Experiencias de vivir con cáncer para los adolescentes,adultos jóvenes y sus familias: revisión narrativa y síntesis

IntroductionAdolescence is a critical life stage marked by significant physical, psychological, and social change. Cancer diagnosis during adolescence profoundly affects this experience for adolescents and young adults (AYA) and their families with an impact that continues throughout life. It is important to understand these experiences to ensure delivery of appropriate and high-quality supportive care. This narrative review critically appraised and synthesised qualitative literature that explored the experiences of AYAs and their families living with cancer.MethodNarrative review and synthesis of qualitative research of AYAs’ and their families’ experiences of cancer. MEDLINE, CINAHL and PsycINFO were searched between February 2000 and September 2019 using search terms including «adolescent», «young people», «young adult», «cancer», «family», and «qualitative». Literature was appraised and synthesised using Popay et al.¹ framework.Results3016 articles were retrieved (Medline n = 1298, CINAHL n = 1632, PsycINFO n = 86). Of these, 151 duplicates were removed. 2865 papers were screened with 121 abstracts considered for eligibility for inclusion. Eighteen papers met the inclusion criteria. Three inter-related themes were identified: being diagnosed with cancer; uncertainty - holding on to life and gaps in care delivery.Discussion and recommendationsFew studies discuss the impact of cancer on the families of AYA living with cancer. Future research should explore this experience. By doing so the relational impact of cancer will be better understood as the basis of supportive family-centred care.PROSPERO Registration: CRD42017084148.     

Investigación-acción-participativa sobre empoderamiento en mujeres mayores: un análisis teórico-metodológico

This article aims to conceptually and methodologically analyse the use of Participatory Action Research (PAR), through field research, in order to increase knowledge about it, and to illustrate its strengths and weaknesses to encourage its use in Health Sciences.Within qualitative methodology, PAR can be used as a tool for the analysis of change and transformation, whose objective is the emancipation and liberation of people who find themselves in an oppressive social context.The assessment of this approach is based on field research with older women who sought to improve their self-care through empowerment. For this purpose, PAR was undertaken, consisting of 22 sessions and two individual telephone calls where qualitative and quantitative data generation tools were used; all this through the most critical modality of PAR. In an exercise of reflexivity, modifications and improvements in the intervention were detected to work with older women in future research.The analysis carried out makes it possible to generate new knowledge on PAR for future research thanks to the identification of critical points: the link generated, the adaptation of tools to older women, and the handling of the high volume of data produced.     

Eficacia de un plan de acogida teórico-práctico dirigido a profesionales de enfermería de nueva incorporación en una Unidad de Cuidados Intensivos Pediátrica: estudio piloto

Aims(1) to design a training programme for newly hired nursing personnel and (2) to determine self-perception and perceived stress before and after the theoretical and practical parts of the programme with high fidelity simulation activities.MethodsA pilot quasi-experimental pretest-posttest study without control group conducted in a Paediatric Intensive Care Unit from October 2018 to April 2019 was conducted. A newly hired nursing personnel training programme was first designed and delivered. Later, the participants’ self-perception was assessed, as well as their perceived stress and grade of satisfaction using two different Likert scales.ResultsA total of 20 newly hired nurses participated in the study, 90% (n = 18) were female with a median age of 25.5 ± 4.53 years. Higher scores were obtained in participants’ self-perception before and after the theoretical training. Lower significant median scores of the participants’ stress perception were found (6.9 ± 1.57 versus 5.6 ± 1.79). In the practical part of the programme, we obtained higher scores in all items, as well as lower median scores in stress perception (6.4 ± 1.73 versus 5.6 ± 1.93).ConclusionsA theoretical and practical programme for newly hired nursing personnel in a Paediatric Intensive Care Unit improved participants’ self-perception and reduced their perceived median scores in stress levels.     

Potencial del índice de masa corporal como indicador de grasa corporal en jóvenes

ObjectiveWe aim to determine the anthropometric indicator that is most strongly associated with the percentage of body fat and self-regulation of eating behaviour and physical activity among young university students.MethodA cross-sectional study was conducted on 3,869 Mexican university students, of which 53.9% were women. Standard procedures for anthropometry were followed, including weight, height and waist circumference. This data was used for calculating Body Mass Index (BMI), A Body Shape Index, waist-to-height ratio, Body Roundness Index and Conicity index. The self-regulation of eating habits scale and the self-regulation of physical activity scale were used. Mean with standard deviation, percentages and Pearson correlation coefficient were estimated.ResultsThe group of men shown a higher prevalence of excess weight compared to the women. Inverse correlations between most anthropometric indices and self-regulation of eating behaviour and physical activity were found. However, in all cases the correlations were weak. The percentage of fat had a medium frequency of association with Conicity index and high with BMI, waist circumference, waist-to-height ratio and Body Roundness Index, where the BMI showed the highest correlation coefficientConclusionsThe BMI shows the highest magnitude of association with percentage of body fat in university students among the indicators analysed. Therefore it is suggested that nurses use BMI to determine obesity because it is easy to calculate.     

