Adolescents with suicidal behaviours: A qualitative study about the assessment of Inpatient Service and Transition to Community.

WHAT IS KNOWN ON THE SUBJECT?: Only a small number of adolescents with suicidal behaviour receives any follow-up treatment. The implementation of recurrent behaviour prevention strategies is crucial in the period following suicide attempts and should take into account adolescents' opinions to be effective and congruent. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: This paper shows that the 33 adolescent participants in the study identified the following protective factors of recurrent suicidal behaviour: family, friends and other trusted persons, as well as the self and newly learned strategies. The adolescents described their family as a constant presence and reported wishing that their parents maintain their current family support. Psychological support, health professionals and occupational activities are what the adolescents value most about hospitalization, and some criticisms are related to the environment, activities and health professionals. The adolescents also emphasize the need to maintain contact with the nurses after hospital discharge and make suggestions for service improvement related to the environment and the interventions implemented. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Knowing the protective factors of recurrent suicidal behaviours, perception of the impact of the intervention, the expectation of future support and healthcare follow-up is crucial for adapting suicide prevention strategies to be put in place by health services for better quality care delivery. The results obtained allow us to define as specific implications the implementation of psychoeducational intervention directed at the adolescent's family with suicidal behaviour during hospitalization and the definition of strategies for maintaining contact and follow-up with the adolescent after discharge. This study emphasizes the need to reinforce training in suicidology for all health professionals for the improvement of clinical practice. ABSTRACT: INTRODUCTION: The prevention of recurrent suicidal behaviours in adolescents should consider their perceptions, needs and expectations. AIM/QUESTION: To identify the protective factors of recurrent suicidal behaviours in adolescents; To describe the family and the expectations for future involvement; To know the most important aspects of hospitalization and discuss expectations of nursing care follow-up after hospital discharge. METHOD: A descriptive, qualitative and exploratory study was carried out in a sample of 33 adolescents with suicidal behaviours. Data were collected through semi-structured interviews, and the data processing used the content analysis technique. RESULTS: Findings arising from data allowed identifying the protective factors: family, friends and other trusted persons. During the hospitalization, the adolescents reinforce the knowledge about themselves and the newly learnt coping strategies. Psychological support and health professionals are what they value most about hospitalization and emphasize the need to maintain contact with the nurses after discharge. DISCUSSION: Knowing the needs and expectations of adolescents with suicidal behaviour will make nursing psychotherapeutic interventions more effective and congruent in this vulnerable group. IMPLICATIONS FOR PRACTICE: Ensuring psychoeducational intervention to the families of adolescents with suicidal behaviour and continuity of care after discharge, and reinforcing the training in suicidology for all health professionals.

Characterization of adopted suicidal behavior and its main influencing factors: A qualitative study with adolescents.

INTRODUCTION: A better understanding of the meanings that adolescents associate with suicide, contributes to the development of psychotherapeutic intervention programs to be implemented by nurse specialists in mental health and psychiatric nursing. Therefore, adolescents need to characterize their adopted suicidal behaviors and identify the personal characteristics that contribute to this same behavior. METHODOLOGY: A descriptive, exploratory, and qualitative study was conducted with 33 adolescents with suicidal behavior, hospitalized in a child psychiatry unit. Data were collected through a structured interview, and data treatment used the content analysis technique. RESULTS: Suicidal behaviors are characterized according to causality, meaning, and intent. Causality is mostly related to psychological factors (sadness, desperation, mental suffering, internal pain, emptiness, and rejection). As to the meaning, suicidal behavior is understood as an escape but also as a personal choice, sometimes regarded as rational. In what concerns intent, the intent to die is the most frequently reported. The most-reported personal characteristics which contributed to the suicidal behavior are feelings of exclusion, rejection, and humiliation, and also introversion. CONCLUSIONS: The results point to the need to reflect on the perceptions of adolescents with suicidal behavior. The current intervention strategies should be adjusted especially through the identification of the signs associated with mental distress in adolescents and the training of gatekeepers, contributing to productive and congruent suicide prevention in this vulnerable group.

