Atividades de extensão em enfermagem: Medidas excecionais em tempos de pandemia por COVID-19 / Extension activities in nursing: Exceptional measures during the COVID-19 pandemic / Actividades de extensión en enfermería: medidas excepcionales en tiempos de pandemia por COVID-19

Resumo Enquadramento: A Escola Superior de Enfermagem de Coimbra, ciente do valor das unidades de extensão na articulação do tripé Ensino-Investigação-Extensão tem na sua estrutura a Unidade de Prestação de Serviços à Comunidade e Coordenação das Atividades de Extensão na Comunidade (UPSCCAEC). Objetivo: Descrever o trabalho desenvolvido pela UPSCCAEC em 2019 e 2020, destacando a sua capacidade adaptativa mediante a pandemia pela COVID-19. Principais tópicos em análise: Utilizaram-se como fonte de dados os relatórios de atividades realizadas no contexto da UPSCCAEC nos anos civis de 2019 e 2020, e realizou-se a comparação com achados nos dois anos, os quais foram discutidos à luz do referencial teórico disponível, considerando a pandemia COVID-19 e o impacte a nível das Instituições do Ensino Superior (IES) em seus processos formativos, de investigação e extensão. Conclusão: A atividade da UPSCCAEC nos referidos anos contribuiu para a afirmação da instituição, do desenvolvimento académico, e constituiu recurso de excelência na resposta aos atuais desafios da sociedade, particularmente num período caracterizado por enorme turbulência resultante da pandemia COVID-19.

Abstract Background: The Nursing School of Coimbra knows the importance of extension units in the articulation between teaching, research, and extension. For this reason, the School has a Service Provision and Community Extension Activities Coordination Unit (UPSCCAEC). Objective: To describe the work developed by the UPSCCAEC in 2019 and 2020, highlighting its adaptive capacity in the face of the COVID-19 pandemic. Main topics under analysis: The reports of activities carried out within the scope of the UPSCCAEC in 2019 and 2020 were used as a data source. A comparison was made with findings in the two years, discussed based on the available theoretical framework and considering the COVID-19 pandemic and its impact on Higher Education Institutions' training, research, and extension processes. Conclusion: The UPSCCAEC's activity in those years contributed to the institution's excellence and academic development and successful response to the current societal challenges in a time of great instability due to the COVID-19 pandemic.

Resumen Marco contextual: La Escuela Superior de Enfermería de Coímbra, consciente del valor de las unidades de extensión en la articulación del trípode Enseñanza-Investigación-Extensión, cuenta en su estructura con la Unidad de Prestación de Servicios a la Comunidad y Coordinación de Actividades de Extensión Comunitaria (UPSCCAEC). Objetivo: Describir el trabajo desarrollado por la UPSCCAEC en 2019 y 2020, y destacar su capacidad de adaptación frente a la pandemia por COVID-19. Principales temas en análisis: La fuente de datos utilizada fueron los informes de las actividades realizadas en el marco de la UPSCCAEC en los años civiles de 2019 y 2020, y se realizó una comparación con los hallazgos en ambos años, los cuales se discutieron considerando el marco teórico disponible, la pandemia del COVID-19 y el impacto en las Instituciones de Educación Superior (IES), en sus procesos de formación, investigación y extensión. Conclusión: La actividad de la UPSCCAEC en estos años contribuyó a la afirmación de la institución, al desarrollo académico y constituyó un recurso de excelencia para responder a los desafíos actuales de la sociedad, particularmente en un período caracterizado por enormes turbulencias derivadas de la pandemia del COVID-19.

Diagnóstico tardio do Vírus da Imunodeficiência Humana e da Síndrome da Imunodeficiência Adquirida em Idosos: protocolo scoping review / Late diagnosis of Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome in the Elderly: scoping review protocol

As pessoas idosas, diagnosticadas tardiamente, tem maior risco de desenvolver AIDS. Com a contagem de CD4 inferior a 200 células/ml3, elas apresentam em média mais chances de morrer no primeiro ano após o diagnóstico. O objetivo desta revisão de escopo é mapear evidências relativas aos fatores associados e de risco do diagnóstico tardio de HIV/AIDS em pessoas idosas, mas especificamente, esta revisão quer dar resposta às seguintes questões: Quais são os fatores associados do diagnóstico tardio de HIV/AIDS em pessoas idosas? Quais são os fatores de riscos do diagnóstico tardio de HIV/AIDS em pessoas idosas? Que contexto o diagnóstico tardio de HIV/AIDS em pessoas idosas foi realizado? Esta revisão será orientada pela metodologia do Joanna Briggs Institute, que assentará na estratégia de definição dos participantes, conceito e contexto. Os resultados serão apresentados pelo resumo lógico e descritivo, apresentados, como um mapa de dados extraídos dos artigos e alinhado com o objetivo e as perguntas da revisão de escopo. Espera-se que esta revisão de escopo contribua para a análise compreensiva das práticas de cuidados à saúde das pessoas idosas.

