Persons with mental disorders and assisted dying practices in Spain: In response to Ramos et al.

Ramos et al. paper offers a narrative review of Spanish Organic Law 3/2021, which regulates euthanasia, focusing on its application to individuals with mental disorders. Ramos et al. examine the application of legal prerequisites from an ethical-legal perspective to ascertain the conditions under which psychiatric euthanasia might be considered legitimate and compliant with legal stipulations. Nevertheless, it is apparent that the core ethical inquiries linked to this matter have not been exhaustively investigated. The criteria laid out are, in our assessment, still open to further debate and broader deliberation. Our article emphasizes the need for a comprehensive ethical and legal debate in Spain regarding psychiatric euthanasia. Competency assessment is central to the legislation, but there are concerns about the validity of assessment tools and the subjective nature of interviews. Furthermore, defining irreversible suffering in mental health contexts poses challenges. The article advocates for a deeper understanding of the needs of individuals with mental disorders before considering euthanasia and emphasizes the importance of comprehensive care and psychosocial interventions in reducing the desire for euthanasia. Ultimately, it underscores the ethical complexities of euthanasia in mental health and the necessity of prioritizing comprehensive care in addressing these complexities.

[Autonomy and medical aid in dying: the place of psychiatry]. / Autonomie revendiquée et aide médicale à mourir, la place de la psychiatrie.

Autonomy has become the highest value in our society, and while it is having an impact on the debate on a future law on medical assistance in dying, it is also opening the door to a reflection on vulnerability. Although seemingly unaffected, at least initially, psychiatry could join the field of this reflection and bring out the avenues of renewal.

[State of the art in palliative sedation]. / État des lieux de la sédation en situations palliatives.

The right to deep and continuous sedation maintained until death was introduced by the law known as the Claeys-Leonetti law. It is no longer a question of reversible sedation, but of maintaining the patient in a deep sleep, without waking, until death. It can be put into care in specific cases. The  borderline between euthanasia and this sedation implemented at the end of life lies in the intentionality of the medical act.

Processo de trabalho e sofrimento psíquico de médicos da atenção primária na pandemia do covid-19 / Work process and psychological suffering of primary care physicians during the COVID-19 pandemic

Resumo A organização e o processo de trabalho são espaços privilegiados para reconhecer as forças que levam ao sofrimento psíquico. Este artigo pretende analisar as percepções de médicos(as) da atenção primária à saúde, que atuam no Programa Mais Médicos, sobre as relações entre sofrimento psíquico e processo de trabalho, no contexto da pandemia do coronavirus. Esta pesquisa foi realizada por meio de um estudo de caso, utilizando métodos e técnicas qualitativas para a coleta, descrição e análise dos dados. Foi selecionada uma amostra intencional em conformidade com a técnica de saturação teórica. A coleta de informações foi realizada com ajuda de entrevistas semiestruturadas, seguindo um roteiro construído para atender aos objetivos desta pesquisa. A análise do discurso dos entrevistados articulou categorias de análise extraidas de cinco eixos temáticos que têm pontos de articulação entre si, com consensos e contradições que dão sentido às visões e posições dos atores no campo da saúde. Os resultados evidenciaram a pandemia como catástrofe sanitária e traumática, redimensionando o processo de trabalho e contribuindo para a sobrecarga, conflitos, medo, sentimento de desamparo e sofrimento psíquico. Inúmeras carências, problemas de infraestrutura, burocracia, interferências políticas, descompasso entre a formação e a prática também contribuiram para esse sofrimento.

Abstract Work organization and process are privileged spaces to recognize the forces that lead to psychological suffering. This study aims to analyze the perceptions of physicians of primary health care, who work in the More Doctors Program, on the relation between psychological suffering and work process during the COVID-19 pandemic. This research was conducted with a case study using qualitative data collection, description, and analysis. An intentional sample was selected in accordance with the theoretical saturation technique. Information was collected by semi-structured interviews, following a script built to meet the objectives of this research. The analysis of interviewees' discourse articulated categories of analysis drawn from five thematic axes with points of articulation between them, consensuses and contradictions that give meaning to the visions and positions of the actors in health. Results evinced the pandemic as a health and traumatic catastrophe, resizing the work process and contributing to overload, conflicts, fear, feelings of helplessness, and psychological suffering. Numerous shortcomings, infrastructure problems, bureaucracy, political interference, mismatch between training and practice also contributed to this suffering.

