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Resumen Objetivo Evitar el deterioro de los pacientes con fibromialgia por actuaciones perjudiciales en la practica clinica potencialmente evitables. Metodos Un panel multidisciplinar de expertos identifico las areas clave, analizo la evidencia cientifica y formulo las recomendaciones a partir de esta evidencia y de tecnicas cualitativas de «evaluacion formal» o «juicio razonado». Resultados Se han elaborado 39 recomendaciones sobre diagnostico, tratamientos no eficaces ni seguros, educacion del paciente y formacion del profesional. En esta parte II se reflejan las 12 recomendaciones, referidas a las dos ultimas areas. Conclusiones Un buen conocimiento de la fibromialgia por el paciente mejora el afrontamiento y la aceptacion de la enfermedad reduciendo la gravedad de algunas manifestaciones clinicas. Los profesionales sanitarios que tratan a los pacientes con fibromialgia deben tener una buena formacion sobre esta enfermedad para mejorar los resultados del tratamiento y la relacion con el paciente.

Aim The aim of this study was to analyze the caregiving experience of parents whose adolescent children with a mental illness require admission to a day treatment hospital for mental health services. Method The study used qualitative interpretative research methods. A total of 18 parents participated in the semi-structured interviews. Data were then transcribed and analyzed in accordance with established methods for the analysis of inductive thematic data. Results Seven themes were identified: questioning an unseen disease, abnormal behavior, a long road, truancy and loss of parental authority, internalized stigma on admission, regaining the meaning of life and an uncertain future. Discussion The experience of the parents was analyzed and various emotional, psychological and interpersonal barriers were found that influenced the help-seeking for the adolescent's treatment. Implications for practice Nursing interventions should be based on detecting barriers and validating the experience of parents with mentally ill adolescents.

Resumen Objetivo Evitar el deterioro de los pacientes con fibromialgia por actuaciones perjudiciales en la practica clinica potencialmente evitables. Metodos Un panel multidisciplinar de expertos identifico las areas claves, analizo la evidencia cientifica y formulo las recomendaciones a partir de esta evidencia y de tecnicas cualitativas de «evaluacion formal» o «juicio razonado». Resultados Se han elaborado 39 recomendaciones sobre diagnostico, tratamientos no eficaces ni seguros, educacion del paciente y formacion del profesional. En esta parte I se reflejan las 27 primeras, referidas a las 2 primeras areas. Conclusiones Establecer el diagnostico mejora el afrontamiento del paciente y reduce los costes sanitarios. Se deben evitar AINE, opioides mayores y benzodiacepinas por los efectos adversos. No existe una evidencia solida que justifique la asociacion de farmacos. Tampoco existe una buena evidencia para recomendar ningun tipo de terapia complementaria. Las cirugias muestran mas complicaciones y un grado de satisfaccion menor por el paciente por lo que deben evitarse si la indicacion no esta claramente establecida.

Objective To prevent the impairment of fibromyalgia patients due to harmful actions in daily clinical practice that are potentially avoidable. Methods A multidisciplinary team identified the main areas of interest and carried out an analysis of scientific evidence and established recommendations based on the evidence and “formal evaluation” or “reasoned judgment” qualitative analysis techniques. Results A total of 39 recommendations address diagnosis, unsafe or ineffective treatment interventions and patient and healthcare workers’ education. This part I shows the first 27 recommendations on the first 2 areas. Conclusions Establishing a diagnosis improves the patient's coping with the disease and reduces healthcare costs. NSAIDs, strong opioids and benzodiazepines should be avoided due to side effects. There is no good evidence to justify the association of several drugs. There is also no good evidence to recommend any complementary medicine. Surgeries show a greater number of complications and a lower degree of patient satisfaction and therefore should be avoided if the surgical indication is not clearly established.

Purpose To explore the perception of the illness and the experience of the illness for relatives of fibromyalgia syndrome (FMS) patients. Materials and methods This qualitative interpretative study adopted a grounded theory research methodology with a purposive sample. We conducted a focus group with 11 family members of FMS patients. There were six men and five women, five were spouses and six were children (four husbands and one wife, and five daughters and one son). Results Three categories of family perceptions of FMS emerged: (1) manifestations of FMS; (2) FMS is regarded as a psychological problem; (3) FMS interferes with traditional gender roles. Three categories of family members' experience of living with FMS patients were identified: (1) emotional concerns and exhaustion; (2) overprotective family members; and (3) escape coping. Conclusions Family members feel emotionally burdened, can be overprotective and over-involved and find it difficult to set limits ultimately succumbing to a vicious cycle of caregiving and emotional exhaustion from which they find it difficult to escape. As the perceptions and experiences of family members of FMS patients are not commonly studied, the present findings offer new insights for families and elucidate important points of intervention.Implications for rehabilitationBecause family members tend to dismiss fibromyalgia as a psychological problem for which ignoring or distracting the patient is the best approach to coping, rehabilitation programs should give family members education and training to develop the ability to better understand fibromyalgia and reduce stereotypes about the condition.Rehabilitation programs should work to identify and manage marital and family systems dysfunction that may be interfering with fibromyalgia patients' adjustment and quality of life.Family members often engage in maladaptive escape coping to manage the demands of living with patients with fibromyalgia, and rehabilitation professionals should be ready to engage and refer to allied specialists to assist family members in finding alternatives for more effective coping approaches that improve patient and family mental health and social relations.Rehabilitation programs for fibromyalgia patients should use a gender perspective and emphasize patient and spouse equality in activities of daily living as many patients and family members feel uncomfortable about not fulfilling traditional gender roles.