Elderly people, diagnosed late, have a higher risk of developing AIDS. With a CD4 count of less than 200 cells / ml3, they are on average more likely to die in the first year after diagnosis. The purpose of this scope review is to map evidence regarding the associated risk factors of late diagnosis of HIV / AIDS in older people, but specifically, this review aims to address the following questions: What are the associated factors of late diagnosis of HIV / AIDS in elderly people? What are the risk factors for late diagnosis of HIV / AIDS in elderly people? In what context was the late diagnosis of HIV / AIDS in elderly people given? This review will be guided by the methodology of the Joanna Briggs Institute, which will be based on participant definition strategy, concept and context. Results will be presented by the logical and descriptive summary, presented as a map of data extracted from the articles and aligned with the objective and scope review questions. This scope review is expected to contribute to a comprehensive analysis of the health care practices of elderly people.

Las personas mayores, diagnosticadas tardíamente, tienen un mayor riesgo de desarrollar SIDA. Con un recuento de CD4 de menos de 200 células/ml3, tienen en promedio más probabilidades de morir en el primer año después del diagnóstico. El objetivo de esta revisión de alcance es mapear las evidencias relacionadas con los factores asociados y de riesgo del diagnóstico tardío del VIH/SIDA en personas mayores, pero específicamente esta revisión tiene como objetivo responder a las siguientes preguntas: ¿Cuáles son los factores asociados con el diagnóstico tardío del VIH/SIDA en las personas mayores? ¿Cuáles son los factores de riesgo para el diagnóstico tardío del VIH/SIDA en las personas mayores? ¿Cuál es el contexto del diagnóstico tardío del VIH/SIDA en las personas mayores? Esta revisión se guiará por la metodología del Joanna Briggs Institute, que se basará en la estrategia de definición, concepto y contexto de los participantes. Los resultados se presentarán mediante un resumen lógico y descriptivo, presentado como un mapa de los datos extraídos de los artículos y alineados con el objetivo y las preguntas de la revisión del alcance. Se espera que esta revisión del alcance contribuya al análisis exhaustivo de las prácticas de atención de la salud de los ancianos.

Administration of chemotherapy in patients admitted to a haematology service: a best practice implementation project.

OBJECTIVES: To promote evidence-based practices related to the prevention of adverse events associated with medication administration (only chemotherapy) in a hospital service. INTRODUCTION: The medication management process in a hospital setting is highly complex, going through multiple stages from drug selection, procurement and storage, to prescription, validation, dispensing, preparation, administration and monitoring. METHODS: An evidence implementation project based on an audit and feedback approach was conducted from December 2019 to April 2021 using the JBI Practical Application of Clinical Evidence System and Getting Research into Practice. RESULTS: The results of the baseline audit showed that the 10 audit criteria were mostly met; however, two of the criteria (criterion 6: the expiry date of medication is checked before use and criterion 7: the nurse who prepares the medication administers the medication to the patient) had low compliance (respectively, 0 and 67.9%). After identifying the barriers and implementing strategies to deal with the identified barriers, we verified a significant improvement in compliance with best practices (criterion 6 improved to 64.3% and criterion 7 to 78.6%). CONCLUSION: This implementation project was a success, achieving a great improvement of the implementation of evidence-based guidelines concerning the prevention of adverse events associated with medication administration in a hospital in central Portugal. More such projects should be planned to sustain the implementation of evidence-based methods to improve health outcomes, patient safety, costs and health systems.

Fazer a Diferença 3 - um programa de estimulação cognitiva individual para pessoas idosas: Aceitabilidade e aplicabilidade / Making a Difference 3 - an individual cognitive stimulation program for older people: Appropriateness and feasibility / Fazer a Diferença 3 - un programa de estimulación cognitiva individual para personas mayores: Aceptabilidad y aplicabilidad

Resumo Enquadramento: A estimulação cognitiva individual desenvolvida em contexto domiciliar por um cuidador é uma intervenção inovadora. O programa de estimulação cognitiva Fazer a Diferença 3 (FD3) é um exemplo deste tipo de intervenção. Objetivo: Explorar a aceitabilidade e a aplicabilidade do programa FD3 para a população portuguesa. Metodologia: Estudo desenvolvido em duas fases: na Fase 1 realizaram-se entrevistas exploratórias a académicos, profissionais de saúde e cuidadores, com o intuito de se conhecer a recetividade a este tipo de intervenção; na Fase 2 conduziu-se um painel de peritos e grupos focais, com cuidadores, para explorar a suas perceções sobre o programa FD3, versão portuguesa. Resultados: A Fase 1 foi impulsionadora do estudo. As partes interessadas analisaram este tipo de intervenção como muito útil e versátil. A Fase 2 permitiu perceber as potencialidades em termos de aceitabilidade e de aplicabilidade da intervenção, traduzida e adaptada, para a população portuguesa. Conclusão: O programa FD3 poderá ser uma excelente ferramenta no cuidado à pessoa idosa com deterioração cognitiva a residir em contexto domiciliar.

Abstract Background: The delivery of individual cognitive stimulation by caregivers in a home-based setting is an innovative intervention. An example of this type of intervention is the Making a Difference 3 (MD3) cognitive stimulation program. Objective: To explore the appropriateness and feasibility of the MD3 program for the Portuguese population. Methodology: This study was developed in two phases. In Phase 1, exploratory interviews were conducted with academics, healthcare professionals, and caregivers to identify the receptivity to this type of intervention. In Phase 2, a panel of experts and focus groups with caregivers were conducted to explore their perceptions about the Portuguese version of the MD3 program. Results: Phase 1 was the driving force behind the study. Participants considered this type of intervention very useful and versatile. Phase 2 allowed identifying the level of appropriateness and feasibility of the intervention that was translated and adapted to the Portuguese population. Conclusion: The MD3 program can be an excellent tool in caring for older adults with cognitive impairment living at home.