Contexto familiar e sofrimento mental em adolescentes: uma revisão integrativa / Family context and mental suffering in adolescents: an integrative review / Contexto familiar y sufrimiento mental en adolescentes: una revisión integradora

Resumo Contexto: A adolescência é um período de fragilidade que pode potencializar o surgimento de eventos estressores e crises. Diversos fatores têm sido associados a problemas de saúde mental no adolescente, sendo a família, um eixo fundamental a ser avaliado, pois pode apresentar fatores de proteção e risco para o adolescente. Objetivo: Identificar situações do contexto familiar que ocasionam sofrimento mental em adolescentes. Método: Trata-se de uma revisão integrativa norteada pelas recomendações do modelo PRISMA, realizada nas bases de dados PubMed, LILACS e SciELO, com publicações de 2014 a 2019, utilizando os descritores "adolescent", "mental health" e "family relations". Resultados: Foram incluídos 19 estudos, predominando publicações internacionais. As situações do contexto familiar que se associam ao sofrimento mental de adolescentes são o estilo parental, sofrimento mental dos pais, conflito e violência intrafamiliar, abuso de substâncias psicoativas por familiares, divórcio, migração e encarceramento parental. O sofrimento mental dos adolescentes foi evidenciado por uma série de sintomas internalizantes e externalizantes, risco aumentado de automutilação e tentativa de suicídio, além do uso nocivo de substâncias psicoativas. Conclusão: Os resultados obtidos reforçam a vulnerabilidade dos adolescentes ao sofrimento mental e apontam a necessidade de desenvolver intervenções eficazes no enfrentamento desse importante problema de saúde pública além do fortalecimento das redes de apoio aos adolescentes e famílias.

Abstract Context: Adolescence is a period of fragility that can potentiate the emergence of stressful events and crises. Several factors have been associated with mental health problems in adolescents, being the family, a fundamental axis to be evaluated, as it may present protective and risk factors for the adolescent. Objective: To identify situations in the family context that cause mental suffering in adolescents. Method: This is an integrative review guided by the recommendations of the PRISMA model, carried out in the databases PubMed, LILACS and SciELO, with publications from 2014 to 2019, using the descriptors "adolescent", "mental health" and "family relations". Results: 19 studies were included, with predominance of international publications. The situations in the family context that are associated with the mental suffering of adolescents are the parenting style, the parents' mental suffering, conflict and intrafamily violence, abuse of psychoactive substances by family members, divorce, migration and parental incarceration. The adolescents' mental suffering was evidenced by a series of internalizing and externalizing symptoms, an increased risk of self-mutilation and attempted suicide in addition to the harmful use of psychoactive substances. Conclusion: The results obtained reinforce the vulnerability of adolescents to mental suffering and point to the need to develop effective interventions to deal with this important public health problem, in addition to strengthening support networks for adolescents and families.

Resumen Contexto: La adolescencia es un período de fragilidad que puede potenciar el surgimiento de crisis y eventos estresantes. Varios factores se han asociado a los problemas de salud mental en el adolescente, siendo la familia un eje fundamental a evaluar, ya que puede presentar factores protectores y de riesgo para el adolescente. Objetivo: Identificar situaciones en el contexto familiar que provocan sufrimiento mental en adolescentes. Método: Se trata de una revisión integradora guiada por las recomendaciones del modelo PRISMA, realizada en las bases de datos PubMed, LILACS y SciELO, con publicaciones de 2014 a 2019, utilizando los descriptores "adolescente", "salud mental" y "relaciones familiares". Resultados: Se incluyeron 19 estudios, con predominio de publicaciones internacionales. Las situaciones en el contexto familiar que se asocian al sufrimiento mental de los adolescentes son el estilo de crianza, el sufrimiento mental de los padres, el conflicto y la violencia intrafamiliar, el abuso de sustancias psicoactivas por parte de los familiares, el divorcio, la migración y el encarcelamiento de los padres. El sufrimiento mental de los adolescentes se evidenció por una serie de síntomas internalizantes y externalizantes, un mayor riesgo de automutilación e intento de suicidio, además del uso nocivo de sustancias psicoactivas. Conclusión: Los resultados obtenidos refuerzan la vulnerabilidad de los adolescentes al sufrimiento mental y señalan la necesidad de desarrollar intervenciones efectivas para enfrentar este importante problema de salud pública, además de fortalecer las redes de apoyo a adolescentes y familias.

Predictors for Estimating Scars' Internalization in Victims with Post-Traumatic Scars versus Patients with Postsurgical Scars.

(1) Background: Scars are the consequence of physiological inherent healing processes of post-traumatic and surgical lesions with a psychological impact. Post-traumatic scarring may induce emotional and behavioral changes through social stigma. In this study we analyze the internalization of scars and their impact on hopelessness, depression, or the perception of social support in subjects with post-traumatic scars compared to people with surgical scars. (2) Methods: to research this suggested model, we analyzed data collected from 110 participants 61 women and 49 men, aged between 18 and 64 years; 55 participants had post-traumatically and 55 surgically acquired scars. They all were examined to assess the characteristics of scars, were asked to complete four psycho-social scales, and the results were compared. (3) Results: our results indicate that people with post-traumatic scars are oriented toward the internalization of scars, depending on their shape and size. We argue that hopelessness, appreciation of scars, age, and how scars are produced are important predictors of internalization. (4) Conclusions: the patient's attitude toward the appearance of a scar is an indicator of how he/she will react in the future and it could predict the vulnerability to hopelessness. Finally, we nuance the impact of objective bodily harm on the psychological and moral suffering.