Introduction Fibromyalgia (FM) is a pathology that causes physical, psychological, and social problems. For this reason, it requires treatment that involves all of these elements. The main of study is to examine multidisciplinary rehabilitation treatment (MRT) in fibromyalgia and to identify healthcare approaches developing effective MRT tools for the treatment of FM. Evidence acquisition In this systematic review, we searched the following databases: CINAHL, PubMed, Scopus, Cuidatge, Cuiden, ENFISPO, IBEC and IME. Evidence synthesis Of 356 articles found we selected 13 to analyze and summarize. We created 4 different categories: (1) multidisciplinary rehabilitation treatment focusing on health education and cognitive behavioral therapy (CBT), (2) multidisciplinary rehabilitation treatment that includes dietetics, (3) multidisciplinary rehabilitation treatment adapted to the patients' characteristics and (4) multidisciplinary rehabilitation treatment based on physical exercise. Conclusions This review identifies the most effective treatments that may be usefully applied in many different rehabilitation contexts. These include all treatments that incorporated an education (ED) program to patients and an exercise program complete with aerobic exercise (AE), stretching (SE), relaxation (RE), strengthening (TE), endurance (EN), and which includes the entire body and biofeedback. Furthermore, many approaches also include Cognitive Behavioral Therapy (CBT) for self-management such as occupational therapy, moderation, acceptance, commitment, motivation to change and forgiveness.

Fibromyalgia patients experience difficulties in their daily lives that are difficult to identify and recognize due to the stigma associated with the disease. Nurses can help identify them to establish biopsychosocial coping and treatment. The main aim of this study was to explore Spanish nurses’ perceptions of the illness experiences of their fibromyalgia patients. Qualitative content analysis from the etic perspective was used. Eight nurses met in focus groups to report their perceptions of the illness experiences of FM patients after led group-based problem-solving therapy in fibromyalgia patients. Four themes emerged: (1) the presence of a “specific trigger” (stressful event) for FM symptoms; (2) fulfilling expected gender roles; (3) a lack of support from the family; (4) abuse. Nurses recognize the mind–body connection after the impact of stress on patients’ bodies. The expected gender roles interfere with patients’ recovery because they feel frustration and guilt about not being able to fulfil them. Managing emotions and improving communication in fibromyalgia is recommended. Clinicians might also consider issues such as abuse and the absence of social–family support for the comprehensive evaluation and effective management of fibromyalgia.

Fibromyalgia syndrome (FMS) is a chronic musculoskeletal disorder of unknown etiology that affects up to 5.0% of the world population. It has a high female predominance, between 80 and 96%. Due to the low number of diagnosed men, research work has focused mainly on women. The extensive body of literature on sex differences in pain in the general population suggests that men and women differ in their responses to pain, with greater sensitivity to pain and a higher risk of clinical pain commonly observed among women. This review aims to: (1) determine how pain is assessed or what types of questionnaires are used, (2) examine whether there are differences in pain characteristics between men and women with FMS and (3) describe how pain is conceptualized or manifested in patients at a qualitative level. In this study, the scoping review method of articles published in the last 5 years (2016–2022) was used. Ten articles were included. The most used questionnaires and scales to assess pain were the PVAS (Pain Visual Analogue Scale) and the FIQ (Fibromyalgia Impact Questionnaire). On the other hand, five categories were obtained: (1) qualities of pain, (2) uncertainty and chaos, (3) pain as an aggravating factor, (4) adaptation to the new reality and (5) the communication of pain. It has been observed that both subjective perception and widespread pain are higher in women. Men, on the other hand, have a worse impact of the pathology, more painful experiences and more catastrophic thoughts about pain. An updated knowledge of pain in FMS and whether it differs according to sex would be beneficial for clinicians to make an earlier diagnosis and treatment and, in turn, benefit patients suffering from this chronic disease.

Children and adolescents spend most of their time at school. Therefore, teachers could be of help to improve the quality of life of students with chronic pain while they are at school. The aim of this study was to identify teachers’ educational needs and resources to help improve the adjustment to and function in the school of students with chronic pain. A Delphi survey including two rounds was conducted. Overall, 49 needs were identified in the first round. They were related to education, training, organization/logistics, and communication with the family and the health care center. Among the most important needs, based on the importance given and consensus reached, were (1) having information about the most appropriate attitudes and responses to a student with chronic pain, (2) how to reduce absenteeism, (3) how to ease the return to school after a long absence due to his or her pain problem, and (4) how to establish effective communication with the family. The results of this study provide new important data on the educational needs and resources which teachers would like to have to help their students with chronic pain at school, which could be used to develop educative programs for teachers.

Aim This study aimed to analyse risk and protective factors for teen suicide and bullying. Background Research shows that high percentages of bully-victims report suicidal thinking or suicide attempts. Design This was an international integrative review. Data sources Five databases including CINAHL, Scopus, PubMed, Google Scholar and Cuiden were searched between January 2010 and December 2020. Review methods Review methods included problem identification; search, evaluation and analysis of literature; and presentation of results. Results Eighteen studies were included. We grouped the selected articles into seven thematic categories. The most significant risk factors were being male, having a previous personal and/or family suicide attempt, mental health problems, substance abuse, previous physical and/or sexual abuse, low socio-economic level, belonging to a single-parent family, underachievement, family dysfunction and violent environment. The most common protective factors for both suicide and bullying were being female, having good mental health, belonging to a two-parent family, safe school environment, good family relationships and having an involved teacher. Conclusion Suicide resulting from bullying is a social and public health problem, so nurse practitioners and paediatric primary care nurses have a responsibility to educate teachers and parents in order to promote early detection and the development of more effective prevention and action plans.