Resumen Marco contextual: La estimulación cognitiva individual, desarrollada en casa, por un cuidador, es una intervención innovadora. El programa de estimulación cognitiva Marcando la diferencia 3 (MD3) es un ejemplo de este tipo de intervención. Objetivo: explorar la aceptabilidad y aplicabilidad del programa MD3 para la población portuguesa. Metodología: se desarrollaron dos fases. En la Fase 1, se realizaron entrevistas exploratorias con académicos, profesionales y cuidadores, con el fin de conocer la receptividad a este tipo de intervenciones; La Fase 2, se desarrolló un panel de expertos y grupos focales para explorar sus percepciones sobre el programa, versión portuguesa. Resultados: La Fase 1 fue la fuerza impulsora detrás del estudio. Los grupos de interés consideraron este tipo de intervención como muy útil y versátil. La Fase 2 permitió percibir las potencialidades en términos de aceptabilidad y aplicabilidad de la intervención, traducida y adaptada, para la población. Conclusión: El programa MD3 puede ser una excelente herramienta para el cuidado de las personas mayores con deterioro cognitivo que viven en el hogar.

Citizen involvement in scientific activities and extension of knowledge to society.

High-quality health research must involve the citizen, bringing merit, relevance, and value to research and ensuring the transfer of new knowledge or outputs to the community. This theoretical study aimed to conceptualize and discuss the role of Citizen Involvement and Extension to Society in research processes and outcomes, revealing that both concepts have different purposes. Research units and research funding agencies are promoting Citizen Involvement in all steps of the research process because it adds quality to it. Moreover, universities, research units, and researchers should extend their knowledge to society, the citizens, or the end-users as part of their social responsibility. Citizen Involvement and Extension to Society should be considered strategic areas for the development of research in general and nursing research in particular. More studies are needed to generate new knowledge and useful products to better serve the real needs of society.

Citizen involvement in scientific activities and extension of knowledge to society / Envolvimento do cidadão nas atividades científicas e extensão do conhecimento à sociedade / Intervención del ciudadano en actividades científicas y extensión del conocimiento a la sociedad

ABSTRACT High-quality health research must involve the citizen, bringing merit, relevance, and value to research and ensuring the transfer of new knowledge or outputs to the community. This theoretical study aimed to conceptualize and discuss the role of Citizen Involvement and Extension to Society in research processes and outcomes, revealing that both concepts have different purposes. Research units and research funding agencies are promoting Citizen Involvement in all steps of the research process because it adds quality to it. Moreover, universities, research units, and researchers should extend their knowledge to society, the citizens, or the end-users as part of their social responsibility. Citizen Involvement and Extension to Society should be considered strategic areas for the development of research in general and nursing research in particular. More studies are needed to generate new knowledge and useful products to better serve the real needs of society.

RESUMO Investigação de alta qualidade em saúde deve envolver o cidadão, pois promove mérito, relevância e valor às atividades de investigação e assegura a transferência de novos conhecimentos ou resultados para a comunidade. Este estudo teórico teve como objetivo conceituar e discutir o Envolvimento do Cidadão nos processos de investigação e Extensão à Sociedade dos seus resultados, revelando que ambos os conceitos têm finalidades distintas. Unidades de investigação e agências de financiamento incentivam o Envolvimento do Cidadão em todas as etapas do processo de pesquisa, acreditando-se que o mesmo adiciona qualidade aos processos de pesquisa. Por outro lado, universidades, unidades de investigação e pesquisadores têm a responsabilidade social de estenderem seus conhecimentos à sociedade, aos cidadãos ou aos usuários finais. O Envolvimento do Cidadão e a Extensão à Sociedade devem ser considerados áreas estratégicas para o desenvolvimento da pesquisa em geral e da enfermagem em particular. Estudos que envolvam o cidadão são necessários para gerar novos conhecimentos e produtos úteis para melhor atender às reais necessidades da sociedade.

RESUMEN La investigación en salud de alta calidad debe involucrar el ciudadano, aportar mérito, relevancia y valor a la investigación y garantizar la transferencia de nuevos conocimientos o resultados para la comunidad. Este estudio teórico tuvo como objetivo conceptuar y debatir el rol de la Intervención Ciudadana y de la Extensión a la Sociedad en los procesos y conclusiones de investigación, revelando que ambos los conceptos tienen finalidades distintas. Unidades de investigación y agencias de fomento a la investigación han promovido la Intervención del Ciudadano en todas las etapas del proceso de investigación una vez que ella aporta calidad a los mismos. Por otro lado, universidades, unidades de investigación e investigadores deben "extender" sus conocimientos a la sociedad, a los ciudadanos o a los usuarios finales como parte de su responsabilidad social. La Intervención del Ciudadano y la Extensión a la Sociedad deben ser consideradas áreas estratégicas para el desarrollo de la investigación en enfermería, específicamente. Más estudios son necesarios para generar nuevos conocimientos y productos útiles con la finalidad de atender mejor a las necesidades de la sociedad.

Forgiveness facilitation in palliative care: a scoping review.

