Departamento de Enfermería

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A Qualitative View of Homecare Support Workers on Unmet Health Needs of People with Dependency
(MDPI, 2020) Martínez-Linares, José Manuel; Andújar, Francisco Antonio; Martínez-Yébenes, Rocío; López-Entrambasaguas, Olga María
Background: Longevity and population growth generate an increase in the number of people with dependency, who require homecare assistance to meet their health needs. Homecare support workers provide this care in Spain, and they may have unique insights into the unmet health needs of those receiving homecare assistance. The aim of this study was to determine the unmet health needs of people with dependency based on the perspective of homecare support workers. Methods: Qualitative exploratory-descriptive study. Through convenience sampling, homecare support workers from a Spanish province were selected, following inclusion and exclusion criteria. Four focus groups, transcription and thematic analyses were performed using Atlas.ti. Coding triangulation was carried out, applying criteria for scientific rigour. Results: The six themes obtained were classified into the material, psychoemotional, socioeconomical and psychosocial needs of people with dependency from the point of view of homecare support workers, along with the contributions of improvements and the need of these professionals for continuous training. Conclusions: People with dependency need complex technical assistance, materials, psychological attention due to their situation, and more effective assessments of their health and disability status. Homecare support workers perceive themselves to be essential in these assessments. They ask for psychological assistance, due to the emotional burden of their work, and believe this help would contribute to improving the quality of their service. Homecare support workers perceive that they are capable of performing their job, although they believe that some delegated activities are beyond their levels of competency.
A Systematic Review and Meta‑analysis of Gamified Affective Sexual Health Interventions in Schools
(Springer, 2025-04-01) Sierra‑Yagüe, Alba; Zafra‑Agea, José Antonio; Aguilar‑Quesada, Ana; González‑Cano‑Caballero, María; del‑Pino, Rafael; Lima, Marta
Abstract Introduction Adolescent sexual education targets risk reduction in STIs, pregnancies, and gender inequality. Inadequacies in traditional methods drive exploration of innovative approaches. This systematic review aims to synthesise, compare, and evaluate gamified affective sexual health interventions for adolescents within the school. Methods A systematic literature review was conducted across five databases from March 2022, with an update in December 2023, including PubMed, Scopus, PsycINFO, WOS, and EMBASE. Experimental studies of gamified interventions in schoolbased affective sexual health for adolescents aged 10–19 years were included. Methodological quality was assessed using the Quality Assessment Tool for Quantitative Studies by the Effective Public Health Practice Project. The selected articles were conducted primarily in the USA, encompassing 13 randomised controlled trials, two quasi-experimental studies, and one clinical trial. A subsequent meta-analysis was conducted using the random-effects model to calculate combined effect sizes and 95% confidence intervals (CI). Results Interventions yielded positive short and long-term impacts, improving attitudes, knowledge, and behaviours, and delaying sexual initiation. Studies revealed a statistically significant effect in follow-ups of less than six months, with 81% of outcomes showing positive impacts on delaying the initiation of any sexual activity and 50% on contraceptive use, knowledge, and improved attitudes. In follow-ups exceeding six months, a consistently positive and significant effect was maintained, ranging between 19% and 62.5%, for the delay in sexual initiation, contraceptive use, knowledge, and attitudes. The results from the meta-analysis indicate that gamified interventions are effective in delaying sexual initiation among adolescents, achieving an 15% reduction in the probability of initiating sexual relationships. Conclusions To enhance affective sexual health, a recommended methodological framework standardizes the design of universal interventions, enabling comprehensive effectiveness analysis. Emphasizing the encouragement of early initiation of interventions, adopting technological advances to enhance traditional education and address contemporary challenges in adolescent sexual health is highlighted. Policy Implications Sex education is essential to prevent risky behaviours, unwanted pregnancies, and STIs. This requires effective educational programmes that improve knowledge, skills, attitudes, and behaviours in a standardised way that is accessible to all adolescents.
