The experience of hope in dyads living with advanced chronic illness in Portugal: a longitudinal mixed-methods study.

BACKGROUND: Hope is an important resource that helps patients and families thrive during difficult times. Although several studies have highlighted the importance of hope in different contexts, its specific manifestations in the realm of advanced chronic illness need further exploration. In this study, we sought to elucidate the intricate interplay between the construct of hope and the lived experience of advanced chronic illness within patient-caregiver dyads. Our objectives were (a) to explore the dyadic experience of hope as a changing dynamic over time for patients living with advanced chronic illness and their informal caregivers and (b) to evaluate variations of hope and symptom burden across time. METHODS: We conducted a longitudinal mixed-methods study with a convergent design between December 2020 and April 2021. Patients living with advanced chronic illness and informal caregivers participated as a dyad (n = 8). The Herth Hope Index scale was used to measure dyads' level of hope and the Edmonton Symptom Assessment System was used to measure patients' symptom burden. Descriptive statistics were undertaken. A thematic analysis as described by Braun and Clarke was conducted to analyze dyadic interview data. Dyads' experience of hope was described by using the six dimensions of hope in the Model of Hope of Dufault and Martocchio. RESULTS: Dyadic scores of hope and patients' symptom burden were stable over time. The constructs of hope in dyads included "Living one day at the time," "Having inner force/strength," and "Maintaining good health." Changes in patterns of hope were captured for each dyad in their transition over time. Data converged for all dyads except one. CONCLUSIONS: The findings of our study show a constant presence of hope even in the face of adversity. Healthcare professionals must find ways to promote hope in dyads of patients living with advanced chronic diseases. Nurses play a pivotal role; dyadic interviews should be promoted to create a safe space for both patients and informal caregivers in order to share experiences. More research is needed to address patients' and informal caregivers' hope in chronic illness because current hope-based interventions primarily target cancer diagnoses.

The experiences of daily smartphone use among older adults in Brazil: A grounded theory analysis.

Background: Digital inclusion of older people is an important agenda for the future and well-being of the older population, as it represents a form of social inclusion with significant gains for healthy aging. The present study aimed to understand the experiences of Brazilian older adults who use smartphones and the implications in their daily lives. Method: A qualitative study was developed using a constructivist grounded approach. Older people (≥60 years) with prior access to a smartphone were invited to participate in the study. Participation took place through semi-structured, audio-recorded interviews. Data collection and analysis occurred simultaneously using a constant comparative approach. Data management and analysis used the Atlas.ti® software. Results: Overall, 37 older people participated, with an average age of 70.60 ± 6.95 years, predominantly female (n = 33), white (n = 25), married (n = 26) and retired (n = 27). The first sample group included 27 older people with family support and the second group included 10 older people without family support (who lived alone in their homes). A core category emerged from the data analysis-"Expanding the personal and social development of older adults through smartphone communication"-around which three main categories emerged: 1) The smartphone as "a window to the world"; 2) The problem of misinformation and fake news on virtual networks; 3) Technological paradoxes in the use of smartphones. Conclusions: The digital transition associated with smartphone use brings unimaginable benefits to older adults who adopt positive habits to improve their well-being and expand their social connections, following efforts proposed by the Decade of Healthy Aging. However, older adults still face disparities and experience a significant digital divide, which represents a major challenge. Barriers to access are further aggravated in developing countries. We hope this study contributes to public health policies on digital inclusion and healthy aging.

Well-Being and Dispositional Hope in a Sample of Portuguese Citizens: The Mediating Role of Mental Health.

In our pursuit of a fulfilling and contented life, the study of well-being has emerged as a fundamental field of research. Higher levels of well-being are associated with better mental health outcomes. Individuals with better mental health might possess the personal resources necessary to set and pursue meaningful goals, maintain positive expectations, and overcome adversities. We aim to explore the positive relationship between well-being (hedonic, psychological, and social) and dispositional hope. We suggest that mental health acts as a mediator in this relationship, since improved mental health can create a conducive environment for the development and maintenance of dispositional hope. Data were collected using an e-survey through social media during the last quarter of 2022. The hypothesis of this study was tested using mediation analysis. The sample was composed of 471 participants (85.4% female) with a mean age of 47.72 ± 11.86 years. Participants were mainly workers (88.6%), followed by pensioners (6.8%), university students (2.5%), and unemployed (2.1%). Results revealed that well-being was positively and significantly associated with dispositional hope. Additionally, well-being presented a significant and positive relationship with mental health, which, in turn, also presented a significant and positive relationship with dispositional hope. Finally, using the Hayes process macro for SPSS, we found that mental health mediates the relationship between well-being and dispositional hope. Our findings reinforce the conceptual frameworks that consider well-being and mental health as key contributors to a resilient and optimistic mindset. Interventions that aim to cultivate positive affect, facilitate personal growth, and foster supportive social environments might help improve mental health outcomes.

