Occupational stress and coping strategies of nursing staff in times of Covid-19

Introduction: The increase in the workload of health professionals and the degree of complexity of patients, attribute greater risk to psychosocial stress. Objective: To evaluate the associations between occupational stress, quality of life at work, and coping strategies by the hospital nursing team during the COVID-19 pandemic. Methods: Cross sectional, quantitative study with convenience sampling, data collection from August to December 2020; in two units of the private hospital network, with sociodemographic, occupational and health questionnaires; visual analogue scale for assessing quality of life at work; Demand-Control-Support (DCS); Occupational Coping Scale. Results: The total sample consisted of 196 nursing professionals. There was significant certainty (negative, however, the dimension "Demand" of the DCS and QWL (<0.001, r=-0.367). Control over work-related work has a significant quality (but the "Control" dimension of the DCS and QWL (=0.025, r=0.160); and significantly negative, however, between the "Social Support" dimension of DCS and "Negative Equivalence" of Coping (p=0.003, r=-0.2013). Conclusion: The findings of this study allowed the correlation between occupational stress, coping and quality of life at work, showing that the lower the social support, the greater the use of avoidance strategies and consequently decline in quality of life at work. They also allowed us to identify the coping strategies used by the nursing staff and quality of life at work in the face of occupational stress during the COVID-19 pandemic.

A qualitative study on redefining normality in relatives of patients with advanced cancer.

OBJECTIVE: To obtain insight into adaptation processes of redefining normality and its influencing factors in relatives of patients with advanced cancer. METHODS: An exploratory qualitative study among relatives of patients with advanced cancer was conducted. Participants were purposively recruited. Ten in-depth individual (relative only) and 16 dyad (relative and patient together) interviews were conducted, transcribed verbatim, and analyzed by means of thematic analysis, drawing on elements of grounded theory, combining both inductive and deductive elements. RESULTS: Two adaptation processes of (redefining) normality were identified: assimilation and accommodation. The latter was found to be the main way of adapting to new events. Assimilative coping strategies entailed "continuing to do the same activities as done before the disease," "difficulty accepting the situation," "avoiding to think about the disease," and "living in the short term." Accommodative strategies involved "arranging practical matters," "thinking about the future," "doing what is feasible," "engaging in new activities," "accepting the situation," "seeking distraction," "living in the short term," and "focusing on what truly matters in life." The interplay between the diagnosis and treatment of cancer, a deteriorating disease status, and the accompanying uncertainty about the future was of influence on the relatives' coping strategies. CONCLUSION: When the new situation is too divergent to assimilate, accommodation may be necessary for relatives to cope with the growing complexity of the consequences of their loved one's illness. Accommodative coping then involves accepting the changing reality and actively making the necessary adjustments to build resilience and cope with the new circumstances.

Resilience, coping and Personal Factors of medical students at a Public University; Karachi, Pakistan.

OBJECTIVE: To assess resilience levels of medical students, identify factors associated with it, and explore association between coping styles and resilience level among medical students. METHODS: The analytical, cross-sectional study was conducted at the Dow Medical College, Dow University of Health Sciences, Karachi, from February to June 2022, and comprised medical students regardless of gender and the academic year. Data was collected using self-administered socio-demographic form, Brief Resilience Scale and Brief Cope. Data was analysed using SPSS 28. RESULTS: Out the 301 participants, 197(65.4%) were females and 104(34.6%) were males. The overall mean age was 20.7±1.849 years. Of the total, 132(43.9%) students had low resilience, with males having better resilience compared to females (p<0.001). Higher resilience was seen in year 1 students compared to those of clinical years (p=0.029). There was a significant positive correlation between high resilience and problem-focussed coping, while a significant negative correlation was found between resilience and avoidant and emotionally focussed strategies (p<0.05). There was a significant negative correlation between resilience levels and age (p<0.025). There was a significant difference in resilience scores with respect to the last grade point average, sleep hours, and hours spent studying (p<0.05). CONCLUSIONS: More than one-third medical students demonstrated low resilience, and the majority reported adopting emotion-focussed coping style.

Sentido de coherencia en mujeres lactantes: una revisión de alcance / Sense of coherence in breastfeeding women: A scoping review

Fundamento. El establecimiento de la lactancia materna puede resultar una situación potencialmente estresante. El objetivo del estudio es analizar el sentido de coherencia en mujeres lactantes, establecer los recursos generales de resistencia que lo modulan, y determinar las intervenciones profesionales que lo promueven. Metodología. Se incluyeron estudios en inglés, español o portugués, que evaluaran el sentido de coherencia de las mujeres lactantes, localizados en las bases de datos PubMed, PsycINFO, ScienceDirect y CINAHL entre marzo y mayo de 2023. La calidad de los estudios y el riesgo de sesgo se evaluaron siguiendo los criterios ICROMS y STROBE. Resultados. Se identificaron 316 registros, de los que se incluyeron un total de ocho estudios, tres cualitativos y cinco cuantitativos, todos con calidad suficiente. Un alto nivel de sentido de coherencia materno se relacionó con mayor duración, autoeficacia y disfrute de la experiencia de lactancia, y mayor apego. Los principales recursos generales de resistencia fueron percibir apoyo social, especialmente de parejas, madres y personal sanitario, además de experiencia previa positiva y una actitud positiva. Las intervenciones que favorecieron el sentido de coherencia fueron las relacionadas con un apoyo profesional estrecho, empático, personalizado, integral y centrado en la familia. Conclusiones. La determinación del nivel de sentido de coherencia en madres lactantes puede ayudar a identificar a mujeres con mayor riesgo de destete temprano, y a establecer estrategias de intervención profesional que mejoren la experiencia de lactancia materna. (AU)

Background. The establishment of breastfeeding may sometimes be stressful. We aimed to analyze the sense of coherence in lactating women to determine the general resistance resources during lactation and the professional interventions that promote a high sense of coherence. Methods. A search of studies in English, Spanish, or Portuguese on lactating women's sense of coherence was carried out in PubMed, PsycINFO, ScienceDirect, and CINAH databases published between May and November 2022. Study quality and risk of bias were examined according to ICROMS and STROBE criteria. Results. We identified 316 studies, of which eight -all of adequate quality- were included, three qualitative and five quantitative. A high level of maternal sense of coherence was related to longer duration, self-efficacy, attachment, and enjoyment of the breastfeeding experience. The main general resistance resources were to receive social support, particularly from partners, mothers, and health professionals. The interventions that favored the sense of coherence were mainly those related to a close, empathic, personalized, comprehensive, and family-centered professional support. Conclusions. The detection of the level of sense of coherence in lactating mothers may help identify women with a higher risk of weaning and establish professional intervention strategies that improve the breastfeeding experience. (AU)

Expected changes in parenting after an online parent training for ADHD.