OBJECTIVE: The objective of this review is to map the nature and extent of forgiveness facilitation intervention implemented and evaluated in palliative care contexts. INTRODUCTION: Spiritual beliefs often include reconciliation and forgiveness, which are critical to patients and families in palliative care. Forgiveness facilitation can represent a valuable response as a multidisciplinary and non-pharmacological intervention to reduce suffering. INCLUSION CRITERIA: Studies including palliative care patients aged 18 years or over and assisted by palliative care teams, including all healthcare professionals, chaplains, and volunteers, were included in this review. METHODS: This scoping review is based on JBI methodology. The search was conducted in June 2017 and updated in December 2018 using international databases and gray literature in English, Spanish, German, Italian, and Portuguese. RESULTS: A total of 23 articles were included in this review. The results suggest a growing interest in forgiveness facilitation in palliative care in different spiritual and religious traditions. Most studies are based on a psychological perspective. Several activities related to the intervention have been identified, but few details or characteristics are described. Social workers, nurses, doctors, and psychologists were most identified as healthcare staff involved in forgiveness facilitation. The outcomes related to the intervention are mental, physical, and relational well-being; quality of life, decision-making and communication; self-esteem and hope; depression, anger, and anxiety; and inner peace. CONCLUSIONS: Forgiveness facilitation is critical in palliative care and is grounded in a multidisciplinary approach, but further evidence is needed to inform clinical implementation. These results open new perspectives for research and training on palliative healthcare staff.

Protocolo de intervenção individual baseado na terapia de reminiscência em idosos com perturbação neurocognitiva / Individual intervention protocol based on reminiscence therapy for older people with neurocognitive disorders / Protocolo de intervención individual basado en la terapia de reminiscencia en personas mayores con trastornos neurocognitivos

Enquadramento: A literatura sugere que a terapia de reminiscência (TR) é uma das terapias não-farmacológicas com melhores evidências na população idosa com perturbação neurocognitiva (PNC), permitindo estimular a neuroplasticidade e a reserva cognitiva, podendo ter um efeito protetor na pessoa com PNC. Objetivo: Apresentar de forma pormenorizada a estrutura e o conteúdo de um protocolo de intervenção em idosos com PNC, baseado na TR individual. Metodologia: Identificação das fases preliminares ao desenho do protocolo de intervenção. Resultados: Protocolo de intervenção individual baseado na TR, em formato misto, composto por 26 sessões, com frequência bissemanal e com duração aproximada de 50 minutos por sessão, administrado por terapeutas treinados. Conclusão: O programa de TR individual pormenorizado permite uma implementação e replicabilidade adequada, podendo contribuir para atenuar a progressão da PNC.

Background: The literature suggests that reminiscence therapy (RT) is one of the non-pharmacological treatments with better evidence for older people with neurocognitive disorders (NCD). RT stimulates neuroplasticity and cognitive reserve, and it may have a protective effect on the person with NCD. Objective: To describe in detail the structure and contents of an individual RT intervention protocol applied to older people with NCD. Methodology: Identification of the phases prior to the design of the intervention protocol. Results: Individual RT intervention protocol, in a mixed format, consisting of 26 sessions, twice a week, of approximately 50 minutes each, conducted by trained therapists. Conclusion: The detailed individual RT program can be adequately implemented and replicated, and it may delay the progression of NCD.

Marco contextual: La literatura sugiere que la terapia de reminiscencia (TR) es una de las terapias no farmacológicas con mejores resultados en la población anciana con trastorno neurocognitivo (PNC, en portugués), pues permite la estimulación de la neuroplasticidad y la reserva cognitiva, y puede tener un efecto protector en la persona con PNC. Objetivo: Presentar de forma pormenorizada la estructura y el contenido de un protocolo de intervención para personas mayores con PNC, basado en la TR individual. Metodología: Identificación de las fases preliminares al diseño del protocolo de intervención. Resultados: Protocolo de intervención individual basado en la TR, en formato mixto, compuesto por 26 sesiones, con una frecuencia quincenal y una duración aproximada de 50 minutos por sesión, administrado por terapeutas capacitados. Conclusión: El programa de TR individual pormenorizado permite una implementación y una replicabilidad adecuadas, y puede contribuir a suavizar el progreso de la PNC.

Learning to lead: A scoping review of undergraduate nurse education.

AIM: To explore undergraduate student's preparation for leadership roles upon registration. BACKGROUND: Effective leadership is vital when promoting positive workplace cultures and high-quality care provision. However, newly registered nurses are not always well-prepared for leadership roles. EVALUATION: A scoping review of primary research published in English between 2009 and 2019 was undertaken. Data were analysed using an adapted version of Arksey and O'Malleys' (2005. International Journal of Social Research Methodology: Theory and Practice, 8, 19) framework. Nine papers met the review eligibility criteria. KEY ISSUES: Findings revealed three themes: leadership education content; positioning of leadership education within the nursing programme; and teaching and learning delivery. CONCLUSIONS: The review highlighted some agreement about the knowledge, skills and behaviours to be addressed in leadership education. What varied more was the pedagogical methods used to deliver this, the extent of its integration throughout the programme and the nature of collaborative academic-practice working to ensure good quality clinical supervision. IMPLICATIONS FOR NURSING MANAGEMENT: (a) Students must be exposed to positive leadership practices during clinical placements to facilitate theory-practice integration. (b) Bullying negatively impacts on students' self-efficacy whereas positive role modelling from registered nurses supports development of leadership competence. (c) Leadership theory and competence should be introduced early and revisited throughout the programme.