Long COVID among Brazilian Adults and Elders 12 Months after Hospital Discharge: A Population-Based Cohort Study.

The persistence of symptoms for more than three months following infection with severe acute respiratory syndrome coronavirus 2 is referred to as "Long COVID". To gain a deeper understanding of the etiology and long-term progression of symptoms, this study aims to analyze the prevalence of Long COVID and its associated factors in a cohort of Brazilian adults and elders, twelve months after hospital discharge. An observational, prospective, and follow-up study was performed with a cohort of adults and older adults diagnosed with COVID-19 in 2020 in the State of Paraná, Brazil. Twelve months after hospital discharge, patients answered a phone questionnaire about the persistence of symptoms after three levels of exposure to COVID-19's acute phase (ambulatory, medical ward, and intensive care unit). According to the characteristics of participants, the prevalence of Long COVID-19 was calculated, and logistic regression analyses were conducted. We analyzed data from 1822 participants (980 adults [≥18-<60 years] and 842 older people [≥60 years]) across three exposure levels. The overall Long COVID prevalence was 64.2%. Long COVID was observed in 646 adults (55%; of which 326 were women) and 523 older people (45%; of which 284 were women). Females had a higher prevalence of long-term symptoms (52%) compared with men. The most common post-COVID-19 conditions in the 12-month follow-up were neurological (49.8%), followed by musculoskeletal (35.1%) and persistent respiratory symptoms (26.5%). Male individuals were less likely to develop Long COVID (aOR = 0.50). Other determinants were also considered risky, such as the presence of comorbidities (aOR = 1.41). Being an adult and having been hospitalized was associated with the development of Long COVID. The risk of developing Long COVID was twice as high for ward patients (aOR = 2.53) and three times as high for ICU patients (aOR = 3.56) when compared to non-hospitalized patients. Presenting clinical manifestations of digestive (aOR = 1.56), endocrine (aOR = 2.14), cutaneous (aOR = 2.51), musculoskeletal (aOR = 2.76) and psychological systems (aOR = 1.66) made adults more likely to develop Long COVID. Long COVID was present in a large proportion of people affected by the SARS-CoV-2 infection. Presence of Long COVID symptoms displayed a dose-response relationship with the level of disease exposure, with a greater prevalence of symptoms associated with the severe form in the acute period.

Physical Activity and Associated Factors among Brazilian Adult Inmates: A Cross-Sectional Study.

Previous studies on health in prison facilities have determined that imprisonment has adverse effects on both physical and emotional well-being. Therefore, the introduction of public health measures is encouraged. This study aimed to (a) evaluate the levels of physical activity and the health condition of a sample of Brazilian prisoners and (b) determine the predictors of low physical activity. An observational and cross-sectional study was developed following the STROBE checklist. Data collection took place between June and November 2019 in a maximum-security Brazilian prison institution. This study's final sample included 220 people selected through convenience sampling, of which 115 (53.2%) were aged 18 to 29 years, followed by 79 (36.6%) aged 30 to 44 years and 22 (10.2%) aged 45 to 59 years old. Overall, 64.3% of participants failed to meet the World Health Organization (WHO) recommendation for physical activity [at least 150-300 min of moderate-intensity or 75 min of vigorous-intensity aerobic physical activity per week]. The majority reported unhealthy food consumption (116; 53.7%). Regarding body mass index (BMI), 50.2% of individuals were classified as eutrophic, 38.1% were overweight and 11.6% were obese. Older age (AOR: 0.95; CI95%: 0.92-0.99; p = 0.01) and sitting time (AOR: 0.74; CI95%: 0.65-0.85; p < 0.01) were associated with low adherence to physical activity. Our results highlight the importance of practicing physical activity within the prison context and the need for institutional programs that promote regular physical activity.

Spiritual Care[Givers] Competence in Palliative Care: A Scoping Review.

To deliver spiritual care, professionals must be skilled in physical, mental, social, and spiritual care. Spiritual care competence includes knowledge, behaviors, attitudes, and skills that enable successful or efficient care. This review aims to identify the scope of competence and the specific skills, knowledge, and attitudes used in providing spiritual care to people needing palliative care, and the main challenges and facilitators. A scoping review was developed using the Joanna Briggs Institute methodology. Six databases (Web of Science; MEDLINE/Pubmed; Scopus; CINAHL; MedicLatina and SciELO) were searched in September 2023, with an update in January 2024. The resulting 30 articles were analyzed using a content analysis approach. Information was categorized into three domains: cognitive, affective, and functional (based on three personal resources: intrapersonal, interpersonal, and transpersonal). Palliative care professionals face a lack of training and insufficient preparation to deliver spiritual care. Spiritual care competence depends on professional spiritual development and experience, spiritual intelligence (cognitive), spiritual humility (affective), and having a critical and reflexive mind (functional). In the future, palliative care should seek to improve competent spiritual care. This review could help clarify the real configuration of competent spiritual care and lead to improvements in a professional's empowerment when delivering effective spiritual care to patients and families.