Objective To prevent the deterioration of patients with fibromyalgia due to potentially avoidable harmful actions in clinical practice. Methods A multidisciplinary panel of experts identified key areas, analysed the scientific evidence and formulated recommendations based on this evidence and qualitative techniques of “formal assessment” or “reasoned judgement”. Results Thirty-nine recommendations were made on diagnosis, ineffective and unsafe treatments, patient education and practitioner training. This part II shows the 12 recommendations, referring to the latter two areas. Conclusions Good knowledge of fibromyalgia on the part of patients improves their coping and acceptance of the disease and reduces the severity of some clinical manifestations. Healthcare professionals treating patients with fibromyalgia should be well trained in this disease to improve treatment outcomes and patient relationships.

Resumen Objetivo principal: Conocer la experiencia, el impacto percibido y el manejo de la experiencia de la reconstrucción de la vida cotidiana de los postcuidadores familiares después del proceso de duelo. Metodología: Se realizaron entrevistas en profundidad a 14 informantes que cuidaron a sus familiares durante más de 2 años y que dejaron de atenderlos más de 2 años antes. Los datos fueron recolectados durante un período de 13 meses en 2014-2015. El estudio se enmarca en la teoría fundamentada. Resultados principales: Se obtuvieron tres categorías a partir del análisis de los relatos: el vacío en el postcuidar, el fin del tiempo como cuidador y la transición hacia una nueva vida. Todos los informantes mencionan un vacío, marcado por el aumento del tiempo libre y la pérdida de sentido de su vida. Conclusión principal: Los postcuidadores experimentan una transición en la reconstrucción de su vida cotidiana, en la que el apoyo de los profesionales es esencial. Los postcuidadores pueden ser una fuente de apoyo para otros cuidadores. Abstract Objective: To know the experience, the perceived impact and the management of the experience of the reconstruction of the daily life of the family post-caregivers after the grieving process. Methods: In-depth interviews of 14 former caregivers who had cared for their relative for more than 2 years and who had stopped caring for them more than 2 years previously. Data were collected over 13 months in 2014-2015. The data analysis was performed using Grounded Theory. Results: Three categories were obtained from the data analysis: The emptiness in post-caring, the end of the time as a caregiver and the transition towards a new life. All the informants mention an emptiness but a new determining factor, the increase in free time, also emerges in the study. Within this increase in their free time, caregivers feel the need to occupy their time by becoming involved in caring for others. Conclusions: Former caregivers experience a transition in the reconstruction of their everyday life, in which support from professionals is essential. Former caregivers may be a source of support for other caregivers.

Background and Aims Fibromyalgia Syndrome (FMS) is a chronic centralized pain disorder characterized by widespread pain and fatigue. Of those affected by FMS, the majority are women, and minimal research exists involving men. The purpose of this paper is to describe the pain and fatigue experiences of men with FMS from two Western countries, Spain and the United States, in order to support more accurate and earlier recognition and diagnosis in men. Design and Methods We used individual and focus group interviews with qualitative and quantitative assessments. Settings and Participants/Subjects Ten men in Spain and seven men in the United States provided information about their symptoms, psychosocial and health-seeking behaviors, and gender experiences with FMS. Results Men articulated types, trends, and triggers of pain and fatigue that enrich an understanding of their symptoms. For example, men report more localized pain than generalized pain. Employment status and activities, among other contextual factors, impacted men's pain and fatigue experiences. Conclusions Men experience distinct facets of pain and fatigue compared with women, with notable similarities and differences across the Spanish and U.S. samples. Cross-cultural comparisons highlight contextual factors that may inspire future inquiries about determinants of men's experiences with FMS. Clinical Implications The present study could be useful for anyone treating men suffering from FMS, especially care providers in nursing, medical, and psychology fields. These initial findings may prompt a closer examination of recommendations for assessment and diagnostic criteria used internationally for patients with FMS with better recognition of men's experience.

