Coping strategies and anxiety in caregivers of palliative cancer patients.

The study purpose was to determine the relationship between coping strategies and anxiety in primary family caregivers of palliative cancer patients. A cross-sectional study was carried out in a Pain and Palliative Care Unit in Spain. Data were collected through interviews from fifty primary family caregivers of palliative cancer patients. Main research variables were: (1) dependent variable: anxiety (subscale of anxiety from Goldberg's scale); (2) independent variable: coping (Brief COPE); (3) control variables: functional capacity and perceived burden. Analyses comprised descriptive statistics, correlation coefficients and multiple linear regression. Anxiety was present in the majority of caregivers surveyed (76%). Anxiety was related to the perception of perceived burden (ß = 0.42, P < 0.001), the emotion-focused coping (ß = -0.28, P = 0.01) and dysfunctional coping (ß = 0.41, P < 0.001), after adjusting for control variables. Thus, emotion-focused coping is negatively associated with anxiety, while dysfunctional coping is positively associated with anxiety. Problem-focused coping is not related to anxiety. Assessment of coping should be done in a systematic way in caregivers of palliative cancer patients.

El Espacio Europeo de Educación Superior y las competencias enfermeras / The european higher education space and the nursing competence

El Proyecto Tuning pretende impulsar la construcción de un Espacio Europeo de Educación Superior a través de un movimiento de debate y reflexión sobre el papel de la Universidad en la formación de los profesionales preparados para el desempeño en la sociedad del siglo XXI. En su base se encuentran profundas transformaciones en los procesos de enseñanza-aprendizaje, el rol a desempeñar por profesores y alumnos, la definición de un sistema de créditos, etc. El concepto de competencia ocupa un lugar central en el lenguaje de la organización del curriculum y la definición de los perfiles de competencias permitirá comparar el desempeño y guiar la docencia hacia objetivos concretos impulsando un nuevo paradigma educativo basado en el aprendizaje. Este artículo analiza el concepto de competencia y su relación con los cuidados como objeto y fundamento del saber enfermero

The Tuning Project aims at promoting the construction of a European Higher Education Space through a process of debate and reflection on the role of the universities in training qualified students for their future professional duties in the 21st century. For this purpose, deep transformations will have to be implemented with regard to the teaching/learning process, the role of teachers and students, the new definition of the credits system, etc. The concept of competence is a major constituent of the organization of the curriculum. Defining that competence will permit to analyse duty performance, guide teaching procedures towards concrete objectives and promote a new learner-based educational system. This article analyses the concept of competence and its relation to nursing attention and care

[Nursing practice in home care: social-demographic profile and professional practice]. / La práctica enfermera en atención domiciliaria: perfil sociodemográfico y práctica profesional.

OBJECTIVES: To characterise the Andalusian nurses providing home care (HC), to describe the activities developed, to define the components of nursing practice and to identify differences between the care of terminal cancer, of AIDS patients, of elderly people with dementia and of patients who had undergone more serious out-patient surgery. DESIGN: Cross-sectional descriptive study using a postal questionnaire. SETTING: Primary care centres in Andalusia. PARTICIPANTS: 348 PC nurses working in home care. Multi-stage sampling, proportional by provinces. MAIN MEASUREMENTS: Social-demographic and work characteristics, nursing activity in the home, type and frequency of activities performed in the care of each kind of patient and use of protocols. RESULTS: 61.14% reply rate. 65.5% were women, with mean age of 39.7 and averaging 10 years of PC experience. Mean number of patients attended was 10.5 per week, and mean time was 20.7 minutes. 90.1% had attended cancer patients, 16.7% AIDS patients, 83.3% elderly people with dementia, and 87.2% patients discharged early. In all cases the most commonly developed item was the technical one, followed by preventive/health promotion and psycho-social. Except in the case of evaluation of physiological needs, in all the other activities the frequency of the item was in function of the pathology of the patient (P<.05). Nursing practice in the home of terminal cancer patients and of elderly people with dementia only differs in the handling of emotional problems in both patient and carer, and in the preventive item (P<.05). 60% of the sample said they used no protocol in home care. CONCLUSIONS: The most common activities in care of home care patients are giving treatment, dressings, bandages, and monitoring of the vital constants, followed by assessment of physiological needs. Nursing practice does not seem to be fully conditioned by the pathology, but rather in function of groups of patients with similar needs and problems. Most Andalusian home-care nurses use no protocol in caring for these four classes of patient.

