Ansiedad y depresión en las madres de recién nacidos prematuros. Estrategias de intervención y revisión de la bibliografía / Anxiety and depression in mothers of preterm infants. Intervention strategies and literature review

INTRODUCCIÓN: El parto prematuro es una situación muy estresante para las mujeres que lo sufren, ya que supone enfrentarse a una realidad no esperada, en la que se pierden sus expectativas sobre la vivencia del embarazo y el parto normal. Además, deberán afrontar no sólo la separación inicial de su hijo, sino también la pérdida de su rol maternal, ya que los cuidados se asumirán en la unidad neonatal (UNN). Por todo ello, durante el puerperio estas mujeres serán especialmente vulnerables a los problemas de salud mental, y tendrán más riesgo de sufrir niveles altos de ansiedad, depresión e incluso síntomas de estrés postraumático. OBJETIVOS: Conocer y valorar las estrategias de intervención que han demostrado ser eficaces para prevenir, mejorar y/o tratar los riesgos para la salud mental de las madres que pasan por el proceso de tener un hijo prematuro. METODOLOGÍA: Se ha realizado una búsqueda de la bibliografía publicada en los últimos 5 años en las bases de datos CINHAL, PubMed, Web of Science y PsycINFO. RESULTADOS: Las estrategias que han demostrado ser eficaces para mejorar la salud mental son las que incluyen a las madres como cuidadoras, ya sea a través de la promoción de la lactancia materna, el método canguro o los masajes en la UNN, y también las intervenciones que aumentan los conocimientos, tanto en referencia al ambiente de la UNN como a los cuidados y progresos de sus hijos. CONCLUSIONES: La matrona, como profesional de referencia del cuidado del puerperio, ha de conocer el riesgo para la salud mental de estas puérperas, con el fin de detectarlo precozmente y promover actividades preventivas que faciliten su rol maternal, y así contribuir a mejorar la experiencia de tener un hijo prematuro

INTRODUCTION: Preterm birth represents a stressful situation for women who suffer it. They have to face an unexpected reality. A new reality far from their initial expectations about pregnancy and birth, as well as the separation from their baby after giving birth. Premature babies need special cares assumed by the neonatal intensive care unit so mothers have to delegate her maternal role to health professionals. Therefore, all women who have to face a preterm birth are especially vulnerable during the postpartum period to develop mental health problems and to present more anxiety, depression and even post-traumatic stress. OBJECTIVE: Identify and evaluate intervention strategies that proved to be effective in order to prevent, improve and/or treat the risks in mental health of all mothers who have to face a preterm baby. METHODOLOGY: Bibliographic research in the scientific literature published during the last five years in the databases CINHAL, PubMed, Web of Science and PsycINFO. RESULTS: The strategies which demonstrated to be more effective to improve the mental health are interventions that included mothers as the responsible of giving care to the baby. There are different strategies such the promotion in breastfeeding, the kangaroo method or the introduction in massage techniques in the neonatal unit. The activities that help them to increases the knowledge about the function of the neonatal intensive care unit and giving them all the information about the care and progress of their baby are effective options as well. CONCLUSIONS: The midwife is the responsible to take care of mothers during the postpartum. This professional has to know the risk of this women to develop mental health problems during this process. In that case, they have to detect it early and work to promote preventive activities that help mothers to develop her maternal role in this way they will contribute to improve the experience of having a premature baby

Niveles de ansiedad en enfermos hospitalizados afectados de cardiopatía isquémica / Anxiety levels of hospitalized patients with ischemic heart disease

