AIMS: To assess the effect of a multicomponent intervention on reducing social isolation and loneliness and improving the quality of life in community-dwelling older adults. DESIGN: A cluster-randomized controlled clinical trial. METHODS: A total of 56 older adults participated in the control group and 63 older adults in the experimental group. The intervention consisted of 6 home-based face-to-face sessions, intercalated with 5 telephone calls and was conducted by nursing students and volunteer staff with experience in the subject. The study was conducted between April 2018 and December 2019. In terms of statistical analysis, several procedures were carried out: a statistical analysis per protocol and intention to treat, considering isolation, loneliness and quality of life as endpoints; a comparison of paired means, to analyse the behaviour of the outcome variables at baseline and the end of the study; and finally, a binary logistic regression analysis, considering social support as a dependent variable. RESULTS: The study results do not show the effectiveness of the modified CARELINK programme, analysed as a whole, on the decrease in social isolation or loneliness or the improvement in HRQL. However, a detailed analysis of the behaviour of some of the variables during the study indicates some results that deserve to be commented on. Comparing the mean confidential support scores between the experimental and control group at the initial and final stages shows significant differences in the analysis by protocol, and close to statistical significance in the analysis by intention to treat. Comparing the paired means obtained in the experimental group, an improvement in emotional loneliness scores was found. Finally, the variables associated with the social support of the subjects at the end of the follow-up period were as follows: having people who help them and mobility. CONCLUSION: Although the results obtained do not allow us to affirm that the intervention programme is effective, these same results point to improved confidential support and emotional loneliness in older adults participating in the intervention. Having people to help them and a greater degree of mobility are factors favouring the decrease in social isolation. IMPACT: This study suggested that modified CARELINK, a multicomponent intervention performed by trained volunteers, could improve confidential support in community-dwelling older adults. It also reports the importance of considering the level of mobility and support networks as determinants of the improvement caused by the intervention.
Independent Living , Loneliness , Humans , Aged , Loneliness/psychology , Quality of Life/psychology , Social Isolation/psychology , Social Support
The role of nurse case managers (NCM) involves a rarely visible emotional labor, even more when their role focuses on the care of elders at risk (EAR). Motivated by the lack of qualitative research on the emotional universe of NCM, this study explores the emotional universe (EU) of NCM regarding the care they provide to EAR in primary health care as well as the reasons that generate these emotions. An interpretative-phenomenological approach was implemented in southern Spain, with a purposive sampling that included nurses playing the NCM role for at least three years. Data collection was conducted in two periods (between September 2019 and July 2022). The primary collection tool was the semi-structured individual interview, with starting categories based on Bisquerra's EU taxonomy. The analysis followed Ricoeur's considerations, using the Nvivo software. In the NCM's EU, the recognition of the social phenomena stands out, with an open feeling of empathy regarding the desire of the EAR to continue living at home. However, there was also helplessness, resignation, disappointment, and frustration when EAR rejected their proposals. Furthermore, the system's limitations aroused compassion in the NCM and made them go beyond the limits of their role. This EU requires that their role be valued more, and higher responsiveness must be enforced to improve EAR care.
Case Managers , Humans , Aged , Spain , Emotions , Nursing , Qualitative Research
AIMS: To identify the factors conditioning the feasibility of an intervention to reduce social isolation and loneliness in noninstitutionalized older adults from the perspective of the intervention agents. DESIGN: A Dimensional Grounded Theory study conducted from December 2019 to January 2020. METHODS: Twelve participants were recruited from an experimental study developed in a health district of a southern Spanish city. Data were collected through focus group meetings, individual interviews, biograms, anecdote notebooks, and the field diaries of two participants not included in the other techniques. Transcripts were analyzed using thematic analysis. FINDINGS: Findings were divided into three themes: (a) the elderly between the walls of loneliness, economic difficulties, losses, and the past; (b) intervention agents/volunteers between the walls of inexperience in the management of psychological/emotional processes, lack of moral authority, and difficulty in planning results adapted to the (elderly) person; and (c) intervention between the walls of (interest in) company and assistance at home, lack of involvement ("waiting for you to save them"), and withdrawal/"abandonment". CONCLUSION: A profile of the specialized intervention agent, professionalized (or at least a mentored agent), with both technical and relational competencies; a clear understanding of the purposes of the intervention (empowerment, as opposed to having company or being helped with household chores) and the commitment to active participation by the elder; or adequate management of the completion of the intervention (flexibility, attachment management) are some of the main factors contributing to the feasibility of these approaches. IMPACT: The findings have potential implications in the field of primary healthcare because primary and community healthcare services can implement corrections to the proposed intervention and ensure its effectiveness under feasible conditions. The nurse is shown as the most appropriate profile to conduct this intervention, although more research is needed to analyze the feasibility of this type of intervention in the daily practice of community nurses.