Managing long COVID symptoms and accessing health services in Brazil: A grounded theory analysis.

Background: The worldwide community has shown significant interest in researching the management of Long COVID. However, there is scarce evidence about the daily experiences of people living with Long COVID and their insights into the healthcare services provided to them. Aims: This study aims to understand the experience of Long COVID sufferers with their symptoms and in accessing health services. Method: We employed Charmaz's grounded theory methodology, informed by constructivism, and applied the COREQ guidelines for qualitative research. Sixty-six Brazilians living with Long COVID participated in the study. The data was collected using semi-structured telephone interviews and analyzed using a constant comparative process. Findings: The findings refer firstly to the consequences of persistent Long COVID symptoms. Secondly, they describe how the disease trajectory required Long COVID sufferers to reorganize their routines and develop adaptive strategies. Lastly, they reflect a diverse array of both positive and negative interactions inside the healthcare system conveyed by individuals suffering from Long COVID. These elements converge towards the core category of the study: "The limbo of Long COVID sufferers: between the persistence of symptoms and access to health services". Conclusions: Long COVID is characterized by its varied nature, including a range of physical and emotional repercussions experienced by individuals. There is a need for enhanced comprehension and discourse about Long COVID across several domains, including the general public, policy-making entities, and healthcare professionals. In this sense, the development of specialized services or the reinforcement of existing services to support long COVID sufferers is imperative.

Mental Health Promotion and Illness Prevention in Vulnerable Populations.

Several cases of social and health inequity have occurred in recent centuries [...].

Ethical Issues in Clinical Decision-Making about Involuntary Psychiatric Treatment: A Scoping Review.

In mental health and psychiatric care, the use of involuntary psychiatric treatment for people with mental disorders is still a central and contentious issue. The main objective of this scoping review was to map and systematize the literature on ethical issues in clinical decision-making about involuntary psychiatric treatment. Five databases (Embase, PsycINFO, CINAHL, Medline, and Scopus) were searched for articles on this topic. Out of a total of 342 articles found, 35 studies from 14 countries were included based on the selection criteria. The articles were analyzed using the inductive content analysis approach. The following main categories were identified: (1) ethical foundations that guide clinical decision-making; (2) criteria for involuntary psychiatric treatment; (3) gaps, barriers, and risks associated with involuntary psychiatric treatment; (4) strategies used to reduce, replace, and improve the negative impact of involuntary treatment; and (5) evidence-based recommendations. Most of the selected articles discuss the logic underlying involuntary treatment of the mentally ill, exploring ethical principles such as autonomy, beneficence, non-maleficence, or justice, as well as how these should be properly balanced. During the process of involuntary psychiatric admission, there was a notable absence of effective communication and a significant power imbalance that disenfranchised those seeking services. This disparity was further intensified by professionals who often use coercive measures without a clear decision-making rationale and by family members who strongly depend on hospital admission. Due to the pluralistic and polarized nature of opinions regarding legal capacity and the complexity and nuance of involuntary admission, further studies should be context-specific and based on co-production and participatory research.

Spiritual Care through the Lens of Portuguese Palliative Care Professionals: A Qualitative Thematic Analysis.

Providing spiritual care is paramount to patient-centered care. Despite the growing body of data and its recognized importance in palliative care, spiritual care continues to be the least advanced and most overlooked aspect. This study aims to explore the perceptions and experiences of spiritual care from the perspective of PC professionals and identify their strategies to address spiritual care issues. Data were collected through semi-structured personal interviews and managed using WebQDA software (Universidade de Aveiro, Aveiro, Portugal). All data were analyzed using thematic content analysis, as recommended by Clark and Braun. The study included 15 palliative care professionals with a mean age of 38.51 [SD = 5.71] years. Most participants identified as lacking specific training in spiritual care. Thematic analysis spawned three main themes: (1) spiritual care as key to palliative care, (2) floating between "shadows" and "light" in providing spiritual care, and (3) strategies for competent and spiritual-centered care. Spiritual care was considered challenging by its very nature and given the individual, relational, and organizational constraints lived by professionals working in palliative care. With support from healthcare institutions, spiritual care can and should become a defining feature of the type, nature, and quality of palliative care provision. Care providers should be sensitive to spiritual needs and highly skilled and capable of an in-the-moment approach to respond to these needs. Further research on educating and training in spiritual care competence is a priority.