A systematic review and meta-analysis of the association between anxiety symptoms and coping in family carers of dependent people aged 18 and over
(Wiley, 2023-08-02) Muñoz-Cruz, Juan Carlos; López-Martínez, Catalina; Orgeta, Vasiliki; Del-Pino-Casado, Rafael
Anxiety symptoms are prevalent in family carers of dependent people. Despite accumulating evidence in the area, there are still inconsistent findings on the association between carer anxiety symptoms and coping strategies. The aim of our study was to systematically analyse the relationship between anxiety symptoms and coping strategies in carers of dependent adults aged 18 years and older, and examine possible sources of heterogeneity in the results. The study design was a systematic review and meta-analysis. We searched several international databases (Pubmed, CINAHL, PsycINFO and LILACS) from June 2022 up to February 2023. We followed the preferred reporting items for systematic reviews and meta-analyses statement and performed several subgroup analyses to examine whether study design, cause of dependency and whether or not controlling for various biases influenced results. Forty-one studies were included in the review. We found significant associations between greater use of dysfunctional coping and higher anxiety symptoms. Greater use of problem-focused coping was associated with lower anxiety symptoms in carers of frail older people, but higher anxiety in carers of people surviving cancer. Emotion-focused coping and some of its individual strategies, such as acceptance and positive reappraisal, in probabilistic samples, were associated with lower anxiety symptoms across all groups. Most of the studies included in this review were cross-sectional. Evidence overall indicates that only specific dimensions and strategies of coping are significantly associated with anxiety symptoms in family carers. These findings should be considered when developing future interventions supporting carers.
AMEE Consensus Statement: Planetary health and education for sustainable healthcare
(Taylor & Francis, 2021) Shaw, Emily; Walpole, Sarah; McLean, Michelle; Álvarez-Nieto, Carmen; Barna, Stefi; Bazin, Kate; Behrens, Georgia; Chase, Hannah; Duane, Brett; El Omrani, Omnia; Elf, Marie; Faerron, Carlos A.; Falceto, Enrique; Gibbs, Trevor J.; Groome, Jonny; Hackett, Finola; Harden, Jeni; Hothersallr, Eleanor J.; Houriane, Maca; Huss, Norma May; Ikiugu, Moses; Joury, Easter; Leedham-Green, Kathleen; MacKenzie-Shalders, Kristen; Madden, Diana Lynne; McKimm, Judy; Schwerdtle, Patricia Nayna; Parkes, Margot W; Peters, Sarah; Redvers, Nicole; Sheffield, Perry; Singleton, Judith; Tun, SanYouMay; Woollard, Robert
The purpose of this Consensus Statement is to provide a global, collaborative, representative and inclusive vision for educating an interprofessional healthcare workforce that can deliver sustainable healthcare and promote planetary health. It is intended to inform national and global accreditation standards, planning and action at the institutional level as well as highlight the role of individuals in transforming health professions education. Many countries have agreed to ‘rapid, far-reaching and unprecedented changes’ to reduce greenhouse gas emissions by 45% within 10 years and achieve carbon neutrality by 2050, including in healthcare. Currently, however, health professions graduates are not prepared for their roles in achieving these changes. Thus, to reduce emissions and meet the 2030 Sustainable Development Goals (SDGs), health professions education must equip undergraduates, and those already qualified, with the knowledge, skills, values, competence and confidence they need to sustainably promote the health, human rights and well-being of current and future generations, while protecting the health of the planet. The current imperative for action on environmental issues such as climate change requires health professionals to mobilize politically as they have before, becoming strong advocates for major environmental, social and economic change. A truly ethical relationship with people and the planet that we inhabit so precariously, and to guarantee a future for the generations which follow, demands nothing less of all health professionals. This Consensus Statement outlines the changes required in health professions education, approaches to achieve these changes and a timeline for action linked to the internationally agreed SDGs. It represents the collective vision of health professionals, educators and students from various health professions, geographic locations and cultures. ‘Consensus’ implies broad agreement amongst all individuals engaged in discussion on a specific issue, which in this instance, is agreement by all signatories of this Statement developed under the auspices of the Association for Medical Education in Europe (AMEE). To ensure a shared understanding and to accurately convey information, we outline key terms in a glossary which accompanies this Consensus Statement (Supplementary Appendix 1). We acknowledge, however, that terms evolve and that different terms resonate variably depending on factors such as setting and audience. We define education for sustainable healthcare as the process of equipping current and future health professionals with the knowledge, values, confidence and capacity to provide environmentally sustainable services through health professions education. We define a health professional as a person who has gained a professional qualification for work in the health system, whether in healthcare delivery, public health or a management or supporting role and education as ‘the system comprising structures, curricula, faculty and activities contributing to a learning process’. This Statement is relevant to the full continuum of training – from undergraduate to postgraduate and continuing professional development.