Uso de contenciones mecánicas en unidades de cuidados críticos: caracterización,estándares de aplicación y factores relacionados. Resultados de un estudio multicéntrico

ObjectivesTo describe and characterise the use of mechanical restraint (MR) in critical care units (CCU) in terms of frequency and quality of application and to study its relationship with pain/agitation-sedation/delirium, nurse:patient ratio and institutional involvement.MethodMulticentre observational study conducted in 17 CCUs between February and May 2016. The observation time per CCU was 96 h. The main variables were the prevalence of restraint, the degree of adherence to MR recommendations, pain/agitation-sedation/delirium monitoring and institutional involvement (protocols and training of professionals).ResultsA total of 1070 patients were included. The overall prevalence of restraint was 19.11%, in patients with endotracheal tube (ETT) 42.10% and in patients without ETT or artificial airway it was 13.92%. Adherence rates between 0% and 40% were obtained for recommendations related to non-pharmacological management and between 0% and 100% for those related to monitoring of ethical-legal aspects. The lower prevalence of restraint was correlated with adequate pain monitoring in non-communicative patients (P < .001) and with the provision of training for professionals (P = .020). An inverse correlation was found between the quality of the use of MR and its prevalence, both in the general group of patients admitted to CCU (r = ?.431) and in the subgroup of patients with ETT (r = ?.521).ConclusionsRestraint is especially frequently used in patients with ETT/artificial airway, but is also used in other patients who may not meet the use profile. There is wide room for improvement in non-pharmacological alternatives to the use of MC, ethical and legal vigilance, and institutional involvement. Better interpretation of patient behaviour with validated tools may help limit use of MR.     

Percepción de los estudiantes del Grado en Enfermería sobre su entorno de prácticas clínicas: un estudio fenomenológico

AimTo explore the perception of fourth-year nursing students of the healthcare environment where their training process in clinical practices takes place.MethodsPhenomenological qualitative study based on the hermeneutical philosophy of Gádamer that included the development of focus groups and semi-structured interviews in a sample of fourth-year nursing students from the University of Almería. The collection period was in February 2016. The information obtained was transcribed and analyzed by inductive strategies in search of emerging categories.ResultsThe analysis revealed two main categories: (1) influence of the clinical environment on the healthcare and teaching performance of nurses and on student learning and (2) training and job prospects for the future professionals. Each of them showed two subcategories with their corresponding codes. The information collected showed the experiences and perceptions of Nursing students regarding the healthcare environment where their training process in clinical practices takes place.ConclusionsThis study enabled us to discover the perception of fourth-year nursing students of the environment where their training process in clinical practices takes place. Knowledge of this phenomenon helps to identify deficits in students’ clinical learning and to adapt university curricula to their training needs in order to guarantee their success as professionals facing future clinical-labour demands.     

Prevalencia de las úlceras de pierna en la provincia de Cuenca: un estudio en Atención Primaria

ObjectiveTo determine the prevalence of leg ulcers, and to describe the affected patients, wounds, and treatment.MethodObservational, cross-sectional prevalence study. An ad hoc online questionnaire was sent to all nurses attending Primary Care centres of the “Gerencia de Atención Integrada de Cuenca” (Integrated Care Management of Cuenca, Spain). Data regarding patient sociodemographic and clinical variables, lesion characteristics and the type of intervention (concerning prevention and treatment) were collected.ResultsIn total, 152 professionals (response rate = 98.1%) completed the questionnaire, collecting data from 131,190 inhabitants. A total of 63 patients (75.5 ± 12.6 years old) with 75 ulcers were identified, finding an overall prevalence of 0.480‰ (CI 95%: 0.375-0.614), distributed as: venous ulcer 0.274‰ (n = 36), diabetic foot 0.145‰ (n = 19), and arterial ulcer 0.061‰ (n = 8).The prevalence was similar regarding gender (0.535‰ vs. 0.426‰, respectively, p = .365), but men exhibited more diabetic foot (0.214‰ vs. 0.076‰, p = .037).In all three types of lesions prevalence increased with age, reaching 1.743‰ in 64 + age group.The median of the leg ulcer duration and corrected area were 190.0 ± 340.0 days and 5.0 ± 13.7 cm², respectively, with a recurrence rate of 74.7%.ConclusionsThe prevalence of chronic leg ulcers was lower than that reported in other studies, although with high recurrence rates. Overall estimators from previous studies may have overestimated the prevalence, especially in regions with a high rural component.     