Objetivo: Identificar los principales condicionantes que los profesionales de atención primaria indican a la hora de implementar y desarrollar intervenciones sobre el aislamiento y la soledad.Diseño: Investigación cualitativa con análisis Sistemático de Teoría Fundamentada y Diseño narrativo de tópicos.Emplazamiento: Desarrollada en 13 centros de atención primaria del Distrito Sanitario Córdoba y Guadalquivir, abarcando zonas urbanas y rurales.Participantes: Se identificaron 3 perfiles: medicina de familia/atención comunitaria, enfermería comunitaria y enfermería de gestión de casos. La selección se llevó a cabo entre aquellos que mostraron mayor motivación y compromiso con una intervención sobre aislamiento/soledad.Método: Muestreo intencional. El trabajo se fundamentó en entrevistas en profundidad individuales, en grupos focales y entrevistas dialógicas.Resultados :a) Persisten imágenes deformadas sobre la soledad/aislamiento social y el vivir solo que dificultan su identificación; b) Los principales determinantes disruptivos en la estructura y organización del sistema de atención tienen que ver con la ausencia de programas de detección, la hegemonía del modelo biomédico y el déficit de recursos (a la luz de este modelo); c) Los principales facilitadores se vinculan con el rol enfermero, privilegiado para estas intervenciones según los participantes; y, finalmente, d) Es necesario contar con componentes personales, tanto de la persona mayor como de los profesionales.Conclusiones: La intervención sobre el aislamiento social y la soledad en atención primaria está condicionada por factores, organizacionales y estructurales, profesionales y personales. Contar con ellos es fundamental a la hora de garantizar su factibilidad.
Objective: To identify the main conditioning factors that Primary Care professionals indicate when implementing and developing interventions on isolation and loneliness.Design: Qualitative research with grounded theory, systematic analysis and narrative design of topics.Location: Developed in 12 Primary Care centres of the Health District of Córdoba and Guadalquivir, covering urban and rural areas.Participants: Three profiles were identified: family medicine/community care, community nursing and case management nursing. The selection was carried out among those who showed greater motivation and commitment to an intervention on isolation/loneliness.Method: Purposive sampling. The work was based on individual in-depth interviews, focus groups and dialogic interviews.Results: (a) Distorted images persist about loneliness/social isolation and living alone that make it challenging to identify; (b) the main disruptive determinants in the structure and organization of the care system have to do with the absence of screening programs, the hegemony of the biomedical model and the deficit of resources (in light of this model); (c) the main facilitators are linked to the nursing role, privileged for these interventions according to the participants; and, finally, (d) personal components are necessary, both from the older adult and from the professionals.Conclusions: Intervention on social isolation and loneliness in Primary Care is conditioned by organizational and structural, professional and personal factors. It is essential to take them into account in order to guarantee their feasibility.
Humans , Aged , Aged, 80 and over , Health Sciences , Primary Health Care , Social Isolation/psychology , Loneliness/psychology , Old Age Assistance/trends , Sampling Studies
OBJECTIVE: To identify the main conditioning factors that Primary Care professionals indicate when implementing and developing interventions on isolation and loneliness. DESIGN: Qualitative research with grounded theory, systematic analysis and narrative design of topics. LOCATION: Developed in 12 Primary Care centres of the Health District of Córdoba and Guadalquivir, covering urban and rural areas. PARTICIPANTS: Three profiles were identified: family medicine/community care, community nursing and case management nursing. The selection was carried out among those who showed greater motivation and commitment to an intervention on isolation/loneliness. METHOD: Purposive sampling. The work was based on individual in-depth interviews, focus groups and dialogic interviews. RESULTS: (a) Distorted images persist about loneliness/social isolation and living alone that make it challenging to identify; (b) the main disruptive determinants in the structure and organization of the care system have to do with the absence of screening programs, the hegemony of the biomedical model and the deficit of resources (in light of this model); (c) the main facilitators are linked to the nursing role, privileged for these interventions according to the participants; and, finally, (d) personal components are necessary, both from the older adult and from the professionals. CONCLUSIONS: Intervention on social isolation and loneliness in Primary Care is conditioned by organizational and structural, professional and personal factors. It is essential to take them into account in order to guarantee their feasibility.
Loneliness , Social Isolation , Aged , Humans , Primary Health Care , Qualitative Research
AIM: To acquire an understanding of the emotional universe of intensive care unit nurses, working in Spain and the United Kingdom. METHODOLOGY: The study used a hermeneutic study design and was set in an academic environment. Participants included nurses with clinical experience in intensive care units. Data were collected from seven in-depth interviews, four in Spanish and three in English. The analysis followed Ricoeur's Theory of Interpretation. The affective taxonomy Universe of Emotions, served to establish starting categories in it. FINDINGS: Six themes were identified: 1) Critical patient care, critical context; 2) Intensive care for whom?; 3) Nursing a dying patient; 4) In the company of others; 5) But is it worth it? and 6) Emotional labour is crucial. These all describe different, multifaceted nurses' affective journeys, through categories such as: So little time-so much to do, Relatives, Young death vs. elderly death, Poorly-valued work and I'm in the profession I want to be. CONCLUSION: The sociocultural context shared by the Spanish and English nurses working in intensive care units generates a complex emotional universe, with opposing affective experiences, such as those related to fear, anxiety, sadness, anger, shame, love, surprise and happiness.