Assessment of nursing care and teaching: A qualitative approach
(MDPI, 2019) Martínez-Linares, José Manuel; Martínez-Yébenes, Rocío; Andújar, Francisco Antonio; López-Entrambasaguas, Olga María
Background: The reform of the Spanish higher education to adapt to the European Higher Education Area involves, among other issues, the students’ participation in the curriculum assessment. The aim is to understand the insights of both nursing professionals and current undergraduate students of nursing on the connection between the knowledge acquired throughout the degree and the professional healthcare practice. Methods: An exploratory, descriptive qualitative study was carried out at a Spanish University. By convenience sampling, twelve nursing professionals and twelve 4th-year students of the Degree in Nursing were included. In two phases, twelve semi-structured interviews and two focus groups were conducted in order to triangulate data. A thematic analysis of data was carried out, later to be coded by two researchers. Results: Two main themes were identified: Evidence-based nursing vs. experience-based nursing, and a theory-practice gap. The topics that were specifically highlighted were the coexistence between professionals who work according to evidence and those whose work is based on experience, and the lack of connection between the training received during the degree and actual healthcare practice. Conclusion: Nursing care work varies in terms of the implementation of evidence-based care. Nursing training is perceived as being affected by a theory-practice gap. To achieve the linking between nursing theory and practice, a great effort on stakeholders would be needed.
Association between Sense of Coherence and Mental Health in Caregivers of Older Adults
(MDPI, 2019-10-09) López-Martínez, Catalina; Serrano-Ortega, Natalia; Moreno-Cámara, Sara; del-Pino-Casado, Rafael
The purpose of this study was to analyze association between sense of coherence and perceived burden, anxiety, depression, and quality of life in caregivers of older adults. A cross-sectional study was carried out with a probabilistic sample of 132 caregivers of older relatives from the regions of Jaén, Spain. The measures assessed were sense of coherence (Life Orientation Questionnaire), subjective burden (Caregiver Strain Index of Robinson), anxiety and depression (Goldberg Scale), and quality of life (Health Questionnaire SF-12). The main analyses included bivariate analysis using Pearson’s correlation coefficient and multivariate analysis through canonical correlation analysis. Our findings show that the sense of coherence explained 50.8% of the variance shared between subjective burden, anxiety, depression, and quality of life. We highlighted manageability as the variable within the dimensions of the sense of coherence with the greatest participation in the model. The sense of coherence may be an important protective factor for the mental health of the caregiver of dependent elderly relatives.
Attitudes of Spanish Nurses towards Pressure Injury Prevention and Psychometric Characteristics of the Spanish Version of the APuP Instrument
(MPDI, 2020-11-18) López-Franco, María Dolores; Parra-Anguita, Laura; Comino-Sanz, Inés; Pancorbo-Hidalgo, Pedro Luis
The prevention of pressure injuries in hospitalised patients is a critical point of care related to patient safety. Nurses play a key role in pressure injury (PI) prevention, making it important to assess not only their knowledge but also their attitude towards prevention. The main purpose of this study was to translate into Spanish and evaluate the psychometric properties of the Attitude towards Pressure ulcer Prevention instrument (APuP); a secondary aim was to explore the associations of attitude with other factors. A Spanish version was developed through a translation and back-translation procedure. The validation study was conducted on a sample of 438 nursing professionals from four public hospitals in Spain. The analysis includes internal consistency, confirmatory factorial analysis, and construct validity in known groups. The 12-item Spanish version of the APuP fit well in the 5-factor model, with a Cronbach’s alpha of 0.7. The mean APuP score was 39.98, which means a positive attitude. Registered nurses have a slightly better attitude than Assistant nurses. A moderate correlation (R = 0.32) between knowledge and attitude for the prevention of PI was found. As concluded, the Spanish version of the APuP questionnaire is a valid, reliable and useful tool to measure the attitude toward PI prevention in Spanish-speaking contexts. This version has 12 items grouped into 5 factors, and its psychometric properties are similar to those of the original instrument.