BACKGROUND: Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in children and adolescents. Treatments for this population should be multidisciplinary and must be initiated as early as possible. Non-pharmacological interventions for ADHD include psychoeducation, parent behavioural training programs and school interventions and accommodations. In response to the COVID-19 pandemic, we developed an online version of a combined psychoeducation and behavioural training program to facilitate access to mental health treatment and ensure continuity of care. OBJECTIVE: The study assessed the acceptability of this online parent training program, among parents and caretakers of children and adolescents with ADHD. METHODS: The program consisted of ten online sessions over the course of two consecutive days (five sessions a day). Satisfaction, usefulness and general comments about the program were assessed with open-ended questions and visual-analogous scales. Parents/caretakers' use of strategies to manage behavioural problems was assessed using the Parenting and Family Adjustment Scales. RESULTS: A total of 206 parents participated in the online program 175 of whom completed the evaluation. Participants were satisfied with the content of the program. More than half of participants had already started using strategies included in the program. The engagement was high and no major obstacles were identified other than some internet connection issues. DISCUSSION: In our survey, online delivery was described as more convenient, and participants were satisfied with the content of the program finding it beneficial for their child. Despite this, some difficulties in implementing new strategies were observed. Online BTP increased access to the BTP programs while being effective on ADHD symptoms and behavioural disturbances. CONCLUSIONS: With these measures, we hope to improve engagement in online psychoeducation and behavioural therapy programs. Future research evaluating online behavioural training programs should focus on ways to make them more accessible and adaptable to families' obstacles.

Coping familiar no cuidado à criança com síndrome de Down: revisão de escopo / Family coping in caring for children with Down syndrome: a scoping review

RESUMO Objetivo mapear as estratégias de coping que contribuem para o cuidado familiar à criança com síndrome de Down. Métodos revisão de escopo, segundo o método JBI. Foram consultadas seis bases de dados eletrônicas e uma biblioteca virtual com apoio da plataforma Rayyan. Os critérios de elegibilidade foram estudos disponíveis e publicados na íntegra, que abordassem estratégias de coping no cuidado familiar a crianças com síndrome de Down. A análise dos dados foi do tipo narrativa. Resultados foram recuperados 381 registros e 14 permaneceram nesta revisão. Seis estilos de coping foram identificados: manejo das emoções, tomadas de decisão, aquisição de conhecimentos sobre a síndrome de Down e situações que a envolvem, busca de apoio, comunicação intrafamiliar e com profissionais e práticas de espiritualidade. Conclusão para equilibrar as demandas apresentadas pelas crianças e os recursos disponíveis, os integrantes da família precisam adotar estratégias cognitivas e comportamentais para lidar com as adversidades nos cuidados com a criança com síndrome de Down. Contribuições para a prática: o estudo apresenta evidências para nortear enfermeiros e outros profissionais de saúde a guiar famílias na utilização de diferentes formas de enfrentamento diante dos eventos estressores vivenciados por estas.

ABSTRACT Objective to map the coping strategies that contribute to family care for children with Down syndrome. Methods scoping review, using the JBI method. Six electronic databases and a virtual library were consulted with the support of the Rayyan platform. The criteria for eligibility were studies available and published in full, which addressed coping strategies in family care for children with Down syndrome. Data analysis was of the narrative type. Results 381 records were retrieved and 14 remained in this review. Six coping styles were identified: managing emotions, decision-making, acquiring knowledge about Down's syndrome and situations involving it, seeking support, communicating within the family and with professionals, and practicing spirituality. Conclusion in order to balance the demands presented by the children and the resources available, family members need to adopt cognitive and behavioral strategies to deal with the adversities of caring for a child with Down syndrome. Contributions to practice: the study presents evidence to guide nurses and other health professionals to help families use different ways of coping with the stressful events they experience.

O enfermeiro recém-formado na condição de segunda vítima / El enfermero recién graduado en condición de segunda víctima / The newly graduated nurse as a second victim

Resumo Objetivo Descrever a prevalência de enfermeiros recém-formados como segundas vítimas de eventos adversos e conhecer as condições de apoio recebidas nas instituições de saúde. Métodos Estudo transversal, descritivo e de abordagem quantitativa, cuja população foi constituída por enfermeiros recém-formados, que aceitaram responder ao questionário online, com perguntas relacionadas à admissão na instituição, envolvimento em eventos adversos e gerenciamento da condição de segunda vítima, contatados por e-mail, intermediado pelo Conselho Regional de Enfermagem de São Paulo. Foi realizada a análise descritiva dos dados e teste de igualdade de proporções. Resultados A amostra final foi de 138 enfermeiros, 54,3% desconheciam o termo segunda vítima, 44,9% desconheciam a existência de protocolos institucionais para apoio emocional aos profissionais e 26,8% estiveram envolvidos em eventos adversos. Destes, 94,6% apresentaram como desfecho diante do evento o sofrimento emocional, frustração, culpa, tristeza, estresse, incapacidade, constrangimento e insegurança para realizar suas funções no trabalho; 59,5% receberam algum tipo de apoio e 21,6% receberam punição institucional. Conclusão A prevalência de enfermeiros recém-formados envolvidos em eventos adversos foi de 26,8%, e, entre os que vivenciaram esse incidente, a maioria apresentou como desfecho, sentimentos negativos e de insegurança na condução do trabalho. Após o evento, o apoio recebido partiu, na maioria das vezes, de colegas de trabalho e pessoas significativas, e, quanto ao apoio institucional, destaca-se ainda a necessidade de programas para suporte emocional, a fim de que esses profissionais superem quando se encontram na condição de segunda vítima.