Depressive disorders constitute a group of disorders with great clinical heterogeneity that are characterized by a set of symptoms that include sadness, hopelessness, inhibition, and hypo-activity. Often pharmacological and psychological interventions are necessary. The relationship between depression and physical illness and disease is complex (Chinchilla-Moreno, 2008).Depression often predisposes individuals to physical illness and disease, and likewise, the presence of physical illness and disease often increases the probability of depression (World Health Organization, 2012). This is because activation of the endocrine and immune systems by the central nervous system is coordinated by a bidirectional network of signals. Hence, depression and inflammation are capable of affecting and being affected by the balance of cytokine messengers produced by the immune system (Montese) & MartA­nez, 2009). The main modulator of these signals is the hypothalamicpituitary-adrenal (HPA) axis, which regulates the activity of neurotransmitters and their receptors in the maintenance of homeostasis. Depression is considered a pathological response of our organism to stress, and patients often identify stressful situations with depression and the subsequent onset of illness (PiquerasRodrA­guez, Ramos-Linares, MartA­nez-Gonzalez, & Oblitas, 2009).Recently, research has been expanding to include the role of depression in predicting the onset of physical illness among previously healthy individuals and has focused on a number of potential explanatory mechanisms. For example, depressed individuals consume more alcohol, smoke more tobacco, engage in less physical activity, eat less healthily, and show lower levels of health care (Holahan, Pahl, & Cronkite, 2010). Each of these health behaviors offers a potential explanation for the association of depression with physical illness and disease. The main aim of the present review is to summarize the recent literature on depression as a predictor of physical illness and disease. There are two goals. First, it is important to summarize the literature that shows that depression can act as a risk factor for physical illness and disease. Second, equally important is to show potential mechanisms of this association, paying attention to those modifiable factors in which nursing could assist in prevention or treatment.MethodsEligibility CriteriaSelected publications come from six developed countries (Australia, Canada, Mexico, Norway, Spain, and the United States), covering the period 2004 to 2015. We have selected scientific articles found in scientific health databases (Table 1). In the bibliographic search, 24 articles were selected for the review of the total of 375 potentially eligible studies after eliminating duplicates and screening titles, abstracts, and key words. We excluded commentaries, editorials, or those without abstracts.Data SourcesThe electronic databases consulted for the bibliographic search were PubMed, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), APA PsycNET, Scopus, Dialnet, and CUIDEN. Search terms used in each database are provided in Table 1.ResultsFollowing is a detailed review of the most critical evidence of depressive disorders and their association with physical illness and disease. Results of this review are structured according to the illness and disease categories that were found to be common in the review (Table 2).Cardiovascular DiseaseCardiovascular disease (CVD) is commonly associated with depression. For example, Borreu-Foguet et al. (2013) determined that the most common cardiovascular risk factors (CVRFs) in patients with depression were as follows: 38% hypertension, 41% smoking, and 56% dyslipidemia. Smith-Patrick and Blumenthal (2011) observed that the onset and progression of CVRFs may be a consequence of negative emotions, mood states (depression, stress, anxiety) and low perceived social support. …

Aims and objectives To understand the relation between the experience of violence and sociodemographic and clinical factors, and to determine whether diagnosed depression and the presence of anxiety and stress are related to having experienced workplace and domestic violence in different genders and age groups. Background Previous studies indicate that domestic and workplace violence increase the risk of suffering from depression. However, no studies have evaluated these two types of violence in a same cohort. Design and methods We designed a descriptive cross-sectional study from 317 individuals randomly selected from the population in southern Catalonia (Spain). Sociodemographic and Goldberg anxiety–depression questionnaires were administered by telephone survey to 160 men and 157 women in December 2008. The data obtained were analysed by a logistic regression model. Results A quarter of the individuals had suffered from violence: 48·29% of them had experienced domestic violence and 32·9% had experienced workplace violence. Nearly half of the individuals with depression had experienced violence. No statistical difference has been observed between domestic and workplace violence regarding diagnosed depression. Women were twice as likely as men to have suffered from violence. People working outside their home and those who claimed to have no social support had a greater risk of suffering from violence. A greater consumption of medication, above all of psychotropic drugs, is associated with experiencing violence and with greater comorbidity. Predictive factors for suffering from depression are being women, having experienced violence, having suffered stress or anxiety, having little or no social support, having overload of task or having no secondary education and no tertiary education. Conclusions This study suggests that when considering depression, anxiety and stress, especially in women, we must take into account whether an individual has suffered violence. Relevance to clinical practice Identifying violence can help health professionals, managers and researchers improve care and reduce suffering in families and communities.

Aims and objectives To produce changes in the therapeutic relationship between clinical practice nurses and patients in psychiatric units by implementing evidence-based practices through participatory action research. Background The therapeutic relationship is the cornerstone of nursing care in psychiatric units. The literature suggests that theoretical knowledge alone is insufficient to establish the therapeutic relationship in practice. Therefore, strategies are needed to adequately establish the therapeutic relationship in psychiatric units. Design Participatory action research. Methods Participants consisted of nurses from two psychiatric units of a university hospital. Data were collected through focus groups and reflective diaries, which were analysed using the content analysis method. The COREQ guidelines were followed to ensure rigour. Results Nurses conceptualised the therapeutic relationship in their practice, identifying facilitating elements and limitations. They were able to compare their clinical practice with the recommendations of scientific evidence and constructed three evidence-based proposals to improve the therapeutic relationship: (a) a customised nurse intervention space, (b) knowledge updating and (c) reflective groups, which they subsequently implemented and evaluated. Conclusions This study shows that nurses in psychiatric units can generate changes and improvements in the therapeutic relationship. The process of implementing evidence-based practice enhanced participants' awareness of their clinical practice and allowed them to make changes and improvements. Relevance to clinical practice The process confirmed that the implementation of evidence-based practice through participatory methods, such as participatory action research, is valid and produces lasting changes. This study also reveals the need to rethink nurses' functions and competencies in current psychiatric units.