Burden and anxiety in family caregivers in the hospital that debut in caregiving
(MDPI, 2019-10-18) Pérez-Cruz, Margarita; Parra-Anguita, Laura; López-Martínez, Catalina; Moreno-Cámara, Sara; Del-Pino-Casado, Rafael
This cross-sectional study aims to determine the level of subjective burden and anxiety of caregivers of dependent older relatives that start providing care in the hospital and to analyse the relationship between objective burden, subjective burden and anxiety in these caregivers. Seventy-two caregivers of dependent older relatives were recruited in a medium–long stay hospital. Sociodemographic variables, number of basic activities of daily living (ADLs) attended, hours of surveillance, burden, and anxiety were collected from caregivers. A trajectory analysis was used to analyse the relationship between variables. Of the caregivers, 36.1% had subjective burden and 14.9% had anxiety. Subjective burden was positively associated with the number of basic ADLs attended, the hours of surveillance, and the cognitive impairment of the care recipient. Anxiety was also positively associated with subjective burden. Subjective burden mediated the effects of the number of basic ADLs attended, hours of surveillance and the cognitive impairment of the care recipient on anxiety. The levels of subjective burden and anxiety in caregivers debuting in hospital care are elevated, showing the need for these caregivers to be cared for. Subjective burden is a possible risk factor for anxiety, independent of the objective burden; it may buffer the effects of objective burden on anxiety.
Caregiving Satisfaction, Psychological Distress and Caregiver Burden in Family Caregivers of Dependent Older People: A Longitudinal Study
(Wiley, 2025-01-10) López-Martínez, Catalina
Background and Objectives Although a substantial amount of research has focused on negative aspects of caregiving, less research has been conducted investigating positive aspects of providing informal care. The aim of this study was to investigate the longitudinal association between caregiving satisfaction and psychological distress in informal carers of dependent older people, and whether this relationship is mediated by caregiver burden. Research Design and Methods Prospective longitudinal study with a probabilistic sample of 332 caregivers of older relatives, with data collected at baseline and at 1-year follow-up. We measured caregiving satisfaction, psychological distress, subjective caregiver burden and several covariates (caregivers' sex, age and objective caregiver burden). Data were analysed using generalised estimation equations with multiple imputation. The STROBE checklist was used to support the writing of this document. Results After controlling for covariates, caregiving satisfaction was significantly negatively associated with lower levels of subjective caregiver burden (B = −0.17, 95% CI: −0.23, −0.11) and emotional distress (B = −0.23, 95% CI: −0.36, −0.11). When subjective burden was included in the model, the relationship between caregiving satisfaction and psychological distress was no longer significant (B = −0.11, 95% CI: −0.23, 0.02), whereas the association between subjective burden and psychological distress remained (B = 0.75, 95% CI: 0.57, 0.92). The Sobel test confirmed these results (p < 0.001), indicating that subjective caregiver burden mediates the relationship between caregiving satisfaction and psychological distress (complete mediation) over time. Discussion and Implications Caregiving satisfaction exerts a longitudinal protective effect on carers' psychological distress via subjective burden. Our findings indicate that interventions aimed at strengthening caregiving satisfaction may play a significant role in maintaining positive mental health outcomes for informal caregivers.
