Estigma: la relevancia del contacto social en el trastorno mental / Stigma: The relevance of social contact in mental disorder

Introducción: El estigma asociado a la enfermedad mental es un problema de salud, discriminando y limitando las oportunidades de las personas que lo padecen. El contacto social con personas que sufren un trastorno mental es una estrategia utilizada para producir cambios en los estereotipos en la población. El objetivo del estudio fue examinar las diferencias en el nivel de estigma en muestras con contacto social y población general. Método: El estudio incluye dos experiencias. La primera (n=42) incluye jugadores de una liga de fútbol abierta en la que juega un equipo de jugadores con diagnóstico de esquizofrenia. En la segunda se compara una muestra sin contacto conocido (n=62) y una muestra con contacto (n=100). La herramienta utilizada de evaluación fue el AQ-27, en versión española (AQ-27-E). Se analizaron la diferencia de medias entre las dos muestras, de cada una de las 9 subescalas. Resultados: En la primera experiencia, todas las subescalas presentaron menor puntuación en poscontacto que en precontacto, excepto responsabilidad, dos subescalas que mostraron diferencias significativas fueron coacción (t=6,057, p= 0,000) y piedad (t=3,661, p= 0,001). En la segunda experiencia, siete subescalas mostraron nivel de significación (p=< 0,05). Responsabilidad y segregación no lo mostraron. Conclusiones: Se observa que el contacto social realizado en entornos cotidianos puede producir un impacto positivo en la reducción del estigma, esto puede contribuir a favorecer la igualdad de oportunidades (AU)

Introduction: The stigma associated with mental illness is a health problem, discriminating and limiting the opportunities for sufferers. Social contact with people suffering a mental disorder is a strategy used to produce changes in population stereotypes. The aim of the study was to examine differences in the level of stigma in samples with social contact and the general population. Method: The study included two experiments. The first (n=42) included players in an open football league who played in a team with players with schizophrenia. In the second included, a sample without known contact (n=62) and a sample with contact (n=100) were compared. The evaluation tool used was AQ-27, Spanish version (AQ-27-E). The mean difference between the two samples of each of the 9 subscales was analyzed. Results: In the first experiment, all the subscales had lower scores in post-contact than in pre-contact, except for responsibility. The two subscales that showed significant differences were duress (t=6.057, p=.000) and Pity (t=3.661, p=.001). In the second experiment, seven subscales showed a significance level (p=<.05). Segregation and responsibility and did not. Conclusions: It is observed that the social contact made in daily situations can have a positive impact on the reduction of stigma. This can help to promote equality of opportunity (AU)

Controlled drugs and the principle of double effect: the role of the district nurse.

The role of district nurses in the effective management of pain in palliative care has been strengthened by the Misuse of Drugs (Amendment No.2) (England, Wales and Scotland) Regulations 2012 that allow district nurses who are independent or supplementary prescribers to prescribe and administer controlled drugs. However, prescribing controlled drugs brings increased responsibility and accountability for the safe management of these medicines. In this article Richard Griffith considers the principle of double effect that seeks to ensure that patients in intractable pain receive the analgesia they require to manage that pain while district nurses avoid liability and prosecution under the law of murder.

Can covert administration of medicines be in a patient's best interests?

In this article Richard Griffith considers whether it is ever in a patient's best interests to be given medicine by covert means, such as disguising it in food.

Covert administration of medicines: a contentious issue.

In its State of Care (2015) report the Care Quality Commission once again highlight unsafe management of medicines as a key concern in those care providers that require improvement. Underpinning the poor management of medicines is the unsafe and routine use of covert administration. In this article Richard Griffith looks at the legal and professional obligations for district nurses when they consider advising the use of covert medicines.

Understanding the Code: keeping accurate records.

In his continuing series looking at the legal and professional implications of the Nursing and Midwifery Council's revised Code of Conduct, Richard Griffith discusses the elements of accurate record keeping under Standard 10 of the Code. This article considers the importance of accurate record keeping for the safety of patients and protection of district nurses. The legal implications of records are explained along with how district nurses should write records to ensure these legal requirements are met.