Death Unpreparedness Due to the COVID-19 Pandemic: A Concept Analysis.

The COVID-19 pandemic imposed changes upon the capacity of healthcare systems, with significant repercussions on healthcare provision, particularly at end-of-life. This study aims to analyze the concept map of death unpreparedness due to the COVID-19 pandemic, capturing the relationships among the attributes, antecedents, consequences, and empirical indicators. Walker and Avant's method was used to guide an analysis of this concept. A literature search was performed systematically, between May 2022 and August 2023, using the following electronic databases on the Elton Bryson Stephens Company (EBSCO) host platform: Medical Literature Analysis and Retrieval System Online (Medline), Psychological Information Database (PsycINFO), Cumulative Index to Nursing and Allied Health Literature (CINAHL) Complete, Cochrane Library, and Nursing and Allied Health Collection. Thirty-four articles were retrieved. The unexpected and unpredictable impositions associated with inexperience and unskillfulness in dealing with COVID-19 configured challenges for healthcare professionals, family/caregivers, and even the dying person. Nine key attributes emerged in three main domains: (1) Individual: (a) disease-related conditions, (b) separation distress, and (c) scarcity of death and grief literacy; (2) Relational: (a) Dying alone, (b) poor communication, and (c) existential issues; and (3) Contextual: (a) disrupted collective mourning and grieving, (b) disrupted compassionate care and, (c) pandemic social stigma. This study contributed a full definition of death unpreparedness in a global pandemic scenario such as COVID-19. In this sense, feeling unprepared or unready for death brought new challenges to the bioecological resources of those affected. It is essential to embrace strategies capable of providing emotional and spiritual support in the dying process and to respect patient wishes. The lessons learned from COVID-19 should be applied to events with a comparable impact to minimize their consequences.

Illness Experiences of Brazilian People Who Were Hospitalized Due to COVID-19 and Faced Long COVID Repercussions in Their Daily Life: A Constructivist Grounded Theory Study.

Long COVID is a multisystem condition that has multiple consequences for the physical, mental, and social health of COVID-19 survivors. The impact of the long COVID condition remains unclear, particularly among middle-aged and older adults, who are at greater risk than younger people of persisting symptoms associated with COVID-19. Therefore, we aimed to understand the experiences of middle-aged and older people who had been hospitalized for COVID-19 and the repercussions of long-term COVID symptoms in their daily lives. A qualitative study was carried out, adopting the framework of the constructivist grounded theory (CGT) proposed by Kathy Charmaz. Fifty-six middle-aged and older adult participants from the southern region of Brazil were recruited. Data were gathered from semi-structured telephone interviews. Concomitantly a comparative analysis was performed to identify categories and codes using the MaxQDA® software (version 2022). Three subcategories were identified: (1) experiencing COVID-19 in the acute phase; (2) oscillating between 'good days' and 'bad days' in long COVID; and (3) (re)constructing identity. These concepts interact with each other and converge upon the central category of this study: recasting oneself to the uniqueness of the illness experience of long COVID. Our findings provided insights related to the disruption in the lives of long COVID-19 sufferers who still live with persistent symptoms of the disease, including physical, social, family, emotional and spiritual repercussions. Likewise, this study may aid in developing friendly and welcoming social environments, lowering stigma and prejudice towards patients with long COVID, and fostering prompt and suitable policy support and mental health care for these individuals.

The multidimensional model of hope as a recovery-focused practice in mental health nursing / O modelo multidimensional de esperança como uma prática focada no recovery em enfermagem de saúde mental / El modelo multidimensional de la esperanza mientras práctica dirigida por el recovery en enfermería de salud mental

ABSTRACT Objective: To analyze the theoretical dimensions of hope as a recovery-oriented practice in mental health nursing. Method: This is a reflective and discursive study based on theoretical and experiential aspects of hope in the recovery process of people facing mental health disorders. Results: Maintaining hope in adverse situations, especially while facing mental suffering, requires skills to manage the factors that promote and inhibit hope. This balance can be tricky to reach without the presence of high-skilled professionals. The study presents the concept of hope-inspiring competence and its main dimensions. The nurse's hope-inspiring competence is recognized as a crucial advanced practice that optimizes mental health by providing motivational resources. Final Considerations: Hope-inspiring competence should be a core principle for recovery-oriented mental health professionals. Despite this recognition, the promotion of hope in mental health nursing specialized practice lacks evidence and visibility.