Nursing Students' Attitudes, Future Role, and Knowledge Regarding Euthanasia Due to Unbearable Mental Suffering: A Single-Site Pilot Study.

BACKGROUND: This study examines the attitudes, view of their future role, and knowledge of nursing students regarding euthanasia due to unbearable mental suffering (UMS euthanasia) in Belgium. Nurses have a key role in this situation at many levels. The practice of euthanasia is expanding globally and laws are changing, making more research essential. METHOD: A cross-sectional design and online survey were used. All nursing students at a Belgian university college participated. RESULTS: The majority of nursing students had a high degree of acceptance towards UMS euthanasia and highlighted their important role in the euthanasia decision-making process, but also reported a lack of knowledge and skills. CONCLUSION: Nursing education at all levels needs to recognize this knowledge gap, taking into account the complexity and broader context of end-of-life care.

Prevalência e fatores associados a distúrbios psíquicos menores em fisioterapeutas intensivistas de uma grande cidade do estado da Bahia / Prevalencia y factores asociados a trastornos psíquicos menores en fisioterapeutas de cuidados intensivos de una gran ciudad de Bahía (Brasil) / Prevalence and factors associated with minor psychic disorders in intensive care unit physiotherapists in a large city in the state of Bahia

RESUMO Estudos indicam que fatores relacionados ao trabalho podem levar ao adoecimento de trabalhadores de unidades de terapia intensiva, mas estudos sobre distúrbios psíquicos menores (DPMs) em fisioterapeutas intensivistas ainda são escassos. Este estudo visa estimar a prevalência e os fatores associados a DPMs em fisioterapeutas intensivistas de uma grande cidade do estado da Bahia. Trata-se de um estudo epidemiológico de corte transversal que analisou uma população de 60 fisioterapeutas trabalhadores da terapia intensiva na cidade de Feira de Santana, Bahia. Um questionário autoaplicável avaliou dados sociodemográficos, características do trabalho, aspectos psicossociais do trabalho e presença de DPMs. A prevalência de DPMs encontrada foi de 41,7% e verificou-se associação entre as variáveis sociodemográficas, características do trabalho, hábitos de vida, aspectos psicossociais do trabalho e DPM. Observou-se elevada prevalência e uma diversidade de fatores associados aos DPMs entre os fisioterapeutas estudados. Os resultados apontam a necessidade de novos estudos epidemiológicos que possam identificar com mais precisão os fatores associados a DPMs nesses trabalhadores.

RESUMEN Los estudios indican que los factores relacionados con el trabajo pueden llevar a la enfermedad entre los trabajadores de las unidades de cuidados intensivos, pero todavía son pocos los que tratan de los trastornos psíquicos menores (TPM) en fisioterapeutas de cuidados intensivos. Este estudio tiene como objetivo estimar la prevalencia y los factores asociados a los TPM en fisioterapeutas de cuidados intensivos en una gran ciudad de Bahía (Brasil). Se trata de un estudio epidemiológico, transversal, en el que participó 60 fisioterapeutas que actúan en cuidados intensivos en la ciudad de Feira de Santana, Bahía. Un cuestionario autoaplicable evaluó los datos sociodemográficos, las características del trabajo, los aspectos psicosociales del trabajo y la presencia de TPM. La prevalencia de TPM fue del 41,7%, y hubo asociación entre las variables sociodemográficas, las características del trabajo, los hábitos de vida, los aspectos psicosociales del trabajo y el TPM. Se observó una alta prevalencia y diversidad de factores asociados a los TPM entre los fisioterapeutas estudiados. Los resultados apuntan a la necesidad de realizar nuevos estudios epidemiológicos para identificar con mayor precisión los factores asociados con los TPM en los trabajadores.

ABSTRACT Studies indicate that work-related factors can make intensive care unit workers ill, but those addressing minor psychological disorders (MPDs) in ICU physical therapists are still scarce. This study aim to estimate the prevalence and factors associated with MPDs in ICU physical therapists in a large municipality in the state of Bahia. This is a cross-sectional epidemiological study that analyzed 60 ICU physical therapists in the municipality of Feira de Santana, Bahia. A self-reporting questionnaire evaluated sociodemographic data, work characteristics, psychosocial aspects of the work and the presence of MPDs. The prevalence of MPDs was 41.7%, with an association between sociodemographic variables, work characteristics, lifestyle, psychosocial aspects of the work and MPD. We observed a high prevalence and a diversity of factors associated with MPDs among the studied physical therapists. The results suggest new epidemiological studies that can better identify the factors associated with MPDs in these workers.

[Towards freedom to claim the right to die]. / Vers une liberté à revendiquer le droit à mourir.

current evolution of society makes it possible to debate the issue of the end of life for people suffering from pathologies in which the vital prognosis is not involved; this concerns psychiatric situations in particular. This debate, which bears the seeds of a real desire to die as a personal choice, is likely to profoundly modify the doctor-patient relationship in the particular field of psychiatry.

