Aplicación práctica de los modelos de Mercer y Beck en las especialidades de enfermería

El vínculo afectivo es la atracción que un individuo siente por otro. La conducta de apego busca la unión emocional y seguridad del bebé hacia su madre. Distintas especialidades de enfermería indican la importancia de trabajar el vínculo afectivo, las relaciones familiares y utilizar el proceso enfermero partiendo de modelos conceptuales. Los modelos conceptuales de Mercer y Beck estudian factores a considerar en la formación y desarrollo de vínculos afectivos entre madres e hijos. Este estudio pretende desarrollar conocimientos, habilidades y actitudes que permitan una atención óptima al bebé y su familia. Analizando los elementos comunes y diferenciadores de ambos modelos y justificando la necesidad de prestar especial atención a la formación y mantenimiento del vínculo maternofilial desde la perspectiva de las diferentes especialidades de enfermería, se utiliza el proceso enfermero para la detección y resolución de problemas que afecten al vínculo afectivo y a las relaciones familiares.

Attachment insecurity, depression, and the transition to parenthood

In a longitudinal study of adult attachment and depression during the transition to parenthood, 76 couples completed questionnaires on three occasions: during the second trimester of pregnancy, and six weeks and six months postbirth. On the first and second occasions, the couples were also interviewed about their experiences of pregnancy and parenthood, respectively. Measures were also completed at similar time intervals by a comparison group of 74 childless couples. Attachment security was assessed in terms of the dimensions of discomfort with closeness and relationship anxiety. Relationship anxiety was less stable for transition wives than for other participants. Relationship anxiety also predicted increases in new mothers' depressive symptoms, after controlling for a broad range of other risk factors. However, the association between relationship anxiety and maternal depression was moderated by husbands' caregiving style. Maternal depression was linked to increases in husbands' and wives' attachment insecurity and marital dissatisfaction. Results are discussed in terms of the impact of depression and negative working models of attachment on couple interaction.

Family violence: Walking the tight rope between maternal alienation and child safety

Mothers are often alienated from their children when child abuse is suspected or confirmed, whether she is the primary abuser of the child or not. An abusive or violent partner often initiates the process of maternal alienation from children as a control mechanism. When the co-occurrence of maternal and child abuse is not recognised, nurses and health professionals risk further alienating a mother from her children, which can have detrimental effects in both the short and long term. Evidence shows that when mothers are supported and have the necessary resources there is a reduction in the violence and abuse she and her children experience; this occurs even in situations where the mother is the primary abuser of her children. The family-centred care philosophy, which is widely accepted as the best approach to nursing care for children and their families, creates tension for nurses caring for children who are the victims of abuse as this care generally occurs away from the context of the family. This fragmented approach to caring for abused children can inadvertently undermine the mother-child relationship and further contribute to maternal alienation. This paper discusses the complexity of family violence for nurses negotiating the 'tight rope' between the prime concern for the safety of children and further contributing to maternal alienation, within a New Zealand context. The premise that restoration of the mother-child relationship is paramount for the long-term wellbeing of both the children and the mother provides the basis for discussing implications for nursing practice.

Parental attachment and conflict behavior: Implications for offspring's attachment, loneliness, and relationship satisfaction

This study assessed the implications of parental attachment security and parental conflict behavior for offspring's relational adjustment (attachment security, loneliness, and relationship satisfaction). Further, reports of parental conflict behavior were obtained from both parents and offspring, addressing questions regarding agreement between reporters and the origin and extent of discrepant perceptions. Results revealed consistent patterns of conflict behavior and moderate agreement between reporters. However, offspring reported parental conflict behavior more negatively than parents, especially when offspring or parents were anxious about relationships. Parental attachment security had direct associations with offspring's relationship anxiety, whereas associations between parental attachment and offspring's loneliness and discomfort with closeness were mediated by parental conflict behavior. Parental conflict behavior was also associated with offspring's relationship satisfaction. The results are discussed in terms of the mechanisms involved in the intergenerational transmission of relationship difficulties.