RESUMO Objetivo: Analisar as dimensões teóricas da esperança enquanto prática orientada pelo recovery em enfermagem de saúde mental. Métodos: Estudo reflexivo e discursivo baseado nos aspectos teóricos e vivenciais da esperança no processo de recovery de pessoas que enfrentam transtornos mentais. Resultados: Manter a esperança em situações adversas, principalmente no sofrimento mental, requer habilidades para gerenciar os fatores que a promovem e a inibem. Esse equilíbrio pode ser difícil de alcançar sem a presença de profissionais qualificados. Apresentamos o conceito de competência inspiradora de esperança e suas principais dimensões. A competência do enfermeiro inspirador de esperança é uma prática avançada crucial que otimiza a saúde mental ao fornecer recursos motivacionais. Considerações finais: A competência inspiradora de esperança deve ser um princípio fundamental para profissionais de saúde mental orientados para o recovery. Apesar desse reconhecimento, a promoção da esperança na prática especializada de enfermagem em saúde mental carece de evidências e visibilidade.

RESUMEN Objetivo: Analizar dimensiones teóricas de esperanza mientras práctica dirigida por recovery en enfermería de salud mental. Métodos: Estudio reflexivo y discursivo basándose en aspectos teóricos y experiencias de la esperanza en el proceso de recovery de personas que enfrentan trastornos mentales. Resultados: Mantener la esperanza en situaciones adversas, principalmente en el enfrentamiento del sufrimiento mental, requerir habilidades para administrar factores que proveen e inhiben. Ese equilibrio puede ser difícil de alcanzar sin la presencia de profesionales altamente cualificados. Presentamos concepto de competencia inspiradora de esperanza y sus principales dimensiones. Competencia del enfermero inspirador de esperanza es reconocida como una práctica avanzada crucial que optimiza la salud mental al fornecer recursos motivacionales. Consideraciones finales: Competencia inspiradora de esperanza debe ser un principio fundamental para profesionales de salud mental dirigidos por recovery. Aunque ese reconocimiento, la promoción de esperanza en práctica especializada de enfermería en salud mental carece de evidencias y visibilidad.

Hope in a depression therapeutic group: a qualitative case study / Esperança num grupo terapêutico de doentes deprimidos: estudo de caso qualitative / Esperanza en un grupo terapéutico de pacientes deprimidos: un estudio de caso cualitativo

ABSTRACT Objective: to understand the perceptions of hope for people with depression in the context of a therapy group. Methods: using a qualitative case study approach, a semi-structured in-depth interview and a self-report questionnaire were conducted with seven women with depression integrated in a therapy group at a Portuguese day-care psychiatric unit. Data collection and analysis used triangulation of sources. Results: the participants evidenced hope founded on the positive experiences of the past with a strong affiliation component. Hope management is done fundamentally through the interpersonal relationships established between the members of the group, based on communicational patterns that are established on a regular basis, mediated by the group therapist. Conclusion: the therapy group functioned towards the reinforcement of hope in people who experience depression, and it works as a motivation to manage the implications of illness in the participants' life and health project.

RESUMO Objetivo: Conhecer as percepções de esperança para pessoas com depressão no contexto de um grupo terapêutico. Métodos: Utilizando uma abordagem qualitativa de estudo de caso, foi realizada uma entrevista semiestruturada em profundidade e um questionário de autoavaliação com 7 mulheres com depressão integradas num grupo terapêutico num hospital de dia psiquiátrico português. Na coleta e análise de dados usou-se a triangulação de fontes. Resultados: Os participantes evidenciaram esperança alicerçada nas experiências positivas do passado com forte componente de afiliação. O gerenciamento da esperança é feito fundamentalmente por meio das relações interpessoais estabelecidas entre os membros do grupo, a partir de padrões comunicacionais que se estabelecem regularmente, mediados pelo terapeuta do grupo. Conclusão: O grupo terapêutico funcionou no sentido de reforçar a esperança nas pessoas que vivenciam depressão e funciona como uma motivação para gerir as implicações da doença no projeto de vida e saúde dos participantes.

RESUMEN Objetivo: Conocer las percepciones de esperanza de las personas con depresión en el contexto de un grupo terapéutico. Métodos: Con un enfoque de estudio de caso cualitativo, se realizó una entrevista en profundidad semiestructurada y un cuestionario de autoinforme con 7 mujeres con depresión integradas en un grupo terapéutico en una unidad psiquiátrica de atención diurna portuguesa. La recopilación y el análisis de datos utilizan la triangulación de fuentes. Resultados: Los participantes evidenciaron esperanza fundada en las experiencias positivas del pasado con un fuerte componente de afiliación. La gestión de la esperanza se realiza fundamentalmente a través de las relaciones interpersonales que se establecen entre los miembros del grupo, basadas en patrones comunicacionales que se establecen de forma regular, mediada por el terapeuta de grupo. Conclusión: El grupo terapéutico funcionó para reforzar la esperanza en personas que experimentan depresión y funciona como una motivación para manejar las implicaciones de la enfermedad en el proyecto de vida y salud de los participantes.

