Factors associated with nurses' positive attitudes towards families' involvement in nursing care: A scoping review.

AIM: To map the factors associated with nurses' positive attitudes towards families' involvement in nursing care and to identify any existing gaps in knowledge. BACKGROUND: Several tools have been proposed to assess the attitudes, beliefs and practices of nurses towards families in different care contexts. However, there is a knowledge gap on how the results of these tools can identify the factors that are associated with more positive attitudes of nurses. DESIGN: A scoping review based on the steps proposed by the Joanna Briggs Institute. METHODS: Three independent reviewers searched the databases: PUBMED/Medline; LILACS; Virtual Health Library; PsycInfo; Google Scholar; SCOPUS and CINAHL, from 2006 to August 2021, guided by the question: What are the factors associated with nurses' positive attitudes towards families´ involvement in nursing care, in studies that used one or both of the following two scales 'Families' Importance in Nursing Care- Nurses' Attitudes' and 'Family Nursing Practice Scale'? This review was conducted in accordance with PRISMA-ScR. RESULTS: Twenty-six primary studies were identified, in which 9,620 nurses participated. Positive attitudes were associated with three types of variables: (a) personal-longer working career (42.3%) and older age (26.9%); (b) educational-higher level of academic education (30.8%) and family nursing education (23.0%); and (c) workplace-working in primary health care and/or outpatient clinics (34.6%) or in a unit with philosophy/approach to families (23.0%). CONCLUSIONS: Personal variables such as age and time of service are non-modifiable aspects, but educational and workplace variables are subject to intervention to improve nurses' attitudes towards families' involvement in nursing care. Continuing development programmes about family care can constitute important strategies to improve positive attitudes of nurses towards families in practice. RELEVANCE TO CLINICAL PRACTICE: Recognising the characteristics associated with nurses´ positive attitudes towards families may enable the development of tailored interventions that promote family-focused care.

The experience of coronaphobia among health professionals and their family members during COVID-19 pandemic: A qualitative study.

Background: Coronaphobia is an excessive fear of becoming infected by the COVID-19 virus. Situations of coronaphobia against health professionals have been identified. Therefore, there is a need to develop studies to understand family impact and experience of COVID-19 pandemic and coronaphobia. Aim: To describe the coronaphobia experience of health professionals and of one of their family members during the first wave of the COVID-19 pandemic. Methods: Exploratory qualitative study using narrative inquiry was used. This study was guided by the concept of coronaphobia and Family Systems Nursing as conceptual frameworks. Face-to-face and telephone interviews were conducted from September to November 2020 with 14 health professionals, including nurses and physicians and one of their family members (n = 14). Findings: Three descriptive themes were identified which highlight professional-family dyads' experience of coronaphobia as a reciprocal and relational process. Coronaphobia was demonstrated by unknown or close people, in a disguised or explicit way, and generated suffering in the dyads and in the family unit. Consequently, individual and/or family strategies were developed to allow for the protection of the family system and the maintenance of its functioning. Discussion: This study describes how the dyads of health professionals and their family members identify the experiences of coronaphobia. In addition, it was possible to analyze the repercussions of coronaphobia on the dyad and the strategies they used to deal with it. Conclusions: This study extends understanding about the relationships between the experience of coronaphobia among health professionals and one of their family members and the experience of physical, cognitive and emotional suffering during the COVID-19 pandemic.

Plantar Cutaneous Sensory Stimulation Improves Foot Sensibility and Gait Speed in Older Adults With Diabetes: A Clinical Trial.

OBJECTIVE: To determine the effect of an intervention involving muscular ankle strengthening and feet sensory stimuli to improve gait speed and balance in older adults with diabetes mellitus type 2 (DM2). DESIGN: A clinical trial with concealed allocation, assessor blinding, and intention-to-treat analysis. PARTICIPANTS: The trial enrolled 66 people 60 years or older with DM2 who were physically independent (did not require assistance with activities of daily living). INTERVENTION: The experimental group performed 12 weeks of plantiflexor and dorsiflexor muscle strengthening exercises with resistance bands, proprioceptive exercises on balance boards and a buoy, and plantar sensory stimulation with bristle brushes and cloths, as well as general foot care instructions. The control group received foot care instructions only. OUTCOME MEASURES: The primary outcome was plantar cutaneous sensibility as measured with Semmes-Weinstein monofilaments. Secondary outcomes included muscular strength (plantar flexion and dorsiflexion torque as measured with an isokinetic dynamometer), gait speed, and balance (total displacement area, mediolateral displacement, anteroposterior displacement, mediolateral displacement speed, and anteroposterior displacement speed) on right and left bipedal and unipedal supports. RESULTS: In comparison with the control group, the experimental group demonstrated improved plantar cutaneous sensibility on the right foot (3.46 points; 95% confidence interval [CI], 3.85-9.80), left foot (3.46 points; 95% CI, 4.06-9.76), and an increase in gait speed (0.15 m/s; 95% CI 0.12-0.42). There were no meaningful changes in participants' ankle muscle strength or balance. CONCLUSIONS: This study showed that plantar cutaneous sensory stimulation can improve foot sensibility and increase the gait speed of older adults with DM2. However, there were no meaningful dorsiflexor or plantiflexor gains after 12 weeks.