Tradução e adaptação de instrumentos sobre prática baseada na evidência para estudantes de enfermagem portugueses / Translation and cross-cultural adaptation of evidence-based practice instruments for Portuguese nursing students / Traducción y adaptación de instrumentos relativos a la práctica basada en la evidencia para estudiantes de enfermería portugueses

Enquadramento: A implementação da prática baseada na evidência (EBP) em contextos clínicos é recomendada pelo seu impacto positivo na saúde, contudo, permanece abaixo do desejável. A formação de estudantes de licenciatura em enfermagem em EBP é fundamental, pelo que é crucial haver medidas válidas e confiáveis desta aprendizagem. Objetivo: Traduzir e adaptar transculturalmente para português europeu as escalas EBP Beliefs Scale (EBPB), EBP Implementation Scale for Students (EBPI-S) e Organizational Culture & Readiness for School-wide Integration of Evidence-based Practice Survey for students (OCRSIEP-ES). Metodologia: Tradução e adaptação transcultural segundo recomendações internacionais. Validação preliminar em estudantes portugueses de licenciatura em enfermagem, provenientes de nove instituições. Resultados: Às versões prefinais dos instrumentos os participantes sugeriram incluir a possibilidade de resposta “não tenho conhecimento suficiente que me permita responder” e aumentar o período de recordação no instrumento EBPI-S. Na fase II participaram 167 estudantes. O a para o EBPB, EBPI-S e OCRSIEP-ES foi 0,854, 0,943 e 0,970, respetivamente. Conclusão: Os resultados preliminares revelaram uma forte consistência interna. É necessário realizar mais estudos de validação com amostras robustas para testar a confiabilidade e validade dos instrumentos.

Background: The implementation of evidence-based practice (EBP) in clinical contexts is recommended due to its positive impact on health, but it remains under the desirable. The training of undergraduate nursing students in the use of EBP is crucial, and, for that, there must be valid and reliable measures of EBP learning. Objective: To translate and to cross-cultural adapt into European Portuguese of the EBP Beliefs Scale (EBPB), EBP Implementation Scale for Students (EBPI-S), and Organizational Culture & Readiness for School-wide Integration of Evidence-based Practice Survey for Students (OCRSIEP-ES). Methodology: Translation and cross-cultural adaptation according to international recommendations. Preliminary validation in Portuguese undergraduate nursing students from nine institutions. Results: In the pre-final versions of the instruments, the participants suggested including the optional answer “I do not have sufficient knowledge to be able to answer” and increasing the recall period in the EBPI-S instrument. Phase 2 included 167 participants. The a for EBPB, EBPI-S, and OCRSIEP-ES was 0.854, 0.943, and 0.970, respectively. Conclusion: Preliminary results showed good internal consistency. Further validation studies with robust samples are required to test the reliability and validity of the instruments.

Marco contextual: Se recomienda implementar la práctica basada en la evidencia (EBP) en contextos clínicos, debido a su impacto positivo en la salud, aunque sigue estando por debajo de lo deseable. La formación de los estudiantes de enfermería de grado en el uso de la EBP es crítica. Por ello, tener medidas válidas y fiables de este aprendizaje supone un aspecto clave. Objetivo: Traducir y adaptar al portugués europeo: la EBP Beliefs Scale (EBPB), la EBP Implementation Scale for Students (EBPI-S) y la Organizational Culture & Readiness for School-wide Integration of Evidence-based Practice Survey for students (OCRSIEP-ES). Metodología: Traducción y adaptación intercultural de acuerdo con las recomendaciones internacionales. Validación preliminar en estudiantes de enfermería portugueses de grado de nueve instituciones. Resultados: En las versiones prefinales de los instrumentos, los participantes sugirieron incluir la respuesta “no sé” y aumentar el periodo de recuerdo en el instrumento EBPI-S. En la fase II participaron 167 estudiantes. El a para EBPB, EBPI-S y OCRSIEP-ES fue de 0,854, 0,943 y 0,970, respectivamente. Conclusión: Los resultados preliminares mostraron una fuerte consistencia interna. Se requieren más estudios de validación con muestras sólidas para probar la fiabilidad y la validez de los instrumentos.

Schizophrenia and Progressive Muscle Relaxation - A systematic review of effectiveness.

OBJECTIVE: We perform a systematically search, appraise and synthesize of the best available evidence on the effectiveness of Progressive Muscle Relaxation (PMR) in the adults with schizophrenia, in any setting, regarding anxiety, personal and social functioning, cognition, and well-being. METHOD: Major databases were searched to find both published and unpublished studies from inception until April 2017, using Schizophren* AND Relax* as keywords, and studies published in Portuguese, English, Spanish, Italian, French were considered for inclusion in this review. Methodological quality was assessed by two independent reviewers using the Critical Appraisal Checklist for Randomized Controlled Trials from the Joanna Briggs Institute. RESULTS: From a total of 1172 studies, five studies, involving 216 adults with schizophrenia, met the inclusion criteria for this systematic review after assessment of their methodological quality. These studies reported benefits in experimental group participants after PMR intervention on anxiety (assessed with State anxiety inventory, Beck Anxiety Inventory and Spielberger Trait Anxiety Inventory), well-being (assessed with Subjective Exercise Experiences Scale) and personal and social functioning (assessed with Sheehan Disability Scale and Therapist Rating Scale). CONCLUSIONS: Evidence suggests that PMR was effective in adults diagnosed with schizophrenia, except in one study where was only effective when combined with education. Thus, PMR may be useful to decrease state anxiety, improve well-being and social functioning in adults diagnosed with schizophrenia. However, due to the diversity of clinical intervention designs of PMR (different number and length of sessions) and outcome assessment scales, no strong evidence was found in this systematic review.

