Nurses' Perceptions Regarding Their Professional Commitment and Development during the COVID-19 Pandemic.

INTRODUCTION: During the pandemic, nurses have undergone a high level of professional burnout, suffering emotional exhaustion, depersonalization, and lack of personal realization. OBJECTIVE: The object of this study is to understand in depth, through a phenomenological study of Giorgi, the perceptions on commitment and professional development of frontline nurses during the first and second waves of the COVID-19 pandemic. METHOD: Qualitative study designed and analyzed using Giorgi's phenomenological focus. For data collection, semi-structured interviews were utilized in a theoretical sample of frontline nurses who worked in public hospitals of Extremadura and Madrid, Spain, until saturation of data. The interviews were conducted between the months of May and December 2020 following an outline of topics. The analysis was based on the phenomenological focus of Giorgi and was supported by the software Atlas-Ti 8.0. RESULTS: A total of 14 nurses participated in this study. Two main themes emerged to explain the perceptions of the nurses: (1) the professional commitment of the nurses during the pandemic and (2) the effects of the pandemic on professional development; seven subcategories were also identified. CONCLUSION: The social and professional development of nurses is important. If nurses feel that they are quality professionals, this will enable them to protect their psychosocial health and increase professional commitment toward their patients in difficult situations such as pandemics. The results of this study may serve as a guide for better understanding the problems and needs of nurses as healthcare providers. This may help administrators in the generation of solutions for the establishment of a safe and reliable work environment, which will in turn promote a healthcare system that can efficiently respond to future catastrophes.

Nurses' Perceptions of Ethical Conflicts When Caring for Patients with COVID-19.

The COVID-19 pandemic has caused ethical challenges and dilemmas in care decisions colliding with nurses' ethical values. This study sought to understand the perceptions and ethical conflicts faced by nurses working on the frontline during the first and second waves of the COVID-19 pandemic and the main coping strategies. A qualitative phenomenological study was carried out following Giorgi's descriptive phenomenological approach. Data were collected through semi-structured interviews until data saturation. The theoretical sample included 14 nurses from inpatient and intensive care units during the first and second waves of the pandemic. An interview script was used to guide the interviews. Data were analyzed following Giorgi's phenomenological method using Atlas-Ti software. Two themes were identified: (1) ethical conflicts on a personal and professional level; and (2) coping strategies (active and autonomous learning, peer support and teamwork, catharsis, focusing on care, accepting the pandemic as just another work situation, forgetting the bad situations, valuing the positive reinforcement, and humanizing the situation). The strong professional commitment, teamwork, humanization of care, and continuous education have helped nurses to deal with ethical conflicts. It is necessary to address ethical conflicts and provide psychological and emotional support for nurses who have experienced personal and professional ethical conflicts during COVID-19.

The couple's tree of life: Promoting and protecting relational identity.

We present The Couple's Tree of Life (CTOL) as a new collective narrative methodology to strengthen couple relationships and prevent conflicts. The CTOL, based on the tree of life methodology (Ncube & Denborough, Tree of Life, mainstreaming psychosocial care and support: a manual for facilitators, REPSSI, 2007), aims to reinforce the identity and strengths of the couple. We explain the CTOL implementation process and illustrate it step by step with a group of 14 adult heterosexual Caucasian couples who belonged to Protestant churches in Madrid (Spain). As a way to assess its usefulness before applying the CTOL to other groups of couples, we conducted a pre-post evaluation using the Dyadic Adjustment Scale of Spanier(1976). We found an improvement in dyadic adjustment, quality, understanding of, and satisfaction with, the relationship. The results, though not generalizable at this stage, suggest that the CTOL could reinforce the couple's identity while maintaining individual identities. We also discuss the possible applications of couples therapy.