Objetivo. Evaluar el nivel de ansiedad de los pacientes diagnosticados de cardiopatía isquémica en el ingreso y en el alta hospitalaria. Material y método. Estudio longitudinal con pacientes hospitalizados por cardiopatía isquémica en el Hospital Universitari Josep Trueta de Girona. Se estudiaron variables sociodemográficas, características y gravedad de la enfermedad y nivel de ansiedad mediante el inventario State-Trait Anxiety Inventory (STAI) Estado (E) y Rasgo (R) al ingreso y alta. Los datos se analizaron mediante el programa SPSS 19.0. Se realizaron modelos de regresión lineal para estudiar las variables asociadas a la ansiedad estado al ingreso y alta. Resultados. Se estudiaron 72 pacientes, 72 % hombres y 28 % mujeres, con edad media de 62.5 (DS = 4), jubilados (42 %), con diagnóstico de infarto (76 %) y con algún tipo de antecedente psiquiátrico (27 %). Las mujeres presentaron puntuaciones superiores de ansiedad respecto a los hombres en el STAI E al alta (p = 0.034), STAI R al ingreso (p = 0.008) y STAI R al alta (p = 0.008). Los participantes con menos estudios presentaron mayor ansiedad. Los pacientes con antecedentes de ansiedad, depresión o ambos presentaron mayor ansiedad STAI R al ingreso (p = 0.006) y los que tuvieron complicaciones tenían puntuaciones más elevadas de STAI R al alta (p = 0.007). En los modelos de regresión lineal, el STAI E al ingreso y al alta se asoció con el STAI R al ingreso (p = 0.000). Conclusiones. Los pacientes con cardiopatía isquémica presentan niveles moderados de ansiedad. El ser mujer, tener un menor nivel de estudios, presentar antecedentes de trastorno mental, presentar complicaciones intrahospitalarias y puntuaciones elevadas de ansiedad rasgo son factores relacionados con la ansiedad estado. El conocimiento de estos factores permitirá intervenciones enfermeras para mejorar el bienestar y la calidad de vida de las personas hospitalizadas (AU)

Objective. To evaluate anxiety levels in hospitalized patients with ischemic heart disease during admission and discharge. Materials and methods. Longitudinal study of hospitalized patients with ischemic heart disease at the University Hospital Josep Trueta in Girona. Sociodemographic variables, characteristics and disease severity, together with levels of anxiety measured through the State-Trait Anxiety Inventory (STAI) State (E) and Trait (R) at admission and discharge were studied. Data was analysed using SPSS 19.0 software. Linear regression models were performed to study the variables associated to state anxiety upon admission and discharge. Results. 72 patients, 72 % male and 28 % female, with a mean age of 62.5 (SD = 4), retired (42 %), with a diagnosis of infarction (76 %) and with some type of psychiatric history (27 %). were studied. Women showed higher anxiety scores than men in the STAI E at discharge (p = 0.034), STAI R at admission (p = 0.008) and STAI R at discharge (p = 0.008). Participants with lower levels of studies reported greater anxiety levels. Patients with a history of anxiety disorders, depression or both, experienced higher anxiety STAI R at admission (p = 0.006). Patients with complications had STAI R scores higher at discharge (p = 0.007). In linear regression models, the STAI E at admission and discharge was associated with STAI R at admission (p = 0.000). Conclusions. Patients with ischemic heart disease have moderate levels of anxiety. The female gender, lower levels of education, a history of mental disorders, presenting hospital complications and high scores of trait anxiety are factors related to state anxiety. Knowledge of these factors will allow nursing interventions to improve the well being and life quality of these hospitalized patients (AU)

[Discussion around the use of yoga in psychiatry]. / Réflexion sur l'usage du yoga en psychiatrie.

Many mind-body practices have recently been introduced into psychiatric care including yoga. An experiment in the field addresses the issue of the organisation and applications of this discipline, and envisages the possibility of extending the scope of indications.

[Relaxation, a complementary approach for mental health nurses]. / La relaxation, une approche complémentaire pour l'infirmier en santé mentale.

Relaxation is arousing growing interest in mental health. Its positive effects are in line with an active approach which brings together body and mind and place the individual back on the path of self-awareness. The relationship with the patient constitutes the "therapeutic we" ensuring its therapeutic importance. It represents a complementary and original approach to caring.

