Factores relacionados a la depresión durante la adolescencia: una revisión integrativa / Factors related to depression during adolescence: an integrative review

INTRODUCCIÓN: La depresión es un problema de salud mental común en la etapa de la adolescencia, se manifiesta por descenso del humor, tristeza y pérdida de interés en actividades cotidianas. Esta etapa es sensible por los grandes cambios biopsicosociales. OBJETIVO: identificar factores relacionados a la depresión en adolescentes que puedan actuar como factores protectores o factores de riesgo. METODOLOGÍA: se realizó una búsqueda bibliográfica en las bases de datos WoS, PUBMED, Scopus, y BVS; se utilizaron descriptores normalizados para la expresión de búsqueda "Adolescente AND factores protectores OR factores de riesgo AND depresión", seleccionando 38 artículos. RESULTADOS: se obtuvieron 34 factores, que pueden actuar como de riesgo y protectores, y agrupados en dimensiones: a) biológica: género, edad, índice de masa corporal, problemas de salud; b) psicológica: autorregulación, autoestima, afecto positivo/negativo, pensamientos negativos, imagen corporal, estrés, alexitimia, calidad de vida, y c) social, subdividida en tres grupos: c.1) hábitos: consumo de sustancias nocivas, actividad física/sedentarismo, adicción a pantallas, rendimiento académico, participación comunitaria, estilo de vida, actividad sexual, sueño; c.2) contexto familiar: experiencias familiares, relación padres-hijos, funcionalidad familiar, composición familiar, nivel socioeconómico; y c.3) entorno: escuela urbana, implicación escolar, bullying, apoyo social, exposición a violencia, eventos vitales negativos, alfabetización en salud y áreas verdes. CONCLUSIÓN: Existen factores relacionados a la depresión en adolescentes que podrán actuar como factores protectores o de riesgo, su conocimiento por parte de los profesionales de la salud y de la enfermera en particular es fundamental para intervenirlos.

INTRODUCTION: Depression is a common mental health problem in adolescence, manifested by poor mood, sadness and loss of interest in daily activities. Adolescents are especially susceptible to depression due to the great biopsychosocial changes in this stage of life. OBJECTIVE: To identify risk factors and protective factors associated with adolescent depression that are evidence-based. METHODOLOGY: a bibliographic search was carried out in the WoS, PUBMED, Scopus, and VHL databases. Standardized descriptors used to conduct the search included Adolescent AND protective factors OR risk factors AND depression. 38 articles were selected. RESULTS: 38 factors were identified, classified as risky and protective, and grouped into the following dimensions: a) biological: gender, age, BMI, health problems; b) psychological: negative or positive affection, negative thoughts, satisfaction with body image, stress, alexhythemia, quality of life, self-regulation, self-esteem; and c) social, subdivided into three groups: c.1) habits, physical activity, consumption of harmful substances, screen addiction, lifestyle that needs to be improved, sexual activity, community participation, sleep duration, academic performance; c.2) family context: experiences, parent-child relationship, composition, socioeconomic level, functionality, educational level of parents; and c.3) environmental:: social support, bullying, exposure to violence, belonging to an urban school, negative life events, school involvement, neighborhood with green areas and health literacy. CONCLUSION: Several factors that affect depression in adolescents are reported by the literature. In the biological dimension, they tend to be risk factors, and in the psychological and social dimensions, they may increase risk or be protective. Knowledge of these factors by the nurse is essential to guide interventions.

Validez y confiabilidad de una escala de apoyo social percibido en población adolescente / Validity and reliability of a scale of perceived social support in adolescent population