Two -way direction of influence in mother-infant interaction as denoted by concurrent reciprocal learning processes

This series of 5 single-subject studies used the operant conditioning paradigm to investigate, within the two-way influence process, how (a) contingent infant attention can reinforce maternal verbal behaviors during a period of mother-infant interaction and under subsequent experimental manipulation. Differential reinforcement was used to determine if it is possible that an infant attending to the mother (denoted by head-turns towards the image of the mother plus eye contact) increases (reinforces) the mother's verbal response (to a cue from the infant) upon which the infant behavior is contingent. There was also (b) an evaluation during the contrived parent-infant interaction for concurrent operant learning of infant vocal behavior via contingent verbal responding (reinforcement) implemented by the mother. Further, it was noted (c) whether or not the mother reported being aware that her responses were influenced by the infant's behavior. Findings showed: the operant conditioning of the maternal verbal behaviors were reinforced by contingent infant attention; and the operant conditioning of infant vocalizations was reinforced by contingent maternal verbal behaviors. No parent reported (1) being aware of the increase in their verbal response reinforced during operant conditioning of parental behavior nor a decrease in those responses during the DRA reversal phase, or (2) noticing a contingency between infant's and mother's response. By binomial 1-tail tests, the verbal-behavior patterns of the 5 mothers were conditioned by infant reinforcement (p < 0.02) and, concurrently, the vocal-response patterns of the 5 infants were conditioned by maternal reinforcement (p < 0.02). A program of systematic empirical research on the determinants of concurrent conditioning within mother-child interaction may provide a way to evaluate the differential effectiveness of interventions aimed at improving parent-child interactions. The work conducted in the present study is one step in this direction. ^

Adolescent substance use in the context of the family: a qualitative study of young people’s views on parent-child attachments, parenting style and parental substance use

Background: Adolescent substance use can place youth at risk of a range of poor outcomes. Few studies have attempted to explore in-depth young people’s perceptions of how familial processes and dynamics influence adolescent substance use.
Objectives: This paper aimed to explore risk and protective factors for youth substance use within the context of the family with a view to informing family based interventions.
Methods: Nine focus groups supplemented with participatory techniques were facilitated with a purposive sample of sixty-two young people (age 13-17 years) from post-primary schools across Northern Ireland. The data were transcribed verbatim and analysed using thematic analysis.
Results: Three themes emerged from the data: 1) parent-child attachments, 2) parenting style and 3) parental and sibling substance misuse. Parent-child attachment was identified as an important factor in protecting adolescents from substance use in addition to effective parenting particularly an authoritative style supplemented with parental monitoring and strong parent-child communication to encourage child disclosure. Family substance use was considered to impact on children’s substance use if exposed at an early age and the harms associated with parental substance misuse were discussed in detail. Both parent and child gender differences were cross-cutting themes.
Conclusion: Parenting programmes (tailored to mothers and fathers) may benefit young people via components on authoritative styles, parental monitoring, communication, nurturing attachments and parent-child conflict. Youth living with more complex issues, e.g. parental substance misuse, may benefit from programmes delivered beyond the family environment e.g. school based settings.

Dificuldades na amamentação no 1º mês de vida : contextos sociodemográficos e psicológicos