Using health psychology to help patients: common mental health disorders and psychological distress.

This article provides an overview of how health psychology can be used by nurses to help patients experiencing common mental health problems and psychological distress. Mental health problems are common and are associated with poor outcomes, especially for patients with comorbid physical health conditions. Mental health problems are associated with unhealthy behaviours such as smoking, physical inactivity, overeating and excessive alcohol use, which will result in poorer outcomes for patients. Consideration of a patient's psychological health is therefore important for all nurses providing holistic care. Awareness of the symptoms of psychological distress, good communication skills and simple screening instruments can be used by nurses to assess patients' mental health. The cognitive and behavioural risk factors associated with depression and anxiety are also explored, as an understanding of these can help nurses to provide appropriate care.

The effect of a researcher designated music intervention on hospitalised psychiatric patients with different levels of anxiety.

AIMS AND OBJECTIVES: The purpose of this study was to investigate the effects of a music intervention on hospitalised psychiatric patients with different levels of anxiety. BACKGROUND: In clinical practice, psychiatric inpatients and nurses routinely suffer from anxiety. A music intervention may possibly be useful, but knowledge as to how useful and how effective it is in patients with different levels of anxiety is limited. DESIGN: The study design was a three-group, repeated-measures experimental study. METHODS: Subjects were 22 psychiatric patients who were divided into three groups based on their level of anxiety. They listened to 20 minutes of music each day for 10 days and were assessed using the Beck Anxiety Inventory before and after the music intervention and at a one-week follow-up; an electroencephalogram and finger temperature were monitored before and during the music intervention. RESULTS: Anxiety levels of all three groups showed a significant difference (p = 0·0339) after the intervention. The difference alpha and beta electroencephalogram percentages for all three groups showed a significant difference (p = 0·04; p = 0·01). The finger temperature showed a non-significant difference (p = 0·41). CONCLUSIONS: A music intervention can effectively alleviate the anxiety of hospitalised psychiatric patients who suffer from all levels of anxiety. RELEVANCE TO CLINICAL PRACTICE: The study recommends a practice in alleviating anxiety. Effective lower-cost interventions to reduce anxiety in psychiatric inpatient settings would be of interest to nurses and benefit patients.

Imagery for Self-Healing and Integrative Nursing Practice.

Imagery has been used as a healing practice since ancient times. Its reemergence in modern medicine began in the second half of the 20th century, when research suggested that imagery could help reduce patients' pain and anxiety and improve their quality of life and outlook on their illness. While current evidence is insufficient to support claims that imagery affects disease progression, research suggests that this method of inducing relaxation encourages patients' healing process and gives them a greater sense of autonomy in relation to disease and its management. Because imagery is noninvasive, the risks associated with its use are minimal and it is now widely used in integrative nursing. The author discusses imagery's uses and benefits, as well as the potential pitfalls in its use, and describes an imagery technique she has found effective in practice, providing a sample script and explaining how the technique might be used to help patients in various settings.

Angústia espiritual: a busca por novas evidências / Angustia espiritual: la búsqueda por nuevas evidencias / Spiritual distress: the search for new evidence

Objective: To investigate the understanding of the concept of spiritual distress and existing methods toidentify it. Method: it is an integrative literature review conducted in LILACS, MEDLINE, BDENf, CINAHL,IBECS, PUBMED, using the terms "spiritual distress", "spiritual suffering", together with the descriptor: nursing. Results: after analysis of 30 articles, nine were selected, and only four (44.4%) conceptualized spiritual distress, some using more than one concept, with the deficiencies in the constructs of transcendence, connection, beliefs/values systems, sense of meaning and purpose in life that most prevailed. Strategies to identify the phenomenon range from close observation of the patient to the application of psychometric assessment instruments. Conclusion: he combined use of all methods will enable healthcare professionals to have the means to identify and assess spiritual distress and thus offer care that meets the spiritual needs of the patient.