Understanding the Code: the duty of candour.

A key recommendation of the Mid Staffordshire Inquiry (Francis, 2013) was to establish a culture of openness in all health services through a duty of candour. A professional duty of candour is a key requirement of the Nursing and Midwifery Council's revised Code (2015). It requires all district nurses to be candid with patients about any errors in their care and treatment. District nurses working in England are also subject to a statutory duty of candour imposed on their employer by the Care Quality Commission. In this article, the author considers the organisational and professional duties of candour and their effect on a district nurse's practice.

Understanding the Code: exceptions to the duty of patient confidentiality.

Last month's article considered the scope of a district nurse's duty to maintain the confidentiality of patient information under the Nursing and Midwifery Council (NMC) Code, their contract of employment, and the law. This month, Richard Griffith considers the exceptions to these duties and sets out when a district nurse would be justified in disclosing patient information.

Ethical concerns of visiting nurses caring for older people in the community.

BACKGROUND: An understanding of the ethical concerns encountered by visiting nurses in the community is needed. Yet, there is a lack of research on this topic. OBJECTIVES: The purpose of this study was to explore the ethical concerns that visiting nurses experience when caring for vulnerable older people living in a community. DESIGN AND SAMPLE: A qualitative thematic analysis was used to explore the nature of the ethical issues experienced by visiting nurses (N = 13) who care for vulnerable older people, over 65 years of age, in a South Korean community. METHODS: In-depth interviews were conducted with visiting nurses. Qualitative thematic analysis was used to explore the main themes of the phenomenon. ETHICAL CONSIDERATIONS: This study was approved by the Institutional Review Board of Chung-Ang University Bioethics Committee in South Korea. RESULTS: Four ethical themes emerged from the qualitative data: (a) quantitative performance rather than quality care, (b) clients being invisible, (c) tuning the level of the relationship with clients, and (d) facing the visiting nurses' own limitations. CONCLUSION: This study provides a theoretical basis to understand the ethical aspects of visiting nurses' interactions with clients, which should facilitate the development of ethical guidelines for visiting nurses to use in making ethical decisions in their practice.

Development and psychometric evaluation of the Moral Competence Scale for Home Care Nurses in Japan.

PURPOSE: The purpose of this study was to evaluate the validity and reliability of the Moral Competence Scale for Home Care Nurses (MCSHCN). METHODS: A self-administered questionnaire that included the preliminary MCSHCN (90 items) was distributed to home care nurses (HCNs) in Japan. Usable data (from 1,961 questionnaires) were analyzed. RESULTS: Item and exploratory factor analysis for the MCSHCN revealed 45 items that loaded on 5 factors. This 5-factor model showed reasonable fit to the data by confirmatory factor analysis (root mean square error of approximation [RMSEA] = 0.070). Thus, the model closely corresponded to the theoretical components of moral competence. Cronbach's alpha ranged from .78 to .93. CONCLUSIONS: The construct validity and internal consistency reliability were supported. Further research is needed to refine this scale to increase the generalizability.

Maintaining professional boundaries: keep your distance.

Maintaining professional boundaries is essential to an effective nurse-patient relation whose sole focus must be on the care and treatment needs of the patient. Complaints about failures to maintain professional boundaries are increasing, with the Nursing and Midwifery Council reporting some 247 new cases in the year 2012-12. The article outlines the scope of the nurse-patient relationship, what activity is considered to be outside the professional and considers the consequences for community nurses if they are found to have breached a professional boundary.