Presentamos El árbol de la vida de la pareja (CTOL, por sus siglas en inglés) como una nueva metodología narrativa colectiva, con el fin de fortalecer las relaciones de pareja y para la prevención de conflictos. El CTOL, basado en la metodología del árbol de la vida (Ncube & Denborough, Tree of Life, mainstreaming psychosocial care and support: a manual for facilitators, REPSSI, 2007), tiene como finalidad reforzar la identidad y las fortalezas de la pareja. Explicamos el proceso de implementación del CTOL y lo ejemplificamos paso a paso con un grupo de 14 parejas heterosexuales caucásicas adultas que pertenecían a iglesias protestantes en Madrid (España). Como forma de evaluar su utilidad antes de aplicar el CTOL a otros grupos de parejas, realizamos una evaluación previa y posterior utilizando la Escala de Ajuste Diádico de Spanier (1976). Hallamos una mejora en el ajuste diádico, en la calidad, en la comprensión de la relación y en la satisfacción con esta. Los resultados, aunque no son generalizables en esta etapa, sugieren que el árbol de la vida de la pareja podría reforzar la identidad de la pareja y a la vez mantener las identidades individuales. También explicamos las posibles aplicaciones a la terapia de pareja.

Resilience, Emotional Intelligence, and Occupational Performance in Family Members Who Are the Caretakers of Patients with Dementia in Spain: A Cross-Sectional, Analytical, and Descriptive Study.

BACKGROUND: The concern in the scientific community for the study of people with dementia and their families is comprehensible, especially the importance of knowing the effects that caring for the patient has on their family dynamic, paying special attention to the main caregiver. The objective of this study was to analyze the relationship of resilience and emotional intelligence with functional performance in the main caregivers of people with dementia in Spain according to the phase of the disease. METHODS: A cross-sectional, descriptive, and analytical study was carried out. A total of 144 primary family caregivers of patients with dementia in Spain were included in the study. The following variables were measured: sociodemographic, psychosocial, and occupational, as well as resilience and emotional intelligence. RESULTS: The caregivers obtained a low moderate resilience (mean = 64.01 ± 14.5), an emotional intelligence bordering between moderate and high (mean = 78.48 ± 14.82), and a 61.8% self-care categorized as somewhat and quite a bit. The presence of higher levels of resilience in family caregivers of people with dementia were positively related to the time spent on self-care (r = 0.227; p = 0.033) and leisure (r = 0.262; p = 0.014), especially in the moderate phase of the disease, while in the severe phase, this relationship appeared with productivity (r = 0.355; p = 0.034). The higher levels of emotional intelligence were positively related to a greater time dedicated to self-care (r = 0.233, p = 0.005), as well as the data observed in the moderate and severe phase (r = 0.214; p = 0.046 and r = 0.398; p = 0.016 respectively). CONCLUSIONS: The primary caregivers of relatives with dementia who have higher levels of resilience and emotional intelligence spend more time on self-care and leisure activities, especially in the moderate phase of the disease.

The Relationship between Differentiation of Self and Psychological Adjustment to Separation.

Many individuals suffer negative mental health consequences such as anxiety and depression following separation from a romantic partner and/or co-parenting conflict due to divorce. Consequently, treating the psychological aftermath of divorce and partner separation remains a predominant concern for mental health practitioners. According to family systems theory, high interdependence and low differentiation of self are associated with a lessened capacity for managing anxiety or adapting to stressful events since intense emotions may inhibit the ability to cope. To assess the relationship between differentiation of self and psychological adjustment to separation, 84 divorced adults completed an online survey. Multiple regression analysis demonstrated that a model based on fusion with others, I-position, and emotional cutoff was a statistically significant predictor of lonely/negativity. Bivariate correlation analyses confirmed significant linear relationships between fusion with others, lonely/negativity, and co-parenting conflict. No differences between genders were found. There is a continuing need to develop interventions to address the negative consequences of divorce, help reduce emotional suffering, and encourage healthy co-parenting. Individuals struggling with psychological adjustment post-divorce, or those seeking education for managing the psychological effects of divorce and co-parenting, may benefit from counseling strategies that incorporate an assessment of differentiation of self and psychological adjustment to separation.