Resumen Objetivo Describir la prevalencia de enfermeros recién graduados como segundas víctimas de eventos adversos y conocer las condiciones de apoyo recibidas en las instituciones de salud. Métodos Estudio transversal, descriptivo y de enfoque cuantitativo, cuya población estuvo compuesta por enfermeros recién graduados, que aceptaron responder un cuestionario digital con preguntas relacionadas con la admisión en la institución, la participación en eventos adversos y la gestión de la condición de segunda víctima, contactados por correo electrónico e intermediado por el Consejo Regional de Enfermería de São Paulo. Se realizó el análisis descriptivo de los datos y prueba de igualdad de proporciones. Resultados La muestra final fue de 138 enfermeros. El 54,3 % desconocía el término segunda víctima, el 44,9 % desconocía la existencia de protocolos institucionales para apoyo emocional a profesionales y el 26,8 % estuvo involucrado en eventos adversos. De estos, el 94,6 % presentó, como consecuencia del evento, sufrimiento emocional, frustración, culpa, tristeza, estrés, incapacidad, vergüenza e inseguridad para realizar sus funciones en el trabajo; el 59,5 % recibió algún tipo de apoyo, y el 21,6 % recibió sanción institucional. Conclusión La prevalencia de enfermeros recién graduados involucrados en eventos adversos fue del 26,8 % y, de los que pasaron por estos incidentes, la mayoría presentó, como consecuencia, sentimientos negativos y de inseguridad en la conducción de su trabajo. Después del evento, el apoyo recibido, la mayoría de las veces, surgió de compañeros de trabajo y personas importantes. Respecto al apoyo institucional, también se observa la necesidad de programas para apoyo emocional para que estos profesionales se sobrepongan cuando se encuentren en condición de segunda víctima.

Abstract Objective To describe the prevalence of newly graduated nurses as second victims of adverse events and to know the conditions of support received in health institutions. Methods Cross-sectional, descriptive, quantitative study. The population consisted of newly graduated nurses who agreed to answer the online questionnaire with questions related to being hired at the institution, involvement in adverse events and management of the second victim condition. Contacted was by email, intermediated by the Regional Nursing Council of São Paulo. Descriptive data analysis and the test of equality of proportions were performed. Results The final sample consisted of 138 nurses, 54.3% were unaware of the term 'second victim', 44.9% were unaware of the existence of institutional protocols for emotional support to professionals and 26.8% were involved in adverse events. Of these, 94.6% presented emotional distress, frustration, guilt, sadness, stress, inability, embarrassment and insecurity to perform their duties at work as an outcome of the event; 59.5% received some type of support and 21.6% received institutional punishment. Conclusion The prevalence of newly graduated nurses involved in adverse events was 26.8%, and among those who experienced this incident, the majority presented negative feelings and insecurity in performing their work as an outcome. After the event, most of the time, the support received came from work colleagues and significant others. Regarding institutional support, the need for programs for emotional support is also highlighted, so that these professionals can overcome when finding themselves in the place of the second victim.

Estresse ocupacional e estratégias de coping de enfermeiros e técnicos de enfermagem durante a pandemia de COVID-19 / Nurses' and nursing technicians' occupational stress and coping strategies during the COVID-19 pandemic / Estrés ocupacional y estrategias de afrontamiento de enfermeros y técnicos de enfermería durante la pandemia de COVID-19

Objetivos: avaliar os fatores geradores do estresse ocupacional dos enfermeiros e técnicos de enfermagem atuantes no cuidado direto aos pacientes acometidos pela COVID-19, durante a pandemia, e verificar sua relação com estratégias de coping adotadas pela equipe de enfermagem. Métodos: estudo transversal analítico, realizado em um hospital no interior do estado de São Paulo. A amostra de conveniência (n = 112) foi constituída por profissionais de enfermagem que responderam ao Inventário de Estresse de Enfermeiros e Inventário de Respostas de Coping no Trabalho. Para as análises inferenciais foram utilizados os testes Qui-quadrado ou Exato de Fisher, o teste de Mann-Whitney e o teste de Spearman (p < 0,05). Resultados: verificou-se elevado nível de estresse ocupacional em enfermeiros (M = 106,0; DP ± 23,1) e técnicos de enfermagem (M = 98,5; DP ± 25,1), com maior pontuação de enfermeiros para fatores intrínsecos ao trabalho, em comparação com técnicos de enfermagem. As relações interpessoais foram a principal fonte de estresse. As estratégias de coping com maiores médias foram as respostas de enfrentamento tanto para enfermeiros (M = 43,2; DP ± 8,5) quanto para os técnicos de enfermagem (M = 41,4; DP ± 9,1). Conclusões: a identificação dos fatores de estresse ocupacional e das estratégias de coping, bem como, suas repercussões no contexto laboral trouxeram contribuições importantes para entender a realidade contextual.

Objectives: to assess the factors that generate occupational stress among nurses and nursing technicians working in direct care for patients affected by COVID-19 during the pandemic and verify their relationship with coping strategies adopted by the nursing staff. Methods: an analytical cross-sectional study, carried out at a hospital in the countryside of the state of São Paulo. The convenience sample (n = 112) consisted of nursing professionals who answered the Nurses' Stress Inventory and the Coping Responses Inventory for Working Settings. For inferential analyses, chi-square test or Fisher's exact test, Mann-Whitney test and Spearman test were used (p < 0.05). Results: there was a high level of occupational stress in nurses (M = 106.0; SD ± 23.1) and nursing technicians (M = 98.5; SD ± 25.1), with higher scores among nurses for factors intrinsic to work compared to nursing technicians. Interpersonal relationships were the main source of stress. The coping strategies with the highest means were coping responses for both nurses (M = 43.2; SD ± 8.5) and nursing technicians (M = 41.4; SD ± 9.1). Conclusions: the identification of occupational stress factors and coping strategies and their repercussions at work brought important contributions to understanding the contextual reality.