Climate change effects in older people's health: A scoping review
(Wiley, 2024) Montoro-Ramírez, Eva María; Parra-Anguita, Laura; Álvarez-Nieto, Carmen; Parra-Anguita, Gema; López-Medina, Isabel María
Background: Climate change has serious consequences for the morbidity and mortal-ity of older adults.Objective: To identify the effects of climate change on older people's health.Methods: A scoping review was conducted following the Joanna Briggs Instituteguidelines and the PRISMA-ScR checklist. Quantitative research and reports from or-ganizations describing the effects of climate change on older people were selected.Results: Sixty-three full-text documents were selected. Heat and air pollution werethe two factors that had the most negative effects on cardiovascular and respiratorymorbidity and mortality in older people. Mental health and cognitive function werealso affected.Conclusions: Climate change affects several health problems in older individuals,especially high temperatures and air pollution. Nursing professionals must have thenecessary skills to respond to the climate risks in older adults. More instruments arerequired to determine nursing competencies on climate change and the health of thispopulation group.
Communication skills training in undergraduate nursing programs in Spain
(Elsevier, 2020) Ferrández-Antón, Teresa; Ferreira-Padilla, Guillermo; del-Pino, Rafael; Ferrández-Antón, Pilar; Baleriola-Júlvez, Jose; Martínez-Riera, José Ramón
Objectives of the present cross sectional study were to analyze the offer of subjects with communication skills in the nursing degree in Spain and to describe the distribution of these subjects. Documentary, systematic and independent search of web pages from Spanish universities was carried out to collect the following variables: subjects with communication skills, course in which the subject is taught, type of teaching (exclusive or combined), type of subject (compulsory or optional) and number of credits on communication skills. Although an average of 3.6 subjects per center was offered, most of the subjects were combined and with little communication content load. In one third of the centers, the offer was below 2.3 credits. Only 1 in 6 centers had exclusive communication skills subjects, and a quarter of them were optional. The teaching load of communication contents was highest in optional subjects. The offer of communication skills contents in Spanish Nursing Schools was scarce and very heterogeneous between centers and between courses in a center, with excessive presence of combined and optional subjects. Our results may be useful when developing the teaching guides for subjects with communication skills, as well as when defining communication competencies in the different Nursing Schools.
Competencies On Environmental Health And Pedagogical Approaches In The Nursing Curriculum: A Systematic Review Of The Literature
(2019) López-Medina, Isabel María; Álvarez-Nieto, Carmen; Grose, Jane; Elsbernd, Astrid; Huss, Norma May; Huynen, Maud; Richardson, Janet
It has been suggested that climate change is the biggest threat to public health for the 21st Century; increased demand on health services will impact on already overstretched resources and systems will need to be able to respond. However limited attention is given to climate change and sustainability in nursing education; there is no clear guidance on curricula content for nurses or recommendations regarding the skills and competencies that will be required. Literature published in Dutch, English, German, and Spanish was searched and 32 papers met the inclusion criteria for the review. Results suggests that holistic/systems thinking is relevant to healthcare so bringing a ‘sustainability lens’ to nursing curricula could be seen as being consistent with wider determinants of health. The literature review has identified the educational approaches necessary to provide a broad based curriculum and a cross-disciplinary approach. The findings suggest that topics such as the use of resources, food, health promotion, globalism, disease management, and the environmental impact of delivering healthcare, if embedded in nursing education could support the nursing profession's response for this new and important aspect of healthcare.
Context as a Facilitator of the Implementation of Evidence-based Nursing: A Meta-synthesis
(SAGE PUBLICATIONS INC, 2020-04-22) Clavijo-Chamorro, María Z.; Sanz-Martos, Sebastián; Gómez-Luque, Adela; Romero-Zarallo, Gema
Nurses have numerous difficulties in implementing science due to obstacles related to the work context. The aim is to explore the work-context-related facilitators of the application of evidence in clinical practice by nursing professionals. Qualitative meta-synthesis of primary studies on nurses’ experiences of work-context-related facilitators, as defined by the Promoting Action on Research Implementation in Health Services model. Using the Qualitative Appraisal and Review Instrument of the Joanna Briggs Institute. Of the total 57 primary research articles included, an explanatory model of the facilitating factors related to the work context was generated on the basis of four general categories: institutional support (leadership), multidisciplinary support (teamwork and communication), culture of improving quality of care (nursing professionals’ attitudes towards change) and use of research (valuing research). Action can be taken on the facilitating factors of the evidence-based practice application in nursing clinical environments, providing resources and motivation from the organization.