Family presence during cardiopulmonary resuscitation and invasive procedures: a meta-synthesis.

OBJECTIVE: To synthesize the best qualitative evidence regarding the perception of family members, patients and health professionals about family presence during cardiopulmonary resuscitation and invasive procedures. METHOD: Systematic review with meta-synthesis performed in the databases of Web of Science, Scopus, CINAHL, PsycINFO, LILACS, MEDLINE, Embase and VHL. Articles published between 2010 and 2017 were included and evaluated with use of the Qualitative Data Extraction Instrument. RESULTS: In total, were found 2,391 articles, out of which 26 were selected, and 24 were analyzed. The identified meta-theme was 'A pendular perspective: different views on family presence during cardiopulmonary resuscitation and invasive procedures', which is supported by the following themes: Benefits resulting from family presence; Disadvantages and/or limiting factors of family presence; and Context: environmental, sociocultural and care factors influencing the perception of family presence. CONCLUSION: The perception of family members, patients and professionals about family presence is still controversial. The sensitization of these subjects can potentiate the practice by making it more systematized and qualified.

Difficulties to implement patient safety strategies: perspectives of management nurses. / Dificuldades para implantar estratégias de segurança do paciente: perspectivas de enfermeiros gestores.

OBJECTIVE: To understand the difficulties to implement patient safety strategies in the hospital environment from the perspective of nurse managers. METHODS: Descriptive, exploratory and qualitative study, carried out in four public university hospitals, using a semi-structured interview script, from January to March 2015. The sample was of 72 nurses. Content analysis was carried out, in the thematic modality. RESULTS: The following categories were identified: Inadequate sizing of nursing staff; Lack of support of the top management: from policies to concrete actions and; Lack of adherence of the professionals to patient safety strategies. CONCLUSIONS: In order for the institution to succeed in the implementation of patient safety strategies, it is necessary to have a continuous and permanent education policy, to raise awareness and to involve professionals from the top management to the front line employees.

Conceptual structure of aging in different ethnicities. / Estrutura conceptual do envelhecimento em diferentes etnias.

OBJECTIVE: To develop a conceptual framework that explains how elderly people from different cultures experience aging, formulate concepts and assign values to the process of aging. METHOD: Qualitative research conducted with 33 elderly people in a municipality of the triple border. The data were collected between February and August of 2011, using Symbolic Interactionism and the Grounded Theory as the theoretical and methodological strategy. RESULTS: The central theme identified was: "Having to age: sociocultural practices guiding aging in different ethnicities", which was made up of sub processes that characterize the study's structural concepts: aging conceived as multifactorial (physical, biopsychic and sociocultural); Experiencing aging in the process of cultural adaptation; Experiencing aging as the continuation of life; Redefining social roles; and The culture influencing habits and customs in healthcare. CONCLUSION: The experience of aging proved to be a unique process for each individual and the values assigned to it are influenced by one's own culture.

Patterns of behaviour in families of critically ill patients in the emergency room: a focused ethnography.

