Storylines of family medicine III: core principles-primary care, systems and family.

Storylines of Family Medicine is a 12-part series of thematically linked mini-essays with accompanying illustrations that explore the many dimensions of family medicine, as interpreted by individual family physicians and medical educators in the USA and elsewhere around the world. In 'III: core principles-primary care, systems, and family', authors address the following themes: 'Continuity of care-building therapeutic relationships over time', 'Comprehensiveness-combining breadth and depth of scope', 'Coordination of care-managing multiple realities', 'Access to care-intersectional, systemic, and personal', 'Systems theory-a core value in patient-centered care', 'Family-oriented practice-supporting patients' health and well-being', 'Family physician as family member' and 'Family in the exam room'. May readers develop new understandings from these essays.

Informal caregivers' experiences of support from a tailored primary healthcare unit for older adults - A focus group study.

BACKGROUND: Informal caregivers are an essential part of health and social care systems worldwide. As such, they may need professional support. AIM: The aim of this study was to describe informal caregivers' experiences and need for support from a tailored primary health care (PHC) unit. METHODS: This is a qualitative descriptive study using data collected from five semi-structured focus group discussions with a purposeful sample of 16 informal caregivers of older relatives. Respondents were recruited from a tailored PHC unit for people aged 75 years or older in a region in central Sweden. The data were analysed by qualitative content analysis with an abductive approach, based on the principles of the patient- and family-centred care framework. RESULTS: The overarching theme was 'Striving for partnership'. The findings indicate that informal caregivers to some extent felt supported by the healthcare professionals. However, the caregivers expressed a need to be further acknowledged by the professionals in order to participate in the care of their older relatives in the way they wanted. Moreover, insufficient information regarding the older adult's health condition and care provided by the professionals had a negative impact on the caregiver's participation in care. CONCLUSIONS: Informal caregivers have unmet needs for support and strive for a partnership with the PHC professionals. PHC professionals should be more attentive and invite informal caregivers to participate in the care of the older adult in order to meet their support needs and build an equal partnership. The patient- and family-centred care framework may be of guidance when providing care for older adults in a PHC context.

Community Nurses' Perspectives on Conceptual Challenges Related to the Need for Nursing Care in Germany: A Constructivist Grounded Theory Study.

In Germany, a person's need for nursing care is assessed by evaluators according to the federal legal definition of the statutory long-term care insurance (LTCI). This definition and the associated standardized assessment tool constitute the conditions for providing nursing care in a community care setting in Germany. Furthermore, the community care setting is regulated by state law and negotiations between long-term care funds and associations of providers of nursing care. During nursing care, nurses engage in a variety of interactions with people. The extent to which the legal definition of the need for nursing care leads to challenges in these interactions is unclear. To address this knowledge gap, we conducted 22 problem-centered interviews with nurses in the community and analyzed the data using the constructivist grounded theory. The results revealed that the negotiation processes are settled within professional-family relationships and vary between the constructs of closeness and distance, advocacy and submission of responsibility, and ethos and technocracy; these are the central challenges nurses encounter in this setting. We discuss the implications and questions that arise from the findings for the nursing profession regarding its own current and future role as well as the design of nursing support in the community, to nurture more advanced nurse practitioners and community health nurses.

Chinese family care partners of older adults in Canada have grit: A qualitative study.

AIM: To explain the process taken by Chinese family care partners of older adults in the Greater Toronto Area, Canada, to access health and social services in their communities. The research question was: What mechanisms and structures impact the agency of Chinese family care partners of older adults, in the process of assisting them to access health and social services? DESIGN: This qualitative study was informed by critical realism. METHODS: Chinese family care partners of older adults in the Greater Toronto Area, Canada, were interviewed from August 2020 to June 2021. Transcripts underwent thematic analysis. FINDINGS: Twenty-eight Chinese family care partners expressed a firm commitment to maintain caregiving conditions and to judiciously access health and social services. Their commitment was made up of three parts: (a) legislative and cultural norms of family, work, and society; (b) their perseverance to fill gaps with limited social and financial resources; (c) the quality of their relationship to, and illness trajectory of the older adults. The social structures created tension in how Chinese family care partners made decisions, negotiated resources, and ultimately monitored and coordinated timely access with older adults. CONCLUSION: Participants' commitment and perseverance were conceptualized as "grit," central to their agency to conform to legislative and cultural norms. Moreover, findings support grit's power to motivate and sustain family caregiving, in order for older adults to age in place as long as possible with finite resources. IMPLICATIONS FOR THE PROFESSION: This study highlights the importance of cultural awareness education for nurses, enabling continuity of care at a systems level and for a more resilient healthcare system. IMPACT: Family care partners' grit may be crucial for nurses to harness when together, they face limited access to culturally appropriate health and social services in a system grounded in values of equity and inclusion, as in Canada. REPORTING METHOD: When writing this manuscript, we adhered to relevant EQUATOR guidelines of the Consolidated Criteria for Reporting Qualitative Research (COREQ). PATIENT OR PUBLIC INVOLVEMENT AND ENGAGEMENT: No patient or public involvement.