Grupo Focal de discusión como herramienta para el estudio de las relaciones de género en miembros de una comunidad urbana / Focus Group discussion as tool to study gender relations in urban community members

Objetivo: Esta investigación cualitativa con perspectiva de género tiene como meta mostrar la utilidad del Grupo Focal de discusión en el estudio de los factores que influyen en las relaciones de género partiendo de las concepciones de los miembros de una comunidad urbana. La metodología incluyó la realización de un grupo focal con un total de n=5 mujeres y n=5 hombres, todos pertenecientes a la comunidad seleccionada para el estudio. Para la sistematización de los datos se manejó Atlas ti 6.2 (versión Demo) y en la etapa de razonamiento de los testimonios fue usado análisis del discurso. Los resultados mostraron: Las relaciones de género basadas en el modelo de género tradicional representan un riesgo para la salud física y mental del grupo estudiado. Las demostraciones de hombría, individualidad y promiscuidad en el género masculino ponen su salud en riesgo. En el género femenino la sumisión puede desencadenar baja autoestima, sentimientos de culpa y sufrimiento mental. Conclusiones: Este estudio describe cómo grupo focal de discusión representó una herramienta efectiva durante el ejercicio de la enfermería comunitaria, ya que este tipo de técnica promueve el dialogo y el intercambio con miembros de la comunidad(AU)

Aim: This qualitative research with gender perspective aims to illustrate the usefulness of Focus Group Discussion in the study of factors influencing gender relations, based on the conceptions of urban community members. The methodology included focus groups with n=5 women and n=5 men members of the community selected. For the systematization of the data handled Atlas ti 6.2 (Demo) and the stage of reasoning of the testimony was used discourse analysis. The results showed: Gender relations based on the traditional gender represent a risk to physical and mental health of the group being studied. Demonstration of manhood, individuality and promiscuity in the male gender, put them in such risk. In female gender submissiveness may trigger low self-esteem, blaming and mental suffering. Conclusions: This study describes how Focal Group Discussion represented an effective tool during the exercise of community nursing because this kind of technique promoted dialogue and exchange with community members(AU)

Ethical tensions associated with the promotion of public health policy in health visiting: a qualitative investigation of health visitors' views.

AIM: To explore whether and how health visitors experience ethical tensions between the public health agenda and the need to be responsive to individual clients. BACKGROUND: Current health policy in England gives health visitors a key role in implementing the government's public health agenda. Health visitors are also required by their Professional Code to respond to the health-related concerns and preferences of their individual clients. This may generate tensions. METHODS: A total of 17 semi-structured individual interviews covering participants' experiences of implementing public health interventions and perceptions of the ethical tensions involved were conducted. Interviews were audio-recorded, transcribed and analysed thematically using a Framework approach. FINDINGS: Health visitors raised a number of ethical concerns, which they attributed to organisational resource allocation and the introduction of protocols and targets relating to public health goals. They did not always regard it as appropriate to raise topics that employing organisations had identified as public health priorities with particular clients for whom they were not priorities, or who had other more pressing needs. They noted that resources that were allocated towards reaching public health targets were unavailable for clients who needed support in other areas. Organisational protocols designed to monitor performance put pressure on health visitors to prioritise achieving targets and undermined their ability to exercise professional judgement when supporting individual clients. This had implications for health visitors' sense of professionalism. Health visitors saw trusting relationships as key to effective health visiting practice, but the requirement to implement public health priorities, combined with a lack of resources in health visiting, eroded their ability to form these. Policies need to be evaluated with regard to their impact upon a broader range of processes and outcomes than public health goals. The erosion of health visitors' professional values and ability to develop relationships with clients could have numerous adverse implications.

