[Organization and costs of stroke care in outpatient settings: Systematic review]. / Organización y costes de la atención extrahospitalaria del ictus. Revisión sistemática de la literatura.

OBJECTIVE: To review the bibliography on stroke costs (ICD-10 code I63) in the field of primary care. DESIGN: Systematic review. DATA SOURCES: PubMed/Medline, ClinicalTrials.gov, Cochrane Reviews, EconLit, and Ovid/Embase between 01/01/2012-12/31/2021 with descriptors included in Medical Subject Heading (MeSH). SELECTION OF STUDIES: Those with a description of the costs of activities carried out in the out-of-hospital setting. Systematic reviews were included; prospective and retrospective observational studies; analysis of databases and total or partial costs of stroke as a disease (COI). Articles were added using the snowball method. The studies were excluded because: a) not specifically related to stroke; b) in editorial or commentary format; c) irrelevant after review of the title and abstract; and d) gray literature and non-academic studies were excluded. DATA EXTRACTION: They were assigned a level of evidence according to the GRADE levels. Direct and indirect cost data were collected. RESULTS AND CONCLUSIONS: Thirty studies, of which 14 (46.6%) were related to post-stroke costs and 12 (40%) to cardiovascular prevention costs. The results show that most of them are retrospective analyzes of different databases of short-term hospital care, and do not allow a detailed analysis of the costs by different segments of services. The possibilities for improvement are centered on primary and secondary prevention, selection and pre-hospital transfer, early discharge with support, and social and health care.

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 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).

Nursing assessment as an effective tool for the identification of delirium risk in older in-patients: A case-control study.

AIMS AND OBJECTIVES: To evaluate the usefulness of comprehensive nursing assessment as a strategy for determining the risk of delirium in older in-patients from a model of care needs based on variables easily measured by nurses. BACKGROUND: There are many scales of assessment and prediction of risk of delirium, but they are little known and infrequently used by professionals. Recognition of delirium by doctors and nurses continues to be limited. DESIGN AND METHODS: A case-control study. A specific form of data collection was designed to include the risk factors for delirium commonly identified in the literature and the care needs evaluated from the comprehensive nursing assessment based on the Virginia Henderson model of care needs. We studied 454 in-patient units in a basic general hospital. Data were collected from a review of the records of patients' electronic clinical history. RESULTS: The areas of care that were significant in patients with delirium were dyspnoea, problems with nutrition, elimination, mobility, rest and sleep, self-care, physical safety, communication and relationships. The specific risk factors identified as independent predictors were as follows: age, urinary incontinence, urinary catheter, alcohol abuse, previous history of dementia, being able to get out of bed/not being at rest, habitual insomnia and history of social risk. CONCLUSIONS: Comprehensive nursing assessment is a valid and consistent strategy with a multifactorial model of delirium, which enables the personalised risk assessment necessary to define a plan of care with specific interventions for each patient to be made. RELEVANCE TO CLINICAL PRACTICE: The identification of the risk of delirium is particularly important in the context of prevention. In a model of care based on needs, nursing assessment is a useful component in the risk assessment of delirium and one that is necessary for developing an individualised care regime.

Positive Mental Health and Prevalence of Psychological Ill-Being in University Nursing Professors in Catalonia, Spain.

The aim of the current study was to examine the prevalence of psychological ill-being among university nursing professors in Spain and determine their grade of positive mental health. A cross-sectional study was conducted from June 2013 to December 2013 with a sample of 263 university nursing professors. Sociodemographic and occupational variables, as well as variables related to daily habits and lifestyle, were collected. Psychological ill-being was measured using the General Health Questionnaire (GHQ-12) and positive mental health was evaluated with the Positive Mental Health Questionnaire (PMHQ). Prevalence of psychological ill-being (GHQ-12 score >2) among the sample was 27% (range = 21.8% to 32.6%), with a higher prevalence in teachers from first and second cycles (Bachelor's degree and Master's degree, respectively) and a lower prevalence in those having very satisfactory social relationships. Significant differences were found in relation to consumption of tranquilizer drugs and Bach flower remedies. PMHQ scores were lower among teachers with a GHQ-12 score >2. Participants presented a good level of positive mental health. Preventive policies should be applied with the aim of reducing psychological ill-being among professors and potentiating positive mental health. [Journal of Psychosocial Nursing and Mental Health Services, 55(7), 38-48.].

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.

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.

Diagnosed, identified, current and complete depression among patients attending primary care in southern Catalonia: different aspects of the same concept.

The aims of this study were to explore the prevalence and the conceptualizations of depression detected by the healthcare system, identified by the patient or classified/identified in the validated Goldberg's questionnaire in a community. We conducted a cross-sectional evaluation of 317 patients. The different types of depression diagnosed, identified, current or total were stratified by age and gender groups. The difference in the conceptualization of depression from the medical or ordinary people point of view indicate that depression care requires the understanding of the lifestyle, beliefs, attitudes, family and social networks of the people the physicians and nurses care for.

