Effectiveness of problem-solving technique in caring for family caregivers: a clinical trial study in an urban area of Catalonia (Spain).

AIMS AND OBJECTIVES: To evaluate the effectiveness of the problem-solving technique in reducing symptoms of anxiety and depression among primary caregivers and to describe and evaluate the process carried out by nurses to find strengths and areas of improvement. BACKGROUND: In Spain, home care for the chronically ill patients and their family caregivers should be a priority in health and social policies due to the increase in ageing population and the progressive increase in dependent individuals. One of the areas involved is home-based nursing and counselling for family caregivers. DESIGN: This is a clinical trial study (during 2007-2011) with a mixed analysis methodology. METHODS: Quantitative analysis was used to evaluate the effectiveness of the problem-solving technique in reducing symptoms of anxiety and depression. The clinical trial involved a control and experimental group and pre-post intervention measurements, using the Goldberg Scale. The practical application of the technique was evaluated by qualitative analysis. RESULTS: There was a statistically significant improvement in symptoms of anxiety and depression in the intervention group after application of the technique. Positive aspects and resistance factors in its implementation were noted. CONCLUSIONS: The problem-solving technique is a cost-effective intervention for reducing symptoms of anxiety and depression in family caregivers of the chronically ill patients. Positive aspects of the technique were satisfaction of the caregiver and nurse, and work done together based on reflection. Resistance factors identified were difficulty in maintaining written records and subjective perception of a lack of time in everyday practice for its consistent application. RELEVANCE TO CLINICAL PRACTICE: The problem-solving technique is an important tool to reduce the suffering of family caregivers of chronically ill patients and a prevention element of family claudication.

Cuidar a una cuidadora familiar en Atención Primaria a partir de la teoría de la incertidumbre / Care for a family carer in Primary Care using the uncertainty theory

El análisis del caso parte de la Teoría de la Incertidumbre frente a la enfermedad de Merle H. Mishel, que aportó la idea de que aun sin haber una solución a la incertidumbre, el individuo debería aceptarla como parte de la realidad y reinterpretarla como una oportunidad que promueve un nuevo punto de vista de la vida regido por la probabilidad. La autora nos propone conceptos teóricos que permiten abordar los fenómenos que viven las cuidadoras familiares desde las perspectivas de sus vivencias y estrés. Plantea la incertidumbre y la indeterminación como contradicciones que no deberían crear angustia permanentemente. Esta puede liberarse, poco a poco, si creamos líneas de fuga a través del cuidado. Entre estas líneas se sitúa la técnica de resolución de problemas como estrategia útil en Atención Primaria para disminuir la incertidumbre de la cuidadora. El artículo describe la evolución de Isabel una mujer de 63 años cuidadora familiar de una madre dependiente y de una hija con anorexia. La enfermera de Atención Primaria en las visitas domiciliarias identifica un problema de cansancio del rol de cuidador y el de conflicto de decisiones. Se expone la valoración realizada a partir de los conceptos principales de la teoría y se trabaja con la cuidadora desde el Método de Resolución de Problemas con el objetivo de reducir su ansiedad y ayudarla a movilizar los recursos internos y aumentar su bienestar (AU)

This article describes the outcome of Isabel, a 63- year-old female family caregiver of her dependent mother and her daughter with anorexia. The primary care nurse identifies the problem of weariness of the care-givers role and that of conflict of decisions during home visits. It describes the assessment made from the main concepts of the theory and the work with the care-givers by the problem solving method in order to reduce anxiety and help to mobilize internal resources and increase their welfare. This case discussion starts from the Uncertainty Theory of illness of Merle Mishel, who raised the idea that even without a solution to the uncertainty, a person should accept it as a part of their life and reinterpret it as an opportunity to promote a new view of life governed by probability. The author proposes theoretical concepts that allow the phenomena experienced by family caregivers to be approached from the perspective of their experiences and stress. It establishes uncertainty and indecisiveness as contradictions that should not create anxiety permanently. This can be released gradually, if we create lines of flight though the care. Among these lines are located the Problem Solving Method as a strategy useful in primary health care to reduce the uncertainty of the caregivers (AU)

[Care for a family carer in Primary Care using the uncertainty theory]. / Cuidar a una cuidadora familiar en Atención Primaria a partir de la teoría de la incertidumbre.

This case discussion starts from the Uncertainty Theory of illness of Merle Mishel, who raised the idea that even without a solution to the uncertainty, a person should accept it as a part of their life and reinterpret it as an opportunity to promote a new view of life governed by probability. The author proposes theoretical concepts that allow the phenomena experienced by family caregivers to be approached from the perspective of their experiences and stress. It establishes uncertainty and indecisiveness as contradictions that should not create anxiety permanently. This can be released gradually, if we create lines of flight though the care. Among these lines are located the Problem Solving Method as a strategy useful in primary health care to reduce the uncertainty of the caregivers. This article describes the outcome of Isabel, a 63- year-old female family caregiver of her dependent mother and her daughter with anorexia. The primary care nurse identifies the problem of weariness of the care-givers role and that of conflict of decisions during home visits. It describes the assessment made from the main concepts of the theory and the work with the care-givers by the problem solving method in order to reduce anxiety and help to mobilize internal resources and increase their welfare.