Reframing care while enduring the traumatic nature of witnessing disrupted family-patient-nurses' relationships during COVID-19.

AIM: To describe the lived experiences of nurses caring for patients and families in the context of COVID-19 in Brazil and United States. DESIGN: A phenomenological philosophical approach following the van Manen analysis method. METHODS: Participants were recruited in Brazil and the United States, including nurses working in health care settings caring for COVID-19 patients. Recruitment used purposive and snowball sampling. Participants completed a demographic survey and semi-structured interviews that were audio-recorded and transcribed for analysis. A cross-cultural examination occurred among researchers from each country. RESULTS: The result was described (n = 35) by the themes, representing the essences of each lifeworld (relationship, time, space and body). The nurses' lived experience was one of reframing care while enduring repeated trauma of witnessing disrupted patient-family-nurse relationships. Themes were as follows: (a) Living a silent and lonely experience; (b) Providing connectedness for disrupted patient and family relationships; (c) Feeling the burden of the demands; (d) Being a helping connector; (e) Reshaping spaces amidst evolving interventions and policies; (f) Creating safe spaces, surrounded by turmoil, threat, and distress within an unsafe environment; (g) Reorganizing care and reframing time; (h) Reconciling losses, regrets, victories and lessons. CONCLUSION: The nurses' lived experience of caring for patients and families during the COVID-19 pandemic prompted the need to respond to repeated traumas and distress posed by interrupted patient-family and nurse-own family relationships, vulnerable bodies, threatened space and dynamic and volatile time. IMPACT: Cultural nuances were discovered depending on the practice setting, political discourse and the autonomy of the nurse. Innovative models of care that create structures and processes to support nurses in caring for patients in threatening environments and the commitment to connecting family members have potential to contribute to the ongoing health of the nursing profession.

Percepções das mães que são profissionais de saúde sobre as relações na unidade neonatal / Health professionals mothers' perceptions about relationships in the neonatal unit / Percepciones de las madres profesionales de la salud sobre las relaciones en la unidad neonatal

Objetivo: discutir as percepções das mães que são profissionais de saúde sobre as relações na unidade neonatal. Método: estudo qualitativo, apoiado no Interacionismo Simbólico, com 11 mães de recém-nascidos pré-termo que são profissionais da saúde. Após aprovação pelo Comitê de Ética em Pesquisa, os dados foram coletados de maio a outubro de 2021, por meio de entrevistas individuais, e submetidos à análise de conteúdo temática. Resultados: apesar de as mães serem profissionais da saúde, as relações na unidade neonatal foram difíceis, sofridas, desconfortantes e restritivas ao processo de 'ser e tornar-se mãe'. Estas desvelaram sentimentos de não pertencimento ao cuidado e de afastamento de suas crianças. Conclusão: as relações entre mães e profissionais da saúde atuantes na unidade neonatal estiveram marcadas por sofrimentos, limitações e desconfortos, sendo lacunares em processos colaborativos, na contramão do Cuidado Centrado na Família.

Objective: to discuss the perceptions of mothers who are health professionals about relationships in the neonatal unit. Method: a qualitative study, based on Symbolic Interactionism, with 11 mothers of preterm newborns who are health professionals. After approval by the Research Ethics Committee, data was collected from May yo October 2021, through individual interviews, and subjected to thematic content analysis. Results: despite the mothers being health professionals, relationships in the neonatal unit were difficult, painful, uncomfortable, and restrictive to the process of 'being and becoming a mother'. They revealed feelings of not belonging to care and of being away from their children. Conclusion: the relationships between mothers and health professionals working in the neonatal unit were marked by suffering, limitations, and discomfort, and were lacking in collaborative process, going against Family-Centered Care.

Objetivo: discutir las percepciones de las madres profesionales de salud sobre las relaciones en la unidad neonatal. Método: estudio cualitativo, basado en el Interaccionismo Simbólico, con 11 madres de recién nacidos prematuros que son profesionales de la salud. Previa aprobación del Comité de Ética en Investigación, se recolectaron los datos de mayo a octubre de 2021, mediante entrevistas individuales y los sometieron a análisis temático de contenido. Resultados: aunque las madres eran profesionales de salud, las relaciones en la unidad neonatal fueron difíciles, dolorosas, incómodas y restrictivas al proceso de 'ser y volverse madre'. Revelaron sentimientos de no pertenencia a los cuidados y de alejamiento de sus hijos. Conclusión: las relaciones entre las madres y los profesionales sanitarios que trabajan en la unidad neonatal estaban marcadas por el sufrimiento, las limitaciones y la incomodidad, y carecían de procesos de colaboración, lo que iba en contra de la Atención Centrada en la Familia.

Quality of interaction between the nursing personnel and the informal caregivers of people with memory disorders: A systematic review and metasummary of qualitative studies.