CONTEXTO: Los cuidadores familiares construyen su vida en base su familiar. Una vez este que este se muere deben reconstruir su vida. OBJETIVO: Comprender la experiencia vivida de los postcuidadores familiares en la reconstrucción de su vida cotidiana desde la teoría de Afaf Meleis. MÉTODO: un estudio cualitativo basado en la Teoría fundamentada. El método de recogida de datos fue mediante entrevistas en profundidad a 14 postcuidadores familiares, durante el periodo entre junio de 2014 y diciembre de 2015 en la región de Cataluña (España). RESULTADOS: En el análisis de las entrevistas surgieron las categorías: rememorando la vida de cuidador, la transición del postcuidar y la nueva vida como postcuidador. Al profundizar en el análisis de los discursos se observó que los elementos que estructuraban la transición de los postcuidadores familiares coincidían con las bases teóricas de la Teoría de las Transiciones de Meleis. Se presenta un análisis de todos los elementos que componen la transición del postcuidar desde la Teoria de las Transiciones. CONCLUSIÓN: La teoría de las Transiciones posee un cuerpo de conocimientos que nos hacen comprensibles las situaciones que viven los postcuidadores y nos permiten comprender la diversidad de sus experiencias. CONTEXTO: Os cuidadores familiares constroem as suas vidas com base no seu familiar. Uma vez que este morre, estes devem reconstruir as suas vidas. OBJETIVO: Compreender a experiência vivida pelos pós-cuidadores familiares na reconstrução da sua vida quotidiana a partir da teoria de Afaf Meleis. MÉTODOS: Estudo qualitativo assente na teoria fundamentada. A colheita de dados foi realizada através de entrevistas em profundidade com 14 pós-cuidadores familiares, durante o período entre junho de 2014 e dezembro de 2015, na região da Catalunha (Espanha). RESULTADOS: A partir da análise das entrevistas emergiram as seguintes categorias: relembrando a vida de cuidador, a transição do pós-cuidar e a nova vida como pós-cuidador. Ao aprofundar a análise dos discursos verificou-se que os elementos que estruturavam a transição dos pós-cuidadores familiares coincidiam com as bases teóricas da Teoria das Transições de Meleis. Assim, apresenta-se uma análise de todos os elementos que compõem a transição do pós-cuidar a partir da Teoria das Transições. CONCLUSÃO: A Teoria das Transições apresenta um corpo de conhecimento que torna compreensíveis as situações vivenciadas pelos pós-cuidadores e permite compreender a diversidade das suas experiências. BACKGROUND: Family caregivers build their lives based on their relative. When he dies, they must rebuild their lives. AIM: To understand the experience of post-caregivers family in the reconstruction of their daily lives from the theory of Afaf Meleis. METHODS: A qualitative study based on grounded theory. The method of data collection was through in-depth interviews with 14 family post-caregivers during the period between June 2014 and December 2015, the region of Catalonia (Spain). RESULTS: When analyzing interview 3 categories emerged: remembering the life of the caregiver, the transition from post-care and new life as a post-caregiver. To deepen the analysis of discourses it was observed that the elements that structured the transition of post-caregivers family coincided with the theoretical basis of the Theory of Transitions Meleis. An analysis of all the elements that make the transition from post-care to the Transitions theory is presented. CONCLUSION: Transitions theory has a body of knowledge that makes us understandable situations experienced by post-caregivers and allows us to understand the diversity of their experiences.

Aims and objectives To identify which are the needs arised from feelings, perceptions and experiences of the family members during any time within the death process in an emergency service of an acute care hospital, with regard to the assistance received. Background The publications refer to the needs expressed by bereaved families, who explain the support they received right after the death of a relative in an emergency service, and during the months after the tragedy. Design Qualitative study drawing on grounded theory based on Charmaz (2006). Methods Ten interviews were conducted to a member of each family, who had been in an emergency service with a relative during any of the stages of the dying process. Data were collected from September 2015-June 2016. The analysis was made while data were being collected. Three types of codification were carried out: open, axial and selective. Theoretical saturation was achieved after data collection and analysis. Results Three thematic categories emerged: the power of information/communication (a), decisions taken by professionals within the dimension of caring (b) and the humanisation of death in emergency services (c). Conclusions The quality of the information given to families in the process of death in an emergency service affects to their satisfaction. Family support must be essential in a situation of death. Institutions must guarantee standards of practice, which include orientation on the care of people in bereavement, and the commitment to provide specialised attention those families. Relevance to clinical practice Research findings reveal the need to create changes within clinical practice, regarding how to take care of the family involved in a death process in an emergency service. From the needs detected by the participants, it could be possible to implement an interventional programme, which offers the relatives the emotional support they may need.

AIM The aim of this study was to identify the main biological, psychological and sociological problems and potential solutions for patients diagnosed with fibromyalgia by use of Group Problem-Solving Therapy. BACKGROUND Group Problem-Solving Therapy is a technique for identifying and solving problems, increasing assertiveness, self-esteem and eliminating negative thoughts. DESIGN Qualitative phenomenological interpretive design: Group Problem-Solving Therapy sessions conducted with patients suffering fibromyalgia were studied; participants recruited via the Rheumatology Department at a general hospital and associations in Catalonia, Spain with sessions conducted in nearby university setting. METHODS The study included 44 people diagnosed with fibromyalgia (43 female, 1 male) from 6 Group Problem-Solving Therapy sessions. Data collected from March-June 2013. A total of 24 sessions were audio recorded, all with prior informed consent. Data were transcribed and then analysed in accordance with established methods of inductive thematic analysis, via a process of reduction to manage and classify data. FINDINGS Five themes were identified: (1) Current problems are often related to historical trauma; (2) There are no "one size fits all" solutions; (3) Fibromyalgia is life-changing; (4) Fibromyalgia is widely misunderstood; (5) Statistically Significant impacts on physical, psychological and social are described. CONCLUSION The majority of patients' problems were associated with their previous history and the onset of fibromyalgia; which may be related to trauma in adolescence, early adulthood or later. The solutions provided during the groups appeared to be accepted by the participants. These findings can improve the self-management of fibromyalgia patients by helping to enhance adaptive behaviours and incorporating the female gender approach.

