometabolic risk factors, frequency of app use, and participant satisfaction after 12 months. DISCUSSION: The results of our study will offer evidence of the effectiveness of an intervention using one of the most popular free apps and wearable devices in achieving weight loss among patients who are overweight or obese. If these new technologies are proven effective in our population, they could be readily incorporated into primary care interventions promoting healthy weight. The open design and study characteristics make it impossible for the participants and researchers to be blinded to study group assignment. Researchers responsible for data analysis will be blinded to participant allocation. TRIAL REGISTRATION: Clinical Register: NCT02417623. Registered 26 March 2015.

Mobile Phone Apps to Promote Weight Loss and Increase Physical Activity: A Systematic Review and Meta-Analysis.

BACKGROUND: To our knowledge, no meta-analysis to date has assessed the efficacy of mobile phone apps to promote weight loss and increase physical activity. OBJECTIVE: To perform a systematic review and meta-analysis of studies to compare the efficacy of mobile phone apps compared with other approaches to promote weight loss and increase physical activity. METHODS: We conducted a systematic review and meta-analysis of relevant studies identified by a search of PubMed, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Scopus from their inception through to August 2015. Two members of the study team (EG-F, GF-M) independently screened studies for inclusion criteria and extracted data. We included all controlled studies that assessed a mobile phone app intervention with weight-related health measures (ie, body weight, body mass index, or waist circumference) or physical activity outcomes. Net change estimates comparing the intervention group with the control group were pooled across studies using random-effects models. RESULTS: We included 12 articles in this systematic review and meta-analysis. Compared with the control group, use of a mobile phone app was associated with significant changes in body weight (kg) and body mass index (kg/m(2)) of -1.04 kg (95% CI -1.75 to -0.34; I2 = 41%) and -0.43 kg/m(2) (95% CI -0.74 to -0.13; I2 = 50%), respectively. Moreover, a nonsignificant difference in physical activity was observed between the two groups (standardized mean difference 0.40, 95% CI -0.07 to 0.87; I2 = 93%). These findings were remarkably robust in the sensitivity analysis. No publication bias was shown. CONCLUSIONS: Evidence from this study shows that mobile phone app-based interventions may be useful tools for weight loss.

Effectiveness of Three Types of Interventions in Patients with Fibromyalgia in a Region of Southern Catalonia.

Several pharmacological and nonpharmacological treatments can be used to alleviate the symptoms of fibromyalgia, although none of them are completely effective at present. In this study, we analyzed the effectiveness of different therapies in three groups of people diagnosed with fibromyalgia. The sample for this randomized controlled trial was made up of 66 people diagnosed with fibromyalgia in southern Catalonia. In turn, this sample was divided into three groups of 22 participants each, who were treated with: i) cervical infiltration with botulinum toxin, ii) group problem-solving therapy, or iii) both therapies. The variables recorded were quality of life, suicidal thoughts, perception of pain, quality of sleep, and satisfaction. Female patients composed 96.9% (n = 64) of the study sample. Satisfaction with the infiltration was 5.1 ± 2.7 points, while in group problem-solving therapy it was 6.6 ± 3.2. Self-perceived health in the infiltration group (p = .016) and the therapy group (p = .001) improved after the intervention took place. The risk of suicide decreased in the both treatments/groups (p = .049). Pain was reduced by 31.8% with infiltration, 13.6% with therapy, and 22.7% with both treatments. Anxiety/depression decreased by 45% with therapy, 36.3% with infiltration, and 36.3% with both treatments. The results also showed that the use of both treatments significantly reduces suicidal thoughts (p = .049). In conclusion, this study showed the complexity of reducing chronic pain and increasing the quality of life of people with fibromyalgia.

[NURSING DIAGNOSES AND MIGRATION: PHENOMENOLOGICAL STUDY FROM THE IMMIGRANT'S POINT OF VIEW]. / Diagnósticos de enfermería y migración. ESTUDIO FENOMENOLÓGICO DESDE LA VISIÓN DE LOS INMIGRANTES.

OBJECTIVE: The objective of this research is to identify nursing diagnosis NANDA which is predominant within the immigrant community, linked to the migratory process and part of the framework of the Outcome Present State Test (OPT) of Pesut and Herman's critical awareness. METHODOLOGY: Keeping in mind the objectives of this research, this approaches the quality-based paradigm and follows the proposals of phenomenology research. The study was carried out using an individual semi-structured interview of 30 immigrants. A categorization of the data has been applied in accordance with the domains of NANDA for the identification of nursing diagnosis and its analysis has been carried with computer support with Atlas-ti 6.0. RESULTS: Twenty three diagnoses were identified in nine out of thirteen taxonomy NANDA domains. Analysis of their interrelationships according to the OPT model were carried out and a clinical reasoning net was created. The main diagnoses achieved in our study was: Readiness for Enhanced Coping. CONCLUSIONS: NANDA taxonomy doesn't include the migratory process in the characteristics and related factors of this nursing diagnosis. We consider that nursing taxonomy should be reassessed in order to describe more in depth the specific responses derived from the migratory experience so it can lead to a high quality health care.

Practical knowledge of experienced nurses in critical care: a qualitative study of their narratives.

BACKGROUND: Scholars of nursing practices have claimed practical knowledge is source of knowledge in its own right, nevertheless we know little about this knowledge associated with day-to-day practice. The purpose of this study is to describe knowledge that the more experienced nurses the in ICU make use of and discover the components of care it includes. Understanding this knowledge can contribute to improving the working practices of nurses with less experience. METHODS: We used a phenomenologic and hermeneutic approach to conduct a qualitative study. Open in-depth dialogue interviews were conducted with 13 experienced ICU nurses selected by intentional sampling. Data was compiled on significant stories of their practice. The data analysis enabled units of meaning to be categorised and grouped into topics regarding everyday practical knowledge. RESULTS: Knowledge related to everyday practice was evaluated and grouped into seven topics corresponding to how the ICU nurses understand their patient care: 1) Connecting with, calming and situating patients who cannot communicate; 2) Situating and providing relief to patients in transitions of mechanical respiration and non-invasive ventilation; 3) Providing reassurance and guaranteeing the safety of immobilised patients; 4) The "connection" with patients in comas; 5) Taking care of the body; 6) The transition from saving life to palliative care; and 7) How to protect and defend the patient from errors. The components of caretaking that guarantee success include: the calm, care and affection with which they do things; the time devoted to understanding, situating and comforting patients and families; and the commitment they take on with new staff and doctors for the benefit of the patient. CONCLUSIONS: These results show that stories of experiences describe a contextual practical knowledge that the more experienced nurses develop as a natural and spontaneous response. In critical patients the application of everyday practical knowledge greatly influences their well-being. In those cases in which the nurses describe how they have protected the patients from error, this practical knowledge can mean the difference between life and death. The study highlights the need to manage practical knowledge and undertake further research. The study is useful in keeping clinical practice up-to-date.

Effectiveness of problem-solving technique in caring for family caregivers: a clinical trial study in an urban area of Catalonia (Spain).

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.