El apoyo social percibido por los/as adolescentes, puede influir positiva o negativamente en su salud, lo que hace necesario contar con instrumentos que permitan su medición. Esto podrá orientar el desarrollo de estrategias promotoras de salud más efectivas. Objetivo: Determinar la confiabilidad y validez de la Escala Multidimensional de Apoyo Social Percibido, en población adolescente chilena. Material y Método: Estudio psicométrico, el instrumento fue aplicado a 247 estudiantes de educación secundaria, previo consentimiento informado de un adulto responsable y asentimiento de los adolescentes. Se estableció confiabilidad a través de evaluación de consistencia interna mediante alpha de Cronbach, validez de criterio concurrente a través de correlación con escala de autoeficacia y validez de constructo mediante análisis factorial. Resultados: La confiabilidad es adecuada para la escala total (=0,88) y para cada subescala (= >0,76), la estructura de la escala demostró ser tridimensional al igual que la escala original y positivamente relacionada con autoeficacia. Conclusión: Este instrumento es confiable y válido para ser utilizado en población adolescente chilena (AU)

The perceived social support in adolescents can have a positive or negative influence in their health; therefore it is necessary to have the instruments to measure it. This could guide the development of health promoter strategies. Objective: To determine the reliability and validity of the Multidimensional Scale of Perceived Social Support in Chilean adolescents. Materials and Method: Psychometric study, the instrument was applied to 247 high school students, with previous informed consent of the duty-bearer adult and the adolescent approval. Reliability was established through internal consistency evaluation by Cronbach’s alpha; concurrent criterion validity was established through the correlation with auto efficiency scale; and construct validity was established through factorial analysis. Results: Reliability is adequate for the total scale (=0,88) and for each subscale (= >0,76). Scale structure showed to be tridimensional as the original scale and positively related with auto efficiency. Conclusion: This instrument is reliable and valid to be used in the Chilean adolescent population (AU)

Critical theory and its contribution to the nursing discipline.

This article reflects on the Critical theory, stemming from the most important philosophical concepts and the modifications it has endured over time. Thereafter, we expose the contribution of the Critical theory to Nursing. This emphasizes on the contextual analysis of the phenomena and it is a self-critique to prevent dogmatisms and totalitarianisms. It postulates that in order to establish a truth, we must consider the historical conditions within which said truth emerges. Jürgen Habermas, with his Theory of Communicative Action, reorients the original postulates of the Critical theory, making it more coherent from the social point of view, through the Guiding Interests of Knowledge. Nursing professionals who follow the Critical theory highlight the need to improve the description of the construction of knowledge with an emancipating and liberating purpose, which permits Nursing to provide responses to approach reality through a global and dialectic vision and from a democratic position of knowledge, construct research from the social situational reality that is part of its daily experience; everything that can be unified as a "Philosophy of Nursing Care", which should be incorporated onto the professional formation of the discipline and onto the research area.

[Nursing contribution in health decision making]. / Aporte de enfermería a la toma de decisiones en salud.

Decision making in health is a frequent situation, although potentially difficult, depending on patient/user characteristics and the context or the situation of health. This causes decisional conflicts in patients/users. The present study proposes to analyze the decision making process in health, conceptually, and nurses' contributions to understand and confront the phenomenon. The Ottawa the Model of Decisions Making in Health, proposed by Annette O'Connor, arises as a useful tool that enables nurses to carry out effective interventions with persons who face decision problems. Patients/users can assume a more active participation in the decisions on their own health.

Critical theory and its contribution to the nursing discipline / Teoría crítica y su contribución a la disciplina de enfermería / Teoria crítica e sua contribuição à disciplina de enfermagem

En primera instancia, se reflexiona sobre la Teoría Crítica a partir de los conceptos filosóficos más importantes y las modificaciones que ha sufrido en el tiempo. Seguidamente, se expone la contribución de la Teoría Crítica a la Enfermería. Esta enfatiza en el análisis contextual de los fenómenos y es autocrítica con el fin de impedir los dogmatismos y totalitarismos. Además, postula que para establecer una verdad se deben considerar las condiciones históricas en las cuales surge esa determinada verdad. Jürgen Habermas, con su Teoría de la Acción Comunicativa, reorienta los postulados originales de la Teoría Crítica, haciéndola más coherente desde el punto de vista social, mediante los Intereses Rectores del Conocimiento. Los profesionales de Enfermería, seguidores de la Teoría Crítica, destacan la necesidad de mejorar la descripción de la construcción del conocimiento con una finalidad emancipatoria y liberadora, que permita a Enfermería aportar respuestas para acercarse a la realidad mediante una visión global y dialéctica, y a partir de una posición democrática del conocimiento, construir investigación desde la realidad situacional social que forma parte de su experiencia cotidiana. Todo lo cual pueda unificarse como una "Filosofía del Cuidado" de Enfermería, que debería incorporarse en la formación profesional de la disciplina y en el área investigativa.