AIM: The aim of this study was to understand the patterns of behaviour from relatives of critically ill patients admitted to the emergency room. BACKGROUND: Admission of a critically ill family member to an accident and emergency department is often a sudden and unexpected experience for the family. This stressful event often creates feelings of instability and intense suffering in relatives. Understanding the experiences of these families is essential for the provision of comprehensive health care in the emergency room. DESIGN: A focused ethnography design was applied to the study. METHODS: Peripheral participant observation and informal conversations were conducted in an emergency room in southern Brazil during January 2015. Analysis of data was based on Leininger. FINDINGS: Suffering was recurrent among family members of critically ill patients admitted to the emergency room. The environment, which was conditioned by the patient's life-threatening situation and professionals' attitudes, resulted in relatives experiencing a range of feelings from suffering to calm. A distant approach and poor communication of professionals made relatives confused and silent. Factors that seemed to foster feelings of calm in families were the establishment of a continuous and close communication with professionals and the possibility to remain with the patient outside the established visiting hours. CONCLUSION: The findings of this study challenge emergency department providers and managers to promote comprehensive care in the emergency room by inviting family members to be with the patient and by engaging in family-centred care.

Foot ulceration in patients with diabetes: a risk analysis.

The study reported in this article aimed to analyse factors associated with the risk of ulceration in the feet of patients with diabetes using a conceptual hierarchic model. It was a cross-sectional study carried out with 1515 people with diabetes mellitus aged 40 years and older. The risk of foot ulceration was of higher significance in male patients with diabetes (adjusted odds ratio (OR)=1.39 (95% confidence interval (CI) 1.11 to 1.73); p=0.020), who did not practise a regular physical activity (adjusted OR=1.58 (95% CI 1.15 to 2.15); p=0.013), with time since diagnosis over 10 years (adjusted OR=1.42 (95% CI 1.10 to 1.86); p=0.011), who used insulin (adjusted OR=1.40 (95% CI 1.09 to 1.84); p=0.012), with retinopathy (adjusted OR=1.84 (95% CI 1.38 to 2.45); p=0.001) and who had had a previous stroke (adjusted OR=1.47 (95% CI 1.09 to 2.04); p=0.018). Mycosis on the nails and the interdigital spaces of the feet was statistically associated with ulceration risk independent of other variables of the model (adjusted OR=2.48 (95%CI 1.70 to 3.63); p=0.001). Finding the factors associated with ulceration contributes to the provision of quality care by nurses.

Factors associated with foot ulceration of people with diabetes mellitus living in rural areas. / Fatores associados à ulceração nos pés de pessoas com diabetes mellitus residentes em área rural.

Objective To analyze the factors associated with the risk of ulceration in the feet of people with diabetes mellitus living in rural areas. Methods This is a cross-sectional study conducted with 293 individuals with diabetes mellitus, aged 40 years or older, living in the south of Brazil, in 2014. We analyzed socioeconomic variables, clinical conditions and foot self-care. We used the Poisson multiple regression model and the Prevalence Ratio (PR) and p-value<0.05 as a measure of association. Results 43.7% of the sample presented risk of foot ulceration. The highest prevalence of foot ulceration risk was associated with people with lower purchasing power (PRadjusted=1.62/IC95%:1.52-2.22), with retinopathy (PRadjusted=1.30/IC95%:1.12-1.68) and alteration in foot moisture (PRadjusted=1.57/IC95%:1.22-2.01). We identified low education level (64.2%), high prevalence of arterial hypertension (86.3%) and onychomycosis in the feet (72%). Conclusions Diabetic patients need an assessment of the risk of foot ulceration, especially those with longer diagnosis, chronic complications and low socio-educational level.

Care of cancer patients in the Family Health Strategy: the user's view. / Atenção a pacientes oncológicos na Estratégia Saúde da Família: olhar do usuário.

Objective understand the experiences of cancer patients regarding the care received and the relationship with Family Health Strategy professionals. Method qualitative research based on Heidegger's phenomenology held with ten cancer patients living in the coverage area of three healthcare centers in a city in northwestern Paraná. Data were collected at the patients' homes from November 2012 to February 2013 through open interviews. Results some patients were faced with the impersonality of professionals and lack of empathy, interaction, and singling in care whereas others had their expectations met since they experienced a comprehensive care permeated with concern, sharing of feelings, and respect. Conclusions the understanding of these experiences raises a reflection on the support that is provided in this instance of care and the importance of overcoming impersonal and inauthentic attitudes in order to transcend to a new level of relationship and care.

[Performance of tuberculosis control services in municipalities of Paraná: family centeredness]. / Desempenho dos serviços de controle da tuberculose em municípios do Paraná: enfoque na família.