Ensino clínico de fundamentos de enfermagem na comunidade / Clinical teaching of nursing fundamentals in the community

Objetivo: descrever a metodologia e as estratégias do plano educacional do ensino clínico de Fundamentos de Enfermagem na comunidade que, por meio do estudo de determinantes de saúde com pessoas idosas, tem como meta a formação de competências e capacidades dos estudantes do curso de Licenciatura em Enfermagem. Método: trata-se de um estudo qualitativo, descritivo, do tipo relato de experiência, desenvolvido com estudantes de Enfermagem. Apresentam-se os resultados em forma de figuras. Resultados: conduziu-se os estudantes a desenvolver as competências definidas pelas diferentes capacidades e critérios vivenciados pelos estudantes, neste ensino clínico, durante as experiências de aprendizagem sugeridas, assim como outras que foram implementadas. Conclusão: permitiu-se, ao estudante de Enfermagem, pela integração de atividades de Enfermagem compartilhadas entre equipes e subequipes, construir seu próprio conhecimento e acrescentar qualidade técnica e científica à sua formação. Tornou-se o estudo de determinantes de saúde com pessoas idosas fundamental para a formação de competências dos estudantes do curso de Licenciatura em Enfermagem. Pode-se disponibilizar, por esta experiência, com propostas baseadas no olhar do continente europeu, uma nova dimensão de aprendizagem no ensino clínico da Licenciatura de Enfermagem para outros continentes.(AU)

Objective: to describe the methodology and strategies of the educational plan of the clinical teaching of Nursing Fundamentals in the community that, through the study of health determinants with elderly people, has the goal of training the skills and abilities of undergraduate students in Nursing. Method: this is a qualitative, descriptive, experience-type study developed with Nursing students. The results are presented in figures. Results: the students were led to develop the competencies defined by the different capacities and criteria experienced by the students, in this clinical teaching, during the suggested learning experiences, as well as others that were implemented. Conclusion: the Nursing student was allowed to integrate nursing activities shared between teams and subteams, to build their own knowledge and to add technical and scientific quality to their training. It has become the study of health determinants with older people key to the training of students' undergraduate nursing course. Through this experience, it is possible to offer, based on the perspective of the European continent, a new dimension of learning in the clinical teaching of the Nursing Degree to other continents.(AU)

Objetivo: describir la metodología y las estrategias del plan educativo de la enseñanza clínica de Fundamentos de Enfermería en la comunidad que, a través del estudio de determinantes de salud con personas mayores, tiene como meta la formación de competencias y capacidades de los estudiantes del curso de Licenciatura en Enfermería. Método: se trata de un estudio cualitativo, descriptivo, del tipo relato de experiencia, desarrollado con estudiantes de Enfermería. Se presentan los resultados en forma de figuras. Resultados: se llevó a los estudiantes a desarrollar las competencias definidas por las diferentes capacidades y criterios vivenciados por los estudiantes, en esta enseñanza clínica, durante las experiencias de aprendizaje sugeridas, así como otras que se implementaron. Conclusión: se permitió al estudiante de Enfermería, por la integración de actividades de Enfermería compartidas entre equipos y subequipos, construir su propio conocimiento y añadir calidad técnica y científica a su formación. Se ha convertido el estudio de determinantes de salud con personas de edad avanzada para la formación de competencias de los estudiantes del curso de Licenciatura en Enfermería. Se puede disponer, por esta experiencia, con propuestas basadas en la mirada del continente europeo, una nueva dimensión de aprendizaje en la enseñanza clínica de la Licenciatura de Enfermería para otros continentes.

Adaptation and validation into Portuguese language of the six-item cognitive impairment test (6CIT).

BACKGROUND: The six-item cognitive impairment test (6CIT) is a brief cognitive screening tool that can be administered to older people in 2-3 min. OBJECTIVE: To adapt the 6CIT for the European Portuguese and determine its psychometric properties based on a sample recruited from several contexts (nursing homes; universities for older people; day centres; primary health care units). METHOD: The original 6CIT was translated into Portuguese and the draft Portuguese version (6CIT-P) was back-translated and piloted. The accuracy of the 6CIT-P was assessed by comparison with the Portuguese Mini-Mental State Examination (MMSE). A convenience sample of 550 older people from various geographical locations in the north and centre of the country was used. RESULTS: The test-retest reliability coefficient was high (r = 0.95). The 6CIT-P also showed good internal consistency (α = 0.88) and corrected item-total correlations ranged between 0.32 and 0.90. Total 6CIT-P and MMSE scores were strongly correlated. The proposed 6CIT-P threshold for cognitive impairment is ≥10 in the Portuguese population, which gives sensitivity of 82.78% and specificity of 84.84%. The accuracy of 6CIT-P, as measured by area under the ROC curve, was 0.91. CONCLUSION: The 6CIT-P has high reliability and validity and is accurate when used to screen for cognitive impairment.

Forgiveness facilitation in palliative care: a scoping review protocol.