Enquadramento: A amamentação nutre, protege e favorece o desenvolvimento cognitivo e a criação do vínculo afetivo entre mãe e filho. No entanto, há vários fatores que dificultam a manutenção da amamentação como os psicológicos, socioculturais, profissionais, nível de educação, ação dos profissionais de saúde entre outros. Objetivos: Determinar o perfil sociodemográfico das puérperas; identificar as dificuldades mais frequentes associadas à amamentação ao 7º e 30º dia após o nascimento; analisar a influência das variáveis sociodemográficas associadas às dificuldades na amamentação nos dois momentos de avaliação; avaliar a influência das atitudes maternas e a da vinculação pós-natal nas dificuldades associadas à amamentação nos dois momentos de avaliação. Métodos: Estudo quantitativo, longitudinal em painel de curta duração, descritivo-correlacional, numa amostra não probabilística por conveniência de 255 participantes (média de idades de 30,78 anos). Utilizou-se um questionário para caracterizar sociodemograficamente e os contextos de amamentação da amostra, a escala de atitudes maternas face à amamentação (Pereira, 2004) e a escala de vinculação pós-natal (Airosa, Silva & Bachu, 2012), versão portuguesa de Gomez e Leal (2007). Este foi aplicado às participantes em dois momentos (7º e 30º dias após o nascimento do bebé). Resultados: As participantes são maioritariamente casadas, com o ensino superior, empregadas em tempo completo e residentes na cidade. Quanto às dificuldades mais frequentes associadas à amamentação nos dois momentos de avaliação do estudo (7º e 30º dia de vida do bebé) verificamos que as dificuldades sentidas ao 7º dia se mantêm no 30º, predominando as fissuras (7.º dia 41.7%; 39.3% 30.º dia), as dificuldades na pega (7.º dia 28.8%; 31.9% 30.º dia), o ingurgitamento mamário (7.º dia 16.7%; 14.8% 30.º dia). Em relação à influência das variáveis sociodemográficas nas dificuldades associadas à amamentação ao 7º e 30º dia após o nascimento, apurou-se que as diferenças são estatisticamente significativas em relação à escolaridade (p=0,000), situação profissional (p=0,034) e local de residência (0,042), sugerindo que estas variáveis têm poder explicativo sobre as dificuldades sentidas na amamentação pelas mães nos dois momentos de avaliação. Nenhuma das dimensões relativas às atitudes maternas face à amamentação e à vinculação pós-natal se assumiu preditora das dificuldades associadas à amamentação. Conclusão: Os resultados sugerem que os enfermeiros, especialmente no âmbito da saúde materna, obstétrica e ginecológica, estejam mais despertos para as dificuldades que as mães possam ter na amamentação sobretudo no primeiro mês, considerado o mais crítico na adaptação ao aleitamento materno, de modo a conseguirem que estas ultrapassem essas complicações, evitando assim, o abandono precoce da amamentação. Palavra-chave: Amamentação, Atitudes Maternas, Vinculação pós-natal, Dificuldades na amamentação.

The development of selective copying: children’s learning from an expert versus their mother

This study tested the prediction that, with age, children should rely less on familiarity and more on expertise in their selective social learning. Experiment 1 (N=50) found that 5- to 6-year-olds copied the technique their mother used to extract a prize from a novel puzzle box, in preference to both a stranger and an established expert. This bias occurred despite children acknowledging the expert model’s superior capability. Experiment 2 (N=50) demonstrated a shift in 7-to 8-year-olds towards copying the expert. Children aged 9- to 10-years did not copy according to a model bias. The findings of a follow-up study (N=30) confirmed that, instead, they prioritized their own – partially flawed – causal understanding of the puzzle box.

Aproximaciones a mindfulness en la psicología contemporánea

Este trabajo es una revisión de literatura que abarca una selección de artículos disponibles en bases de datos especializadas y publicados en el periodo comprendido entre los años 2006 a 2016 para artículos científicos y entre los años 2000 a 2016 para libros. En total se revisaron: 1 tesis doctoral, 1 tesis magistral, 111 artículos y 9 libros o capítulos de libros. Se presentan diversas definiciones de mindfulness y formas de conceptualizarla, sus mecanismos de acción, sus enfoques psicoterapéuticos predominantes, los efectos de su práctica estable, sus principales campos de acción y la importancia de la formación de los docentes que imparten la práctica. Finalmente se presentan algunas conclusiones acerca del diálogo entre la literatura psicológica sobre mindfulness y algunas de las concepciones de la tradición budista en torno a la meditación.

[maternal Perception Regarding Hospitalized Newborns].

Cross-sectional descriptive study conducted in the neonatal unit of a public teaching hospital in the state of São Paulo, Brazil, which aimed to determine the perceptions of mothers about their newborns hospitalized children. The sample consisted of 100 women questioned, through the Neonatal Perception Inventory Broussard, about how much trouble was expected to be presented by babies of the general unit, on behaviors such as crying; feeding; regurgitate or vomit; evacuate; sleep and have a routine. Then, the same questions were repeated about their own babies. Ninety mothers considered their children with fewer difficulties than other babies at the unit. Younger women and mothers of infants with higher weights tended to consider their children with more difficulty. The Inventory is easy to apply and may be useful in the evaluation of mother-child interaction, although its result cannot be considered in isolation.