Caring for family caregivers: An analysis of a family-centered intervention.

Objective To assess the effectiveness of Problem-Solving Therapy (PST) on family caregivers through the use of scales to measure anxiety, depression and emotional distress; and to explore facilitating factors and obstacles for its use based on the narrative of nurses. Method A clinical trial and an exploratory focus group with the use of mixed analysis methodology. The study was conducted in a primary health care center in Tarragona, Spain, and the sample consisted of 122 family caregivers who were included in the home care service, and 10 nurses who participated in the intervention group. Family caregivers with evident symptoms of anxiety, depression and emotional distress received PST in the intervention group. The intervention group also consisted of a discussion with eight nurses, which was transcribed and submitted to content analysis. Conclusion Problem-Solving Therapy proved to be effective in reducing perceived anxiety, depression and emotional distress. We identified its strong points and obstacles as described by nurses.

The costs associated with stroke care continuum: a systematic review.

Stroke, a leading cause of death and long-term disability, has a considerable social and economic impact. It is imperative to investigate stroke-related costs. The main goal was to conduct a systematic literature review on the described costs associated with stroke care continuum to better understand the evolution of the economic burden and logistic challenges. This research used a systematic review method. We performed a search in PubMed/MEDLINE, ClinicalTrial.gov, Cochrane Reviews, and Google Scholar confined to publications from January 2012 to December 2021. Prices were adjusted using consumer price indices of the countries in the studies in the years the costs were incurred to 2021 Euros using the World Bank and purchasing power parity exchange rate in 2020 from the Organization for Economic Co-operation and Development with the XE Currency Data API. The inclusion criteria were all types of publications, including prospective cost studies, retrospective cost studies, database analyses, mathematical models, surveys, and cost-of-illness (COI) studies. Were excluded studies that (a) were not about stroke, (b) were editorials and commentaries, (c) were irrelevant after screening the title and abstract,(d) grey literature and non-academic studies, (e) reported cost indicators outside the scope of the review, (f) economic evaluations (i.e., cost-effectiveness or cost-benefit analyses); and (g) studies not meeting the population inclusion criteria. There may be risk of bias because the effects are dependent on the persons delivering the intervention. The results were synthetized by PRISMA method. A total of 724 potential abstracts were identified of which 25 articles were pulled for further investigation. The articles were classified into the following categories: 1)stroke primary prevention, 2) expenditures related to acute stroke care, 3) expenditures for post-acute strokes, and 4) global average stroke cost. The measured expenditures varied considerably among these studies with a global average cost from €610-€220,822.45. Given the great variability in the costs in different studies, we can conclude that we need to define a common system for assessing the costs of strokes. Possible limitations are related to clinical choices exposed to decision rules that trigger decisions alerts within stroke events in a clinical setting. This flowchart is based on the guidelines for acute ischemic stroke treatment but may not be applicable to all institutions.

[Effectiveness of problem solving technique applied by nurses: decreased anxiety and depression in family caregivers]. / Efectividad de la técnica de resolución de problemas aplicada por enfermeras: disminución de la ansiedad y la depresión en cuidadoras familiares.

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

A Mobile App-Based Intervention Program for Nonprofessional Caregivers to Promote Positive Mental Health: Randomized Controlled Trial.