Coping and anxiety in caregivers of dependent older adult relatives
(MDPI, 2019-05-12) Pérez-Cruz, Margarita; Parra-Anguita, Laura; López-Martínez, Catalina; Moreno-Cámara, Sara; Del-Pino-Casado, Rafael
The aim of this study was to analyze the relationship between coping and anxiety in caregivers of dependent older adult relatives. A cross-sectional study was carried out in the province of Jaén (Andalusia, Spain). The convenience sample consisted of 198 family caregivers of dependent older adults. The main measurements were anxiety (Hamilton scale), coping (Brief COPE), subjective burden (Caregiver Strain Index), objective burden and sex of the caregiver. The main analyses were bivariate analysis using the Pearson correlation coefficient, and multivariate analysis using multiple linear regression. An independent regression model was developed for anxiety and each type of coping, adjusting for sex, subjective burden and objective burden. Our results demonstrate that anxiety was negatively associated with planning (partial r = −0.18), acceptance (partial r = −0.22) and humor (partial r = −0.20), and it was positively associated with self-distraction (partial r = 0.19), venting (partial r = 0.22), denial (partial r = 0.27) and self-blame (partial r = 0.25). Planning, acceptance and humor coping strategies may be protective factors of anxiety. Strategies such self-management, relief, denial and self-blame may be risk factors for anxiety.
Coping and anxiety symptoms in family carers of dependent older people: Mediation and moderation effects of subjective caregiver burden
(Wiley, 2024-01-28) López-Martínez, Catalina; Orgeta, Vasiliki; Frías-Osuna, Antonio; Del-Pino-Casado, Rafael
INTRODUCTION: Coping responses influence anxiety symptoms experienced by informal carers. However, only a few studies have investigated the longitudinal association between coping responses and anxiety symptoms in family carers. We also currently have limited knowledge on the mediating or moderating influence of subjective caregiver burden on this relationship over time. The aim of the present study was to investigate the longitudinal relationship between coping and anxiety symptoms in family carers of dependent older people, and examine the mediating or moderating role of subjective caregiver burden over time. DESIGN: Prospective longitudinal study. METHODS: We recruited and enrolled participants from a probability sample of 132 family carers of older dependent relatives. We measured coping strategies, anxiety symptoms, subjective caregiver burden, and several covariates (sex and intensity of care) at baseline and at 1-year follow-up. We used generalized estimating equations with multiple imputations to examine associations over time. RESULTS: Considering both direct and indirect effects through subjective burden, anxiety symptoms were positively associated with proactive coping (B = 0.13), planning (B = 0.15), self-distraction (B = 0.24), denial (B = 1.15), venting (B = 0.94) and self-blame (B = 0.90), and negatively associated with positive reframing (B = -0.83) and acceptance (B = -0.75). Subjective caregiver burden moderated the relationship between anxiety symptoms and planning, and the use of denial as a form of coping. CONCLUSIONS: Our results show that subjective caregiver burden is an important moderator and mediator of the longitudinal association between coping responses and anxiety symptoms in carers. CLINICAL RELEVANCE: Proactive coping and planning when subjective burden is low, self-distraction, denial, venting, and self-blame significantly increase levels of anxiety and caregiver burden in carers over time. Acceptance and positive reframing however as coping responses are associated with lower levels of anxiety and caregiver burden long-term. Our findings highlight the need for a multi-dimensional approach in future caregiving interventions.