Eficácia das intervenções psicoterapêuticas dirigidas a adolescentes com comportamento suicidário: revisão integrativa da literatura / Effectiveness of psychotherapeutic interventions targeted at adolescents with suicidal behavior: an integrative literature review / Eficacia de las intervenciones psicoterapéuticas dirigidas a adolescentes con comportamiento suicida: revisión integradora de la literatura

Enquadramento: A prevenção da recorrência de comportamentos suicidários em adolescentes é fundamental dada a sua dimensão, natureza repetitiva e o risco acrescido de morte por suicídio. Objetivos: Identificar a evidência científica atual e disponível sobre as intervenções psicoterapêuticas dirigidas a adolescentes com comportamentos suicidários e conhecer a e?cácia dessas intervenções ao nível da ideação suicida, depressão e repetição do comportamento suicidário. Metodologia: Revisão integrativa da literatura, através de pesquisa em bases de dados bibliográficas online, com os descritores de pesquisa selecionados, no período de publicação de janeiro de 2007 a dezembro de 2016, em inglês, com referências disponíveis e artigos em texto integral. Resultados: Dos 1.847 artigos encontrados, foram incluídos 10 estudos com adolescentes com comportamento suicidário, alvo de intervenção psicoterapêutica, com resultados positivos com a intervenção cognitivo comportamental com psicoeducação para adolescentes e familiares, intervenção comunitária, terapia dialético comportamental e terapia da mentalização ao nível dos outcomes definidos. Conclusão: Identificaram-se intervenções psicoterapêuticas com e?cácia, mas a heterogeneidade dos estudos exige uma análise e comparação cuidadas das amostras, metodologias e intervenções avaliadas.

Background: The prevention of recurrent suicidal behaviors in adolescents is crucial given their size and repetitive nature, and the increased risk of death by suicide. Objectives: To identify the current and available scientific evidence on the psychotherapeutic interventions targeted at adolescents with suicidal behaviors and to assess the effectiveness of these interventions at the level of suicidal ideation, depression, and repetition of suicidal behavior. Methodology: Integrative literature review, through research in online bibliographic databases, with the selected search descriptors, during the publication period from January 2007 to December 2016, in English, with available references and full-text articles. Results: Of a total of 1,847 papers found we included 10 studies on adolescents with suicidal behavior, targets of psychotherapeutic intervention, with positive results in cognitive-behavioral intervention with psychoeducation for adolescents and their families, community intervention, dialectical-behavioral therapy, and mentalization-based therapy at the level of the defined outcomes. Conclusion: We identified psychotherapeutic interventions with effectiveness, but the heterogeneity of the studies requires thoughtful analysis and comparison of evaluated samples, methodologies, and interventions.

Marco contextual: La prevención de la recurrencia de comportamientos suicidas en adolescentes es fundamental dada su dimensión, naturaleza repetitiva y riesgo adicional de muerte por suicidio. Objetivos: Identificar la evidencia científica actual y disponible sobre las intervenciones psicoterapéuticas dirigidas a adolescentes con comportamientos suicidas y conocer la e?cacia de dichas intervenciones al nivel de la ideación suicida, la depresión y la repetición del comportamiento suicida. Metodología: Revisión integradora de la literatura, a través de una búsqueda en bases de datos bibliográficas en línea, con los descriptores de búsqueda seleccionados, en el período de publicación de enero de 2007 a diciembre de 2016, en inglés, con las referencias disponibles y los artículos en el texto integral. Resultados: De los 1.847 artículos encontrados, se incluyeron 10 estudios con adolescentes con comportamiento suicida, objeto de intervención psicoterapéutica, con resultados positivos con la intervención cognitivo-comportamental con psicoeducación para adolescentes y familiares, la intervención comunitaria, la terapia dialéctico comportamental y la terapia de mentalización al nivel de los resultados definidos. Conclusión: Se identificaron psicoterapias con e?cacia, pero la heterogeneidad de los estudios exige un análisis y una comparación cuidadas de las muestras, las metodologías y las intervenciones evaluadas.