Objetivos: evaluar los factores que generan estrés ocupacional entre enfermeros y técnicos de enfermería que actúan en el cuidado directo de pacientes afectados por COVID-19, durante la pandemia, y verificar su relación con las estrategias de afrontamiento adoptadas por el equipo de enfermería. Métodos: estudio analítico transversal, realizado en un hospital del interior del estado de São Paulo. La muestra por conveniencia (n = 112) estuvo compuesta por profesionales de enfermería que respondieron el Nurses' Stress Inventory y el Coping at Work Response Inventory. Para los análisis inferenciales, se utilizaron las pruebas de chi-cuadrado o exacta de Fisher, Mann-Whitney y Spearman (p < 0,05). Resultados: hubo un alto nivel de estrés ocupacional en enfermeros (M = 106,0; DE ± 23,1) y técnicos de enfermería (M = 98,5; DE ± 25,1), con puntuaciones más altas entre los enfermeros para factores intrínsecos al trabajo, en comparación con los técnicos de enfermería. Las relaciones interpersonales fueron la principal fuente de estrés. Las estrategias de afrontamiento con mayores promedios fueron las respuestas de afrontamiento tanto de enfermeros (M = 43,2; DE ± 8,5) como de técnicos de enfermería (M = 41,4; DE ± 9,1). Conclusiones: la identificación de factores de estrés ocupacional y estrategias de afrontamiento, así como sus repercusiones en el contexto laboral, trajeron importantes aportes para la comprensión de la realidad contextual.

Analysis of role adaptation and associated factors among college freshmen / 中国学校卫生

Objective@#To explore the influencing factors of role adaptation of college freshmen, so as to provide empirical support for developing adaptive education in college.@*Methods@#A cluster sampling method was used to select 3 126 freshmen from six universities of Hefei City and Wuhu City in Anhui Province in October 2022, who were investigated with Positive Psychological Capital Questionnaire (PPQ), Freshmen s Role Adaptability Scale, Connor Davidson Resilience Scale (CD-RISC) and Life Satisfaction Scale. Independent sample t-test and oneway ANOVA were used to compare the scores (caverage score of items) of various variables of college freshmen with different demographic characteristics. Pearson correlation analysis and multiple linear regression analysis were conducted to analyze the correlation.@*Results@#There were statistically significant differences in scores of psychological capital, resilience, life satisfaction and role adaptation among college freshmen of different origin (large and mediumsized cities: ３.６３± ０.５４，３.７３±０.６４，３.４７±０.８０，３.１４±０.６５；county level city or county seat:３.５７±０.５２，３.６１±０.６３，３.３５±０.７５，３.０９±０.６３；villages and towns:３.５０±０.５０，３.５４±０.５８，３.２３±０.７５，３.０６±０.６０), whether in class committee (yes:３.６３±０.５２，３.６９±０.６０，３.４０± ０.７６ ，３.１８±０.５９； no:３.４３±０.５０，３.４８±０.６４，３.２５±０.７７，２.９３±０.６５), father s education level (junior high school or below:３.５２± ０.５１ ，３.５７±０.６１，３.２７±０.７５，３.０７±０.６１； senior high school or technical secondary school:３.６２±０.５３，３.６８±０.６３，３.４４±０.７８，３.１２±０.６３；junior college or above:３.６８±０.５６，３.７８±０.６４，３.５７±０.８０，３.１９±０.６８)，mother s education level(junior high school or below:３.５３±０.５１，３.５８±０.６１，３.２８±０.７５，３.０６±０.６０；senior high school or technical secondary school:３.６３±０.５５，３.７０±０.６３，３.４８±０.７８，３.１５±０.６６；junior college or above:３.７２±０.５４，３.８６±０.６５，３.６２±０.８３，３.２７±０.７０) ( F / t =11.89,21.89,23.02,3.83；10.08，9.20， 5.20 ，10.63；19.34，20.76，29.52，6.44；22.51，26.79，30.94，13.92， P <0.05). The differences of scores in resilience and role adaptation of different genders (boys:3.66±0.64, 3.12±0.65; girls:3.56±0.59, 3.05±0.58) and in life satisfaction whether being an only child (yes:3.40±0.79; no:3.33±0.76) among college freshmen were statistically significant ( t =4.51, 2.75, 2.35, P <0.05). Pearson correlation analysis showed that psychological capital, resilience and life satisfaction of college freshmen were positively correlated with role adaptation ( r =0.49, 0.49, 0.36), while psychological capital, resilience and role adaptation were positively correlated ( r =0.60, 0.59) and Psychological capital was positively correlated with resistance ( r =0.81)( P <0.01). The results of multiple linear regression analysis showed that gender, whether in class committee, psychological capital, resilience and life satisfaction were positively associated with role adaptation among college freshmen ( R 2=0.28, β =0.04, 0.10, 0.23, 0.26, 0.07， P <0.05).@*Conclusions@#Role adaptation of college freshmen is related with psychological capital, resilience and life satisfaction. Schools should strengthen mental health education to promote smooth role transition for college freshmen.

Escala de Coping para Fala em Público (ECOFAP): evidências de validade de conteúdo e processos de resposta / Speaking in Public Coping Scale (ECOFAP): content and response process validity evidence

Resumo Objetivo Apresentar as evidências de validade baseadas no conteúdo e nos processos de resposta da Escala de Coping para a Fala em Público (ECOFAP). Método Estudo metodológico de elaboração e validação de instrumento. Seguiu-se o modelo de elaboração de instrumentos com procedimentos teóricos, empíricos e analíticos, baseados nos critérios de validade do Standards for Educational and Psychological Testing (SEPT). O processo de obtenção das evidências de validade baseadas no conteúdo foi realizado em duas etapas: 1) definição conceitual do construto, elaborado com base nos preceitos teóricos da fala em público e da Teoria Motivacional do Coping (TMC); 2) elaboração dos itens e chave de respostas, estruturação do instrumento, avaliação por comitê de dez especialistas, reestruturação dos itens da escala, realizada em três momentos, até a elaboração da versão piloto da ECOFAP. O processo de resposta foi realizado com amostra de conveniência de 30 indivíduos, com e sem dificuldades de fala em público, no campus de uma universidade brasileira, pertencentes a diferentes extratos sociais e profissões. Nesse processo, foram analisadas qualitativamente as reações verbais e não verbais dos respondentes. Resultados A primeira versão da ECOFAP, composta por 46 itens, foi avaliada pelos juízes e posteriormente reformulada, resultando em uma segunda versão com 60 itens. Essa segunda versão foi novamente submetida à análise de especialistas e calculado o índice de validade de conteúdo por item. Foram excluídos 18 itens, originando uma terceira versão de 42 itens. As evidências de validade com base nos processos de resposta da versão de 42 itens foram aplicadas em uma amostra de 30 indivíduos, resultando na reescrita de um item e inclusão de mais seis itens, originando a versão piloto da ECOFAP de 48 itens. Conclusão A versão piloto da ECOFAP apresenta itens bem estruturados semântica e sintaticamente que representam estratégias de enfrentamento para a fala em público.