This article reflects on the Critical theory, stemming from the most important philosophical concepts and the modifications it has endured over time. Thereafter, we expose the contribution of the Critical theory to Nursing. This emphasizes on the contextual analysis of the phenomena and it is a self-critique to prevent dogmatisms and totalitarianisms. It postulates that in order to establish a truth, we must consider the historical conditions within which said truth emerges. Jürgen Habermas, with his Theory of Communicative Action, reorients the original postulates of the Critical theory, making it more coherent from the social point of view, through the Guiding Interests of Knowledge. Nursing professionals who follow the Critical theory highlight the need to improve the description of the construction of knowledge with an emancipating and liberating purpose, which permits Nursing to provide responses to approach reality through a global and dialectic vision and from a democratic position of knowledge, construct research from the social situational reality that is part of its daily experience; everything that can be unified as a "Philosophy of Nursing Care", which should be incorporated onto the professional formation of the discipline and onto the research area.

Se reflexiona sobre a Teoria Crítica, a partir dos conceitos filosóficos mais importantes e as modificações que sofreu no tempo, seguidamente, expõe-se a contribuição da teoria crítica à Enfermagem. Esta enfatiza a análise contextual dos fenômenos e é autocrítica com o fim de impedir os dogmatismos e totalitarismos. Postula que para estabelecer uma verdade se deve considerar as condições históricas nas quais surge está determinada verdade. Jürgen Habermas com sua Teoria da Ação Comunicativa, reorienta os postulados originais da Teoria Crítica, fazendo-a mais coerente desde o ponto de vista social, através dos Interesses Reitores do Conhecimento. Os profissionais de Enfermagem seguidores da Teoria Crítica, destacam a necessidade de melhorar a descrição da construção do conhecimento com uma finalidade emancipatória e liberadora, que permita a Enfermagem contribuir respostas para acercar-se à realidade por meio de uma visão global e dialética, e desde uma posição democrática do conhecimento, construir investigação desde a realidade situacional social que faz parte de sua experiência cotidiana. Tudo o qual possa unificar-se como uma "Filosofia do Cuidado" de Enfermagem, que deveria incorporar-se na formação profissional da disciplina e na área investigativa.

Aporte de enfermería a la toma de decisiones en salud / Nursing contribution in health decision making / Contribuição da enfermagem na tomada de decisões em saúde

En el ámbito sanitario tomar decisiones es una situación frecuente, aunque potencialmente difícil, ya sea por las características del(la) usuario(a), del contexto o de la situación de salud. Esto provoca conflicto decisional en los(as) usuarios(as). El presente artículo se propone analizar conceptualmente la toma de decisiones en salud y los aportes realizados desde enfermería para comprender y enfrentar el fenómeno. Así, el Modelo de Toma de Decisiones en Salud de Ottawa, propuesto por la enfermera Annette O'Connor, surge como una herramienta útil para que las(os) enfermeras(os) realicen intervenciones efectivas con personas que se enfrentan a problemas decisionales, donde además el(la) usuario(a) puede asumir una participación más activa en las decisiones sobre su propia salud.

Decision making in health is a frequent situation, although potentially difficult, depending on patient/user characteristics and the context or the situation of health. This causes decisional conflicts in patients/users. The present study proposes to analyze the decision making process in health, conceptually, and nurses' contributions to understand and confront the phenomenon. The Ottawa the Model of Decisions Making in Health, proposed by Annette O'Connor, arises as a useful tool that enables nurses to carry out effective interventions with persons who face decision problems. Patients/users can assume a more active participation in the decisions on their own health.