Hope-based interventions in chronic disease: an integrative review in the light of Nightingale / Intervenciones de esperanza en la enfermedad crónica: una revisión integrativa a la luz de Nightingale

ABSTRACT Objective: To identify the available evidence in the scientific literature about the strategies or interventions used to promote hope in people with chronic diseases. Method: An integrative literature review of literature published between 2009-2019, which was conducted in online browsers/databases: b-On, EBSCO, PubMed, Medline, ISI, SciELO, PsycINFO, Google Scholar. Forty-one studies were found, of which eight met the inclusion criteria. Results: Most studies used a quantitative approach. There was a predominance of studies from Asia and America, addressing patients with multiple sclerosis, diabetes, congestive heart failure, and cancer. Hope-based interventions were categorized by the hope attributes: experiential process, spiritual/transcendence process, rational thought process, and relational process. Conclusion: Hope-based interventions, in its essence, are good clinical practices in the physical, psychological, social and spiritual domains. This is congruent with the vision of nursing, first proposed by Florence Nightingale. There seem to be gaps in the literature regarding specific hope promoting interventions.

RESUMEN Objetivo: Identificar las evidencias disponibles en la literatura científica sobre las estrategias o intervenciones utilizadas para promover la esperanza en personas con enfermedad crónica. Método: Revisión integrativa de la literatura entre 2009 y 2019 realizada en navegadores/bases de datos online: b-On, EBSCO, PubMed, Medline, ISI, SciELO, PsycINFO, Google Scholar. Han encontrados 41 estudios, ocho de los cuales cumplieron los criterios de inclusión. Resultados: La mayoría de los estudios utilizó abordaje cuantitativo. Hubo predominancia de estudios de Asia y América, abordando pacientes con esclerosis múltiple, diabetes, insuficiencia cardíaca congestiva y cáncer. Las intervenciones han categorizadas por los atributos de la esperanza: proceso experiencial, proceso espiritual/ trascendente, proceso de pensamiento racional y proceso relacional. Conclusión: Las intervenciones basadas en la esperanza, en su esencia, son buenas prácticas clínicas en los dominios físico, psicológico, social y espiritual. Eso es congruente con la perspectiva de la enfermería holística propuesta por Florence Nightingale. Parece haber lagunas en la literatura en relación a las intervenciones específicas de promoción de la esperanza.

Help2care: ehealth strategies for self care of users and caregivers based on Nightingales work / Help2care: estratégias ehealth de autocuidado para usuários e cuidadores baseadas no trabalho de Nightingale / Help2care: estrategias eSalud de autocuidado para usuarios y cuidadores basadas en el trabajo de Nightingale

ABSTRACT Objective: To report the experience of design and implementation of the Help2Care (an ehealth program that aims to support informal caregivers of dependent people); and to identify its structure and functionality. Methods: This is a Portuguese experience report about Help2Care, a practice-based action research project carried out between 2017 and 2019, having as a guiding axis Florence Nightingale's concepts about the relevance of the home-care environment. Results: The Help2Care program revealed itself to be a valuable support tool for providing better healthcare learning, counselling, and assistance of the informal caregivers of dependent people. Different ehealth strategies were used to empower caregivers in self-care in order to have a safe transition between contexts of care at the time of patient discharge. Conclusion: Help2Care allows to inspire other ways of providing care, as well as a reduction in the readmission rate in health organizations for patients who reveal poor care support in home environments.

RESUMO Objetivo: Relatar a experiência sobre o desenho e implementação do Help2Care (um programa de eSaúde que visa apoiar os cuidadores informais de pessoas dependentes); e identificar a sua estrutura e funcionalidade. Método: Este é um relato de experiência Portuguesa sobre o Help2Care, um projeto de pesquisa-ação (2017-2019), tendo como eixo orientador os conceitos de Florence Nightingale sobre a relevância do ambiente de atendimento domiciliar. Resultados: O programa Help2Care revelou ser uma valiosa ferramenta de apoio para um melhor aprendizado, aconselhamento e assistência dos cuidadores informais de pessoas dependentes. Diferentes estratégias de eSaúde foram utilizadas para capacitar o cuidador no autocuidado, a fim de ter uma transição segura entre contextos de saúde no momento da alta do paciente. Conclusão: O Help2Care permite inspirar outras formas de prestar cuidados, bem como uma redução na taxa de readmissão nas organizações de saúde para pacientes que revelam insuficiente apoio de cuidados em ambientes domiciliares.