OBJECTIVE: To analyse and compare the performance of tuberculosis control services from the perspective of healthcare service users in relation to family centeredness. METHODS: A descriptive, quantitative and qualitative study with 89 patients undergoing TB treatment in the 15th regional health district of Paraná. Data were collected from April to June 2012 using semi-structured interviews. The quantitative data were submitted to variance analysis or to the Kruskal-Wallis test and the qualitative data were subjected to content analysis. RESULTS: The quantitative data showed that the health units performed better for the indicators 'healthcare professionals know the people who live with the user' (p = 0.1340) and 'evaluation of family members with specific tests' (p = 0.1430), while the benchmark outpatient units performed better for 'dialogue with family members about tuberculosis' (p = 0.5203) and 'treatment' (p = 0.4788). Analysis of the qualitative data produced two categories: 'family involvement in the treatment of tuberculosis' and 'disconnection of the health service from the family of patients with tuberculosis'. CONCLUSIONS: Healthcare teams should support and guide the families since they provide the care to patients undergoing tuberculosis treatment.

[Cultural singularities: indigenous elderly access to Public Health Service]. / Singularidades culturais: o acesso do idoso indígena aos serviços públicos de saúde.

OBJECTIVE: Describing how Kaingang seniors and their primary caregivers experience access to public health services. METHOD: A qualitative study guided by ethnography, conducted with 28 elderly and 19 caregivers. Data were collected between November 2010 and February 2013 through interviews and participative observation analyzed by ethnography. RESULTS: The study revealed the benefits and difficulties of the elderly access to health services, the facility to obtain health care resources such as appointments, medications and routine procedures, and the difficulties such as special assistance service problems and delays in the dispatching process between reference services. CONCLUSION: The importance of knowing and understanding the cultural specificities of the group in order to offer greater opportunities for the elderly access to health services was reinforced.

[Acute pain from the perspective of minor trauma patients treated at the emergency unit]. / A dor aguda na perspectiva de pacientes vítimas de trauma leve atendidos em unidade emergencial.

OBJECTIVE: To study the factors that influence the perception of acute pain and the consequences of this experience in patients suffering from mild trauma. METHOD: Descriptive qualitative study conducted in an emergency service in southern Brazil. Data was collected in October 2013, through semi-structured interviews with 29 individuals who reported pain after physical trauma, regardless of the triggering factor. To process the data, we used a Content Analysis technique, subject modality. RESULTS: Two categories emerged: Factors that influence the perception of pain resulting from trauma and, Consequences of acute pain due to trauma. The acute pain sensation was influenced by biological, emotional, spiritual and socio-cultural factors and induced biological and emotional consequences for individuals. CONCLUSION: The health professionals need to consider the factors that influence soreness and its consequences for the proper assessment and management of pain resulting from trauma.

[Risk of developing diabetes mellitus in primary care health users: a cross-sectional study]. / Risco para desenvolvimento do diabetes mellitus em usuários da atenção primária a saúde: um estudo transversal.

OBJECTIVE: to identify the risk of developing diabetes mellitus among primary care users in a municipality of the Southern Brazil. METHOD: data were collected from October 2013 to April 2014 by applying the Finnish Diabetes Risk Score questionnaire on 189 users. RESULTS: the majority of the interviewees presented a slight moderate to moderate risk of developing diabetes mellitus (63.5%). There was a greater prevalence of high risk among the men. The variables with a significant prevalence ratio for high risk were age, obesity, abdominal circumference, sedentarism and family history of diabetes mellitus. CONCLUSION: the identified risk factors for diabetes reveal the importance of the health team and how it can intervene to prevent disease.

[Association between self-reported health and sociodemographic characteristics with cardiovascular diseases in adults]. / Associação entre autopercepção de saúde e características sociodemográficas com doenças cardiovasculares em indivíduos adultos.

OBJECTIVE: To assess the association of sociodemographic and self-rated health in the presence of cardiovascular diseases and the association of this perception with the type of disease. METHODS: A cross-sectional population survey study carried out with 1,232 individuals aged between 20 and 59 years of both genders living in the metropolitan region of Maringá-PR. Data were analyzed using multiple and simple logistic regression. RESULTS: In multivariate analysis, the age range and self-rated health were associated with cardiovascular disease, and in the univariate analysis self-rated regular health was associated with arterial hypertension, while self-rated poor health was associated to heart failure, stroke, and to acute myocardial infarction (heart attack). CONCLUSION: The differences in association of self-rated health with these diseases can indicate how individuals with certain characteristics cope with the disease, allowing for more individualized and specific health care.