Nurses' attitudes regarding the importance of families in pediatric nursing care.

Affective, cognitive and behavioral components affect nurses´ attitudes to include families in the care processes. The purpose of this study was to investigate the attitudes of nurses about the importance of including families in nursing care. Data collection was performed in pediatric and maternal-child unit of a Brazilian university hospital. A sample of 50 nurses completed the Portuguese version of the instrument Families'Importance in Nursing Care-Nurses' Attitudes (FINC-NA). The results indicated that nurses have supportive attitudes regarding families participation in nursing care. Attitudes of lower support for involving families in nursing care were found among nurses with older age, more time in the profession and who had no previous contact with contents related to Family Nursing. The application of the instrument in other contexts of assistance may help to illuminate important aspects of the challenges to implementing a family-centered approach in clinical practice.

Escala da Satisfação com a decisão em saúde: instrumento adaptado e validado para língua portuguesa / Decision making satisfaction in health scale: instrument adapted and validated to portuguese / Escala de la satisfacción con las decisiones en la salud: instrumento adaptado y validado para el idioma portugués

A tomada de decisão é uma área de investigação na saúde que tem vindo a ganhar importância quer pelos modelos de parceria de cuidados que dão protagonismo ao paciente e família, quer pela preocupação crescente com a qualidade e satisfação do cliente com os cuidados disponibilizados. Assim, propusemo-nos efetuar a adaptação transcultural e avaliar as propriedades psicométricas da versão portuguesa da "The Satisfaction with Decision Scale" de Holmes-Rovner (1996), que visa avaliar a satisfação com as decisões tomadas em saúde. A amostra foi constituída por 521 estudantes da Escola Superior de Enfermagem do Porto. Os resultados obtidos nos testes de fiabilidade revelam uma boa consistência interna para o total dos itens (Alpha Cronbach = 0,88). O estudo psicométrico permite-nos afirmar que a versão em Português da "The Satisfaction with Decision Scale", que denominamos "Escala da Satisfação com a Decisão em Saúde", é um instrumento fidedigno e válido.

Decision making is an area of health research that has gained importance both for the partnership models of care that give prominence to the patient and family, either by growing concern about quality and customer satisfaction with the care provided. So we decided to make the cultural adaptation and to evaluate the psychometric properties of the Portuguese version "The Satisfaction with Decision Scale" de Holmes-Rovner (1996), which aims to assess satisfaction with the decisions taken in health. The sample consisted of 521 nursing students the School of Nursing of Porto. The results of reliability tests show good internal consistency for the total items (Alpha Cronbach = 0.88). The psychometric study allows us to state that the Portuguese version of "The Satisfaction with Decision Scale", we call "Escala da Satisfação com a Decisão em Saúde", is an instrument comparable with the original in terms of validity and reliability.

La toma de decisiones es un área de investigación en salud que ha ganado importancia tanto por los modelos de atención dirigida al paciente y su familia, como por la creciente preocupación por la calidad y satisfacción del cliente con la atención recibida. Por esta razón decidimos hacer la adaptación transcultural y evaluar las propiedades psicométricas de la versión portuguesa "The Satisfaction with Decision Scale" de Holmes-Rovner (1996), que tiene como objetivo evaluar la satisfacción con las decisiones adoptadas en materia de salud. La muestra consta de 521 estudiantes de la Escuela de Enfermería del Porto. Los resultados de las pruebas de fiabilidad muestran una buena consistencia interna para la escala total (Alpha Cronbach = 0,88). El estudio psicométrico nos permite afirmar que la versión en portugués de "The Satisfaction with Decision Scale", que nosotros llamamos "Escala da Satisfação com a Decisão em Saúde", es válida.