Abstract Purpose To present the content and response process validity evidence of the Speaking in Public Coping of Scale (ECOFAP). Methods A methodological study to develop and validate the instrument. It followed the instrument development method with theoretical, empirical, and analytical procedures, based on the validity criteria of the Standards for Educational and Psychological Testing (SEPT). The process of obtaining content validity evidence had two stages: 1) conceptual definition of the construct, based on theoretical precepts of speaking in public and the Motivational Theory of Coping (MTC); 2) developing items and response keys, structuring the instrument, assessment by a committee with 10 specialists, restructuring scale items, and developing the ECOFAP pilot version. Item representativity was analyzed through the item content validity index. The response process was conducted in a single stage with a convenience sample of 30 people with and without difficulties speaking in public, from the campus of a Brazilian university, belonging to various social and professional strata. In this process, the respondents' verbal and nonverbal reactions were qualitatively analyzed. Results The initial version of ECOFAP, consisting of 46 items, was evaluated by judges and later reformulated, resulting in a second version with 60 items. This second version was again submitted for expert analysis, and the content validity index per item was calculated. 18 items were excluded, resulting in a third version of 42 items. The validity evidence based on the response processes of the 42-item version was applied to a sample of 30 individuals, resulting in the rewriting of one item and the inclusion of six more items, resulting in the pilot version of ECOFAP with 48 items. Conclusion ECOFAP pilot version has items with well-structured semantics and syntactic, representing strategies to cope with speaking in public.

Efficacy of a program in increasing coping strategies in firefighters: randomized clinical trial / Eficacia de un programa en el aumento de las estrategias de coping en bomberos: ensayo clínico aleatorizado / Eficácia de um programa no aumento das estratégias de coping em bombeiros: ensaio clínico randomizado

Objective: to evaluate the effectiveness of a program in increasing coping strategies focused on military firefighters' problems and emotions. Method: randomized, parallel, single-masked clinical trial. The sample consisted of 51 participants in the intervention group and 49 in the control group. The intervention group received the intervention program including coping strategies based on the Nursing Interventions Classification, lasting six consecutive weeks, one day a week. The control group followed the Service Unit routine. Descriptive statistics, Student's T test with Welch's correction and the Mann-Whitney test were used for the analyses. The magnitude of the intervention effect was calculated using Cohen's d index. A p-value of ≤0.05% was considered. Results: in the analysis of the mean difference between the scores in the groups, the means of the intervention group increased significantly for the coping strategies: social support (p = 0.009), acceptance of responsibility (p = 0.03), problem solving (p = 0.05) and positive reappraisal (p = 0.05). The impact of the intervention was moderate in magnitude for social support (d = 0.54). Conclusion: the intervention program enabled the increase of coping strategies focused on military firefighters' problems and emotions. ReBEC: RBR-8dmbzc.

Objetivo: evaluar la eficacia de un programa en el aumento de las estrategias de coping enfocadas en el problema y en la emoción en bomberos militares. Método: ensayo clínico aleatorizado, paralelo, con enmascaramiento simple. La muestra se constituyó de 51 participantes en el grupo intervención y 49 en el control. El grupo intervención recibió el programa interventivo incluyendo las estrategias de coping basadas en la Clasificación de las Intervenciones de Enfermería, con una duración de seis semanas consecutivas, un día por semana. El grupo control siguió la rutina de la Unidad de Servicio. Para los análisis se utilizó estadística descriptiva, test T de Student con corrección de Welch y el test de Mann-Whitney. La magnitud del efecto de la intervención se calculó con el índice d de Cohen. Se consideró valor p≤0,05%. Resultados: en el análisis del promedio de la diferencia entre los puntajes en los grupos, los promedios del grupo intervención aumentaron significativamente para las estrategias de coping : soporte social ( p = 0,009), aceptación de la responsabilidad ( p = 0,03), resolución de problemas ( p = 0,05) y reevaluación positiva ( p = 0,05). El impacto de la intervención presentó magnitud moderada para el soporte social ( d = 0,54). Conclusión: el programa interventivo posibilitó el aumento de estrategias de coping enfocadas en el problema y en la emoción en bomberos militares. ReBEC: RBR-8dmbzc.

Objetivo: avaliar a eficácia de um programa no aumento das estratégias de coping focadas no problema e na emoção em bombeiros militares. Método: ensaio clínico randomizado, paralelo, com mascaramento simples. A amostra constituiu-se de 51 participantes no grupo intervenção e 49 no controle. O grupo intervenção recebeu o programa interventivo incluindo as estratégias de coping pautadas na Classificação das Intervenções de Enfermagem, com duração de seis semanas consecutivas, um dia por semana. O grupo controle seguiu a rotina da Unidade de Serviço. Para as análises utilizou-se estatística descritiva, teste T de Student com correção de Welch e o teste de Mann-Whitney. A magnitude do efeito da intervenção foi calculada com o índice d de Cohen. Considerou-se valor p ≤0,05%. Resultados: na análise da média da diferença entre os escores nos grupos, as médias do grupo intervenção aumentaram significativamente para as estratégias de coping : suporte social ( p = 0,009), aceitação da responsabilidade ( p = 0,03), resolução de problemas ( p = 0,05) e reavaliação positiva ( p = 0,05). O impacto da intervenção apresentou magnitude moderada para o suporte social (d = 0,54). Conclusão: o programa interventivo possibilitou o aumento de estratégias de coping focadas no problema e na emoção em bombeiros militares. ReBEC: RBR-8dmbzc.

From Surviving to Living (on): A Grounded Theory Study on Coping in People with Pancreatic Cancer.

Little research has been conducted on the experience of pancreatic cancer from a patient's perspective. Several factors suggest that trajectory models of chronic illness or other cancers cannot be applied to pancreatic cancer. Within this grounded theory study, 26 problem-centred interviews were conducted with people with pancreatic cancer from Germany. A cancer-specific trajectory model was developed, depicting both curative and palliative courses. Two successive phases form the core: Immediately after diagnosis, there is an acute phase in which patients focus on mere survival, attempt to overcome the short-term consequences of pancreatic cancer and search for information. This initial phase is followed by a circular phase of living on with pancreatic cancer, characterized by adaptation to the long-term consequences of the disease and a repeated experience of fear of recurrence or progression and threat in the context of follow-up examinations. Understanding disease trajectories from a patient's perspective enables health professionals better to understand patients' needs, concerns, and fears and better support them in coping. Trial registration: German Clinical Trials Register, DRKS00020251, 13.01.2020.