BACKGROUND: While nonprofessional caregivers often experience a sense of fulfillment when they provide care, there is also a significant risk of emotional and physical burnout. Consequently, this can negatively affect both the caregiver and the person being cared for. Intervention programs can help empower nonprofessional caregivers of people with chronic diseases and develop solutions to decrease the physical and psychological consequences resulting from caregiving. However, most clinically tested intervention programs for nonprofessional caregivers require face-to-face training, and many caregivers encounter obstacles that hinder their participation in such programs. Consequently, it is necessary to design internet-based intervention programs for nonprofessional caregivers that address their needs and test the efficacy of the programs. OBJECTIVE: The aim of this study was to evaluate the effectiveness of a smartphone app-based intervention program to increase positive mental health for nonprofessional caregivers. METHODS: This study was a randomized controlled trial of 3 months' duration. A total of 152 caregivers over 18 years of age with a minimum of 4 months' experience as nonprofessional caregivers were recruited from primary health care institutions. Nonprofessional caregivers were randomized into two groups. In the intervention group, each caregiver installed a smartphone app and used it for 28 days. This app offered them daily activities that were based on 10 recommendations to promote positive mental health. The level of positive mental health, measured using the Positive Mental Health Questionnaire (PMHQ), and caregiver burden, measured using the 7-item short-form version of the Zarit Caregiver Burden Interview (ZBI-7), were the primary outcomes. Users' satisfaction was also measured. RESULTS: In all, 113 caregivers completed the study. After the first month of the intervention, only one factor of the PMHQ, F1-Personal satisfaction, showed a significant difference between the groups, but it was not clinically relevant (0.96; P=.03). However, the intervention group obtained a higher mean change for the overall PMHQ score (mean change between groups: 1.40; P=.24). The results after the third month of the intervention showed an increment of PMHQ scores. The mean difference of change in the PMHQ score showed a significant difference between the groups (11.43; P<.001; d=0.82). Significant changes were reported in 5 of the 6 factors, especially F5-Problem solving and self-actualization (5.69; P<.001; d=0.71), F2-Prosocial attitude (2.47; P<.001; d=1.18), and F3-Self-control (0.76; P=.03; d=0.50). The results of the ZBI-7 showed a decrease in caregiver burden in the intervention group, although the results were inconclusive. Approximately 93.9% (46/49) of the app users indicated that they would recommend the app to other caregivers and 56.3% (27/49) agreed that an extension of the program's duration would be beneficial. CONCLUSIONS: The app-based intervention program analyzed in this study was effective in promoting positive mental health and decreasing the burden of caregivers and achieved a high range of user satisfaction. This study provides evidence that mobile phone app-based intervention programs may be useful tools for increasing nonprofessional caregivers' well-being. The assessment of the effectiveness of intervention programs through clinical trials should be a focus to promote internet-based programs in health policies. TRIAL REGISTRATION: ISRCTN Registry ISRCTN14818443; http://www.isrctn.com/ISRCTN14818443. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s12889-019-7264-5.

The structure and contents of the helping relationship as a nursing psychotherapeutic intervention: A modified e-Delphi study.

PURPOSE: The aim of this study is to evaluate the content validity of the helping relationship as a nursing psychotherapeutic intervention. DESIGN AND METHODS: The present research work is a modified e-Delphi study. A total of 205 experts were identified between January and May 2018, and a questionnaire was sent to all of them in different rounds. FINDINGS: The nurse must have specific knowledge (self-knowledge and knowledge about the person) and attitudes (empathy and respect) to be able to carry out the intervention. The helping relationship can address different nursing diagnoses, such as anxiety or depressed mood, and it can be developed in a set of sessions with specific objectives and contents. PRACTICE IMPLICATIONS: The systematization of the helping relationship creates the conditions for its implementation in clinical practice enabling an evidence-based practice that results in the improvement of care.

[Competence of triage nurses in hospital emergency departments]. / Perfil competencial en los profesionales de triaje de los servicios de urgencias hospitalarios.

OBJECTIVES: To identify associations between sociodemographic characteristics variables and competence levels of triage nurses in hospital emergency departments. MATERIAL AND METHODS: Descriptive, cross-sectional, multicenter study of triage nurses in hospital emergency departments in the southwestern area of Catalonia (Ebre River territory). We used an instrument for evaluating competencies (the COM_VA questionnaire) and recording sociodemographic variables (age, sex, total work experience, emergency department experience, training in critical patient care and triage) and perceived confidence when performing triage. We then analyzed the association between these variables and competency scores. RESULTS: Competency scores on the COM_VA questionnaire were significantly higher in nurses with training in critical patient care (P=.001) and triage (P=0.002) and in those with longer emergency department experience (P<.0001). Perceived confidence when performing triage increased with competency score (P<.0001) and training in critical patient care (P<.0001) and triage (P=.045). CONCLUSION: The competence of triage nurses and their perception of confidence when performing triage increases with emergency department experience and training.

OBJETIVO: Identificar la relación entre las variables sociodemográficas estudiadas y el nivel competencial de los enfermeros que realizan triaje en los servicios de urgencias hospitalarios (SUH). METODO: Estudio descriptivo, transversal, multicéntrico realizado a enfermeros que realizan triaje en los SUH de Terres de l'Ebre. Se analiza la relación entre variables del cuestionario evaluativo de competencias COM_VA©, sociodemográficas (edad, sexo, experiencia laboral total y en SUH, formación en paciente crítico y en triaje, seguridad percibida en la realización del triaje) y habilidades profesionales. RESULTADOS: El nivel competencial (COM_VA©) es mayor en enfermeros con formación en paciente crítico (p = 0,001) y triaje (p = 0,002) y con experiencia en el SUH (p < 0,0001). La seguridad percibida al realizar triaje aumenta con el nivel competencial (p < 0,0001) y con la formación en paciente crítico (p < 0,0001) y triaje (p = 0,045). CONCLUSIONES: La formación y experiencia en el SUH aumentan las competencias del enfermero de triaje y la seguridad percibida al realizarlo.

"Living together with dementia": Training programme for family caregivers - A study protocol.