AIM: To explore the factors that affect the quality of interactions between nursing personnel and the informal caregivers of people with memory disorders. DESIGN: Systematic review and metasummary of qualitative empirical research. METHODS: The literature search targeted studies concerning the professional care interactions between nursing personnel and the informal caregivers of people with progressive memory disorders. The search in PubMed, CINAHL, PsycINFO and Scopus covered records from the earliest possible date up to December 2020. The data were summarised using a qualitative metasummary method. Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) checklist was used to validate the reporting process. RESULTS: Ten articles were included. As presented in 33 statements, the factors affecting the quality of interactions were related to (1) expectations, (2) memory disorders, (3) interaction strategies, (4) time and place of interactions and (5) organisational aspects. Meeting the individual interactional needs of informal caregivers is recommended. The results provide guidance for improving the quality of interactions between nursing personnel and informal caregivers.

Needs of family members of patients in intensive care and their perception of medical communication.

OBJECTIVE: To understand the perception of medical communication and needs of family members with loved ones in intensive care. METHODS: The study was mainly qualitative and exploratory, with thematic analysis of comments made by 92 family members with loved ones in intensive care units when answering in-person interviews comprising the Quality of Communication Questionnaire (QoC) and open-ended questions about their need for additional help, the appropriateness of the place where they received information, and additional comments. RESULTS: The participants' mean age was 46.8 years (SD = 11.8), and most of them were female, married and had incomplete or completed elementary education. The following themes were found: perception of characteristics of medical communication; feelings generated by communication; considerations about specific questions in the QoC; family members' needs; and strategies to overcome needs regarding communication. Characteristics that facilitated communication included attention and listening. Characteristics that made communication difficult included aspects of information sharing, such as inaccessible language; lack of clarity, objectivity, sincerity, and agreement among the team; limited time; and inadequate location. Feelings such as shame, helplessness, and sadness were cited when communication was inadequate. Family members' needs related to communication included more details about the loved one's diagnosis, prognosis, and health condition; participation in decisionmaking; and being asked about feelings, spirituality, dying and death. Others were related to longer visitation time, psychological support, social assistance, and better infrastructure. CONCLUSION: It is necessary to enhance medical communication and improve hospital infrastructure to improve the quality of care for family members.

Psychometric Validation of the Korean Version of the Family-Centered Care Questionnaire-Revised.

Background and Purpose: Family-centered care (FCC) is a philosophy of care that applies to all areas of pediatric nursing and is a key component of the care model for patient safety and management activities in the medical environment of hospitalized children. The aim of this study was to translate and evaluate the psychometric properties of the Korean version of the Family-Centered Care Questionnaire-Revised (FCCQ-R). Methods: A total of 239 questionnaires were completed by pediatric nurses at four consenting general hospitals. Results: Fourteen items were removed from the original questionnaire through exploratory factor analysis and nine subscales were reduced to five. The factor loadings of the 30 items on the five subscales ranged from 0.50-0.80. The model of the Korean version of the questionnaire was validated by an exploratory and confirmatory factor analysis. Reliability analysis for internal consistency showed an acceptable to high Cronbach's α of 0.96 in total and the subscales ranged from 0.59-0.92. Conclusions: This study verified the validity and reliability of the tool to measure the perception of FCC. Future research will need to correlate FCC with more relevant measures, such as the nurse-parent partnership measure tool, to confirm predictive and concurrent validity. The Korean version of the FCCQ-R of 30 questions on five subscales is a valid and reliable measurement of Korean nurses' perceptions of FCC.

How clinicians discuss patients' donor registrations of consent and presumed consent in donor conversations in an opt-out system: a qualitative embedded multiple-case study.

BACKGROUND: The Netherlands introduced an opt-out donor system in 2020. While the default in (presumed) consent cases is donation, family involvement adds a crucial layer of influence when applying this default in clinical practice. We explored how clinicians discuss patients' donor registrations of (presumed) consent in donor conversations in the first years of the opt-out system. METHODS: A qualitative embedded multiple-case study in eight Dutch hospitals. We performed a thematic analysis based on audio recordings and direct observations of donor conversations (n = 15, 7 consent and 8 presumed consent) and interviews with the clinicians involved (n = 16). RESULTS: Clinicians' personal considerations, their prior experiences with the family and contextual factors in the clinicians' profession defined their points of departure for the conversations. Four routes to discuss patients' donor registrations were constructed. In the Consent route (A), clinicians followed patients' explicit donation wishes. With presumed consent, increased uncertainty in interpreting the donation wish appeared and prompted clinicians to refer to "the law" as a conversation starter and verify patients' wishes multiple times with the family. In the Presumed consent route (B), clinicians followed the law intending to effectuate donation, which was more easily achieved when families recognised and agreed with the registration. In the Consensus route (C), clinicians provided families some participation in decision-making, while in the Family consent route (D), families were given full decisional capacity to pursue optimal grief processing. CONCLUSION: Donor conversations in an opt-out system are a complex interplay between seemingly straightforward donor registrations and clinician-family interactions. When clinicians are left with concerns regarding patients' consent or families' coping, families are given a larger role in the decision. A strict uniform application of the opt-out system is unfeasible. We suggest incorporating the four previously described routes in clinical training, stimulating discussions across cases, and encouraging public conversations about donation.