Una mirada cualitativa a la violencia de género entre jóvenes consumidores de alcohol en contextos de ocio

ObjectiveTo know the characteristics of gender violence that underlies among adolescents in the context of leisure, their behavior and how they overcome these conflicts in leisure contexts where the consume alcohol.MethodQualitative study, with an ethnographic and feminist approach, with the participation of young people aged 16 to 22, frequenters of nightlife contexts and alcohol consumers, residents of two Andalusian provinces and one of Castilla-La Mancha. The participants were selected through intentional sampling and interviewed in depth.ResultsAdolescents frequently suffer from gender-based violence in leisure contexts that they assume normally as part of the role of having fun, while they use their own protection strategies to minimize risks. The abuse of alcohol and other drugs increases the possibility that a gender violence event take place.ConclusionGender-based violence among young people in the context of leisure, presents special characteristics that it is necessary to know in order to design preventive policies. The most vulnerable are young women who consume alcohol intensively. They usually go to the hospital emergency department for being unconscious due to alcohol consumption.     

La experiencia emocional de enfermeras de la Unidad de Hospitalización a Domicilio en cuidados paliativos: un estudio cualitativo exploratorio

ObjectiveTo explore the emotions experienced by the nurses of a Home Hospitalization Unit as a result of their work role.MethodA qualitative exploratory study was carried out with a phenomenology approach to explore people's experiences and inner-life experiences. The participants were 9 nurses working in the home hospitalization unit. An analysis of qualitative content was undertaken. Units of meaning were grouped into 13 codes that, in turn, were classified into 4 categories, emotional dimension, beneficial and distressing aspects, daily working life and personal life.ResultsNursing professionals working in palliative care suffer continuous exposure to traumatic situations, although they also report feeling satisfactory emotions that compensate for moments of distress. Having resources such as training in self-care and emotional regulation, as well as social support seems to be key to providing quality care and avoiding the onset of compassion fatigue.ConclusionsMaintaining psychosocial well-being in the workplace is crucial for palliative care nurses to be able to undertake their work in the best possible way.     

Educación integral en sexualidad y anticoncepción para los/las jóvenes

According to the National Institute of Statistics (INE) the number of unwanted pregnancies in Spain is increasing every year. This is particularly worrying as regards unwanted in young people, particularly those under 15, which increased by 76% from 2001 to 2005.The younger age when people begin sexual relationships, the increasingly liberal attitudes, a higher number of sexual partners and high risk sexual practices, expose them to very important health problems, such as unwanted pregnancies and sexually transmitted diseases (STD).Adolescence is a vital phase in the personal and sexual identity process. Sexual Education is necessary in a society which seems to be well informed but on the other hand has a high proportion of ignorance and errors, which could seriously affect the emotional balance of people. Teaching to know and accept their own body, seek information or ask for help is an education that can help them to maintain healthier and satisfactory relationships. On the other hand, the increase in undesired pregnancies and sexually transmitted diseases, including HIV, makes this kind of education a priority. Our experience in sexual education for young people answers this need.Young people have the right to an effective sexual education. Information and comprehensive sexual education provide them with the knowledge, skills and attitudes necessary to take decisions in the present and future.     

Participación de la familia en el cuidado del paciente crítico: un estudio exploratorio

ObjectivesTo determine the level of readiness of the healthcare team regarding family participation in the care of the critically ill adult and their relationship with the individual characteristics of the participants in a medical-surgical intensive care unit (ICU) in Santiago de Chile.MethodA cross-sectional correlational study using a quantitative method and including a focus group to explore the perception of healthcare staff of family participation in the care of the critically ill patient.ResultsThe level of readiness of the healthcare team for family participation in the care of the critically ill patient is medium, at 13.81 out of a total 20. The greater the readiness, the lower the age (r=?.215; P=.019), the higher the rating of previous experience working with families (r=.304; P=.006), and the higher the perception of being comfortable with different activities in the care of the critical patient (r=.495: P<.001). The participants also state that the work environment of the unit, the patient's condition, the relatives’ characteristics, personal judgement, and the preparedness of relatives affect their readiness.ConclusionsThe results contribute towards determining the healthcare team's level of readiness in a setting where the subject of the study has not been implemented. The readiness of the healthcare team is medium, and is related to individual characteristics of the healthcare staff, and to organizational and family aspects. Therefore, strategies are required to address these aspects that might increase readiness.     