Perceived stress score among doctors serving at various government and private hospitals in Faisalabad.

OBJECTIVE: To analyse the prevalence of stress among doctors serving at various public and private hospitals. METHODS: The cross-sectional study was conducted at four public and private hospitals in Faisalabad, Pakistan, from July to December 2019, and comprised doctors with at least one year of professional service. Data was collected using the Perceived Stress Scale Questionnaire and was analysed using SPSS 20. RESULTS: Of the 162 respondents, 87(53.7%) were males and 75(46.3%) were females. The females had significantly higher (p<0.05) perceived stress scores compared to the males. Age, number of years in job, and number of children had negative correlation with stress scores (p<0.05). Stress was significantly low in doctors who managed to usually get time-out for relaxation (p<0.01) and in those doing private practice (p<0.05). The effect of doctor's marital status, type of specialty and residence was not significant (p>0.05). CONCLUSIONS: Younger doctors, particularly females, in their early career were found to have higher perceived stress scores compared to their senior colleagues with more children and well-established private practice.

Factors Associated With Mental Suffering in the Brazilian Population: A Multilevel Analysis.

Purpose: To analyze how individual characteristics and the social context are associated with mental distress symptoms in the Brazilian population. Method: A multilevel cross-sectional study with data from the 2013 National Health Survey. There were two dependent variables: (a) decreased vital energy and somatic symptoms, (b) the presence of depressive thoughts. The independent variables were biological characteristics, education and income, habits and lifestyle, and context variables. Bivariate analysis was performed, and Prevalence Ratios calculated in a Poisson Regression (95% CI). A multilevel Poisson Regression was performed to verify the effect of individual and contextual variables. Results: Regarding depressive thoughts, young and middle-aged individuals, low education, women, absence of partner, smokers or former smokers, and absence of health insurance were the categories at highest risk; belonging to classes D-E and living in states with lower expected years of schooling proved to be protective factors. Similar results were found for the second outcome. Conclusions: Symptoms of mental distress were associated with the individual characteristics and contextual aspects of the federation unit. These findings indicate the importance of strengthening psychosocial care aimed at vulnerable groups.

Religiosity and mental suffering experiences of users of the Brazilian public healthcare system / Religiosidade e experiências de sofrimento mental entre usuários da rede pública brasileira de saúde / Religiosité et expériences de souffrance mentale chez les usagers système de santé publique brésilien / Religiosidad y experiencias de sufrimiento mental entre los usuarios de la red pública de salud brasileña

This article aimed to investigate the relationship between religiosity and mental suffering experiences among users of the Brazilian public healthcare system, according to the cultural phenomenology framework. Its specific objective was to investigate the means by which the transformation of experience occurs. The study's design consisted of semi-structured interviews, applying the MINI - McGill Illness Narratives Interview. The results led to the construction of the following categories: causal factors, suffering experiences, healing practices, social support and positive transformation of the experience. The effects of religiosity on mental suffering experiences were predominantly positive, such as in religious rituals, social support and protection against suicide. The main healing mechanisms involved were embracement, symbolic and bodily processes, similarly to psychosocial approaches within professional ethnopsychiatries

O artigo teve como objetivo investigar a relação entre a religiosidade e as experiências de sofrimento mental entre usuários da rede pública de saúde brasileira segundo o referencial da fenomenologia cultural. Seu objetivo específico foi investigar os meios pelos quais a transformação da experiência ocorre. O desenho do estudo consistiu em entrevistas semi-estruturadas, aplicando-se o MINI - McGill Illness Narratives Interview. Os resultados levaram à construção das seguintes categorias: fatores causais, experiências de sofrimento, práticas de cura, suporte social e transformação positiva da experiência. Os efeitos da religiosidade sobre as experiências de sofrimento mental foram predominantemente positivos, como nos rituais religiosos, no apoio social e na proteção contra o suicídio. Os principais mecanismos de cura envolvidos foram o acolhimento,processos simbólicos e corporais, de modo similar às abordagens psicossociais dentro das etnopsiquiatrias profissionais

Le but de cet article est d'étudier le rapport entre la religiosité et les expériences de souffrance mentale chez les utilisateurs du réseau de santé publique brésilien selon le cadre de la phénoménologie culturelle. Son objectif spécifique porte sur l'étude des moyens par lesquels la transformation de l'expérience a lieu. La conception de l'étude comprend des entrevues semi-structurées, appliquant l'entrevue McGill Illness Narratives Interview (MINI). Les résultats ont conduit à la construction des catégories suivantes : facteurs causaux, expériences de souffrance, pratiques de guérison, soutien social et transformation positive de l'expérience. Les effets de la religiosité sur les expériences de souffrance mentale étaient principalement positifs, comme dans les rituels religieux, le soutien social et la protection contre le suicide. Les principaux mécanismes de guérison impliqués étaient l'accueil et les processus symboliques et corporels, de la même manière que les approches psychosociales au sein des ethnopsychiatries professionnelles.