This integrative review offers a systematic synthesis of the international literature regarding the role of depression as a risk factor in physical illnesses and the mechanisms of this connection. Special attention is paid to those modifiable factors.Published studies of depression and physical illness and disease(N = 24) from five countries that were indexed in PubMed, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), APA PsycNET, Scopus, Dialnet, and CUIDEN were examined. Results suggest that depression is a significant risk factor for the development of physical illnesses and diseases. More commonly studied were the connections between depression and cardiovascular disease, metabolic syndrome, biochemical alterations, diabetes, dementia, cognitive impairment, Alzheimer's disease, somatization and chronic pain, asthma, arthritis, and hyperlipidemia. Less frequently studied conditions connected to depression were cancer, infections, allergies, autoimmune disease, gastric ulcer, rhinitis, thyroiditis, bronchitis, migraines, fractures, and osteoporosis.Mechanisms connecting depression to physical illness appear to involve alterations in the hypothalamic-pituitary axis, unhealthy lifestyle, chronic or acute stressors including posttraumatic stress, an increase in C-reactive protein (CRP) in men, taking antidepressant medication, and social and emotional loneliness.A good patient-provider relationship can help to promote decreased acute or chronic stressors, increased family and social support, decreased loneliness, modification of unhealthy lifestyles such as smoking, obesity, physical inactivity, alcohol, control of CRP, and antidepressant medication. Nurses are well placed to help prevent physical diseases through detection and referral of patients who are depressed or undiagnosed and not receiving adequate mental health treatment.

Background: Psychiatric nurses are aware of the importance of the therapeutic relationship in psychiatric units. Nevertheless, a review of the scientific evidence indicates that theoretical knowledge alone is insufficient to establish an adequate therapeutic alliance. Therefore, strategies are required to promote changes to enhance the establishment of the working relationship. The aims of the study are to generate changes in how nurses establish the therapeutic relationship in acute psychiatric units, based on participative action research and to evaluate the effectiveness of the implementation of evidence through this method. Methods/Design: The study will use a mixed method design. Qualitative methodology, through participative action research, will be employed to implement scientific evidence on the therapeutic relationship. A quasi-experimental, one-group, pre-test/post-test design will also be used to quantitatively measure the effectiveness of the implementation of the evidence. Participants will consist of nurses and patients from two psychiatric units in Barcelona. Nurses will be selected by theoretical sampling, and patients assigned to each nurses will be selected by consecutive sampling. Qualitative data will be gathered through discussion groups and field diaries. Quantitative data will be collected through the Working Alliance Inventory and the Interpersonal Reactivity Index. Qualitative data will be analysed through the technique of content analysis and quantitative data through descriptive and inferential statistics. Discussion: This study will help to understand the process of change in a nursing team working in an inpatient psychiatric ward and will allow nurses to generate knowledge, identify difficulties, and establish strategies to implement change, as well as to assess whether the quality of the care they provide shows a qualitative improvement. This study is funded by the College of Nurses of Barcelona as part of the Research Projects Grants (PR- 1915-14/2014).

Justificación: el suicidio es un tema de reflexión para las ciencias médicas pero también para las ciencias sociales. Durkheim analiza el suicidio y describe el estado de anomia -sin normas-, en el cual la ciudadanía, como resultado de un cambio rápido, pierde su conexión con la sociedad y su fe en las reglas sociales y en las instituciones, llevando al individuo a la desesperación y al suicidio. Objetivo: identificar las dificultades de integración social en personas depresivas con pensamientos de suicidio. Metodología: se realiza un estudio cualitativo que forma parte de una investigación más amplia sobre depresión. Antes de realizar la entrevista administramos un cuestionario con datos sociodemográficos, datos sobre depresión y causas identificadas, así como también el test de ansiedad-depresión de Goldberg. Posteriormente se realiza una entrevista en profundidad que la hemos denominado historia de vida. Se realizan entrevistas a 66 personas diagnosticadas de depresión, 52 mujeres y 14 hombres previo consentimiento. De éstas se analizan las que han tenido ideas o intentos de suicidio. Resultados: en muchos de los entrevistados que han pensado o han intentado el suicidio lo que les ha impedido hacerlo es la familia y los hijos. Conclusión: el apoyo social es identificado como el principal factor que ha impedido el suicidio. Rationale: suicide is a subject of investigation for the medical sciences but also social sciences. Durkheim examines suicide and describes the state of anomie, without rules, in which citizenship as a result of rapid change, loses its connection with society and his belief in social rules and institutions, leading to individual despair and suicide. Objective: identify the social integration difficulties in depressive people with suicidal thoughts. Methodology: we performed a qualitative study is part of a broader research on depression. Before the interview administered a questionnaire with demographic data, data on depression and causes identified, as well as test anxiety-depression Goldberg. Subsequently we carried out an in depth interview that we call life story. Were interviewed 66 people diagnosed with depression, 52 women and 14 men consent. Of these are discussed that have ideas or suicide attempts. Results: in many-as respondents who have thought about or attempted suicide that has prevented them from doing so is the family and children. Conclusions: the social support is identified as the main factor that has prevented the suicide.

Purpose To study the significance of ‘therapeutic relationship’ between nurses and patients within the context of a psychiatric hospital. Method Narrative literature review. Content analysis. Findings The significance of the therapeutic relationship is quite similar for both nurses and patients in psychiatric hospital units. Nevertheless, several factors may separate the two positions: the time available for the relationship, the negative perceptions on the part of both parties, and the insecurity of the setting. Practice implications Increased knowledge and understanding of the significance of the therapeutic relationship from the perspective of nurses and patients would allow the strengthening of areas of mutual interest.