Relación del retraso de la lactogénesis II con la percepción materna de leche insuficiente: un estudio longitudinal

AimTo analyze the relationship of delayed lactogenesis II with maternal perception of insufficient milk.MethodsA prospective, multicenter, longitudinal observational study was conducted. Data were obtained at discharge and between 1 and 5 months postpartum on the perception of insufficient milk and related variables, by means of a self-administered questionnaire, and subsequent postal and online follow-up. Logistic regression analysis was used to develop the explanatory model.ResultsA total of 260 puerperal mothers participated. Of these, 31.9% had insufficient milk and 23.6% had delayed lactogenesis II. During postpartum admission, delayed lactogenesis II (OR = 2.26; 95% CI = 1.07-4.79), difficulty in breastfeeding (OR = 1.02; 95% CI = 1.00-1.03), and professional help in breastfeeding (OR = 0.70; 95% CI = 0.50-0.97) were associated with maternal perception of insufficient milk.ConclusionsThe occurrence of breastfeeding difficulties during postpartum admission and at discharge, especially when there is delayed lactogenesis II, should be considered risk indicators, suggesting the need for additional support to standardized care. The perception of insufficient milk is a suitable indicator to assess the quality of professional breastfeeding support in improvement interventions.     

Los factores que influyen en el proceso de adaptación 6 meses después de un ictus:un análisis de trayectoria

ObjectiveThe purpose of this study was to identify the determinant factors that influence the adaptation process and quality of life after a stroke.MethodsThis study is an observational study using a cross-sectional design. Respondents were patients who were 6 months post-discharge after non-hemorrhagic stroke and their family caregivers. Information about respondents was taken from medical record data at two regional general hospitals in West Kalimantan Province, Indonesia. A total of 80 patients were selected using a consecutive sampling method. Theoretical models of patient and caregiver factors that influence adaptation responses and post-stroke quality of life were tested using path analysis.ResultsCaregiver coping, self-efficacy, and illness acceptance had a direct effect on the post-stroke psychosocial adaptation response by 58.1%, with self-efficacy contributing the most (β = 0.668, p < 0.0001). Self-efficacy, illness acceptance, and healthy behavior had a direct effect on the physiological adaptation response by 24.3%, where self-efficacy also contributed the most (β = 0.272, p < 0.014). Psychosocial adaptation and physiological adaptation had a direct effect on the quality of life by 54.6%, where psychosocial adaptation showed the largest contribution (β = 0.63, p < 0.0001).ConclusionSelf-efficacy contributes the most to both psychosocial and physiological adaptations 6 months after stroke. Psychosocial adaptation and self-efficacy have been proven to be the determinant factors that contribute the most to the quality of life of patients 6 months after stroke.     

Efecto de un programa de actividad física en el medio acuático sobre las constantes hemodinámicas en mujeres embarazadas

Objective

To evaluate the effect of a physical activity programme in the aquatic environment with immersion up to the neck, of six weeks duration, on haemodynamic constants in pregnant women.

Calidad de vida sexual de las mujeres ribereñas: análisis de las prácticas y actitudes sexuales

ObjectiveTo analyse the sexual practices, attitudes, and sexual quality of life of Riparian woman and associated factors.MethodA cross-sectional analytical study conducted among Riparian women using the Study of Sexual Behaviour questionnaire. A bivariate analysis and binary logistic regressions were performed to identify factors associated with sexual quality of life.ResultsA total of 138 women participated in the study (n = 138). Of the women, 34.1% and 33.3% reported pain and loss of interest during or after sex, respectively. In terms of practices during sex, women reported kissing (85.5%), cuddling (89.1%), mutual masturbation (37.2%), oral sex (34.8%), and anal sex (23.9%). However, the majority reported not using condoms during sex (63.0%). In terms of sexual quality of life, 39.9% of the women rated it as good. Higher education and early sexual initiation increase the chances of a “good” sexual quality of life.ConclusionBecause Riparian women engage in some risky sexual behaviours, such as not using condoms, educational strategies on the prevention of sexually transmitted infections should be reinforced and incorporated in this population. This may help improve these women's sexual quality of life.