Coping e processo de luto em familiares e pessoas significativas de vítimas mortais de COVID-19 / Grief and coping in family members and significant others of people who died from COVID-19 / Proceso de afrontamiento y duelo en familiares y personas significativas de víctimas mortales de COVID-19

Resumo Enquadramento: As restrições impostas pela pandemia COVID-19 dificultaram a vivência dos processos de luto, contribuindo o desenvolvimento de processos patológicos de luto. Objetivo: Determinar a prevalência de luto patológico em familiares de pessoas vítimas mortais de COVID-19; Verificar se as estratégias de coping predizem o luto. Metodologia: Estudo observacional, descritivo-correlacional e transversal. A amostra não probabilística teve 86 participantes. Os dados foram explorados através de estatística descritiva e inferencial. Resultados: Cinquenta e dois familiares (60,5%) apresentaram um processo de luto complicado. A dimensão Gestão das emoções do coping está correlacionada positivamente com o luto, no global, (p = 0,29; p = 0,01), na dimensão de Negação e revolta (p = 0,35; p < 0,001) e com a dimensão Depressiva (p = 0,28; p = 0,01). Verificou-se ainda uma correlação negativa da dimensão Focada na tarefa com a dimensão específica de Negação e revolta (p = -0,24; p = 0,03). Conclusão: Os participantes apresentam uma elevada probabilidade de desenvolver processos de luto complicado, pelo que devem ser implementadas medidas de apoio psicológico.

Abstract Background: The constraints imposed by the COVID-19 pandemic hindered the experience of grief and promoted the occurrence of complicated grief. Objective: To determine the prevalence of complicated grief in family members of people who died from COVID-19; to verify whether coping strategies can predict grief. Methodology: This is a cross-sectional observational study with descriptive-correlational analysis using a non-probability sample of 86 participants. The data were explored using descriptive and inferential statistics. Results: Fifty-two family members (60.5%) experienced complicated grief. Emotion-oriented coping correlated positively with grief in the Global dimension (p = 0.29; p = 0.01), the Denial and anger dimension (p = 0.35; p < 0.001), and the Depressive dimension (p = 0.28; p = 0.01). Task-oriented coping correlated negatively with the Denial and anger dimension (p = -0.24; p = 0.03). Conclusion: The participants present a high probability of experiencing complicated grief. Thus, the implementation of psychological support measures is recommended.

Resumen Marco contextual: Las restricciones impuestas por la pandemia de COVID-19 dificultaron la vivencia de los procesos de duelo, lo que propició el desarrollo de procesos de duelo patológico. Objetivo: Determinar la prevalencia del duelo patológico en familiares de víctimas fallecidas de COVID-19. Verificar si las estrategias de afrontamiento (coping) predicen el duelo. Metodología: Estudio observacional, descriptivo-correlacional y transversal. La muestra no probabilística contó con 86 participantes. Los datos se exploraron mediante estadística descriptiva e inferencial. Resultados: cincuenta y dos familiares (60,5%) presentaron un proceso de duelo complicado. La dimensión de gestión de las emociones del afrontamiento se correlaciona positivamente con el duelo, en general, (p = 0,29; p = 0,01), con la dimensión de la Negación y la ira (p = 0,35; p < 0,001) y con la dimensión Depresiva (p = 0,28; p = 0,01). También hubo una correlación negativa de la dimensión Centrada en la tarea con la dimensión específica de la Negación y la ira (p = -0,24; p = 0,03). Conclusión: Los participantes tienen una alta probabilidad de desarrollar procesos de duelo complicados, por lo que deben aplicarse medidas de apoyo psicológico.

Correlation between COVID-19-related health anxiety and coping styles among frontline nurses.

BACKGROUND: The long-term epidemic of COVID-19 and its recurrence has exposed frontline nurses to mental disorders such as stress and health anxiety. High levels of health anxiety associated with COVID-19 may lead to maladaptive behaviors. There is no agreement on which coping styles are most effective against stress. Therefore, more evidence is required to find better adaptive behaviors. The present study was conducted to investigate the correlation between the level of health anxiety and the type of coping strategies used by frontline nurses fighting COVID-19. METHODS: This is a cross-sectional study that was performed on a convenience sample of 386 nurses who are working in the COVID department from October to December 2020, coinciding with the outbreak of the third COVID-19 peak in Iran. Data were collected through a demographic questionnaire, the short version of the health anxiety questionnaire, and coping inventory for stressful situations. Data were analyzed using independent T-test, U-Mann-Whitney, and Kruskal-Wallis statistical tests with SPSS version 23 software. RESULTS: The mean score of nurses' health anxiety was 17.61 ± 9.26 which was more than the cut-off point for health anxiety and 59.1% of nurses had COVID-19-related health anxiety. The mean score of problem coping style (26.85 ± 5.19), was higher than emotion (18.48 ± 5.63) and avoidance (19.64 ± 5.88) coping styles and nurses mostly used problem-coping strategies to deal with anxiety caused by COVID-19. There was a positive significant correlation between the scores of health anxiety and emotion coping style (r = 0.54; P < 0.001). CONCLUSION: Based on the findings of this study, COVID-19-related health anxiety was high in front-line nurses and those with high health anxiety were more likely to use emotion-based coping strategies, which are ineffective. Therefore, considering strategies to reduce nurses' health anxiety and holding training programs on effective coping methods in epidemic conditions are recommended.