RESUMEN Objetivo: Relatar la experiencia sobre el dibujo e implementación del Help2Care (un programa de eSalud que objetiva apoyar los cuidadores informales de personas dependientes); y identificar su estructura y funcionalidad. Métodos: Esta es una declaración de experiencia Portuguesa acerca del Help2Care, un proyecto de investigación-acción (2017-2019), con los conceptos de Florence Nightingale sobre la relevancia del ambiente de atención domiciliaria. Resultados: El programa Help2Care demostró ser una valiosa herramienta de apoyo para un mejor aprendizaje, asesoramiento y asistencia a los cuidadores informales de personas dependientes. Se utilizaron diferentes estrategias de eSalud para capacitar a los cuidadores en el autocuidado, para tener una transición segura entre los contextos de salud después del alta del paciente. Conclusión: El Help2Care permite inspirar otras formas de proporcionar atención, así como una reducción en la tasa de reingresos en organizaciones de salud para pacientes que revelan apoyo insuficiente en su casa.

Representações da demência vividas na primeira pessoa: Uma análise hermenêutica / Representations of dementia experienced in the first person: A hermeneutic analysis

A epidemiologia das demências está inevitavelmente ligada ao envelhecimento da população, exibindo um crescimento exponencial nos últimos anos. Enquanto doença crónica, a demência apresenta-se como uma ameaça à existência física e social, amputando ou redefinindo os papéis anteriores, ao conduzir a uma pesada (des)construção sobre o mundo quotidiano. A presente investigação foi orientada para o alcance dos seguintes objetivos: a) descrever as representações da pessoa com demência sobre a doença, após o diagnóstico; b) compreender o processo de ajustamento da pessoa com demência, a partir da experiência vivida. A opção metodológica foi a de um estudo do tipo qualitativo, de cariz fenomenológico-interpretativo e inspirado na filosofia hermenêutica de Paul Ricoeur. Foram entrevistadas 7 pessoas com demência ligeira, a maioria diagnosticadas com doença de Alzheimer e com uma média de 71 anos de idade. A cada participante foram realizadas duas entrevistas, num setting natural [domicílio], tendo a recolha de dados ocorrido entre julho e outubro de 2017. O eixo principal da presente análise centrou-se na identidade da pessoa com demência, sendo que daí foram constituídos dois temas principais. O primeiro tema ?a vida em suspenso? visou descrever o conhecimento e as representações sobre demência. Relativamente à análise da experiência vivida, ficou representada pelo segundo tema ?mapear o processo de transição - viver à beira do precipício?. Os achados deste estudo indicam que as representações de doença são estruturas úteis para desenvolver uma compreensão de como as pessoas com demência tentam gerir as ameaças impostas pela doença à medida que negoceiam o seu dia-a-dia. O desenvolvimento das representações reflete uma compreensão de que o declínio progressivo imposto pela demência está vinculado a um conjunto de consequências que se circunscrevem nas dimensões pessoal, relacional e transcendental. Em síntese a pessoa com demência enfrenta diversos desafios, o primeiro decorre da necessidade de criar e atribuir significado à doença e aos seus papéis sociais e o segundo da necessidade de lidar com as consequências emocionais que resultam do processo de doença, dotando a pessoa de estratégias adaptativas que promovam o seu ajustamento. Com efeito, este estudo para além de desocultar a experiência vivida da pessoa com demência, tem o potencial de contribuir para a melhoria dos cuidados de enfermagem em saúde mental.

Fatores de risco das úlceras de pressão em doentes internados num hospital português / Risk factors of pressure ulcers in hospitalized patients of a Portuguese hospital / Factores de riesgo de úlceras por presión en pacientes hospitalizados en un hospital portugués

RESUMO Objetivo Identificar e caracterizar os fatores de risco das úlceras de pressão (UP) em doentes portadores de UP, internados num Hospital Central Português. Materiais e Métodos Estudo descritivo de corte transversal com uma amostra constituída de 34 indivíduos, 70,6 % do sexo masculino e 29,4 % do sexo feminino com média de idade de 78,93±6,05 anos. O instrumento de colheita de dados foi constituído por uma grelha de análise que contém dados sócio-demográficos, clínicos e terapêuticos. Aplicou-se a estatística descritiva e a análise inferencial, foi utilizado o Teste do qui quadrado de Pearson, para p≤0,05. Resultados Da análise dos dados verificou-se que: os indivíduos com UP já apresentavam UP à entrada no serviço onde estavam hospitalizados; os indivíduos, na sua maioria, têm um tempo de internamento de 6 dias a 1 mês; quanto maior é o tempo de internamento mais elevado é o número de UP que se desenvolvem nos indivíduos; a maioria encontra-se classificada como sendo de alto risco para o desenvolvimento de UP; a UP mais grave predomina na região sagrada e calcâneos; a hipertensão arterial, doença respiratória e Diabetes mellitus constituem as patologias mais frequentes. Conclusão O panorama atual preocupante no que concerne às úlceras de pressão só poderá ser alterado se houver um maior investimento nas medidas de prevenção e no tratamento precoce. Neste sentido, devem ser sistematizadas orientações aos familiares na alta hospitalar e no acompanhamento ambulatório.(AU)