Sleep-related problems as a mediator in the association between depression and work-family conflict in middle-aged female workers: A population-based study.

AIM: To investigate the mediating effect of sleep-related problems on the relationship between depression and work-family conflicts (WFCs) among middle-aged female workers. DESIGN: Secondary analysis of cross-sectional study. METHODS: Overall, 15,718 female workers aged 40-65 years from the Sixth Korean Working Conditions Survey (KWCS) were included. Depression was assessed using the WHO-5 wellbeing index; sleep-related problems and WFCs were measured with five items on a Likert scale. The mediating effect of sleep-related problems between depression and WFCs was analysed using model 4 of Hayes PROCESS macro for SPSS. RESULTS: There was a significant positive correlation between depression and both sleep-related problems (r = 0.225, p < 0.001) and WFCs (r = 0.124, p < 0.001). Depression also had a significant effect on sleep-related problems (ß = 0.221, p < 0.001) and WFCs (ß=0.061, p < 0.001). Sleep-related problems had a significant effect on WFCs (ß = 0.282, p < 0.001). The indirect effect of depression on WFCs by mediating sleep-related problems was ß = 0.062 (95% bootstrap confidence interval = 0.057-0.068). The study also confirmed the significance of the mediating effect of sleep-related problems in the relationship between depression and WFCs.

The impact of COVID-19 on relationships between family/friend caregivers and care staff in continuing care facilities: a qualitative descriptive analysis.

BACKGROUND: The COVID-19 pandemic and related public health measures added a new dynamic to the relationship between caregivers and care staff in congregate care settings. While both caregivers and staff play an important role in resident quality of life and care, it is common for conflict to exist between them. These issues were amplified by pandemic restrictions, impacting not only caregivers and care staff, but also residents. While research has explored the relationship between caregivers and care staff in long-term care and assisted living homes, much of the research has focused on the caregiver perspective. Our objective was to explore the impact of COVID-19-related public health measures on caregiver-staff relationships from the perspective of staff in long-term care and assisted living homes. METHODS: We conducted 9 focus groups and 2 semi-structured interviews via videoconference. RESULTS: We identified four themes related to caregiver-staff relationships: (1) pressure from caregivers, (2) caregiver-staff conflict, (3) support from caregivers, and (4) staff supporting caregivers. CONCLUSIONS: The COVID-19 pandemic disrupted long-standing relationships between caregivers and care staff, negatively impacting care staff, caregivers, and residents. However, staff also reported encouraging examples of successful collaboration and support from caregivers. Learning from these promising practices will be critical to improving preparedness for future public health crises, as well as quality of resident care and life in general.

Qualidade de vida e satisfação dos familiares de pacientes internados nas unidades de terapia intensiva* / Quality of life and satisfaction of relatives of patients admitted to intensive care units* / Calidad de vida y satisfacción de los familiares de pacientes ingresados en unidades de cuidados intensivos*

RESUMO: Objetivo: avaliar a satisfação dos familiares de pacientes internados na Unidade de Terapia Intensiva e sintomas de ansiedade, depressão, estresse pós-traumático e qualidade de vida. Método: estudo longitudinal com familiares de pacientes de uma Unidade de Terapia Intensiva, no sul do Brasil, realizado em dois momentos: após alta do paciente, seguida de três meses, com os instrumentos: FS-ICU 24, HADS, IES-6, EQ-5D-3L. A análise foi realizada no programa Statical Package for the Social Sciences (SPSS). Resultados: 73/100% familiares, sendo 58/79,5% do sexo feminino. A satisfação dos familiares foi de 77,42%. Houve diferença significativa nos sintomas de depressão (p=0,001), estresse pós-traumático (p=0,000) e qualidade de vida, (p=0,007) e "ansiedade e depressão" (p=0,009), quando comparados aos familiares. A ansiedade não apresentou significância (p=0,095). Conclusão: satisfação com os cuidados foi satisfatória. Os que perderam seus entes se mostraram mais deprimidos, estressados e com piores escores de qualidade de vida, contribuindo, assim, para a prática clínica.

ABSTRACT Objective: To evaluate the satisfaction of family members of patients admitted to the Intensive Care Unit and symptoms of anxiety, depression, post-traumatic stress, and quality of life. Method: a longitudinal study with relatives of patients in an Intensive Care Unit in southern Brazil, carried out at two points: after the patient was discharged, followed by three months, using the following instruments: FS-ICU 24, HADS, IES-6, EQ-5D-3L. The analysis was carried out using the Statistical Package for the Social Sciences (SPSS) program. Results: 73/100% of relatives, 58/79.5% of whom were female. Family member satisfaction was 77.42%. There was a significant difference in symptoms of depression (p=0.001), post-traumatic stress (p=0.000) and quality of life, (p=0.007) and "anxiety and depression" (p=0.009) when compared to family members. Anxiety was not significant (p=0.095). Conclusion: Satisfaction with care was satisfactory. Those who lost their loved ones were more depressed, stressed and had worse quality of life scores, thus contributing to clinical practice.