REVIEW QUESTION/OBJECTIVE: The objective of this scoping review is to map the nature and extent of forgiveness facilitation interventions that have been implemented and evaluated in palliative care contexts. More specifically, the review questions are.

Decodificando a síntese da evidência: conceitos / Decoding the synthesis of evidence: concepts / Decodificando la síntesis de la evidencia: conceptos

A stage considered essential to the implementation of the practice informed by evidence is called the synthesis of evidence. However, its design and implementation is still far from researchers, educational institutions and research professionals, etc. In order to facilitate the understanding of readers on the subject, concatenating concepts and practice, are detailed below as the spring and summer OBJN editorials. One of the most accepted ways to develop the synthesis of science is the systematic review of the literature (SLR). The explicit, systematic and reproducible methods used in the SLR aim to minimize different types of bias, including critical evaluation of the quality of the studies that meet the inclusion criteria of the review in question. When the evidence produced generates recommendations for practice and policy, the inclusion of low-quality evidence at high risk of bias is problematic.

Etapa esencial para la implementación de la práctica informada por evidencias es la denominada síntesis de la evidencia. Sin embargo, su concepción y aplicación está todavía distante de los investigadores, instituciones de enseñanza y pesquisas, profesionales etc. Con el objetivo de facilitar la comprensión del tema por los lectores, concatenando conceptos y práctica, seguirán los editoriales de primavera y verano del OBJN. Una de las formas más aceptadas para desarrollar la síntesis de la ciencia es la revisión sistemática de la literatura (RSL). Los métodos explícitos, sistemáticos y reproductibles utilizados en la RSL tienen como objetivo minimizar diferentes tipos de sesgos, incluyendo la evaluación crítica de la calidad de los estudios que atienden a los criterios de inclusión de la revisión en causa. Cuando la evidencia producida genera recomendaciones para la práctica o política, la inclusión de evidencias de baja calidad y con elevado riesgo de sesgo es una problemática

Etapa essencial à implementação da prática informada por evidências é a chamada síntese da evidência. Entretanto, sua concepção e aplicação é ainda distante dos pesquisadores, intituições de ensino e pesquisa, profissionais etc. Com o objetivo de facilitar a compreensão dos leitores acerca do tema, concatenando conceitos e prática, seguirão os editoriais de primavera e verão do OBJN. Uma das formas mais aceitas para desenvolver síntese da ciência é a revisão sistemática da literatura (RSL). Os métodos explícitos, sistemáticos e reprodutíveis utilizados na RSL têm por objetivo minimizar diferentes tipos de viés, incluindo a avaliação crítica da qualidade dos estudos que atendam aos critérios de inclusão da revisão em causa. Quando a evidência produzida gera recomendações para a prática ou política, a inclusão de evidências de baixa qualidade e com elevado risco de viés é problemática.

Efectos de la estimulación cognitiva sobre las personas mayores en el ámbito comunitario / Effect of cognitive stimulation in elderly community

OBJETIVO: Demostrar que la implementación del programa de estimulación cognitiva (EC) «Making a Difference» (MD) mejora la cognición y la sintomatología depresiva en personas mayores y jubiladas que residen en el ámbito comunitario. MÉTODO: Estudio multicéntrico y cuasiexperimental efectuado sobre 45 personas mayores (38 mujeres y 7 hombres) residentes en el ámbito comunitario, con una edad media de 75,29 años, seleccionados en 3 centros de día localizados en contextos rural, semirrural y urbano, en la región central de Portugal. Los participantes asistieron a 14 sesiones bisemanales a lo largo de 7 semanas. La escala de Valoración cognitiva de Montreal (Montreal Cognitive Assessment [MoCA]) y la escala de depresión geriátrica de 15 ítems (15-item Geriatric Depression Scale [GDS-15]) se aplicaron en 3 momentos de la evolución: al inicio del estudio, al final del estudio y en el seguimiento. RESULTADOS: Entre el inicio del estudio y el final del estudio hubo una diferencia estadísticamente significativa en la sintomatología depresiva (F = 7,494; p = 0,010) explicando el 21% de la varianza (valor eta cuadrado parcial [ηp2] = 0,21), potencia = 0,75; sin embargo, no hubo una diferencia estadísticamente significativa respecto a la cognición. Entre el final del estudio y el seguimiento no hubo diferencias en los resultados correspondientes a la cognición ni a la depresión. CONCLUSIONES: Nuestros resultados demuestran una mejoría de la sintomatología depresiva de las personas mayores tras un programa de intervención de 7 semanas de duración, pero sin persistencia del efecto terapéutico a los 3 meses de seguimiento. No se ha demostrado el efecto beneficioso del programa de intervención respecto a la mejora de la cognición. La EC puede tener utilidad para prevenir la sintomatología depresiva de las personas mayores cuando se incluye en el plan de cuidados para la promoción de la salud

OBJECTIVE: To demonstrate that the implementation of the Cognitive Stimulation (CS) program 'Making a Difference' (MD) improves cognition and depressive symptoms in retired community elders. Method: This was a multicenter quasi-experimental study of 45 community dwelling elders (38 women and 7 men), with a mean age of 75.29, from 3 day-care centers in rural, semi-rural and urban environments in the central region of Portugal. Participants attended 14 sessions twice a week over seven weeks. The Montreal Cognitive Assessment (MoCA) and the Geriatric Depression Scale (GDS-15) were administered at the following three time points: baseline, post-test, and follow-up. RESULTS: From baseline to post-test, there is a statistically significant difference in depressive symptoms (F = 7.494; P = .010) explaining 21% of the variance (partial eta squared [ηp2] = .21), power = .75, but there is no statistically significant difference in cognition. From post-test to follow-up, there is no difference in both cognition and depression outcomes. CONCLUSIONS: Our results showed improvement in elders' depressive symptoms after a seven weeks intervention program but it did not have a protective effect after the three months follow-up. No evidence was found for its efficacy in improving cognition. Cognitive stimulation may be a useful in preventing elder's depressive symptoms when included in their health promotion care plan

[Effect of cognitive stimulation in elderly community]. / Efectos de la estimulación cognitiva sobre las personas mayores en el ámbito comunitario.