Objetivo: Investigar sobre a compreensão do conceito de angústia espiritual e os métodos existentes para identificá-la. Método: trata-se de uma revisão integrativa de literatura realizada nas bases de dados LILACS, MEDLINE, BDENF, CINAHL, IBECS, PUBMED, utilizando os termos: “angústia espiritual” (spiritual distress), “sofrimento espiritual” (spiritual suffering), juntamente com o descritor: enfermagem (nursing). Resultados: após análise de 30 artigos, nove foram selecionados, apenas quatro (44,4%) conceituaram a angústia espiritual, alguns utilizaram mais de uma conceituação, sendo as deficiências nos construtos de transcendência, conexão, sistemas de crenças/valores, senso de significado e propósito na vida que mais prevaleceram. Estratégias para identificar o fenômeno abrangem desde observação atentado paciente até a aplicação de instrumentos de avaliação psicométricas. Conclusão: a utilização combinada de todos os métodos possibilitará que profissionais da área da saúde tenham meios de identificar e avaliar a angústia espiritual e assim oferecer um cuidado que supra a necessidade espiritual do paciente.

Objetivo: Investigar la comprensión del concepto de la angustia espiritual y los métodos existentes para identificarlo. Método: Se trata de una revisión integradora de la literatura realizada en las bases de datos LILACS, MEDLINE, BDENF, CINAHL, IBECS, PUBMED, usando los términos "angustia espiritual" (spiritual distress), "sufrimiento espiritual" (spiritual suffering), junto con el descriptor: enfermería (nursing). Resultados: después del análisis de 30 artículos, se seleccionaron nueve, sólo cuatro (44,4%) conceptuaran la angustia espiritual, algunas utilizaran más de un concepto, siendo las diferencias en los conceptos de trascendencia, conexión, sistemas de creencia/valores, el concepto de significado y propósito en la vida que más prevalecieron. Estrategias para identificar el fenómeno abarcan desde una estrecha observación del paciente hasta la aplicación de los instrumentos de evaluación psicométricas. Conclusión: El uso combinado de todos los métodos permiten a los profesionales de la salud que tengan medios para identificar y evaluar la angustia espiritual y así ofrecer una atención que responda a las necesidades espirituales del paciente.

Broken Heart Syndrome: A Typical Case.

This case describes a combination external treatment for "Broken Heart Syndrome" that includes a lavender footbath, massage using moor extract, and oxalis ointment to the abdomen applied by an Anthroposophic nurse for a specific personality type. Lavender footbaths have been used since ancient times for relaxation and calming, while moor extract has been used medicinally in Europe since the middle ages for warmth and environmental protection. Rhythmical massage using moor extract and oxalis ointment poultice to the abdomen are part of the tradition of Anthroposophic nursing when managing stress induced by emotional and physical trauma. An elderly lady with specific characteristics diagnosed as Broken Heart Syndrome received one treatment a week for 4 weeks given by an Anthroposophic nurse at an integrative medical center. Between treatments, education was given to enable self-treatment in the home. The nursing treatments, each using lavender footbaths, moor extract massage, and oxalis ointment poultice to the abdomen, proved very effect, and no negative effects were reported. External applications need to be considered by nurses caring for specific personality types with Broken Heart Syndrome.

Anxiety: etiology, treatment, and Christian perspectives.

Anxiety disorders are the most common mental illness in the United States, affecting 18% or more of adults. Anxiety is a natural response to stress and danger but becomes pathological when excessive and uncontrollable. This article discusses symptoms, risk factors, neurobiology and pathophysiology, psychotherapies and medications used in treatment, nursing interventions, and biblical Christian understanding and support for managing anxiety.

Promoting quality breast cancer care: psychosocial distress screening.