De acuerdo con el marco de la fenomenología cultural, el artículo tuvo como objetivo investigar la relación entre la religiosidad y las experiencias de sufrimiento mental entre los usuarios de la red pública de salud brasileña. Su propósito específico fue investigar los medios por los cuales se da la transformación de la experiencia. El diseño del estudio consistió en entrevistas semiestructuradas, aplicando la entrevista McGill Illness Narratives Interview (MINI). Los resultados llevaron a la construcción de las siguientes categorías: factores causales, experiencias de sufrimiento, prácticas curativas, apoyo social y transformación positiva de la experiencia. Los efectos de la religiosidad sobre las experiencias de sufrimiento mental fueron predominantemente positivos, como en los rituales religiosos, en el apoyo social y en la protección contra el suicidio. Los principales mecanismos de cura involucrados fueron el abrazo y los procesos simbólicos y corporales, de manera similar a los enfoques psicosociales dentro de las etnopsiquiatrías profesionales.

Prevalência de distúrbios psíquicos menores em fisioterapeutas intensivistas de uma grande cidade do estado da Bahia / Prevalence of minor psychic disorders in intensivist physiotherapists from a large city in the state of Bahia

INTRODUÇÃO: Os estudos sobre Distúrbios Psíquicos Menores (DPM) em fisioterapeutas intensivistas são raros, e muitos desses profissionais ainda desconhecem a relação entre o trabalho e saúde mental. OBJETIVO: Estimar a prevalência de Distúrbios Psíquicos Menores (DPM) em Fisioterapeutas intensivistas de uma grande cidade do Estado da Bahia. MÉTODOS: Estudo populacional, descritivo abrangendo 60 fisioterapeutas intensivistas que atuavam na cidade em 2016. O critério de inclusão foi trabalhar em UTI há pelo menos seis meses, para evitar o viés de trabalhador saudável. Os critérios de exclusão foram: atuar em atividade administrativa, estar em gozo de férias, em licença médica ou licença maternidade. Um questionário autoaplicável avaliou dados sociodemográficos, características do trabalho e DPM por meio do Self Report Questionnaire (SRQ-20). RESULTADOS: Dos trabalhadores estudados, 51,7% trabalhavam em UTI adulto, 20,0% em UTI pediátrica e 28,3% em UTI neonatal, 38,4% dos profissionais estudados trabalhavam em duas ou mais unidades. O sexo feminino predominou, com 80,0% dos trabalhadores estudados, a média de idade foi de 32,2 ± 4,9 anos, 45,0% tinham companheiro, 58,3% não tinham filhos. A prevalência de DPM foi de 41,7%. CONCLUSÃO: Observou-se elevada prevalência de DPM entre os fisioterapeutas intensivistas estudados. Os resultados apontam a necessidade de novos estudos que investiguem a relação entre trabalho e saúde mental em fisioterapeutas intensivistas.

INTRODUCTION: Studies on Minor Psychological Disorders (MPD) in intensive care physiotherapists are rare, and many of these professionals are still unaware of the relationship between work and mental health. OBJECTIVE: To estimate the prevalence of Minor Psychiatric Disorders (MPD) in intensive care physiotherapists in a large city in the state of Bahia. METHODS: Population, a descriptive study covering 60 intensive care physiotherapists who worked in the city in 2016. The inclusion criterion was working in the ICU for at least six months, to avoid the bias of a healthy worker. The exclusion criteria were: acting in administrative activity, being on vacation, on sick leave, or maternity leave. A self-administered questionnaire assessed sociodemographic data, job characteristics, and DPM through the Self Report Questionnaire (SRQ-20). RESULTS: Of the workers studied, 51.7% worked in an adult ICU, 20.0% in a pediatric ICU, and 28.3% in a neonatal ICU, 38.4% of the professionals studied worked in two or more units. The female gender predominated, with 80.0% of the workers studied, the average age was 32.2 ± 4.9 years, 45.0% had a partner, 58.3% had no children. The prevalence of MPD was 41.7%. CONCLUSION: There was a high prevalence of MPD among the intensive care physiotherapists studied. The results point to the need for further studies to investigate the relationship between work and mental health in intensive care physiotherapists.

Psychological distress and mother-child relationship: influence of life context on a population sample (BRISA) through the use of directed acyclic graphs (DAG)

This study aimed to investigate the association between maternal psychological distress and impairment in mother-child relationship in a sample from a Northeast capital city in Brazil with a low Human Development Index, using directed acyclic graphs (DAG). A total of 3,215 women were evaluated for the presence of psychological distress through the Self Reporting Questionnaire instrument and for the mother-child relationship by the first factor of Postpartum Bonding Questionnaire, considered the most appropriate in the literature. Demographic and socioeconomic variables were used to construct a theoretical model and, after this, multivariate logistic regression was performed using variables suggested by Directed Acyclic Graphs (DAG). Psychological distress was present in 22.7% of the women and 12.6% of them presented impaired mother-child relationships. After adjustment, the variable 'maternal mental distress' remained associated with impaired mother-child relationship (RR=3.03), and among the explanatory variables only 'primary school level' (RR=1.48) was associated as a risk factor to this outcome. The results indicated that, in this population, women with psychological distress and lower schooling are more likely to present impaired mother-child relationships.