Coping and anxiety symptoms in family carers of dependent older people: Mediation and moderation effects of subjective caregiver burden
(Wiley, 2024-01-05) López-Martínez, Catalina; Orgeta, Vasiliki; Frías-Osuna, Antonio; Del-Pino-Casado, Rafael
Introduction: Coping responses influence anxiety symptoms experienced by informal carers. However, only a few studies have investigated the longitudinal association between coping responses and anxiety symptoms in family carers. We also currently have limited knowledge on the mediating or moderating influence of subjective caregiver burden on this relationship over time. The aim of the present study was to investigate the longitudinal relationship between coping and anxiety symptoms in family carers of dependent older people, and examine the mediating or moderating role of subjective caregiver burden over time.Design: Prospective longitudinal study.Methods: We recruited and enrolled participants from a probability sample of 132 family carers of older dependent relatives. We measured coping strategies, anxiety symptoms, subjective caregiver burden, and several covariates (sex and intensity of care) at baseline and at 1-year follow-up. We used generalized estimating equations with multiple imputations to examine associations over time.Results: Considering both direct and indirect effects through subjective burden, anxiety symptoms were positively associated with proactive coping (B = 0.13), planning(B = 0.15), self-distraction (B = 0.24), denial (B = 1.15), venting (B = 0.94) and self-blame(B = 0.90), and negatively associated with positive reframing (B = −0.83) and acceptance (B = −0.75). Subjective caregiver burden moderated the relationship between anxiety symptoms and planning, and the use of denial as a form of coping.Conclusions: Our results show that subjective caregiver burden is an important moderator and mediator of the longitudinal association between coping responses and anxiety symptoms in carers.Clinical Relevance: Proactive coping and planning when subjective burden is low, self-distraction, denial, venting, and self-blame significantly increase levels of anxiety and caregiver burden in carers over time. Acceptance and positive reframing however as coping responses are associated with lower levels of anxiety and caregiver burden long-term. Our findings highlight the need for a multi-dimensional approach in future caregiving interventions.
Coping and depressive symptoms in family carers of dependent adults aged 18 and over: A systematic review and meta-analysis
(Wiley, 2023-01-12) Muñoz-Cruz, Juan Carlos; López-Martínez, Catalina; Orgeta, Vasiliki; Del-Pino-Casado, Rafael
Being a family carer is associated with increased risk of experiencing depressive symptoms. Despite many decades of research investigating the association between coping strategies and depressive symptoms in carers results across studies remain contradictory. The objective of this study was to systematically review evidence on the association between depressive symptoms and coping strategies in carers of dependent people aged 18 and over and investigate potential sources of heterogeneity of findings. The study design was a systematic review and meta-analysis. We searched Pubmed, CINAHL, PsycINFO and LILACS up to April 2021. We performed meta-analyses following the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement and several subgroup analyses to investigate whether cause of caring dependency, study design, and controlling for several biases influenced results. Fifty-nine studies met our inclusion criteria. We found a robust and statistically significant association between greater use of dysfunctional coping and higher depressive symptoms. Greater use of emotion-focussed coping was associated with fewer depressive symptoms only in studies controlling for confounding bias. Use of problem-focussed coping was related to fewer depressive symptoms in carers of frail older people. The combined use of both problem-focussed and emotion-focussed coping was associated with lower symptoms of depression. Our review concludes that the broad domain of dysfunctional coping is consistently associated with higher levels of depressive symptoms in carers. After controlling for confounders, emotion-focussed coping and several of its individual strategies were consistently associated with fewer depressive symptoms. Whilst problem-focussed coping and some of its individual strategies are also associated with lower depressive symptoms, these strategies may not be as helpful in all caregiving groups.
Coping strategies and psychological distress in family carers of frail older people: A longitudinal study
(Elsevier, 2019) Del-Pino-Casado, Rafael; Serrano-Ortega, Natalia; López-Martínez, Catalina; Orgeta, Vasiliki
Background. Carers of dependent older people experience high levels of psychological distress. However, little is known about the effects of coping on carer distress over time. In this one year longitudinal study we investigated the relationship between distress, and coping strategies in a representative sample of family carers living in Spain. Methods. Primary carers of older people were recruited (N = 200). We used probability sampling and collected data via individual interviews from 2013 to 2015. Variables investigated included psychological distress, coping, and levels of objective and subjective burden. Panel data analysis was used to test a model of association of psychological distress, and coping strategies controlling for key confounders. Results. Acceptance and emotional support were the most frequently used strategies, whereas behavioural disengagement and humour were the least used. In the panel data regressions, positive reframing (B = -0.79, p < 0.001), self-distraction (B = -0.46, p = 0.034), substance use (B = 0.57, p < 0.001) and denial (B = 0.57, p = 0,049) were significantly related to psychological distress at one year follow-up. Limitations. Limitations include participant drop out and assessing substance use coping via a brief measure. Conclusions. Positive reframing and self-distraction were longitudinally associated with lower levels of carer psychological distress. Using denial and substance use coping increased distress long-term. Our results suggest that interventions that focus on positive reframing and assisting carers in decreasing dysfunctional coping may be useful therapeutic targets mitigating carer psychological morbidity.