RESUMEN Objetivo: Evaluar la satisfacción de los familiares de pacientes ingresados en la Unidad de Cuidados Intensivos y los síntomas de ansiedad, depresión, estrés postraumático y calidad de vida. Método: estudio longitudinal con familiares de pacientes internados en una Unidad de Terapia Intensiva del sur de Brasil, realizado en dos momentos: después del alta del paciente, seguido por tres meses, utilizando los siguientes instrumentos: FSICU 24, HADS, IES-6, EQ-5D-3L. El análisis se realizó con el programa Statical Package for the Social Sciences (SPSS). Resultados: Resultados: 73/100% de los familiares, de los cuales 58/79,5% eran mujeres. La satisfacción de los familiares fue del 77,42%. Hubo una diferencia significativa en los síntomas de depresión (p=0,001), estrés postraumático (p=0,000) y calidad de vida, (p=0,007) y "ansiedad y depresión" (p=0,009), en comparación con los familiares. La ansiedad no fue significativa (p=0,095). Conclusión: La satisfacción con los cuidados fue satisfactoria. Los que perdieron a sus seres queridos estaban más deprimidos, estresados y tenían peores puntuaciones de calidad de vida, lo que contribuye a la práctica clínica.

Lose at sunrise, but gain at sunset: Linking social cyberloafing to psychological detachment, personal life enhancement of work, and mental health.

BACKGROUND: Previous research has demonstrated that the personal use of social media, i.e., social cyberloafing, is associated with employee mental health. However, the underlying mechanism through which social cyberloafing is related to mental health has received limited attention. OBJECTIVE: Drawing on conservation of resource theory and work/nonwork enhancement literatures, we developed and tested a model that examines health effect of social cyberloafing. As such, employees' social cyberloafing is posited as positively related to psychological detachment and personal life enhancement of work, which in turn would act as mediators that explain why social cyberloafing improves mental health. METHODS: Data from 375 Chinese employees were analyzed to test research hypotheses using the structural equation modeling and bias-corrected bootstrap method with Mplus 7.4. RESULTS: The results found that social cyberloafing is positively related to psychological detachment, but not with personal life enhancement of work. Social cyberloafing was positively related to employees' mental health through both psychological detachment and through psychological detachment and personal life enhancement of work serially. CONCLUSION: Psychological detachment alone and alongside personal life enhancement of work form part of the mechanisms explaining how and why engaging in social cyberloafing is positively associated with employees' mental health. These mechanisms offer insights to organizations into how the mental health of employees can be improved in the digital workplace.

Needs of family members of patients in intensive care and their perception of medical communication / Necessidades de familiares de pacientes em terapia intensiva e sua percepção da comunicação médica

ABSTRACT Objective: To understand the perception of medical communication and needs of family members with loved ones in intensive care. Methods: The study was mainly qualitative and exploratory, with thematic analysis of comments made by 92 family members with loved ones in intensive care units when answering in-person interviews comprising the Quality of Communication Questionnaire (QoC) and open-ended questions about their need for additional help, the appropriateness of the place where they received information, and additional comments. Results: The participants' mean age was 46.8 years (SD = 11.8), and most of them were female, married and had incomplete or completed elementary education. The following themes were found: perception of characteristics of medical communication; feelings generated by communication; considerations about specific questions in the QoC; family members' needs; and strategies to overcome needs regarding communication. Characteristics that facilitated communication included attention and listening. Characteristics that made communication difficult included aspects of information sharing, such as inaccessible language; lack of clarity, objectivity, sincerity, and agreement among the team; limited time; and inadequate location. Feelings such as shame, helplessness, and sadness were cited when communication was inadequate. Family members' needs related to communication included more details about the loved one's diagnosis, prognosis, and health condition; participation in decisionmaking; and being asked about feelings, spirituality, dying and death. Others were related to longer visitation time, psychological support, social assistance, and better infrastructure. Conclusion: It is necessary to enhance medical communication and improve hospital infrastructure to improve the quality of care for family members.