Reiki as nursing care to people in mental suffering: an integrative review / Reiki como cuidado de enfermería a las personas en sufrimiento psíquico: revisión integrativa / Reiki como cuidado de enfermagem às pessoas em sofrimento psíquico: revisão integrativa

ABSTRACT Objective: To analyze the scientific evidences of the use of Reiki as a care strategy to people in mental suffering. Methods: Integrative review in the databases PubMed, Scielo, Web of Science, and BVS. The study included articles in English, Portuguese, and Spanish, with no time restriction, which answer to the guiding question that was created in accordance to the PICo strategy: "What are the scientific evidences on the use of Reiki as a care strategy to people in mental suffering?" Gray literature was not considered. Results: Ten articles made up the final sample. The use of the Reiki therapy had benefits as a strategy to care for stress, anxiety, depressive symptoms, pain relief, and quality of life improvements, whether the therapy was used isolated or to complement other treatments. Conclusion: The development of the competence of nurses and other health professionals in the use of Reiki can contribute to improve the quality standards of care.

RESUMEN Objetivo: Analizar evidencias científicas del uso del Reiki como estrategia de cuidado a las personas en sufrimiento psíquico. Métodos: Revisión integrativa en las bases de datos PubMed, Scielo, Web of Science y BVS. Incluidos artículos en inglés, portugués y español, sin restricción cuanto al año de publicación, que respondieran a la interrogación con uso de la estrategia PICo: "¿Cuáles las evidencias científicas sobre el uso del Reiki como estrategia de cuidado a la persona en sufrimiento psíquico?". Resultados: Diez artículos compusieron la muestra final. El uso del Reiki presentó beneficios como estrategia de cuidado en el estrés, ansiedad, síntomas depresivos, alivio del dolor y mejora en la calidad de vida, sea la terapia utilizada de forma aislada o complementar a otro tratamiento. Conclusión: El desarrollo de competencias de los enfermeros y demás profesionales de salud utilizando el Reiki contribuye para la mejoría de los estándares de calidad de los cuidados.

RESUMO Objetivo: Analisar as evidências científicas do uso do Reiki como estratégia de cuidado às pessoas em sofrimento psíquico. Métodos: Revisão integrativa nas bases de dados PubMed, Scielo, Web of Science e BVS. Foram incluídos artigos em inglês, português e espanhol, sem restrição quanto ao ano de publicação, que respondessem à pergunta condutora construída com uso da estratégia PICo: "Quais as evidências científicas sobre o uso do Reiki como estratégia de cuidado à pessoa em sofrimento psíquico?" A literatura cinzenta foi excluída. Resultados: Dez artigos compuseram a amostra final. O uso da terapia Reiki apresentou benefícios como estratégia de cuidado no estresse, ansiedade, sintomas depressivos, alívio da dor e melhora na qualidade de vida, seja a terapia utilizada de forma isolada ou complementar a outro tratamento. Conclusão: O desenvolvimento de competências dos enfermeiros e demais profissionais da saúde utilizando o Reiki contribui para a melhoria dos padrões de qualidade dos cuidados.

Coping Processes of Patients with Ostomies in South Korea: A Focus Group Study.

Despite the adverse effects of negative coping after receiving a stoma, there is a lack of information on how patients cope with ostomies and on their families' experiences throughout the coping process. We aimed to explore the coping experiences of individuals with ostomies throughout their illness, applying the Corbin and Strauss Chronic Illness Trajectory Framework, using exploratory qualitative methods involving focus group interviews. Purposive sampling was utilized to recruit 19 participants (split across three groups) through an ostomy association in South Korea. Two focus group interviews were separately conducted from March through to May 2017 until data saturation was achieved. Using qualitative content analysis, we analyzed the transcribed interviews and identified words and themes to interpret the results. The coping experiences of patients with ostomies were expressed through three interrelated themes: struggling and suffering, learning how to live with ostomy, and living with ostomy. We found gender differences in spousal support and a struggle among older patients regarding social coping. The themes identified suggest that gender should be considered when designing interventions to help patients cope with ostomies.