Caso clínico de enfermería: modelo de adaptación en adolescente con síndrome de Felty y Rhupus / Nursing Clinical Case: Model of Adaptation in Adolescent with Felty and Rhupus Syndrome / Relato de caso de enfermagem: modelo de adaptação em adolescente com síndrome de Felty e Rhupus

Introducción. El síndrome de Rhupus es la superposición de dos enfermedades autoinmunes, la artritis reumatoide o artritis idiopática juvenil y el lupus eritematoso sistémico, la prevalencia es de 7-401 por 100,000 niños. El síndrome de Felty se caracteriza por la tríada de artritis idiopática juvenil, esplenomegalia y neutropenia; padecer más de una patología reumática es un extraño fenómeno estimado entre el 0.01-2%. Objetivo. Describir el proceso de atención de enfermería integral en una adolescente con Rhupus y síndrome de Felty, bajo el modelo de adaptación de Callista Roy. Metodología. Caso clínico de enfermería en una paciente de 15 años seleccionada en hospitalización pediátrica, con previo consentimiento informado; intervenida a través del proceso de atención de enfermería estructurado según la taxonomía de la North American Nursing Diagnosis Association, la Clasificación de Resultados de Enfermería, y la Clasificación de Intervenciones de Enfermería, con intervenciones intrahospitalarias y seguimiento con tele-enfermería. Resultados. Mejoría de la ambulación y afrontamiento de problemas evidenciados por el aumento del bienestar de la paciente y la familia. Conclusiones. Ante una enfermedad desconocida, el proceso de atención de enfermería, con intervenciones directas y acompañamiento continuo, permite realizar una atención integral, a fin de lograr la adaptación de la paciente y su familia. Palabras clave: Adaptación Psicológica; Atención de Enfermería; Enfermería; Síndrome de Felty; Lupus Eritematoso Sistémico; Resiliencia Psicológica.

Introduction. Rhupus syndrome is the overlap of two autoimmune diseases, rheumatoid arthritis or juvenile idiopathic arthritis, and systemic lupus erythematosus, with a prevalence of 7-401 per 100,000 children. Felty's syndrome is characterized by the triad of juvenile idiopathic arthritis, splenomegaly, and neutropenia; experiencing more than one rheumatic pathology is a rare phenomenon estimated between 0.01-2%. Objective. Describe the comprehensive nursing care process in an adolescent with Rhupus and Felty's syndrome, under the adaptation model of Callista Roy. Methodology. Nursing case study of a 15-year-old patient selected in pediatric hospitalization, with prior informed consent; intervened through the structured nursing care process according to the taxonomy of the North American Nursing Diagnosis Association, the Nursing Outcomes Classification, and the Nursing Interventions Classification, with in-hospital interventions and follow-up through tele-nursing. Results. Improvement in ambulation and coping with problems evidenced by the increased well-being of the patient and the family. Conclusions. Faced with an unknown disease, the nursing care process, with direct interventions and continuous support, allows for comprehensive care to achieve the adaptation of the patient and her family. Keywords: Adaptation, Psychological; Nursing Care; Nursing; Felty Syndrome; Lupus Erythematosus, Systemic; Resilience, Psychological.

Introdução. A síndrome de Rhupus é a sobreposição de duas doenças autoimunes, artrite reumatoide ou artrite idiopática juvenil e lúpus eritematoso sistêmico, a prevalência é de 7-401 por 100,000 crianças. A síndrome de Felty é caracterizada pela tríade de artrite idiopática juvenil, esplenomegalia e neutropenia; sofrer de mais de uma patologia reumática é um fenômeno estranho estimado entre 0.01-2%. Objetivo. Descrever o processo de assistência integral de enfermagem em uma adolescente com Rhupus e síndrome de Felty, sob o modelo de adaptação de Callista Roy. Metodologia. Caso clínico de enfermagem em uma paciente de 15 anos selecionada em internação pediátrica, com prévio consentimento informado; ela teve intervenção por meio do processo de cuidado de enfermagem estruturado segundo a taxonomia da North American Nursing Diagnosis Association, a Classificação dos Resultados de Enfermagem e a Classificação das Intervenções de Enfermagem, com intervenções intra-hospitalares e acompanhamento com tele-enfermagem. Resultados. Melhora na deambulação e enfrentamento de problemas evidenciados pelo aumento do bem-estar do paciente e da família. Conclusões. Diante de uma doença desconhecida, o processo de assistência de enfermagem, com intervenções diretas e acompanhamento contínuo, permite um cuidado integral, de forma a alcançar a adaptação do paciente e de sua família. Palavras-chave: Adaptação Psicológica; Cuidados de Enfermagem; Enfermagem; Síndrome de Felty; Lúpus Eritematoso Sistêmico; Resiliência Psicológica.

Formas de enfrentamento do câncer de mama: discurso de mulheres mastectomizadas / Ways of coping with breast cancer: discourse of mastectomized women

Introdução: Na neoplasia de mama ocorrem inúmeras transformações na vida da pessoa acometida e de todas as pessoas próximas, sentimentos como medo, angústia e tristeza. Diante disso, a identificação dos métodos usados para enfrentar a neoplasia de mama faz-se crucial, visto que proporciona melhor vivência desse momento por parte da mulher e de todos os envolvidos. Objetivo: Compreender as formas de enfrentamento do câncer de mama por meio do discurso de participantes de um grupo de apoio. Metodologia: Pesquisa descritiva com abordagem qualitativa realizada com 10 mulheres que participam de um grupo geral de apoio, localizado em um município da Paraíba, Brasil. Para a coleta de dados, utilizou-se entrevista semiestruturada, e como processo metodológico para a análise dos dados, o Discurso do Sujeito Coletivo. Resultados: Foi possível a compreensão de três ideias centrais em relação às formas de enfrentamento do câncer de mama: ''Ancoragem na fé e espiritualidade''; ''Suporte familiar''; e ''Grupo de apoio''. Conclusão: O estudo atingiu seu objetivo de identificar as principais formas de enfrentamento do câncer de mama por mulheres mastectomizadas, podendo elucidar a importância da fé e espiritualidade, o suporte familiar e a participação em grupos de apoio por meio do discurso das participantes.