RESUMO Objetivo: Compreender a percepção da comunicação médica e das necessidades de familiares com entes queridos em terapia intensiva. Métodos: O estudo foi principalmente qualitativo e exploratório, com análise temática dos comentários feitos por 92 familiares com entes queridos em unidades de terapia intensiva ao responderem entrevistas presenciais, incluindo o Quality of Communication Questionnaire e perguntas abertas sobre sua necessidade de mais ajuda, a adequação do local onde recebiam informações e outros comentários. Resultados: A média de idade dos participantes foi 46,8 anos (desviopadrão de 11,8), e a maioria deles era do sexo feminino, casada e tinha educação fundamental incompleta ou completa. Foram encontrados os seguintes temas: percepção das características da comunicação médica; sentimentos gerados pela comunicação; considerações sobre questões específicas do Quality of Communication Questionnaire; necessidades dos familiares; e estratégias para suprir as necessidades relativas à comunicação. As características que facilitaram a comunicação incluíram atenção e escuta. As características que dificultaram a comunicação incluíram aspectos de compartilhamento de informações, como linguagem inacessível; falta de clareza, objetividade, sinceridade e concordância entre a equipe; tempo limitado e localização inadequada. Sentimentos como vergonha, impotência e tristeza foram citados quando a comunicação era inadequada. As necessidades dos familiares relacionadas à comunicação incluíam mais detalhes do diagnóstico, do prognóstico e da condição de saúde do ente querido; participação na tomada de decisões e ser questionado sobre sentimentos, espiritualidade, morrer e morte. Outros estavam relacionados às visitas mais longas, ao apoio psicológico, à assistência social e à melhor infraestrutura. Conclusão: É necessário otimizar a comunicação médica e a infraestrutura hospitalar para melhorar a qualidade da assistência a familiares.

Interdisciplinary training for the family approach in primary healthcare / Formación interdisciplinaria para el enfoque familiar en la atención primaria de salud / A formação interdisciplinar para a abordagem familiar na atenção primária à saúde

ABSTRACT Objective: To reflect on the interdisciplinary training of health team professionals to work with the family in Primary Healthcare, considering the complexity of the family phenomenon in their health and illness experiences. Method: A reflection article in which the need to incorporate new concepts for training professionals to work with the family in Primary Healthcare is discussed. Results: The theoretical articulation between the Patient- and Family-Centered Care Model, Interprofessional Education and Primary Healthcare is fundamental to guide interdisciplinary training in health, aiming at including the family as the protagonist of the care of its members and active in the teaching and learning process of the healthcare professionals. Conclusion: It becomes necessary to promote changes in the training model of health professionals to incorporate collaborative practice with the family.

RESUMEN Objetivo: reflexionar sobre la formación interdisciplinar de los profesionales del equipo de salud para el trabajo con la familia en la Atención Primaria de Salud, considerando la complejidad del fenómeno familiar en sus vivencias de salud y enfermedad. Método: artículo de reflexión en el que se discute la necesidad de incorporar nuevos conceptos para la formación de profesionales para el trabajo con la familia en la Atención Primaria de Salud. Resultados: la articulación teórica entre el Modelo de Atención Centrado en el Paciente y la Familia, la Educación Interprofesional y la Atención Primaria de Salud es fundamental para orientar la formación interdisciplinaria en salud, visando incluir a la familia como protagonista del cuidado de sus miembros y activa en el proceso de enseñanza- aprendizaje de los profesionales. Conclusión: es necesario promover cambios en el modelo de formación de los profesionales de la salud para la incorporación de la práctica colaborativa con la familia.

RESUMO Objetivo: refletir sobre a formação interdisciplinar dos profissionais da equipe de saúde para atuar com a família na Atenção Primária à Saúde, considerando a complexidade do fenômeno família em suas experiências de saúde e doença. Método: artigo de reflexão em que se discute a necessidade de incorporar novas concepções para a formação dos profissionais para atuar com a família na Atenção Primária à Saúde. Resultados: a articulação teórica entre o Modelo do Cuidado Centrado no Paciente e na Família, a Educação Interprofissional e a Atenção Primária à Saúde é fundamental para nortear a formação interdisciplinar em saúde, visando a inclusão da família como protagonista do cuidado de seus membros e ativa no processo de ensino-aprendizagem dos profissionais. Conclusão: torna-se necessário promover mudanças no modelo de formação dos profissionais de saúde para a incorporação da prática colaborativa junto à família.

Searching for human connection to transcend symbolisms in pediatric palliative care / Buscando la conexión humana para trascender los simbolismos de los cuidados paliativos pediátricos / Buscando por conexão humana para transcender simbolismos dos cuidados paliativos em pediatria

ABSTRACT Objectives: to present a theoretical model for the interactional context of health professionals and families of children and adolescents under palliative care. Methods: qualitative study based on the theoretical frameworks of Grounded Theory and Symbolic Interactionism. Ten palliative care professionals took part in this study through semi-structured interviews employing snowball technique from 2020 to 2021. Results: the comparative data analysis resulted in the theoretical model "Searching for human connection to transcend symbolisms in pediatric palliative care". It reveals symbolic elements that substantiate the construction of a collaborative context integrating two phenomena: "Overcoming boundaries and intertwining paths" and "Embracing suffering to weave meaningful experiences". Symbolisms in palliative care guide the behavior of families and professionals, which makes them the key factor to be managed. Final Considerations: symbolisms and suffering continually integrate the interactional experience of professionals. Empathy and compassion are fundamental elements to enable their connection with families.