(Re)Visitando a reforma psiquiátrica brasileira: perspectivas num cenário de retrocessos / (Re)Visitando la reforma psiquiátrica brasileña: perspectivas en un escenario de retroceso / (Re)Visiting Brazilian psychiatric reform: Prospects in a setback scenario

Objetivo: o presente trabalho teve por objetivo realizar uma reflexão teórica a respeito da trajetória histórica do cuidado ofertado ao portador de sofrimento mental no Brasil à luz da Política Nacional de Saúde Mental. Síntese de conteúdo: trata-se de uma reflexão teórica com base na análise das conquistas oriundas da Reforma Psiquiátrica Brasileira no tocante aos dispositivos de cuidados disponibilizados no Sistema Único de Saúde aos indivíduos com demandas relacionadas à saúde mental, bem como das mudanças recentes na Política Nacional de Saúde Mental que urgem como passíveis de comprometer o modelo de atenção psicossocial já instituído. Observou-se a ocorrência de uma série de eventos que vão de encontro ao modelo de cuidado instituído baseado na reinserção social e promoção da autonomia dos indivíduos, demonstrando preocupantes indícios de retorno ao modelo manicomial e excludente. Conclusões: pretende-se, a partir deste estudo, provocar debates acerca do rumo do cuidado em saúde mental no Brasil, alertando para a necessidade de participação popular nas decisões das políticas de saúde e incentivando a permanência e o aprimoramento do modelo psicossocial em saúde mental.

Objetivo: el presente trabajo tuvo como objetivo hacer una reflexión teórica sobre la trayectoria histórica de la atención ofrecida a los pacientes con sufrimiento mental en Brasil, a la luz de la Política Nacional de Salud Mental. Síntesis del contenido: esta es una reflexión teórica basada en el análisis de los logros derivados de la Reforma Psiquiátrica brasileña con respecto a los dispositivos de atención disponibles en el Sistema Único de Salud para personas con demandas relacionadas con la salud mental, así como los cambios recientes en la Política Nacional de Salud Mental que urgen como responsables de comprometer el modelo de atención psicosocial ya establecido. Se observó la aparición de una serie de eventos que van en contra del modelo de atención basado en la reintegración social y la promoción de la autonomía de las personas, lo que muestra indicios preocupantes de retorno al asilo y al modelo de exclusión. Conclusiones: este estudio pretende provocar debates sobre la dirección de la atención de la salud mental en Brasil, alertando sobre la necesidad de participación popular en las decisiones de política de salud y alentando la permanencia y la mejora del modelo psicosocial en salud mental.

Objective: To conduct a theoretical reflection on the historical trajectory of care offered to patients with mental suffering in Brazil based on the National Mental Health Policy. Content synthesis: This is a theoretical reflection from the analysis of the achievements of the Brazilian Psychiatric Reform regarding care devices available in the Unique Health System for individuals with mental health demands, as well as recent changes in the National Mental Health Policy that urge deploying the already established psychosocial care model. A series of events that go against the model of care based on the social reintegration and promotion of the autonomy of individuals were observed, which shows worrying indications of return to the asylum and the exclusionary model. Conclusions: This study intends to foster debates about the direction of mental health care in Brazil, alerting to the need for popular participation in health policy decisions and encouraging the permanence and improvement of the psychosocial model in mental health.

Psychological impact of quarantine on healthcare workers.

OBJECTIVES: Exposure to infection is an inherent occupational risk for healthcare workers and may lead them to undergo quarantine during disease outbreaks. Both front-line battle and quarantine are stressful experiences that may make psychological support for healthcare workers necessary. Psychological support measures based on the best available evidence should be included in emergency plans worldwide. We summarise the research evidence on the psychological impact of quarantine on healthcare workers. METHODS: We retrieved 470 articles on the psychological impact of quarantine on healthcare workers from the Web of Science and included in this review all 12 articles that met our inclusion criteria. RESULTS: The reviewed studies reported acute stress during quarantine and long-lasting depressive, post-traumatic stress and alcohol dependency and abuse symptoms. Healthcare workers fear infection for themselves, but more so for their loved ones, and are also concerned about the stigma that may affect their families, most especially their children. CONCLUSIONS: The safety of healthcare workers and their families during disease outbreaks needs to be ensured. Suitable alternative accommodation and personalised monitoring during quarantine are useful intervention measures to prevent adverse effects in healthcare workers. Clear public health communication will help reduce uncertainty, guilt and stigma. Financial aid should be considered for the more severely affected workers. Finally, mental healthcare for healthcare workers should be a priority, as quarantines can be a mental distress trigger. The development of efficient referral paths and the provision of counselling or psychotherapy during the confinement period are an opportunity for early mental health interventions.

Sofrimento nos enfermeiros em cuidados de saúde primários / Suffering in primary care nurses / Sufrimiento de los enfermeros de atención primaria de la salud

Enquadramento: O sofrimento nos enfermeiros advém da prestação de cuidados ao doente em sofrimento e de fatores relacionados com as condições de trabalho. É uma experiência multidimensional que ocorre em situações de perda, dano ou ameaça à integridade da pessoa. Objetivo: Comparar as médias das dimensões do sofrimento (Dor Emocional, Perda Relacional e Evitamento) em função das variáveis sociodemográficas e profissionais dos enfermeiros. Metodologia: Estudo descritivo e transversal de natureza quantitativa. Amostra constituída por 100 enfermeiros. Foi aplicado um questionário de autopreenchimento e para avaliação do sofrimento a Caregiver Grief Scale. Resultados: O sexo feminino com filhos, com companheiro, sem especialização em enfermagem e com mais tempo de serviço apresentou médias mais elevadas de sofrimento. No sexo masculino, as médias mais elevadas verificaram-se nos enfermeiros sem filhos, sem companheiro, com especialização em enfermagem e com mais tempo de serviço. Conclusão: Os enfermeiros apresentaram médias mais elevadas de sofrimento na dimensão Dor Emocional, seguida da Perda Relacional e do Evitamento, sendo maior a expressão do sofrimento no sexo feminino.