No âmbito sanitário, tomar decisões é uma situação frequente, embora potencialmente difícil, devido às características do usuário ou do contexto da situação de saúde. Isso provoca um conflito de decisão nos usuários. O presente artigo propõe-se a analisar conceitualmente a tomada de decisões na saúde e as contribuições realizadas pela enfermeira para compreender e enfrentar o fenômeno. Desta forma, o Modelo de Tomada de Decisões na Saúde de Ottawa proposto pela enfermeira Annette O'Connor surge como uma ferramenta útil para que os profissionais da saúde realizem intervenções efetivas em pessoas que enfrentam problemas de decisões. Além disso, o usuário poderá assumir uma participação mais ativa nas decisões sobre sua própria saúde.

Proceso de enfermería aplicado a una madre y su hijo lactante con enfoque transcultural utilizando taxonomías / Nursing process applied to a mother and her infant with transcultural approach using taxonomies

Este artículo tiene como objetivo describir los resultados de la aplicación de un proceso de enfermería con enfoque transcultural y utilizando taxonomías. Se presenta un estudio de caso de una madre y su hijo hospitalizado en un establecimiento asistencial del Servicio de Salud de la V Región, Chile. Para ello, se realizó la valoración utilizando un instrumento basado en los factores del Modelo del Sol Naciente, de la teoría de la Diversidad y Universalidad de los Cuidados Culturales de Madeleine Leininger. Los Diagnósticos de Enfermería prioritarios se formularon en base a la Taxonomía NANDA-I. Los cuidados culturales congruentes se enfocaron en la preservación, negociación y reestructuración de estos, utilizando la Taxonomía NIC. Para la evaluación, se aplicaron los resultados esperados propuestos por NOC. Para aplicar este proceso de enfermería, se evidenció la relevancia de conocer los valores y creencias del grupo familiar, por el impacto que tienen en la toma de decisiones y prácticas de cuidado. La realización de este proceso evidenció la posibilidad de utilizar conjuntamente el modelo transcultural y las taxonomías. Sin embargo, hubo dificultades para enunciar los Diagnósticos NANDA- I, por lo que es necesario incorporar algunos factores relacionados con el enfoque transcultural.

This article has the purpose to describe the results of the application of a transcultural nursing process approach and using taxonomies. A case study is presented of a mother and son hospitalized in a care establishment of the Health Service of the V Region, Chile. To do this, the assessment was performed using a factor based Model of the Rising Sun, Theory of Diversity and Universality Cultural Care Madeleine Leininger instrument. Priority Nursing Diagnoses were made based on the NANDA-I Taxonomy. Congruent care focused on cultural preservation, negotiation and restructuring of these, using the NIC Taxonomy. For evaluation, the expected results given by NOC were applied. To apply the nursing process, the importance of learning about the values and beliefs of the family, the impact on decision-making and care practices is evident. The completion of this process showed the possibility of jointly using the transcultural model and taxonomies. However, there were diffi culties in stating the NANDA-I diagnoses, so it is necessary to incorporate some related factors transcultural approach.

División sexual del trabajo y Enfermería / Gender division of labor and nursing

La división sexual del trabajo, genera que hombres y mujeres se distribuyan ta-reas e ingresen al mundo laboral de forma diferenciada. Considerando que la Enfermería es ejercida mayoritariamente por mujeres, se realiza un análisis sobre el impacto que ha tenido la división sexual del trabajo en enfermería. Se caracteriza el trabajo reproductivo y productivo, y se analiza la segregación que vivencia la mujer a través de los argumentos aportados por los enfoques económicos y de género. Entre las conclusiones destaca que la subvalorización de la Enfermería es consecuencia de la desvaloración del trabajo femenino y del cuidado a nivel social, como consecuencia de arraigados prejuicios de género. Situaciones que se han comenzado a revertir, las mujeres han logrado hacer visibles las desventajosas condiciones en las que se desempeñan y la Enfermería se ha fortalecido como disciplina profesional demostrando su validez social y científica (AU)

Gender division of labor generates that men and women distribute tasks and join workforce in differentiated ways. Provided that nursing is practiced mostly by women, an analysis is performed about the impact that work division by gender has had on nursing. Reproductive and productive analysis is characterized and segregation by women through arguments given by economical and gender perspective is analyzed. Among some conclusions, nursing undervaluation is a consequence from down-grading of female labor and social care because of deeply-rooted gender prejudice. Situations which have started to revert, women have achieved to make visible certain disadvantaged conditions in which they practice their occupation, and nursing has been strengthened as a professional discipline showing social and scientific validity (AU)

[Protective and family risk factors related to drugs in families of adolescents from Valparaíso, Chile]. / Factores protectores y de riesgo familiar relacionados al fenómeno de drogas, presentes en familias de adolescentes tempranos de Valparaíso, Chile.