La práctica enfermera en atención domiciliaria: perfil sociodemográfico y práctica profesional / Nursing practice in home care: social-demographic profile and professional practice

Objetivo. Caracterizar a las enfermeras andaluzas que prestan atención domiciliaria (AD), describir las actividades desarrolladas, definir los componentes de la práctica enfermera e identificar las posibles diferencias en la atención de pacientes con cáncer o sida terminal, ancianos con demencia y pacientes intervenidos en cirugía mayor ambulatoria. Diseño. Estudio descriptivo transversal mediante cuestionario postal. Emplazamiento. Centros de astención primaria de Andalucía. Participantes. Trescientos cuarenta y ocho profesionales de enfermería de atención primaria que realizaban AD. Muestreo polietápico, proporcional por provincias. Resultados principales. Características sociodemográficas y laborales, actividad enfermera en el domicilio, tipo y frecuencia de las actividades realizadas en el cuidado de cada tipo de paciente y utilización de protocolos. Resultados . Tasa de respuesta del 61,14 por ciento. El 65,5 por ciento son mujeres, la edad media es de 39,7, y los años de experiencia en atención primaria es de 10,0 años. La media de pacientes atendidos es de 10,5 por semana, y el tiempo medio es de 20,7 min. El 90,1 por ciento han atendido a pacientes con cáncer, el 16,7 por ciento a pacientes con sida, el 83,3 por ciento a ancianos con demencia y el 87,2 por ciento a pacientes de alta precoz. En todos los casos el componente desarrollado con mayor frecuencia es el 'técnico', seguido del 'preventivo/de promoción' y del 'psicosocial'. Excepto en el caso de la valoración de las necesidades fisiológicas, en todas las demás actividades la frecuencia de su realización está en función de la patología del paciente (p < 0,05). La práctica enfermera que se realiza en el domicilio con los pacientes oncológicos terminales y con los ancianos con demencia sólo se diferencia en el abordaje de problemas emocionales tanto del paciente como del cuidador y en el componente preventivo (p < 0,05). El 60 por ciento de la muestra dice no utilizar protocolo alguno en la AD. Conclusiones. Las actividades desarrolladas con mayor frecuencia en la atención a este tipo de pacientes son la aplicación de tratamientos, curas, vendajes y control de constantes, seguidas de la valoración de las necesidades fisiológicas. La práctica enfermera parece no estar condicionada en su totalidad por la patología, sino en función de grupos de pacientes con necesidades y problemas similares. La mayoría de las enfermeras andaluzas que realizan AD no utilizan protocolo en el cuidado de estos 4 tipos de pacientes (AU)

[The Vaccination Program of Andalucía: the identification of evaluation indicators in the framework of quality assurance]. / Programa de Vacunaciones de Andalucía: identificación de indicadores de evaluación en el marco de garantía de calidad.

Quality assurance constitutes a major element in the evaluation of health services and has recently been introduced into our field. From this perspective, we intend to identify indicators for the evaluation the Andalusian Vaccination Programme, following the scheme proposed by Donabedian. A group of experts with different training backgrounds agreed upon the techniques on which the methodology used was based. Panels of experts were formed and the nominal group technique was used to identify criteria and standards. Mail surveys were made in order to select the most relevant standards from a multiple perspective: importance, ease of measurement and intervention capability. The aspects to be evaluated were defined about structure process and result. A total of 175 criteria and standards were identified, 42 related to structure, 68 related to process and 65 to results. The aspects to be evaluated, selected according to the priority technique used, are proposed to be employed systematically. The possibility of using them in the different structural levels of the health services is discussed.

[Primary health care: an analysis of the transition in Anadalucía]. / Atención primaria de salud: un análisis sobre la transición en Andalucía.

The article develops an analysis of the process of transformation of primary health care in Andalucía (Spain), related to two fundamental aspects. On the one hand, the strategic aspects of reform are analysed, inspiring principles, as well as legislation and administration. So called "central" changes, that is, those that really suppose transformations in the services: geographic distribution, donation, organisation, human resources, etc., are also analyzed. The second aspect approached is an analysis of the situation of the system related to the limitations and malfunctions, important conditioners of the present functioning and immediate future of primary care.