Purpose: The aim of this study is to explore and understand the experience of the adaptation process among family caregivers in hospitals, who have an active presence in hospital and are essential in ensuring proper patient care. Methods: A qualitative phenomenological approach was used to gain a deeper understanding of caregivers' lived experiences. Data were collected using in-depth interviews to explore six caregivers' experiences of hospitalization. Results: The caregivers' accounts highlight the different determining factors in the transition process of a chronically ill patient's family caregiver during the patient's time in hospital. The most important themes emerging from the analysis were the importance of cultural beliefs and attitudes, meaning of the situation, caregiver's training and knowledge, socio-economic status and the hospital as a community. These categories can be analyzed using transitions theory. Conclusions: The most important conclusion is that the hospital in this study was not designed to accommodate caregivers, and the mechanisms used to meet caregivers' needs endanger their privacy, health, and coexistence in the hospital's rooms. Transitions theory provides a holistic understanding of the experience of the family caregiver.

Se presenta el relato de la que podría ser la experiencia vivida por una persona hospitalizada en una unidad de psiquiatría cualquiera. Los datos se generan mediante la observación no participante, entrevistas informales y la propia experiencia asistencial de los autores. La persona protagonista está hospitalizada de forma involuntaria en una unidad de agudos de psiquiatría, ha recibido del “sistema” la etiqueta diagnóstica de psicosis. A través de su mirada, los autores reflexionan en torno a las percepciones y vivencias que le acontecen en relación con el devenir cotidiano del hospital, y por supuesto con el cuidado recibido por las enfermeras de la unidad. We present the story of what could be the experience of a hospitalized person in whatever psychiatric unit. The data are generated by non-participant observation and care experience of the authors. The protagonist person is involuntarily admitted in a psychiatric acute unit; he has received the diagnostic label of psychosis by the “system”. Through his eyes, the authors reflect about perceptions and experiences that happen him in relation to the daily workings of the hospital, and of course with the care received by nurses in the unit. Nós apresentamos a história do que poderia ser a experiência de uma pessoa internada em qualquer unidade psiquiátrica. Os dados são gerados pela observação não participante e experiência de cuidado dos autores. A pessoa protagonista é involuntariamente internado em uma unidade psiquiátrica aguda; ele recebeu o rótulo diagnóstico de psicose pelo “sistema”. Através de seus olhos, os autores refletem sobre as percepções e experiências que lhe suceder em relação aos trabalhos diários do hospital, e, claro, com o cuidado recebido por enfermeiras da unidade.

Several pharmacological and nonpharmacological treatments can be used to alleviate the symptoms of fibromyalgia, although none of them are completely effective at present. In this study, we analyzed the effectiveness of different therapies in three groups of people diagnosed with fibromyalgia. The sample for this randomized controlled trial was made up of 66 people diagnosed with fibromyalgia in southern Catalonia. In turn, this sample was divided into three groups of 22 participants each, who were treated with: i) cervical infiltration with botulinum toxin, ii) group problem-solving therapy, or iii) both therapies. The variables recorded were quality of life, suicidal thoughts, perception of pain, quality of sleep, and satisfaction. Female patients composed 96.9% (n = 64) of the study sample. Satisfaction with the infiltration was 5.1 ± 2.7 points, while in group problem-solving therapy it was 6.6 ± 3.2. Self-perceived health in the infiltration group (p = .016) and the therapy group (p = .001) improved after the intervention took place. The risk of suicide decreased in the both treatments/groups (p = .049). Pain was reduced by 31.8% with infiltration, 13.6% with therapy, and 22.7% with both treatments. Anxiety/depression decreased by 45% with therapy, 36.3% with infiltration, and 36.3% with both treatments. The results also showed that the use of both treatments significantly reduces suicidal thoughts (p = .049). In conclusion, this study showed the complexity of reducing chronic pain and increasing the quality of life of people with fibromyalgia.

Introducción: Es importante conocer el concepto de patriarcado para entender las dificultades con que se encuentran las mujeres en el avance profesional, social e institucional. La profesión enfermera junto con otras también femeninas se ha enfrentado también con estas dificultades. Metodología: Introduciremos varias teorías que analizan el concepto de género. Algunas teorías justifican la socialización diferencial: estructural-funcionalista (Durkheim, Marx, Engels, Weber, Parsons, Comte...) y el feminismo critica al patriarcado como elemento de dominación para las mujeres (Firestone, Myrdal, B.Ehrenreich...). Analizaremos como las dificultades debidas a la instauración del patriarcado y a la diferente socialización entre hombres y mujeres ha frenado el avance de algunas profesiones femeninas, siendo la profesión enfermera una de ellas. Resultados: En la familia patriarcal que ha existido en nuestra sociedad contemporánea los hombres han ocupado las posiciones más relevantes del poder político, económico y cultural quedando las mujeres en segundo plano. Conclusión: Las desigualdades siguen existiendo en nuestras sociedades transicionales trayendo consigo un aumento de la violencia para las mujeres y con la globalización, una sociedad cada vez más dualizada con sectores más empobrecidos en los que se encuentran mayoritariamente las mujeres.

10.1016/j.apnu.2013.10.002 The aims of this study were to explore the prevalence and the conceptualizations of depression detected by the healthcare system, identified by the patient or classified/identified in the validated Goldberg's questionnaire in a community. We conducted a cross-sectional evaluation of 317 patients. The different types of depression diagnosed, identified, current or total were stratified by age and gender groups. The difference in the conceptualization of depression from the medical or ordinary people point of view indicate that depression care requires the understanding of the lifestyle, beliefs, attitudes, family and social networks of the people the physicians and nurses care for.