Nurses’ attitudes regarding the importance of families in pediatric nursing care / Actitudes de enfermeras sobre la importancia de las familias en los cuidados de enfermería en pediatría / Atitudes de enfermeiros em face da importância das famílias nos cuidados de enfermagem em pediatria

Affective, cognitive and behavioral components affect nurses´ attitudes to include families in the care processes. The purpose of this study was to investigate the attitudes of nurses about the importance of including families in nursing care. Data collection was performed in pediatric and maternal-child unit of a Brazilian university hospital. A sample of 50 nurses completed the Portuguese version of the instrument Families’Importance in Nursing Care-Nurses’ Attitudes (FINC-NA). The results indicated that nurses have supportive attitudes regarding families participation in nursing care. Attitudes of lower support for involving families in nursing care were found among nurses with older age, more time in the profession and who had no previous contact with contents related to Family Nursing. The application of the instrument in other contexts of assistance may help to illuminate important aspects of the challenges to implementing a family-centered approach in clinical practice.



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El propósito de este estudio fue identificar las actitudes de los enfermeros sobre la importancia de incluir a las familias en el cuidado de enfermería. La recolección de datos se llevó a cabo en las unidades de pediatría y materno-infantil de un hospital universitario brasileño. Una muestra de 50 enfermeras completó la versión en portugués del el instrumento Families’ Importance in Nursing Care-Nurses’ Attitudes (FINC-NA). Los resultados indicaron las puntuaciones más altas en dimensiones indicativas de actitudes de apoyo a la participación de las familias en el cuidado. Enfermeras con más tiempo en la profesión y que no tenían conocimiento previo de enfermería de familia tuvieron puntuaciones que indican actitudes de menor apoyo para involucrar a las familias en el cuidado de enfermería. La aplicación de este instrumento en otro tipo de asistencia contextos puede ayudar a iluminar aspectos importantes de los desafíos para la implementación de un enfoque centrado en la familia, en la práctica clínica.
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Objetivo Identificar as atitudes dos enfermeiros sobre a importância de incluir as famílias nos cuidados de enfermagem. Método Estudo de abordagem quantitativa descritiva, cuja coleta de dados foi realizada em unidades de pediatria e materno-infantil de um hospital universitário brasileiro. Uma amostra de 50 enfermeiros completou a versão em português da escala Families Importance in Nursing Care-Nurses Attitudes (FINC-NA). Resultados Indicaram escores mais elevados em dimensões indicativas de atitudes de apoio sobre a participação das famílias no cuidado de enfermagem. Enfermeiros com mais tempo na profissão e que não tiveram conhecimento prévio de enfermagem da família apresentaram escores indicativos de atitudes de menor apoio para envolver as famílias no cuidado de enfermagem. Conclusão A aplicação desse instrumento em outros contextos de assistência poderá contribuir para iluminar importantes aspectos relacionados aos desafios para a implementação de uma abordagem centrada na família na prática clínica e subsidiar o desenvolvimento de pesquisas mais amplas.
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[Decision making satisfaction in health scale: instrument adapted and validated to Portuguese]. / Escala da Satisfação com a decisão em saúde: instrumento adaptado e validado para língua portuguesa.

Decision making is an area of health research that has gained importance both for the partnership models of care that give prominence to the patient and family, either by growing concern about quality and customer satisfaction with the care provided. So we decided to make the cultural adaptation and to evaluate the psychometric properties of the Portuguese version "The Satisfaction with Decision Scale" de Holmes-Rovner (1996), which aims to assess satisfaction with the decisions taken in health. The sample consisted of 521 nursing students the School of Nursing of Porto. The results of reliability tests show good internal consistency for the total items (Alpha Cronbach = 0.88). The psychometric study allows us to state that the Portuguese version of "The Satisfaction with Decision Scale", we call "Escala da Satisfação com a Decisão em Saúde", is an instrument comparable with the original in terms of validity and reliability.