Emotions , Nurses/psychology , Adult , Critical Care Nursing/methods , Critical Care Nursing/standards , Female , Hermeneutics , Humans , Intensive Care Units/organization & administration , Intensive Care Units/statistics & numerical data , Male , Middle Aged , Nurses/statistics & numerical data , Spain , United Kingdom
AIMS: This study aims to evaluate the effectiveness of a multicomponent intervention in non-institutionalized older people. This effectiveness will be assessed in terms of reducing social isolation and loneliness and improving Health-Related Quality of Life. BACKGROUND: The concern for social isolation and loneliness in non-institutionalized older adults has increased in recent decades. In addition, their relationship with numerous negative health outcomes is amply demonstrated. DESIGN: A mixed-method design including a cluster randomized controlled clinical trial and an exploratory qualitative study with focus groups was used. METHOD: Each study group consists of 57 subjects. The experimental group will be subjected to a multicomponent intervention comprising six domiciliary face-to-face sessions and five telephone calls that will be interspersed. Interventions will be conducted by healthcare professionals and volunteers. The control group will not be subjected to any systematized intervention. We are going to consider social isolation, loneliness, and Quality of Life as the primary outcomes. However, the factors that influence both primary outcomes and the feasibility of the intervention in clinical practice will also be assessed. DISCUSSION: Despite the negative influence of social isolation and loneliness on clinical outcomes is widely evidenced, few early detection programs are available, especially interventions at the community setting. This study will examine the effectiveness of the intervention in the Spanish community setting. At the same time, this study will identify the feasibility of this intervention in Primary Care clinical practice. IMPACT: Substantial evidence indicates the detrimental health impact of social isolation and loneliness, particularly on mental wellness. Knowing that mental disorders are associated with high economic cost, this project would have strong clinical implication to inform nursing practice on managing social isolation and loneliness. The findings may also inform primary health policy setting in Spain and the wider European countries.
Independent Living , Loneliness/psychology , Social Isolation/psychology , Aged , Aged, 80 and over , Humans , Quality of Life , Spain
Pese a la importancia de la sexualidad en la trayectoria vital de cualquier individuo, ésta ha sido una cuestión tradicionalmente invisibilizada, algo especialmente evidente y taxativo en el caso de las mujeres, en quienes la cuestión de la sexualidad ha sido normalmente un espacio de control y de resistencia. La ausencia de estudios sobre sexualidad es significativa en disciplinas relacionadas con el cuidado, que han demostrado un tardío interés por esta cuestión, pese a ser reconocido como un espacio condicionador de la salud y el bienestar integral. Cuando ha sido abordado se ha hecho desde una perspectiva fundamentalmente biomédica, sin tener en cuenta el papel condicionante que ejercen las construcciones socio - culturales sobre la misma, cuestión que ha limitado la capacidad de intervención de los profesionales sanitarios. Este trabajo, de carácter cualitativo llevado a cabo mediante entrevistas en profundidad y grupos de discusión con mujeres rurales de la provincia de Córdoba, pretende abordar ese vacío identificado, así como poner de manifiesto cuáles son los principales constructos sobre sexualidad con los que las mujeres gestionan su día a día, con la finalidad de aportar a los profesionales del cuidado herramientas útiles para su desempeño profesional en este ámbito en concreto
Despite the importance of sexuality in the life trajectory of any individual, this has been a traditionally invisible issue, something especially evident and restrictive in the case of women, in whom the issue of sexuality has usually been a space of control and of resistance. The absence of studies on sexuality is significant in disciplines related to care, which have shown a late interest in this issue, despite being recognized as a space conditioning health and well-being. When it has been approached it has been done from a fundamentally biomedical perspective, without taking into account the conditioning role of socio - cultural constructions on it, a question that haslimited the intervention capacity of health professionals. This work, of a qualitative nature carried out through in-depth interviews and discussion groups with rural women in the province of Córdoba, aims to address this identified gap, as well as highlighting the main constructs on sexuality with which women manage their day to day, with the purpose of providing care professionals with useful tools for their professional performance in this particular field
A ausência de estudos sobre sexualidade é significativa nas disciplinas relacionadas ao cuidado, que têm demonstrado um interesse tardio nessa questão, apesar de ser reconhecida como espaço condicionante de saúde e bem-estar. Quando abordado, foi feito a partir de uma perspectiva fundamentalmente biomédica, sem levar em conta o papel condicionante das construções socioculturais, questão que tem limitado a capacidade de intervenção dos profissionais de saúde. Este trabalho, de natureza qualitativa realizado em profundidade entrevistas e discussões em grupo com mulheres rurais na província de Córdoba, pretende abordar essa lacuna identificada, bem como para destacar o que as principais construções da sexualidade com mulheres gerenciar o seu dia a dia, com o objetivo de fornecer aos profissionais de saúde ferramentas úteis para o seu desempenho profissional neste campo particular
Humans , Female , Culturally Competent Care , Cultural Competency , Transcultural Nursing , Sex Education , Sexuality , Interviews as Topic , 25783