OBJECTIVE: To evaluate the feasibility of implementing psychosocial distress screening in a breast center of a comprehensive cancer center, using a model of structure (personnel, resources), process (screening), and outcome (number of patients screened, number referred). METHODS: The first step in the project was to establish administrative support, educate and engage breast center staff, identify stakeholders and persons with expertise in the conduct of evidence based initiatives. A two-phase implementation approach was agreed upon with Phase I being screening of new patients in surgical oncology and Phase II being screening women in medical oncology. RESULTS: A total of 173 patients were screened. The new patients screened in surgical oncology reported higher average distress scores compared to patients in medical oncology (5.7 vs. 4.0). However, a greater number of patients in medical oncology reported scores >4 compared to the new patients screened in surgery (54% vs. 35%). Psychological distress was the most commonly reported distress for patients in surgery. In contrast, 60% of scores >4 in medical oncology were symptom related, managed by the nurse or physician. SIGNIFICANCE OF RESULTS: Nurse led implementation of psychosocial distress screening is feasible, addressing this important quality indicator of patient-centered care.

Trauma and its aftermath for commercially sexually exploited women as told by front-line service providers.

Commercial sexual exploitation of women and girls through forced prostitution and sex-trafficking is a human rights and public health issue, with survivors facing complex mental health problems from trauma and violence. An international and domestic problem, the average age of recruitment into sex-trafficking is between 11 and 14 years old. Given its secrecy and brutality, such exploitation remains difficult to study, which results in a lack of knowledge related to trauma and how best to develop specific services that effectively engage and meet the unique needs of survivors. This qualitative research, using thematic analysis, explored the stories of trauma and its aftermath for commercially sexually exploited women as told by front-line service providers. Three themes emerged regarding the experience of sex-trafficking and its outcomes-Pimp Enculturation, Aftermath, and Healing the Wound-along with seven subthemes. These have important implications for all service and healthcare providers.

Estudio cuasi-experimental sobre las terapias de relajación en pacientes con ansiedad / Quasi-experimental relaxation therapies in patients with anxiety

Introducción: Los trastornos de ansiedad son muy frecuentes en atención primaria y especializada. Para reducir la ansiedad se recomienda el uso de terapias de relajación como terapia alternativa a la psicofarmacología. El objetivo del estudio será averiguar si las terapias de relajación benefician a los pacientes con ansiedad. Material y métodos: Se utilizó metodología cuantitativa: estudio cuasi-experimental de antes y después, longitudinal, prospectivo. Sujetos a estudio: pacientes diagnosticados de ansiedad y que acepten participar en la terapia de relajación en el centro de salud mental Infante (Murcia), desde diciembre hasta marzo de 2010. (n=39). Variable independiente: terapia de relajación; variable dependiente: ansiedad. Otras variables: sexo, edad, nivel educativo y tratamiento con psicofármacos. Se utiliza la escala validada: STAI; se comparan puntuaciones pre-post-intervención (se aplica t de student, xi cuadrado (intervalo de confianza p< 0'05). Resultados: Realizan el test STAI pre-post 39 pacientes, 69% mujeres y 31% hombres. La edad media: 39'84 años. Un 77% tomaban medicación y el 23% no. Predominaba claramente el de educación secundaria obligatoria (ESO). La media de ansiedad estado antes fue de 68 y después de 56. STAI estado (antes/después) con un nivel de significación de p< 0'027, por lo que se aceptó la hipótesis nula. Se observó que en los pacientes que no tomaban psicofármacos, el descenso de ansiedad era significativo con una p<0'036. Conclusiones: Los talleres de técnicas de relajación son útiles en la reducción de la ansiedad en atención especializada, además son más eficaces en pacientes con ansiedad que no tomen medicación (AU)