Correlates of Burden in Primary Caregivers of Older Relatives: A Cross-sectional Study
(Wiley, 2014) Del-Pino-Casado, Rafael; Millan-Cobo, Martín D.; Palomino-Moral, Pedro A.; Frias-Osuna, Antonio
PURPOSE: To analyze the effect of cultural factors on the subjective burden of primary home caregivers of older relatives. DESIGN: Cross-sectional study. Primary home caregivers (N = 208) of older relatives were recruited in Spain using systematic random sampling. METHODS: The data were collected in 2010 through interviews. The measures included sociodemographic characteristics, stressors (the intensity of care provided and the care-recipient's needs; the latter were assessed using the Barthel Index, the Pfeiffer Short Portable Mental Status Questionnaire and the Cummings Neuropsychiatric Inventory), cultural factors (kinship ties, common residence, perceived social support, and cultural motives for caregiving), and caregiver subjective burden (Caregiver Strain Index). The data were analyzed using bivariate procedures and multiple linear regression. FINDINGS: After controlling for caregiver age, caregiver gender, stressors, and duration of caregiving, subjective burden was negatively associated with perceived social support and reciprocity, and in the subgroup of adult children, it was positively associated with common residence. Cultural factors explained 29% of the variance in burden. CONCLUSIONS: Our findings add to the existing evidence regarding the influence of cultural factors in the perception of burden in caregiving situations. CLINICAL RELEVANCE: A risk profile could be proposed for subjective burden in primary family caregivers. Individuals who are at risk are characterized as young, offspring who live with the care recipient, care for a care recipient with behavioral problems, are unsatisfied with the social support received, and have a low balanced reciprocity.
Cross-cultural adaptation of children’s environmental health questionnaires for nursing students in England
(SAGE PUBLICATIONS LTD, 2020-05-04) Álvarez-García, Cristina; Álvarez-Nieto, Carmen; Carter, Rachel; Kelsey, Janet; Sanz-Martos, Sebastián; López-Medina, Isabel María
Objectives: Children are among the most vulnerable population groups with regard to environmental risks. Nursing students must be fully educated on children’s environmental health as they are in a key position to prevent and reduce the effects of environmental hazards. The main objective of this study was to adapt and validate an English language version of two questionnaires about children’s health and the environment, to assess the knowledge and skills of student nurses in England. Design: Observational cross-sectional study. Setting: A university in Southern England. Method: The study involves translating, adapting and validating the Children’s Environmental Health Knowledge Questionnaire (ChEHK-Q) and the Children’s Environmental Health Skills Questionnaire (ChEHS-Q) with nursing students in England (N = 232). Results: The psychometric characteristics of both questionnaires were strong. Infit and outfit values were close to 1. The reliability values for the items and people were 0.96 and 0.79 for ChEHK-Q and 0.98 and 0.89 for ChEHS-Q, respectively. Only 52 (22.41%) and 77 (33.62%) participants had at least good knowledge and skills, respectively. Higher knowledge and skills were found with respect to the vulnerability of children and identification of environmental risks in the home. Lower levels of knowledge and skills were found with respect to the effects of pesticides and the assessment of neoplastic pollutants. Conclusion: Findings demonstrate deficiencies in nursing competencies related to children’s environmental health. The use of these questionnaires will facilitate improvement in both knowledge and skills related to children’s environmental health among future nurses.

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