[Quality of life and living conditions from the viewpoint of residents in a seniors condominium]. / Qualidade e condições de vida sob a ótica dos residentes de um condominio do idoso.

The aim of the study was to understand how residents of a condominium Aging realize the quality and conditions of life in this new housing modality. This is an exploratory qualitative study of 20 elderly residents of the condominium Maringá. Data were collected in February 2012 in the household were semistructured and subjected to content analysis interviews. The results indicate the factors valued by the elderly in their perception of quality of life such as independence, autonomy, having an occupation, developing leisure and acceptance of the aging process activities. Also valued the structure and characteristics of this housing method due to the possibility of social interaction. We conclude that the identification of these aspects allows the planning of strategies for integrated care for the elderly and it is suggested that nurses recognize and value the aspects highlighted in the planning of care with elderly people in general.

[Conception of family members of people with mental disorders on self-help groups]. / Concepção de familiares de pessoas com transtorno mental sobre os grupos de autoajuda.

The aim of this study was to understand how family members of people with mental disorders conceive the performance of self- help groups (SG). This qualitative study was conducted with eleven family members who participate in a SG of the Maringaense Mental Health Association. Data were collected from April to June 2010 during group meetings, in an adjoining room, by means of semi-structured interviews, which were then subjected to content analysis. Two categories emerged: "The group compensates for deficiencies in care", which points out deficiencies arising from the formal care services and the benefits of SG for family members and, "Idealized care", which reveals the expectations of the family in relation to mental health care. It was concluded that family members would like activities of the SG to be incorporated by mental health care services and for family care to become a part of the care plan.

[The existence of nursing in caring for terminally ills'life: a phenomenological study]. / O existir da enfermagem cuidando na terminalidade da vida: um estudo fenomenológico.

By taking care of cancer patients in their process of end of life, nursing experience situations of suffering before the anguish of others. This study aimed to understand the meaning and significance attributed by the nurses from the palliative care cancer hospital. This is a phenomenological research, grounded in Heidegger's thinking, performed with 13 nurses, who work at Oncology hospitalward, through semi-structured interviews, which were analyzed according to the steps recommended by Josgrilberg. From understanding the statementsof the subjects, two ontological themesemerged: Feeling satisfaction and love in the care offered and Feeling anger and inabilitytowards terminally ill patients.We inferred that working in Oncology Ward is something rewarding for these professionals, but it entails physical and mental suffering, from feeling helpless before the death-dying process. Thus, we showedthat nursing professionals need to be recognized as human beings and as such, also deserving of care.

[Access to care for women during childbirth in university hospitals: characterization and associated factors]. / Acesso de parturientes para a assistência ao parto em hospitais universitários: caracterização e fatores associados.

This study aimed to analyze the socioeconomic, demographic, obstetric, neonatal and healthcare factors associated with access to care by women during childbirth. It was a transversal study conducted on puerperal women in two university hospitals in the state of Paraná, Brazil in 2011. Access to childbirth was analyzed according to socioeconomic, demographic, obstetric, neonatal and healthcare variables. The puerperal women were interviewed during hospitalization, in the first 72 hours after birth. The data was analyzed by relative frequencies and calculation of the chi2, considering a significant association when p < or = 0.05. The overall rate of women referred to university hospitals was 17.7%. A significant associated was found between access to childbirth and residing in other cities; premature birth; underweight newborns; complications in the current pregnancy and the use of ambulances. It was concluded that the associated factors found in this study suggest that pregnant women with some risk required referral to university hospitals.

Challenges of nursing research with immigrant and refugee populations: methodological and pragmatic considerations.

The objective of the study was to identify the main challenges in conducting research with immigrants and refugees and to provide seven methodological and pragmatic strategies. The analyses presented, based on the Theory of Culture Care Diversity and Universality, are extracted from insights of the authors' experiences as researchers and the literature. The main challenges are related to cultural, moral, political, and educational differences between researcher and researched; identification of the universe and sampling; access to informants through the barrier of distrust; and communication and language difficulties. Strategies to make research more successful involve: developing a thorough research protocol; creatively recruiting participants; developing strategies to facilitate communication; having a sensitive look; offering a structure of reciprocity; increasing trust, and triangulating research. The main methodological and pragmatic issues in studies with immigrants and refugees were explored, providing valuable guidance for future projects. However, in different migration situations, researchers must be aware of the possibility of other challenges arising during the investigative process.