This quantitative, cross-sectional, descriptive and exploratory research aimed to identify and describe protective and family risk factors related to the phenomenon of drugs in adolescents' families in the community of Valparaiso, Chile. The sample consisted of 61 students enrolled in 2008 and selected through simple random sampling. The data collection instrument was a questionnaire, developed and validated by experts from five countries in the Americas. Of the adolescents, 86.9% perceived the family relations, in general, as a protective factor, highlighting great communication with parents. Tensions, health and behavior problems were found as protective factors by a small number of students who act as neutral actors, in both cases associated with alcohol and drugs consumption by some family member. As risk factors, education and parents' kind of work were appointed.

Factores protectores y de riesgo familiar relacionados al fenómeno de drogas, presentes en familias de adolescentes tempranos de Valparaíso, Chile / Fatores protetores e de risco familiar, relacionados ao fenômeno de drogas, entre adolescentes tempranos de Valparaíso, Chile / Protective and family risk factors related to drugs in families of adolescents from Valparaíso, Chile

Esta investigación cuantitativa, descriptiva-transversal y exploratoria objetivó identificar y describir los factores protectores y de riesgo familiar frente al fenómeno de las drogas en familias de adolescentes tempranos de la comunidad de Valparaíso, Chile. La muestra tuvo 61 estudiantes registrados en 2008 que fueron seleccionados por muestreo aleatorio simple. El instrumento de recolección de datos fue un cuestionario elaborado y validado por expertos de 5 países de la región de las Américas. El 86,9 por ciento de los adolescentes percibieron las relaciones familiares, en general, como factor protector, con destaque para la alta comunicación con los padres. El acumulo de tensiones, problemas de salud y comportamiento fueron vistos como factores protectores por la mayoría, un número pequeño de estudiantes lo considera como factor neutro, en ambos casos asociados al consumo de alcohol y drogas por parte de algún miembro de la familia. También, la mayoría considera como factores de riesgo la educación y el tipo de trabajo de los padres.

O objetivo deste estudo foi identificar e descrever os fatores protetores e de risco familiar frente ao fenômeno das drogas, em famílias de adolescentes tempranos da comunidade de Valparaiso, Chile. Trata-se de pesquisa quantitativa, descritiva transversal e exploratória. A amostra foi composta por 61 estudantes, matriculados em 2008, e selecionados por amostra aleatória simples. O instrumento de coleta de dados foi um questionário elaborado e validado por experts de 5 países das regiões das Américas. Dos adolescentes, 86,9 por cento perceberam as relações familiares. em geral, como fator protetor, com destaque à alta comunicação com os pais. O acúmulo de tensões, problemas de saúde e comportamentais foram encontrados como fatores protetores entre número pequeno de estudantes que atuam como atores neutros, em ambos os casos associados ao consumo de álcool e drogas, por parte de algum membro da família, e, como fatores de risco se destacam a educação e o tipo de trabalho dos pais.

This quantitative, cross-sectional, descriptive and exploratory research aimed to identify and describe protective and family risk factors related to the phenomenon of drugs in adolescents' families in the community of Valparaiso, Chile. The sample consisted of 61 students enrolled in 2008 and selected through simple random sampling. The data collection instrument was a questionnaire, developed and validated by experts from five countries in the Americas. Of the adolescents, 86.9 percent perceived the family relations, in general, as a protective factor, highlighting great communication with parents. Tensions, health and behavior problems were found as protective factors by a small number of students who act as neutral actors, in both cases associated with alcohol and drugs consumption by some family member. As risk factors, education and parents' kind of work were appointed.