RESUMEN Objetivos: presentar un modelo teórico sobre el contexto interaccional entre los profesionales de la salud y las familias de niños y adolescentes en cuidados paliativos. Métodos: estudio cualitativo bajo la Teoría Fundamentada en los Datos y el Interaccionismo Simbólico. Participaron diez profesionales activos en cuidados paliativos, a través de entrevistas semiestructuradas, con base en la técnica de "bola de nieve", entre los años 2020 y 2021. Resultados: el análisis comparativo de los datos resultó en el modelo teórico 'Buscando la conexión humana para trascender simbolismos de los cuidados paliativos pediátricos'. Evidencia los elementos simbólicos que apoyan la construcción del contexto colaborativo integrando dos fenómenos: 'Rompiendo fronteras y entrelazando caminos' y 'Acogiendo el sufrimiento para tejer experiencias de vida significativas'. Los simbolismos de los cuidados paliativos guían los comportamientos de las familias y los profesionales, constituyendo el principal factor a ser manejado. Consideraciones Finales: el simbolismo y el sufrimiento son continuamente parte de la experiencia de interacción del profesional. La empatía y la compasión son elementos fundamentales para su conexión con las familias.

RESUMO Objetivos: apresentar um modelo teórico sobre o contexto interacional entre profissionais de saúde e famílias de crianças e adolescentes em cuidados paliativos. Métodos: estudo qualitativo sob os referenciais da Teoria Fundamentada nos Dados e Interacionismo Simbólico. Participaram dez profissionais atuantes em cuidado paliativo, por meio de entrevista semiestruturada, a partir da técnica "bola de neve", entre os anos 2020 e 2021. Resultados: a análise comparativa dos dados resultou no modelo teórico 'Buscando por conexão humana para transcender simbolismos do cuidado paliativo pediátrico'. Evidencia elementos simbólicos que sustentam a construção do contexto colaborativo integrando dois fenômenos: 'Rompendo fronteiras e entrelaçando caminhos' e 'Acolhendo o sofrimento para tecer experiências de vida significativas'. Simbolismos dos cuidados paliativos orientam comportamentos das famílias e profissionais, constituindo-se no principal interveniente a ser manejado. Considerações Finais: simbolismos e sofrimento integram continuamente a experiência interacional do profissional. Empatia e compaixão são elementos fundamentais para sua conexão com as famílias.

Assessment of the Psychosocial Care Center multidisciplinary team from users' and family members' perspective / Evaluación del equipo multidisciplinario del Centro de Atención Psicosocial desde la perspectiva de los usuarios y familiares / Avaliação da equipe multiprofissional do Centro de Atenção Psicossocial na perspectiva de usuários e familiares

ABSTRACT Objectives: to assess the multidisciplinary team of a Psychosocial Care Center I from users' and family members' perspective. Methods: an evaluative study, anchored in the fourth generation evaluation theoretical-methodological framework, carried out in a Psychosocial Care Center I, from September 2021 to March 2022. Eleven users and 06 family members participated. Data were collected through non-participant observation, individual interviews and negotiation sessions, and analyzed using the Constant Comparative Method, using the MAXQDA software. Results: the team develops its care based on individual and collective care, with integrated and complementary work by professionals. They seek to facilitate treatment initiation and continuation, considering health needs and offering support, understanding and guidance to users and their families. Final Considerations: the multidisciplinary team's work is based on the psychosocial paradigm, which can qualify care and strengthen the service role in the mental health network.

RESUMEN Objetivos: evaluar el equipo multidisciplinario de un Centro de Atención Psicosocial I desde la perspectiva de los usuarios y familiares. Métodos: estudio evaluativo, anclado en el referencial teórico-metodológico de la evaluación de cuarta generación, realizado en un Centro de Atención Psicosocial I, de septiembre de 2021 a marzo de 2022. Participaron 11 usuarios y 06 familiares. Los datos fueron recolectados a través de observación no participante, entrevistas individuales y sesiones de negociación, y analizados mediante el Método Comparativo Constante, utilizando el software MAXQDA. Resultados: el equipo desarrolla su asistencia a partir de la asistencia individual y colectiva, con trabajo integrado y complementario de los profesionales. Busca facilitar el inicio y la continuación del tratamiento, considerando las necesidades de salud y ofreciendo apoyo, comprensión y orientación a los usuarios y sus familias. Consideraciones Finales: la actuación del equipo multidisciplinario se basa en el paradigma psicosocial, que puede calificar la atención y fortalecer el papel del servicio en la red de salud mental.

RESUMO Objetivos: avaliar a equipe multiprofissional de um Centro de Atenção Psicossocial I na perspectiva dos usuários e familiares. Métodos: estudo avaliativo, ancorado no referencial teórico-metodológico da avaliação de quarta geração, realizado em um Centro de Atenção Psicossocial I, de setembro de 2021 a março de 2022. Participaram 11 usuários e 06 familiares. Os dados foram coletados por observação não participante, entrevistas individuais e sessões de negociação, e analisados pelo Método Comparativo Constante, com uso do software MAXQDA. Resultados: a equipe desenvolve sua assistência pautada em atendimentos individuais e coletivos, com trabalho integrado e complementar dos profissionais. Busca facilitar o início e a continuidade do tratamento, considerando as necessidades de saúde e ofertando apoio, compreensão e orientações ao usuário e familiares. Considerações Finais: a atuação da equipe multiprofissional se pauta no paradigma psicossocial, o que pode qualificar o cuidado e fortalecer o papel do serviço na rede de saúde mental.