Falls Prevention and Quality of Life Improvement by Square Stepping Exercise in People with Parkinson's Disease: Project Report.

Parkinson's disease (PD) is a chronic neurodegenerative disorder that affects physical, psychological, and social quality of life. Square Stepping Exercise (SSE) is an effective balance training program to prevent falls and to stimulate cognitive function in the elderly; however, no study has analyzed the effect of SSE in people with PD. The main objective is to investigate whether the application of SSE is safe, applicable, and can improve balance, and is effective in preventing falls, improving cognitive and psychological aspects and thus maximize quality of life in people with PD. Methods/Design: SSE will be performed three times per week for 8 weeks with an additional month follow-up after the intervention. Sixty people with PD will participate, randomly distributed into two groups: experimental group (SSE: n = 30) and control group (Usual care: n = 30). The primary measurements will be: (1) Applicability, (2) Safety, (3) Balance, and (4) Annual number of falls. Secondary measurements will be: (1) Sociodemographic information, (2) Physical condition, (3) Health-related quality of life, (4) Depressive symptoms, (5) Cognitive aspects, (6) Perceived functional social support, and (7) Anticipatory cognition.

Impact of a Postoperative Intervention Educational Program on the Quality of Life of Patients with Hip Fracture: A Randomized, Open-Label Controlled Trial.

The objective of this study was to determine the impact of a postoperative educational intervention program on the health-related quality of life (HRQoL) of patients with hip fracture using a controlled clinical trial in a randomized, multicenter study. In total, 102 patients (45.5%) from trauma units at the two University Hospitals of the province of Cáceres received the educational program, whereas 122 (54.5%) did not. Patients were consecutively included in either an intervention or a control group. Patients from the intervention group received an educational program during admission and the postoperative period. Patients from the control group did not receive any educational program. These patients were managed according to routine protocols. The patients were predominantly female (76.3%), aged 84.6 years (SD 6.1). All dimensions in both groups at 12 months showed a significant decrease with respect to baseline, except for bodily pain in both groups (p = 0.447; p = 0.827) and social functioning in the intervention group (p = 0.268). Patients receiving the educational program showed higher levels in the dimensions of the Mental Component Summary (MCS-12) (p = 0.043), vitality (p = 0.010), and social functioning (p < 0.001), as well as in the dimensions of the SF-12 health survey questionnaire of HRQoL 12 months after surgery. In conclusion, our study of the intervention group showed that there were significant improvements in MCS-12, vitality, and social function dimensions compared to the control group.

Blunted cortisol response to stress in patients with eating disorders: Its association to bulimic features.

OBJECTIVE: Clinical research on cortisol response to stress in patients with eating disorders has provided controversial and even contradictory results. As this might be the consequence of the inclusion in the studies of heterogeneous clinical populations, 3 highly selected samples were studied. METHODS: Dexamethasone suppression test was performed on 15 restricting anorexia nervosa patients without history of bulimia nervosa (BN), 17 BN patients with normal weight and no history of anorexia nervosa, and 22 healthy controls. Three days later, the Trier Social Stress Test was applied, and 8 saliva samples were collected along the trial for cortisol assessment. RESULTS: When the patients were considered as a single group, a slightly blunted cortisol response to stress was observed, but when the 3 groups were considered separately, the blunted response was observed only in the BN patients. DISCUSSION: The results support the association between blunted cortisol response and bulimic features.