Depression has several ways to manifest: affective disorders, cognitive, sleep disturbance, difficulty in sexuality, appetite changes, behavioral changes, pain, paresthesia, headache, dizziness, gastrointestinal, cardiovascular, respiratory, neurovegetative etc. Can fibromyalgia be another way to manifest depression? Or would we be talking about a higher degree of injury to the body that is manifested in this way because of the depression continued throughout life as a result of difficulties experienced by women? Is what we identify as beyond depression.To determine the causes of women who attributed the cause of fibromyalgia. Compare the current level of anxiety and depression, perceived health status of the group of women diagnosed with depression and those diagnosed with fibromyalgia.in-depth interviews with 20 women with fibromyalgia, 52 women with depression in primary care. Systematic sampling in different age groups in different clusters-quota-patients with non-response replenishment. Analysis secondary sources.Women with fibromyalgia have increased work and family stress, perceived violence, perceived difficulties in childhood that women are only diagnosed depression. They also have a lower perception of their health.Women diagnosed with fibromyalgia have made enormous psychosocial difficulties throughout their lives that have been identified as causative factors. The most important thing is that the society and physicians understand the disease.

Up to present times, more studies in medicine have been made on the effects an organic disease can cause in the brain as manifested by depression but, among different health disciplines, researchers are carrying out studies on how the brain can affect the body and cause diseases. By reviewing various epidemiological studies, relationships among some chronic diseases and depression have been noted. The depression-disease order of appearance can de bi-directional. It seems that stress, depression and inflammation have the capacity to affect the balance of cykotines produced by the immunological system. Modulation of the immunological system by the central nervous system is controIled/mediada by a complex bi-directional network composed of signals among the central nervous system, the endocrine system and the immunological system. The most frequent diseases related to depression are chronic but some are acute: of the central nervous system, endocrines, infections. Chronic pain also seems related to this problem. Pain, fatigue or tiredness are considered symptoms of a hidden depression and others, physical as well as psychiatric, could be algias, parestesias, headaches, vertigo, or gastrointestinal, cardio-respiratory neurodegenerative disorders.

Objective To assess the effectiveness of Problem-Solving Therapy (PST) on family caregivers through the use of scales to measure anxiety, depression and emotional distress; and to explore facilitating factors and obstacles for its use based on the narrative of nurses. Method A clinical trial and an exploratory focus group with the use of mixed analysis methodology. The study was conducted in a primary health care center in Tarragona, Spain, and the sample consisted of 122 family caregivers who were included in the home care service, and 10 nurses who participated in the intervention group. Family caregivers with evident symptoms of anxiety, depression and emotional distress received PST in the intervention group. The intervention group also consisted of a discussion with eight nurses, which was transcribed and submitted to content analysis. Conclusion Problem-Solving Therapy proved to be effective in reducing perceived anxiety, depression and emotional distress. We identified its strong points and obstacles as described by nurses. Objetivo Avaliar a efetividade da Técnica de Resolução de Problemas (TRP) em cuidadores familiares mediante escalas positivas de ansiedade, depressão e stress emocional; explorar os fatores facilitadores e as barreiras para sua aplicação a partir das narrativas das enfermeiras. Método Ensaio clínico e grupo focal exploratório, com metodologia de análise mista. Realizado em centros de cuidados primários em Tarragona (Espanha), cuja amosta foi de 122 cuidadores familiares, incluindo atendimento domiciliar e 10 enfermeiros no grupo de intervenção. Grupo implementação experimental do TRP, cuidador familiar com sintomas de ansiedade, depressão e desconforto percebido. No grupo controle a enfermeira executa a intervenção habitual. Feita medição pré e pós intervenção em ambos os grupos. Grupo de discussão com oito enfermeiros do grupo de intervenção, transcrição e análise de conteúdo. Conclusão Ficou demonstrada a eficácia da TRP na redução da ansiedade, depressão e desconforto percebido. Foram identificados os pontos fortes e as barreiras na aplicação da técnica. Objetivo Evaluar la efectividad de la Técnica de Resolución de Problemas (TRP) en cuidadoras familiares mediante escalas positivas de ansiedad, depresión y malestar emocional; explorar los factores facilitadores y barreras en su aplicación a partir de la narrativa de las enfermeras. Método Ensayo clínico y grupo focal exploratorio y metodología de análisis mixta. Ilevado a cabo en el Centro de Atención Primaria de Tarragona (España), cuya muestra fue 122 cuidadoras familiares incluidas en el programa de atención domiciliaria y 10 enfermeras del grupo intervención. Grupo experimental aplicación de la TRP, a la cuidadora familiar con síntomas de ansiedad, depresión y malestar percibido. Grupo control la enfermera realiza la intervención habitual. Medición pre-post en ambos grupos. Grupo de discusión con ocho enfermeras del grupo intervención, trascripción y análisis del contenido. Conclusión Se demuestra la efectividad de la TRP en la reducción de ansiedad, depresión y malestar percibido. Se identifican los puntos fuertes y las barreras descritas por las enfermeras en la aplicación de la técnica.

Purpose To examine how evidence about the therapeutic alliance gleaned from participatory action project affected the level of this alliance and the degree of empathy of psychiatric nurses. Design and Methods Quasi-experimental study in two psychiatric units. In one group, evidence-based practices that affected the therapeutic alliance were implemented; in the comparison group, there was no such intervention. Findings The nurses from the intervention group improved their degree of empathy and factors such as agreement on objectives and tasks with the patient. Practice Implications The results confirm the possibility of measuring and improving the therapeutic relationship in psychiatric care.