Medication reconciliation in pediatrics: a validation of instruments to prevent medication errors / Conciliación medicamentosa en pediatría: validación de instrumentos para la prevención de errores en la medicación / Reconciliação medicamentosa em pediatria: validação de instrumentos para a prevenção de erros na medicação

ABSTRACT Objectives: to develop and validate the content of two instruments for promoting medication reconciliation for the transition of care of hospitalized children. Methods: methodological study, conducted in five stages: scope review for conceptual structure; elaboration of the initial version; content validation with five specialists using the Delphi technique; reassessment; and construction of the final version of the instruments. A content validity index of at least 0.80 was adopted. Results: three rounds of evaluation were carried out to reach the validity index of the proposed contents, whereas a new analysis of 50% of the 20 items of the instrument aimed at families, and 28.5% of the 21 items aimed at professionals was necessary. The instrument aimed at families reached an index of 0.93, and the instrument for professionals, 0.90. Conclusions: the proposed instruments were validated. It is now possible to proceed with practical implementation studies to identify their influence on safety during medication reconciliation at transition of care.

RESUMEN Objetivos: elaborar y validar contenido de dos instrumentos para la promoción de conciliación medicamentosa en la transición de atención de niños hospitalizados. Métodos: estudio metodológico realizado en cinco etapas: revisión de ámbito para estructura conceptual; elaboración de versión inicial; validación del contenido con cinco especialistas utilizando la Técnica Delphi; re-evaluación; y construcción de versión final de los instrumentos. Adoptado índice de validez de contenido, como mínimo, 0.80. Resultados: fueron realizadas tres rondas de evaluación para alcance de índice de validez en los contenidos propuestos, siendo necesario nuevo análisis de 50% de los 20 ítems del instrumento destinado a familias, y 28,5% de los 21 ítems destinados a profesionales. Instrumento dirigido a familias alcanzó índice de 0,93; y el instrumento, a profesionales, 0,90. Conclusiones: instrumentos propuestos fueron validados, siendo posible proseguir con estudio de implementación práctica para identificar influencia en la seguridad durante la conciliación medicamentosa en la transición de atención.

RESUMO Objetivos: elaborar e validar o conteúdo de dois instrumentos para a promoção da reconciliação medicamentosa na transição dos cuidados de crianças hospitalizadas. Métodos: estudo metodológico realizado em cinco etapas: revisão de escopo para estrutura conceitual; elaboração da versão inicial; validação do conteúdo com cinco especialistas utilizando a Técnica Delphi; reavaliação; e construção da versão final dos instrumentos. Adotou-se o índice de validade de conteúdo de, no mínimo, 0.80. Resultados: foram realizadas três rodadas de avaliação para alcance de índice de validade nos conteúdos propostos, sendo necessária nova análise de 50% dos 20 itens do instrumento destinado às famílias, e 28,5% dos 21 itens destinados aos profissionais. O instrumento direcionado às famílias atingiu índice de 0,93; e o instrumento, aos profissionais, 0,90. Conclusões: os instrumentos propostos foram validados, sendo possível prosseguir com estudo de implementação prática para identificar influência na segurança durante a reconciliação medicamentosa na transição dos cuidados.

Family presence during invasive procedures: a pilot study to test a tool.

BACKGROUND: Family Presence During Invasive Procedures (FPDI) generates controversy among healthcare professionals. Twibell and her team designed an instrument that measured nurses' Risk-Benefit and Self-Confidence perceptions regarding family presence during resuscitation and was used in numerous studies. OBJECTIVES: Evaluate the new tool for Family Presence Risk-Benefit and Family Presence Self-Confidence during invasive procedures and find out the opinions of the medical and nursing staff on FPDIP. METHOD: Cross-sectional methodological pilot study. Online and paper questionnaires modified from a previous translation. A factor analysis was performed for the validity of the indices and bivariate analysis for all the variables. Ethical approvals and research permissions were obtained according to national standards. RESULTS: One hundred twenty healthcare professionals (22.18%) answered the survey. Cronbach's α on the Family Presence Risk-Benefit scale was 0.877. Cronbach's α on the Family Presence Self-Confidence scale was 0.937. The correlation between the Risk-Benefit and Self-confidence variables is significant and with a moderate intensity of the relationship. A lower predisposition to Family Presence During Invasive Procedures is observed. Physicians are more reluctant than nurses. CONCLUSIONS: The FPDI generates controversy as it alters health professionals' routines when they decide whether to allow it or not. There is a tendency for younger professionals to support FPDI. In general, health professionals, mainly physicians, do not favor FPDI. Health workers who perceive fewer risks and more benefits in FPDI and have greater self-confidence are more in favor of FPDI. The psychometric properties and internal consistency of the questionnaire indicate the validity and reliability of this tool.