Re-Pensando las complejidades del rol profesional desde la teoría de Bourdieu / Re-thinking the complexities of the professional role from Bourdieu's theory

Este artículo tiene como objetivo realizar una apreciación crítica desde perspectivas teóricas y prácticas a cerca del rol profesional, en un esfuerzo por superar el lenguaje y la práctica dominante. Resaltamos la necesidad de trabajar más allá de las descripciones de tareas autónomas y tareas de colaboración, y mostrar formas que sitúen nuestras prácticas en una cultura de compromiso para promover la creación de contextos que tienen el potencial de ofrecer conocimiento y reconocimiento de cuidados intencionales. Realizaremos el análisis de rol profesional desde la teoría de la práctica de Bourdieu, intentando que ésta nos ayude a clarificar nuestro rol y sobre todo para replantear estructuras y modificar disposiciones, deteniéndonos especialmente en el concepto de habitus y capital simbólico (AU)

The objective of this article is to do a critical appreciation from the theoretical and practical perspectives of the professional role, in an effort to exceed the language and the dominant practice. We highlight the necessity of working beyond the descriptions of autonomous tasks and tasks of collaboration, and showing forms which situate our practices in a culture of compromise to promote the creation of contexts which have the potential to offer knowledge and recognition of intentional caring. We analyse the professional role from the theory of the Bourdieu practice, trying to clarify our role with the help of this practice and mainly to redefine structures and modify dispositions, paying special attention to the concept of habitus and symbolic capital (AU)

Sobre los saberes culturales y el fenómeno "sentirse bien-sentirse mal" / On cultural knowledge and the phenomenon

El objetivo del presente estudio es identificar los saberes culturales inmersos en el fenómeno "sentirse-bien, sentirse mal", en diferentes situaciones de cuidado. Se elaboró un estudio cualitativo con un enfoque fenomenológico interpretativo, mediante el análisis de 18 narrativas a partir de entrevistas en profundidad realizadas por alumnas del Máster en Ciencias de la Enfermería en diferentes contextos de cuidados. Las categorías identificadas fueron: (1) Cronicidad y concepto de sentirse bien-sentirse mal. En la cronicidad este concepto está íntimamente relacionado con la recuperación de las actividades de la vida diaria y es componente importante en la percepción individual del concepto "calidad de vida". (2) Momentos agudos de enfermedad y concepto de sentirse bien-sentirse mal. En el análisis de los relatos del paciente aparecieron aspectos esenciales del fenómeno "sentirse bien-sentirse mal" para aumentar la comprensión de aspectos universales de algunos de sus componentes. Destacar que el fenómeno está íntimamente relacionado con la recuperación de las actividades de la vida diaria, y es un mediador importante en la percepción individual del concepto "calidad de vida". El interés de cara al cuidado es distinguir sus componentes universales, contextualizarlos en la práctica, dentro de las singularidades que presenta cada persona, de modo que nos permita su potenciación. El resultado es un cambio en la experiencia sentida (AU)

The object of the present study is to identify cultural knowledges immersed in the feeling-well, feeling-bad phenomenon in different care settings. A qualitative study was undertaken using a phenomenological interpretation approach through a meta-analysis of 18 narratives of profound interviews undertaken by Nursing Science Master Degree Students in different care situations. The categories established were: (1) Chronicity and the concept of feeling well-feeling bad. In this category, this concept is closely related to the recovery of the daily living activities which is a very important issue in the individual's perception of the concept "quality of life". (2) Moments in acute illness and the concept of feeling well-feeling bad. Essential aspects related to the feeling well-feeling bad phenomenon came up when analysis of the patients' tales was performed, increasing the comprehension of universal aspects that can be put into context without forgetting the singularities of each person (AU)

El relato de la experiencia depresiva. Aplicando los factores cuidativos de Jean Watson / The expression of the depressive experience: the application of Jean Watson caring factors

La elevada frecuencia de personas con trastornos depresivos en todos los niveles de atención y la complejidad de los cuidados, conlleva la necesidad, para la enfermera, de desarrollar nuevas habilidades y competencias en el abordaje integral de los pacientes y su familia. Para la comprensión de una persona con depresión es útil una mirada etnográfica que nos permita conocer la expresión subjetiva de la vivencia de la enfermedad. Un marco adecuado de referencia para ayudar en el cuidado de estos procesos es la teoría de Jean Watson sobre la Filosofía y Ciencia de los Cuidados Humanos, que a través de sus diez factores cuidativos enmarca el rol de la enfermera en “cómo tener cuidado de...”. Este artículo trata de analizar, a través de los factores cuidativos de Watson, las vivencias subjetivas relacionadas con la transformación del cuerpo y la mente de las personas con depresión: el sufrimiento y el dolor, la autoimagen y el reconocimiento, la falta de energía, la pérdida de la esperanza. Se concluye que no es posible controlar el cuerpo sin controlar la mente y para ello nos puede ayudar el análisis subjetivo de la experiencia y la aplicación de los factores cuidativos

The high frequency of people with depressive disorders in Primary Health Care as well as in Hospital and the complexity of care, carry for nurses the need to develop new skills and competences to deal with complete care of patiens and families. To understand a person suffering depressive disorders may be useful an ethnographic look that let us know the subjective expression of the experience of being ill. An appropriate framework to help care is Jean Watson’s Philosophy and Science of Human Caring, trough 10 caring factors that frame the nursing role “to take care of…”. This paper tries to analyze the subjective experience related to body and mind changes: suffering and pain, self-image and acceptance, lack of energy, loss of hope… in patients with depressive disorders. It is not possible to control body and not to control mind. To analyze the subjective experience trough Watson’s 10 caring factors, can be a good help