ABSTRACT Objective To identify and characterize the risk factors of pressure ulcers (PU) in patients admitted in a Portuguese Hospital. Materials and Methods Descriptive and cross-sectional study with a sample consisting of 34 individuals, 70.6 % male and 29.4 % female with a mean age of 78.93 ± 6.05 years. The data collection instrument consisted of an analysis grid that contains socio-demographic, clinical and therapeutic data. Descriptive statistics, and inferential analysis were estimated, the chi-square test of Pearson was used for p≤0.05. Results Data analysis found that individuals already presented with PU upon admission to the hospital, and that most of them stay between 6 days and 1 month; the longer the hospitalization period, the longer the hospitalization time, the greater the number of PU developed by individuals. Most PU patients have a strong prevalence of severe PU in the sacrum and calcaneus region, and hypertension, respiratory disease and Diabetes mellitus are the most frequent pathologies. Conclusion The current gloomy picture of PUs can only be changed if there is greater investment in prevention and accurate treatment. In this sense, guidelines should be systematized for families during hospitalization and outpatient monitoring.(AU)

RESUMEN Objetivo Identificar y caracterizar los factores de riesgo de úlceras por presión (UPP) en pacientes hospitalizados en un Hospital Central Portugués. Materiales y Métodos Se realizó un estudio descriptivo transversal, con una muestra compuesta por 34 individuos, 70,6 % hombres y 29,4 % mujeres, con una edad media de 78.93 ± 6,05 años. El instrumento de recolección de datos consistió en una parrilla de análisis que contiene datos socio-demográficos, clínicos y terapéuticos. Se aplicó estadística descriptiva y análisis inferencial por medio de la prueba de Chi-cuadrado de Pearson, p≤0,05. Resultados Se encontró que los individuos con UPP ya habían presentado UPP a la entrada del servicio donde fueron hospitalizados. En su mayoría tenían un tiempo de internamiento de 6 días a 1 mes; cuanto mayor fue el tiempo de hospitalización mayor fue el número de UPP que se desarrollaron en los individuos. La mayoría estaban clasificados como de alto riesgo para el desarrollo de UPP; la UPP más grave se dio en la región sacra y calcáneo, La hipertensión, enfermedades respiratorias y Diabetes mellitus constituyeron las patologías más frecuentes. Conclusión El sombrío panorama actual con respecto a las UPP sólo se puede cambiar si hay una mayor inversión en la prevención y el tratamiento precoz. En este sentido, se deben dar, de manera sistemática, orientaciones a las familias en el hospital y en el monitoreo ambulatorio.(AU)

De la incertidumbre a la aceptación de quien espera un veredicto médico / From the uncertainty to acceptance of someone who waits a medical verdict

Este estudio tuvo como objetivo abarcar el trayecto en materia de vivencias de quien experimenta la inolvidable espera de un diagnóstico, así como validar el modelo teórico representativo de esa experiencia. Se utilizó el Interaccionismo Simbólico y la Grounded Theory como referencias: teórica, en el primer caso y metodológica en el segundo. El estudio fue llevado a cabo en una unidad médica de un hospital portugués durante los meses de enero y julio de 2009. Se le efectuaron entrevistas a una muestra constituida por 17 sujetos. Los resultados posibilitaron obtener un modelo teórico mediado por el código «transitar¼, el cual presentó cuatro patrones: incertidumbre, espera racional, negación y aceptación. Todos los participantes que usaron, en particular, los patrones de incertidumbre y negación se beneficiaron de una relación terapéutica sólida, pautada por el apoyo emocional. La fase diagnóstica está representada como un período crítico, por lo que los profesionales de la enfermería asumen un lugar destacado como promotores en la transición de la angustia a la confianza(AU)

The objective of present paper was to embrace the distance concerning the experiences of someone experimenting the unforgettable wait of a diagnosis, as well as to validate the theoretical model representative of that experience. Symbolic Interact and the Grounded Theory as references: theoretical in the first case and methodological in the second one. The study was conducted in a medical unit of a Portuguese hospital for January and July, 2009. Seventeen subjects were interviewed. The results allowed us to obtain a "to pass" code-mediated theoretical model, which included for patterns; uncertainty, rational wait, negation and acceptance. All participants used particularly the uncertainty and negation patterns had a solid therapeutic relationship lined by emotional support. The diagnostic phase is represented as a critical period that is why the nursing professionals assume a distinguished place as promoters in the transition from the anxiety to confidence(AU)