Crisis y futuro de la humanidad / Crisis and future of humanity

Vivimos tiempos inquietantes. La crisis económica nos llena de zozobra. Los jóvenes, en paro y atenazados por el miedo a acabar viviendo peor que sus padres, no se ven capaces de hacerse cargo de la situación. ¿Qué ha sucedido para que España y Europa, que hace menos de cuatro años parecían tierra de oportunidades para nativos y foráneos, se hayan convertido en territorios hostiles? La crisis económica no lo explica todo; es sólo un síntoma de que las bases sobre las que estábamos construyendo el futuro no eran tan firmes. Es cierto que la crisis ha puesto al descubierto la obscenidad del capitalismo financiero especulativo. También es cierto que esta crisis puede ser la gran oportunidad para construir el mundo sobre unas bases económicas humanas y sostenibles, es decir, justo lo contrario de la actual sumisión a la dictadura de los mercados financieros. Pero la crisis contemporánea tiene unas raíces más profundas y extensas. Voy a referirme a las otras crisis, tan importantes o más que la económica, porque para atisbar el futuro resulta imprescindible rastrear atentamente el presente y descubrir las «señales débiles» de las oportunidades latentes, que esperan que las convirtamos en realidades(AU)

We live in troubling times. The economic crisis fills us with anxiety. Young, unemployed and throes to finish living worse fear that their parents are not able to take charge of the situation. What has happened to that Spain and Europe, less than four years ago seemed to land of opportunities for native and foreign, have become hostile territories? The economic crisis does not explain everything; It is only a symptom that the basis on which we were building the future were not as firm. It is true that the crisis has brought to bare the obscenity of speculative financial capitalism. It is also true that this crisis can be the great opportunity to build the world on a human and sustainable economic basis, i.e., just the opposite of the current submission to the dictatorship of the financial markets. But the contemporary crisis has deep and extensive roots. I will refer to other crises, as important or more than the economic one, because to glimpse the future it is essential to carefully track the present and discover the «weak signals» the latent opportunities that await we become them realities(AU)

Professional dignity in nursing in clinical and community workplaces.

The purpose of this qualitative study was to analyse nurses' professional dignity in their everyday working lives. We explored the factors that affect nursing professional dignity in practice that emerge in relationships with health professionals, among clinical nurses working in hospitals and in community settings in central Italy. The main themes identified were: (i) nursing professional dignity perceived as an achievement; (ii) recognition of dignity beyond professional roles. These two concepts are interconnected. This study provides insights into professional dignity in nursing being perceived as an achievement linked to the intrinsic dignity of every human being. The 'nursing professional dignity perceived as an achievement' was perceived as having declined in different social factors. Some factors of nursing professional dignity perceived as an achievement were attained more easily in community settings. 'Recognition of dignity beyond professional roles' underpins the intrinsic dignity as an expression of humanity, embedded in persons regardless of any profession, and values, such as: respect, moral integrity, humility, working conscientiously and kindness.

Acting faithfully in community.

The phenomenon of acting faithfully in the nurse-person relationship is an important ethical topic of interest to the discipline of nursing. It may also be conceptually defined and illuminated in nurse-community relationships. This column begins an articulation of what it potentially means to have straight thinking about nurses' obligations with persons in community. The language of nurse science from the humanbecoming school of thought will be used to explore the phenomenon.

Smoking cessation: promoting the health of older people who smoke.

Community nurses are well placed to address smoking behaviour with older people. Smoking cessation can significantly improve the health and wellbeing of older people, and to withhold support for smoking cessation is a form of age discrimination. This paper provides advice to community nurses about how to approach discussions about smoking behaviour with older clients as part of their health education practice. It addresses some of the ethical concerns that have been raised by community nurses, explains how smoking in older people may be reduced using a harm reduction apporoach and through working with the concept of the smoke-free home.

A process for developing a principle-centred district nursing service philosophy.

While it is well known that team vision and values statements in nursing can promote person-centred care, practitioner role clarity and empowerment, and service effectiveness, especially during times of change, their use in district nursing is limited. Accepted practice is to formulate vision and values statements 'from the top', and then seek buy-in from other staff groups, however, this inhibits practitioner engagement. This paper describes the use of group facilitation, based on principle-centred leadership practices, to engage practitioners in all the creative aspects of developing a values statement. Increasing practitioner engagement would be expected to provide the above benefits by improving communication with service-users and other key stakeholders and by motivating performance evaluation and improvement.