Escala de conflito em tomadas de decisão em saúde: instrumento adaptado e validado para língua portuguesa / Escala de conflicto en las tomas de decisiones en salud: instrumento adaptado y validado para el idioma portugués / Scale of conflict in health care decision-making: an instrument adapted and validated for the Portuguese language

As diferentes opções disponibilizadas aos doentes no âmbito da saúde actualmente implicam em processos de tomada de decisão cada vez mais difíceis podendo desencadear conflito no decorrer da mesma. Foi nosso propósito, com este estudo, dispor de um instrumento que nos possibilite conhecer esta variável. Assim, propusemo-nos efectuar a adaptação transcultural e avaliar as propriedades psicométricas da versão portuguesa da Decisional Conflict Scale, que visa obter informações sobre a tomada de decisão e os factores que influenciam a escolha tomada. A amostra constituída por 521 estudantes de Enfermagem, teve como foco a tomada de decisão na síndrome gripal. Os resultados obtidos nos testes de confiabilidade revelam boa consistência interna para o total dos itens (α Cronbach=0,94). O estudo psicométrico permite-nos afirmar que a versão em Português da Decisional Conflict Scale, que denominamos Escala de Conflitos de Tomadas de Decisão em Saúde (ECTDS), é um instrumento fidedigno e válido.

Las diferentes opciones disponibles para el paciente en el ámbito de la salud implican actualmente procesos de toma de decisiones cada vez más difíciles, pudiéndose desencadenar conflictos durante ellos. Objetivamos disponer de un instrumento que nos posibilitara conocer esta variable. Consecuentemente, nos propusimos efectuar la adaptación transcultural y evaluar las propiedades psicométricas de la versión portuguesa de la Decisional Conflict Scale, que apunta a obtener informaciones sobre toma de decisiones y factores que influyen en la elección tomada. La muestra, constituida por 521 estudiantes de Enfermería, se enfocó en la toma de decisiones en el síndrome gripal. Los resultados obtenidos en los tests de confiabilidad expresan buena consistencia interna para todos los ítems (α Cronbach=0,94). El estudio psicométrico nos permite afirmar que la versión en portugués de la Decisional Conflict Scale, que denominamos Escala de Conflictos de Toma de Decisiones en Salud (ECTDS), es un instrumento fidedigno y válido.

The different options available to patients in the health environment now are implicated in increasingly difficult processes of decision-making, and may trigger conflict about them. This study had as its purpose, to develop an instrument that enabled us to know about this variable. Therefore, we decided to effect a transcultural adaptation and evaluation of psychometric properties of the Portuguese version of the Decisional Conflict Scale, which seeks information about decision-making and the factors that influence the choices made. The sample consisted of 521 nursing students, with a focus on decision-making regarding the flu syndrome. The results obtained on the reliability tests showed good internal consistency for all items (Cronbach α=0.94). The psychometric study allowed us to affirm that the Portuguese version of the Decisional Conflict Scale, which we call Scale of Conflicts in Decision-Making in Health (ECTDS), was a reliable and valid instrument.

[Scale of conflict in health care decision-making: an instrument adapted and validated for the Portuguese language]. / Escala de conflito em tomadas de decisão em saúde: instrumento adaptado e validado para língua portuguesa.

The different options available to patients in the health environment now are implicated in increasingly difficult processes of decision-making, and may trigger conflict about them. This study had as its purpose, to develop an instrument that enabled us to know about this variable. Therefore, we decided to effect a transcultural adaptation and evaluation of psychometric properties of the Portuguese version of the Decisional Conflict Scale, which seeks information about decision-making and the factors that influence the choices made. The sample consisted of 521 nursing students, with a focus on decision-making regarding the flu syndrome. The results obtained on the reliability tests showed good internal consistency for all items (Cronbach a=0.94). The psychometric study allowed us to affirm that the Portuguese version of the Decisional Conflict Scale, which we call Scale of Conflicts in Decision-Making in Health (ECTDS), was a reliable and valid instrument.