Introduction: Anxiety disorders are highly prevalent in primary and specialty care. To reduce anxiety the use of relaxation therapy is recommended as an alternative therapy to Psychopharmacology. The aim of the study is determine whether relaxation therapies benefit patients with anxiety. Materials and Methods: We used quantitative methodology: a quasi-experimental study before and after a, longitudinal, prospective study. Subjects studied: patients diagnosed with anxiety who agreed to participate in relaxation therapy at the mental health center Infante (Murcia), from December 2009 to March 2010. (N = 39). Independent variable was relaxation therapy and the dependent variable was anxiety. Other variables were sex, age, educational level and treatment with psychotropic drugs. Validated scale used was STAI, scores comparing pre-post-intervention (t student applies, xi square confidence interval (p <0.05). Results: The test was performed by pre-post STAI 39 patients, 69% female and 31% male. The mean age was 39'84 years. 77% were taking medication and 23% were not. There was a clearly dominance of secondary education (ESO). Mean state anxiety before was 68 and after 56. STAI state (before / after) with a significance level of p <0'027, so the null hypothesis was accepted. It was observed that in patients not taking psychotropic drugs, the decrease in anxiety was significant at p <0'036. Conclusions: Workshops in relaxation techniques are helpful in reducing anxiety in specialized care, and are more effective in patients with anxiety who do not take medication (AU)

Evaluation of effectiveness and satisfaction outcomes of a mental health screening and referral clinical pathway for community nursing care.

The study aimed to explore the effectiveness of a mental health screening and referral clinical pathway for generalist community nursing care of war veterans and war widow(er)s in Australia on outcomes of client self-reported mental health, quality of life, and client and carer satisfaction. The pathway was developed by literature review and consultation, then trialled and evaluated. Validated screening tools were embedded within the pathway to support generalist nurses' mental health decision making. Pre- and post-measures were applied. Clients on whom the pathway was trialled were invited to complete an evaluation survey questionnaire, as were their informal carers. Most clients and carers who responded to these questionnaires were highly satisfied or satisfied with care provided through application of the pathway. This study adds understanding about one way that community nurses might identify people with mental health difficulties. The trialled pathway, which was modified and refined following the study, is now available on the Internet as an evidence-based resource for community nurses in Australia to guide practice and maximize holistic care for war veterans and war widow(er)s where that care is funded by Department of Veterans' Affairs.

Effect of visual art on patient anxiety and agitation in a mental health facility and implications for the business case.

There is a growing body of evidence on the impact of the environment on health and well-being. This study focuses on the impact of visual artworks on the well-being of psychiatric patients in a multi-purpose lounge of an acute care psychiatric unit. Well-being was measured by the rate of pro re nata (PRN) medication issued by nurses in response to visible signs of patient anxiety and agitation. Nurses were interviewed to get qualitative feedback on the patient response. Findings revealed that the ratio of PRN/patient census was significantly lower on the days when a realistic nature photograph was displayed, compared to the control condition (no art) and abstract art. Nurses reported that some patients displayed agitated behaviour in response to the abstract image. This study makes a case for the impact of visual art on mental well-being. The research findings were also translated into the time and money invested on PRN incidents, and annual cost savings of almost $US30,000 a year was projected. This research makes a case that simple environmental interventions like visual art can save the hospital costs of medication, and staff and pharmacy time, by providing a visual distraction that can alleviate anxiety and agitation in patients.

Terapia de la risa. En el dolor crónico músculo-esquelético / Laughter Therapy for chronic skeletal muscular pain

Se explican los efectos de la introducción de talleres de risoterapia y relajación en una unidad de educación terapéutica y rehabilitación funcional, y se comprueba si su aplicación ayuda a disminuir el dolor, mejorar la movilidad y reducir el estado emocional alterado (ansiedad-depresión) del paciente(AU)

The authors explain the effects introducing workshops for laughter therapy and relaxation to a unit dedicated to therapeutic education and functional rehabilitation; the authors test to see if the application of this therapy hepls to decrease pain, to improve mobility and to reduce na altered emotional state, such as anxiety-depression, common among chronic pain patients(AU)