Papel de la depresión y la impulsividad en la psicopatología de la bulimia nerviosa / The role of depression and impulsivity in the psychopathology of bulimia nervosa

Introducción. El presente estudio trató de analizar el papel de la depresión y la impulsividad en la psicopatología de la bulimia nerviosa (BN). Materiales y métodos. Se examinó a 70 mujeres con un diagnóstico de bulimia nerviosa basado en la cuarta revisión del Manual diagnóstico y estadístico de los trastornos mentales (DSM-IV), subtipo purgativo, para los síntomas relacionados con el trastorno de la conducta alimentaria, insatisfacción corporal, síntomas afectivos, impulsividad y rasgos de personalidad. Para el análisis estadístico se utilizaron métodos de análisis factorial y de modelos de ecuaciones estructurales. Resultados. La BN se presentó como un proceso que incorporaba 5 dimensiones generales: a) episodios recurrentes de gran voracidad o «atracones» y conductas compensadoras; b) conducta alimentaria restrictiva; c) insatisfacción corporal; d) rasgos de personalidad disocial; y e) una agrupación (cluster) de características que se denominó «inestabilidad emocional». Las 5 dimensiones obtenidas pueden agruparse en 2 factores básicos: insatisfacción corporal/conducta alimentaria y rasgos de personalidad/psicopatología. El primero contiene los ítems clínicos utilizados para la definición de la BN como proceso clínico en el DSM-V y la Clasificación Internacional de las Enfermedades, y refleja la morfología y la gravedad de los síntomas relacionados con la conducta alimentaria. La segunda dimensión incluye una agrupación de síntomas (síntomas depresivos, impulsividad y rasgos límite de personalidad [borderline]), conducta autodestructiva y disocial) que podrían considerarse como la «base psicopatológica de la bulimia nerviosa» y pueden condicionar su curso y su pronóstico (AU)

Introduction. The study aimed to analyze the role of depression and impulsivity in the psychopathology of bulimia nervosa (BN). aterials and methods. Seventy female patients with DSM-IV BN, purging subtype, were assessed for eating-related symptoms, body dissatisfaction, affective symptoms, impulsivity, and personality traits. Factor analysis and structural equation modeling methods were used for statistical analysis. Results. BN appeared as a condition which incorporated 5 general dimensions: a) binge eating and compensatory behaviours; b) restrictive eating; c) body dissatisfaction; d) dissocial personality traits; and e) a cluster of features which was called «emotional instability» The 5 obtained dimensions can be grouped into 2 basic factors: body dissatisfaction/eating behaviour and personality traits/psychopathology. The first one contains the clinical items used for the definition of BN as a clinical condition in the DSM-V and the International Classification of Diseases 10, and reflects the morphology and the severity of the eating-related symptoms. The second dimension includes a cluster of symptoms (depressive symptoms, impulsivity, and borderline, self-defeating and dissocial personality traits) which could be regarded as the «psychopathological core» of BN and may be able to condition the course and the prognosis of BN (AU)

The role of depression and impulsivity in the psychopathology of bulimia nervosa.

INTRODUCTION: The study aimed to analyze the role of depression and impulsivity in the psychopathology of bulimia nervosa (BN). MATERIALS AND METHODS: Seventy female patients with DSM-IV BN, purging subtype, were assessed for eating-related symptoms, body dissatisfaction, affective symptoms, impulsivity, and personality traits. Factor analysis and structural equation modeling methods were used for statistical analysis. RESULTS: BN appeared as a condition which incorporated 5 general dimensions: a) binge eating and compensatory behaviours; b) restrictive eating; c) body dissatisfaction; d) dissocial personality traits; and e) a cluster of features which was called «emotional instability¼ The 5 obtained dimensions can be grouped into 2 basic factors: body dissatisfaction/eating behaviour and personality traits/psychopathology. The first one contains the clinical items used for the definition of BN as a clinical condition in the DSM-V and the International Classification of Diseases 10, and reflects the morphology and the severity of the eating-related symptoms. The second dimension includes a cluster of symptoms (depressive symptoms, impulsivity, and borderline, self-defeating and dissocial personality traits) which could be regarded as the «psychopathological core¼ of BN and may be able to condition the course and the prognosis of BN.