Introducción: Con el cáncer de mama se producen numerosos cambios en la vida de la persona afectada y de las personas cercanas, en los que se manifiestan sentimientos como el miedo, la angustia y la tristeza. Ante eso, la identificación de los métodos utilizados para enfrentar el cáncer de mama es crucial, ya que permite una mejor vivencia de ese momento para la mujer y los involucrados. Objetivo: Comprender las formas de afrontamiento del cáncer de mama, a través del discurso de mujeres mastectomizadas en un grupo de apoyo. Metodología: Investigación descriptiva con enfoque cualitativo realizada con 10 mujeres que participan en un grupo de apoyo, ubicado en un municipio de Paraíba, Brasil. Para la recolección de datos, se utilizaron entrevistas semiestructuradas. Además, como proceso metodológico de análisis de datos, se aplicó el Discurso Colectivo del Sujeto. Resultados: Fue posible comprender tres ideas centrales sobre las formas de enfrentamiento del cáncer de mama: ''Anclaje en la fe y la espiritualidad''; ''Apoyo familiar''y ''Grupo de apoyo''. Conclusión: El estudio alcanzó su objetivo de identificar las principales formas de enfrentamiento del cáncer de mama por parte de las mujeres con mastectomía. Se pudo dilucidar la importancia de la fe y la espiritualidad, el apoyo familiar y la participación en grupos de apoyo, a través del discurso de las participantes.

Introduction: When facing breast cancer, patients and their loving ones experiment many changes in their lives filled with feelings such as fear, anguish, and sadness. In the light of this, the identification of the coping methods used to face breast cancer is crucial to provide a better experience for all those involved. Objective: To understand the ways of coping with breast cancer through the discourse of mastectomized women in a support group. Methodology: Descriptive research with a qualitative approach carried out with 10 women who participate in a support group, located in a municipality in Paraíba, Brasil. For data collection, semi-structured interviews were conducted and as a methodological process for data analysis, the Collective Subject Discourse was used. Results: It was possible to understand three central coping mechanisms: ''Anchoring in faith and spirituality''; ''Family support'', and ''Support group''. Conclusion: The study reached its objective of identifying the main ways of coping with breast cancer by women who had mastectomies, their discourse highlighted the importance of faith and spirituality, the support of their families, and their participation in support groups.

The 'chessboard of healing strategies': A cardiological application.

RATIONALE: The question of how to adaptively cope with chronic illnesses, aging, and other sources of bodily impairment is crucial for patients and clinicians alike, though sometimes overlooked in the focus on biomedical treatment. AIMS AND OBJECTIVES: To examine the array of strategies available to patients and their practitioners, to employ in the face of bodily breakdown. METHOD: Co-written by a philosopher and cardiologist, this article uses a detailed case study of a patient suffering a myocardial infarction leading to chronic heart failure, with examples of effective or suboptimal care. This enables a discussion of how the clinician or clinical team can best facilitate existential healing, that is, adaptive and creative resilience in the face of chronic impairment. RESULTS AND CONCLUSIONS: We outline a "chessboard of healing," involving the possibility-spaces for dealing constructively with bodily breakdown. This set of strategies is shown to be nonarbitrary, drawn directly from contemporary work on the phenomenology of the lived body. For example, as we both experience the body as that which 'I am', and as that which 'I have', separable from the self, patients can react to illness by moving towards their bodies in modes of listening and befriending, or away from their body, ignoring or detaching themselves from symptoms. Then too, as the body is ever changing in time, one can seek restoration to a previous state, or transformation to new patterns of bodily usage, including passage into a whole new life-narrative.

Family caregivers' perspective of caring for cancer patients during radiotherapy: A qualitative study.

Objectives: To explore the perspective of family caregivers of cancer patients undergoing radiotherapy. Method: The descriptive, qualitative study was conducted at the Indonesia Cancer Foundation, Surabaya, Indonesia, in July and August 2019, and comprised family caregivers of cancer patients undergoing radiotherapy. Data was collected using in-depth semi-structured interviews which were recorded, transcribed and analysed using conventional content analysis. RESULTS: Of the 26 caregivers aged 24-65 years, 16(62%) were men, 19(73%) were married, and 14(56%) had close relationships with the patients. Among the patients, 4(15.4%) had breast cancer, 2(7.6%) had nasopharyngeal cancer and 20(77%) had cervical cancer. The themes identified were uncertainty, disintegration and burden. CONCLUSIONS: Caregivers of cancer patients tended to have both physical and emotional challenges.

The family dynamics of COVID-19 survivors: The perspectives of parents and their children.

Objectives: To explore the family dynamics of coronavirus disease-2019 survivors from the perspective of parents and children. Method: The descriptive, qualitative study was conducted from May 27 to December 7, 2021, in Surabaya, East Java, Indonesia, and comprised parents and children of individuals who survived a coronavirus disease-2019 infection. Data was collected through in-depth interviews. Data was analysed using thematic analysis. RESULTS: The descriptive, qualitative study was conducted from May 27 to December 7, 2021, in Surabaya, East Java, Indonesia, and comprised parents and children of individuals who survived a coronavirus disease-2019 infection. Data was collected through in-depth interviews. Data was analysed using thematic analysis. CONCLUSIONS: Coronavirus disease-2019 patients, in addition to medical support need psychosocial support for better health outcomes.

Model of spiritual nursing care in enhancing quality of life of patients with heart failure.

Objectives: To develop a spiritual nursing care model to improve the quality of life of heart failure patients. Method: The cross-sectional study was conducted at two government hospitals in East Java, Indonesia, from August to November 2019, and comprised patients of either gender aged 30 years or above having classic heart failure symptoms of weariness, ankle swelling and dyspnoea. Standardised questionnaires were used to collect data regarding disease, psychosocial, spiritual, demographic and environmental factors as well as stressors, formation of meaning, coping strategy, spiritual wellbeing, and quality of life. Data was analysed using partial least squares structural equation modelling. RESULTS: Of the 222 patients, 124(55.9%) were males and 98(44.1%) were females. The overall mean age was 57.7±9.96 years. Overall, 33(14.9) patients were suffering from heart failure for >5 years, 36(16.2) had been hospitalised >5 times, and 8(3.6%) had no health insurance cover. Psychosocial (T=2.110), spiritual (T=1,998) and environmental (T=2,019) factors had an effect on the ability to assess stressors. Disease (T=5.497), spiritual (T=3.596) and environmental (T=3.172) factors had an effect on spiritual wellbeing. Disease (T=7.553), psychosocial (T=2.230) and environmental (T=2.625) factors affected the quality of life. The ability to assess stressors affected meaning formation (T=3.293), which had an effect on coping strategies (T=3.863), which, in turn, had an effect on spiritual wellbeing (T=9.776), and that affected the quality of life (T=2.669). CONCLUSIONS: The spiritual nursing care model was found to be influenced by disease, psychosocial and environmental factors as well as by spiritual wellbeing.