Background: Suffering in nurses is associated with the delivery of care to patients in suffering and factors related to the working conditions. It is a multidimensional experience that occurs in situations of loss, damage, or threat to human integrity. Objective: To compare the mean scores in the dimensions of suffering (Emotional Pain, Relational Loss, and Avoidance) based on the sociodemographic and professional variables of nurses. Methodology: A descriptive and cross-sectional study with a quantitative approach was conducted with a sample of 100 nurses. A self-administered questionnaire was applied, as well as the Caregiver Grief Scale for assessing suffering. Results: Women with children, with a partner, without specialization in nursing, and with more years of service had higher mean scores of suffering. In men, the highest mean scores were found in nurses without children, without a partner, with specialization in nursing, and with more years of service. Conclusion: Nurses showed higher mean scores of suffering in the dimension of Emotional Pain, followed by Relational Loss, and Avoidance, and suffering was higher among women.

Marco contextual: El sufrimiento de los enfermeros proviene de la prestación de cuidados al paciente que sufre y de factores relacionados con las condiciones de trabajo. Es una experiencia multidimensional que se produce en situaciones de pérdida, daño o amenaza a la integridad de la persona. Objetivo: Comparar las medias de las dimensiones del sufrimiento (Dolor Emocional, Pérdida Relacional y Evitación), según las variables sociodemográficas y profesionales de los enfermeros. Metodología: Estudio descriptivo y transversal de naturaleza cuantitativa. La muestra constó de 100 enfermeros. Se aplicó un cuestionario de autocumplimentado y, para evaluar el sufrimiento, se utilizó la Caregiver Grief Scale. Resultados: El sexo femenino con hijos, con pareja, sin especialización de enfermería y con más tiempo de servicio presentó medias más elevadas de sufrimiento. En el sexo masculino, las medias más altas se encontraron en los enfermeros sin hijos, sin pareja, con una especialización en enfermería y con más tiempo de servicio. Conclusión: Los enfermeros presentaron medias más altas de sufrimiento en la dimensión Dolor Emocional, seguido de Pérdida Relacional y Evitación, y la expresión del sufrimiento fue mayor en el sexo femenino.

"Por trás da máscara da loucura": cenários e desafios da assistência à pessoa com esquizofrenia no âmbito da Atenção Básica / "Behind the Mask of Madness": scenarios and challenges of assistance to individuals with schizophrenia in primary care

Objetivo: Analisar os cenários e desafios enfrentados pelos profissionais de saúde na assistência às pessoas com esquizofrenia na Atenção Básica. Método: Pesquisa qualitativa, de caráter descritivo-exploratório, realizada junto a médicos e enfermeiros que atuam na Atenção Básica do município de Pau dos Ferros, Rio Grande do Norte. Utilizaram-se entrevistas semiestruturadas com dez profissionais; as falas foram analisadas em quatro categorias, através da Análise de Conteúdo. Resultado: constatou-se que a assistência prestada à pessoa com esquizofrenia não consegue identificar e atender às suas reais necessidades e que as propostas das políticas públicas de saúde mental se distanciam da realidade, pois as ações na atenção básica se limitam à orientação da medicação e ao encaminhamento para o serviço de referência, o que contraria o princípio da integralidade da assistência, sendo necessárias aos profissionais da atenção básica maior autonomia e participação nesse processo. Para tanto, se faz imprescindível o uso de um trabalho integrado entre os profissionais, a adoção de um modelo de contrarreferência e a diversificação dos instrumentos de intervenção em saúde.(AU)

Objective: To analyze the scenarios and challenges faced by health professionals in the care of people with schizophrenia in Primary Care. Method: Qualitative research, descriptive and exploratory, performed with physicians and nurses who work in Primary Care in the city of Pau dos Ferros, Rio Grande do Norte. We used semi-structured interviews with ten professionals, the lines were analyzed in four categories, through Content Analysis. Result: was found that the assistance provided to the person with schizophrenia can not identify and meet their real needs and that the proposals of the public policies of mental health are distanced from the reality, since the actions in the basic attention are limited to the orientation of the medication and the referral service, which is contrary to the principle of integral care, and it is necessary for the primary care professionals to have greater autonomy and participation in this process. Therefore, it is essential to use integrated work among professionals, the adoption of a counter-reference model and the diversification of health intervention instruments.(AU)