OBJECTIVE: To demonstrate that the implementation of the Cognitive Stimulation (CS) program 'Making a Difference' (MD) improves cognition and depressive symptoms in retired community elders. METHOD: This was a multicenter quasi-experimental study of 45 community dwelling elders (38 women and 7 men), with a mean age of 75.29, from 3 day-care centers in rural, semi-rural and urban environments in the central region of Portugal. Participants attended 14 sessions twice a week over seven weeks. The Montreal Cognitive Assessment (MoCA) and the Geriatric Depression Scale (GDS-15) were administered at the following three time points: baseline, post-test, and follow-up. RESULTS: From baseline to post-test, there is a statistically significant difference in depressive symptoms (F=7.494; P=.010) explaining 21% of the variance (partial eta squared [ηp(2)]=.21), power=.75, but there is no statistically significant difference in cognition. From post-test to follow-up, there is no difference in both cognition and depression outcomes. CONCLUSIONS: Our results showed improvement in elders' depressive symptoms after a seven weeks intervention program but it did not have a protective effect after the three months follow-up. No evidence was found for its efficacy in improving cognition. Cognitive stimulation may be a useful in preventing elder's depressive symptoms when included in their health promotion care plan.

Comprometimento cognitivo em idosos da comunidade, de centros­ dia e residentes em lares geriátricos / Cognitive impairment in elderly people from the community, day care centers, and those living in geriatric homes / Deterioro cognitivo en ancianos de la comunidad, de centros de cuidados diurnos y los que viven en residencias geriátricas

Objetivo: investigar o comprometimento cognitivo em idosos e possíveis fatores associados. Método: estudo descritivo, quantitativo, de corte transversal, com amostra composta por 460 idosos residentes em lares geriátricos, de centros­dia e da comunidade de Coimbra, Portugal. Para coleta dos dados foi utilizado um questionário estruturado com informações sociodemográficas, procedência e avaliação cognitiva segundo o Miniexame do Estado Mental. Resultados: prevaleceram os idosos do sexo feminino (63,7%), na faixa etária de 75 a 84 anos (44,8%), viúvos (45,2%), com até 4 anos de estudo (57,8%) e residentes em lares geriátricos (43%). O comprometimento cognitivo foi observado em 59,8% dos idosos e foi verificada associação significativa no modelo bivariado com faixa etária, escolaridade e procedência. No modelo multivariado, todas as variáveis se mantiveram associadas à variável dependente, com assertividade para o modelo de 73%. Conclusão: destacase a importância do problema investigado por sua prevalência elevada e impacto na saúde e qualidade de vida dos idosos.(AU)

Objective: investigate cognitive impairment in the elderly and possible associated factors. Method: descriptive, quantitative, study, with a cross-sectional approach and a sample consisting of 460 elderly people living in geriatric homes, from day care centers and the community in Coimbra, Portugal. A structured questionnaire with socio-demographic information, origin, and cognitive assessment according to the MiniMental State Examination was used for data collection. Results: there was a prevalence of elderly women (63.7%), within the age group from 75 to 84 years (44.8%), widowed (45.2%), with a maximum of 4 years of education (57.8%), and those living in geriatric homes (43%). Cognitive impairment was observed in 59.8% of the elderly individuals and a significant association was found in the bivariate model with age group, education, and origin. In the multivariate model, all variables remained associated with the dependent variable, and the 73% model showed assertiveness. Conclusion: the significance of the problem under analysis is highlighted due to its high prevalence and impact on the elderly health and quality of life.(AU)

Objetivo: investigar el deterioro cognitivo en ancianos y posibles factores asociados. Método: estudio descriptivo, cuantitativo, de abordaje transversal, con muestra de 460 ancianos que viven en residencias geriátricas, de centros de cuidados diurnos y de la comunidad de Coimbra, Portugal. Para la recogida de datos se utilizó un cuestionario estructurado con información demográfica, origen y evaluación cognitiva según la Mini Prueba del Estado Mental. Resultados: prevalecieron ancianos del sexo femenino (63,7%), dentro de la franja etaria de 75 a 84 años (44,8%), viudos (45,2%), con un máximo de 4 años de educación (57,8%) y los que viven en residencias geriátricas (43%). El deterioro cognitivo se observó en 59,8% de los ancianos y hubo una asociación significativa en el modelo bivariado con franja etaria, educación y origen. En el modelo multivariado, todas las variables se mantuvieron asociadas con la variable dependiente, con asertividad para el modelo de 73%. Conclusión: se destaca la importancia del problema investigado por su alta prevalencia e impacto en la salud y calidad de vida de los ancianos.(AU)