HIGHLIGHTS: The increased incidence of dementia places the family in the role of caregiver.It is important to create, to implement and to validate training programmes for family caregivers of people with dementia living at home.The programme "Living together with dementia" addressed in this protocol seeks to be a response to empower these caregivers. INTRODUCTION: Due the increase incidence of Dementia, the creation, implementation and evaluation of the effectiveness of training programmes for family caregivers of people with dementia living at home should be a goal of health professionals. The aim of this paper is to describe the randomised control trial protocol that will assess the effectiveness of the training programme for family caregivers who care for people with dementia at home "Living together with Dementia". METHODS: Randomised control trial. Family caregivers of people with dementia in early and moderate stages will be recruited through a neurology appointment at the São João Hospital Centre, Porto-Portugal. The inclusion criteria employed will be as follows: to be the main caregiver of the person with dementia; to be literate; the care target has dementia in early or moderate stage; the person with dementia does not suffer from any other severe mental pathology. Caregivers will be randomised and assigned to control and experimental groups. 3 assessment moments will take place: initial, after the intervention and a follow up of 3 to 6 months. The assessment instruments include a survey containing sociodemographic data, Caregiver Burden Scale, Caregiver Assessment Satisfaction Index and Caregiver Assessment Difficulties Index. The participants of the experimental group will be submitted to a 7-week individual psychoeducational programme. The study was approved by the Health Ethics Committee of the São João Hospital Centre in September 2015. DISCUSSION: This programme might prove an asset to family caregivers of people with dementia living at home, since it pinpoints understanding and preparation of their role. It also facilitates the intervention of health professional, as it features as a guideline for their performance with this target population.

Caring for family caregivers: An analysis of a family-centered intervention / Cuidar a la cuidadora familiar: análisis de una intervención centrada en la familia / Cuidar a la cuidadora familiar: análisis de una intervención centrada en la familia

Objective To assess the effectiveness of Problem-Solving Therapy (PST) on family caregivers through the use of scales to measure anxiety, depression and emotional distress; and to explore facilitating factors and obstacles for its use based on the narrative of nurses. Method A clinical trial and an exploratory focus group with the use of mixed analysis methodology. The study was conducted in a primary health care center in Tarragona, Spain, and the sample consisted of 122 family caregivers who were included in the home care service, and 10 nurses who participated in the intervention group. Family caregivers with evident symptoms of anxiety, depression and emotional distress received PST in the intervention group. The intervention group also consisted of a discussion with eight nurses, which was transcribed and submitted to content analysis. Conclusion Problem-Solving Therapy proved to be effective in reducing perceived anxiety, depression and emotional distress. We identified its strong points and obstacles as described by nurses.

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Objetivo Avaliar a efetividade da Técnica de Resolução de Problemas (TRP) em cuidadores familiares mediante escalas positivas de ansiedade, depressão e stress emocional; explorar os fatores facilitadores e as barreiras para sua aplicação a partir das narrativas das enfermeiras. Método Ensaio clínico e grupo focal exploratório, com metodologia de análise mista. Realizado em centros de cuidados primários em Tarragona (Espanha), cuja amosta foi de 122 cuidadores familiares, incluindo atendimento domiciliar e 10 enfermeiros no grupo de intervenção. Grupo implementação experimental do TRP, cuidador familiar com sintomas de ansiedade, depressão e desconforto percebido. No grupo controle a enfermeira executa a intervenção habitual. Feita medição pré e pós intervenção em ambos os grupos. Grupo de discussão com oito enfermeiros do grupo de intervenção, transcrição e análise de conteúdo. Conclusão Ficou demonstrada a eficácia da TRP na redução da ansiedade, depressão e desconforto percebido. Foram identificados os pontos fortes e as barreiras na aplicação da técnica.
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Objetivo Evaluar la efectividad de la Técnica de Resolución de Problemas (TRP) en cuidadoras familiares mediante escalas positivas de ansiedad, depresión y malestar emocional; explorar los factores facilitadores y barreras en su aplicación a partir de la narrativa de las enfermeras. Método Ensayo clínico y grupo focal exploratorio y metodología de análisis mixta. Ilevado a cabo en el Centro de Atención Primaria de Tarragona (España), cuya muestra fue 122 cuidadoras familiares incluidas en el programa de atención domiciliaria y 10 enfermeras del grupo intervención. Grupo experimental aplicación de la TRP, a la cuidadora familiar con síntomas de ansiedad, depresión y malestar percibido. Grupo control la enfermera realiza la intervención habitual. Medición pre-post en ambos grupos. Grupo de discusión con ocho enfermeras del grupo intervención, trascripción y análisis del contenido. Conclusión Se demuestra la efectividad de la TRP en la reducción de ansiedad, depresión y malestar percibido. Se identifican los puntos fuertes y las barreras descritas por las enfermeras en la aplicación de la técnica.
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