Brincando no ambiente natural : uma contribuição para o desenvolvimento sensorio-motor da criança portadora de paralisia cerebral

Universidade Estadual de Campinas . Faculdade de Educação Física

Visceral leishmaniasis and pregnancy: analysis of cases reported in a central-western region of Brazil

Objectives Because of the large number of cases of visceral leishmaniasis (VL) recorded in Brazil over the last few years, this disease has been showing characteristics different from previously known ones. We report cases of pregnant women treated for VL, describing their course and outcome and the chemotherapeutic medication used according to the clinical signs and symptoms of each patient. Study design We report five cases of pregnant women treated for VL in a central-western region of Brazil. Results No case of vertical transmission was observed, even in patients who were treated after delivery. One of the patients with a late diagnosis made after the onset of symptoms died. Thus, the treatment of VL during pregnancy reduces maternal mortality and the rate of vertical transmission of the disease, being safe and effective as long as the disease is diagnosed early. Conclusion At present, amphotericin B and its derivatives appear to be the best therapeutic option for the mother-child binomial.

Estudo do sobre o impacto do risco biológico e ambiental na qualidade da interacção mãe-filho(a)

O presente estudo exploratório tem como principais objectivos: averiguar o impacto do risco biológico e ambiental, ou ambos, na interacção mãe-filho(a), e contribuir para a adaptação de uma escala de observação da qualidade da interacção mãe-filho(a) em interacção livre. Para o efeito observámos 40 díades mãe-filho(a) em jogo livre distribuídas por 4 grupos de estudo: o primeiro grupo composto por 14 díades sem condições assinaláveis de risco, o segundo grupo composto por 8 díades assinaláveis de risco biológico, o terceiro grupo composto por 7 díades em risco ambiental e por fim, o quarto grupo por 10 díades em risco ambiental e biológico. A recolha de dados foi realizada nos concelhos do Porto e Viseu. A qualidade de interacção foi inicialmente observada em 50 casos com a Escala de Comportamentos Interactivos dos bebés e das mães em jogo livre (Fuertes, Faria, Oliveira-Costa & Soares, 2010), tendo sido posteriormente adaptada para condições de risco tomando a designação de escala Escala de Avaliação de Comportamentos Interactivos mãe-filho(a)-Adaptada para Condições de Risco (Fuertes & Canelhas, 2011). Os comportamentos maternos e infantis foram cotados, independentemente, relativamente à expressão facial, expressão vocal, expressão afectiva, posicionamento, directividade e jogo. Os resultados foram analisados com recurso a estatística descritiva e multinominal. Os resultados do nosso estudo sugerem que as díades sem condições de risco tinham interacções mais positivas, recíprocas e ajustadas à idade das crianças, do que as díades sujeitas, quer a situações de risco biológico, quer a condições de risco ambiental. Adicionalmente, verificámos que alguns factores demográficos (e.g., risco na gravidez, área de residência, estabilidade profissional das mães e a frequência de creche (em oposição a amas) afectam a qualidade da interacção mãe-filho(a). Por fim, encontramos uma forte concordância entre as duas escalas, sugerindo que a nossa escala (Escala de Avaliação de Comportamentos Interactivos mãe-filho(a)-Adaptada para Situações de Risco), tem indicadores capazes de captar a natureza interactiva do jogo mãe-filho(a) e deverá ser validada.

Developmental and evolutionary assumptions in a study about the impact of premature birth and low income on mother–infant interaction

In order to study the impact of premature birth and low income on mother–infant interaction, four Portuguese samples were gathered: full-term, middle-class (n=99); premature, middle-class (n=63); full-term, low income (n=22); and premature, low income (n=21). Infants were filmed in a free play situation with their mothers, and the results were scored using the CARE Index. By means of multinomial regression analysis, social economic status (SES) was found to be the best predictor of maternal sensitivity and infant cooperative behavior within a set of medical and social factors. Contrary to the expectations of the cumulative risk perspective, two factors of risk (premature birth together with low SES) were as negative for mother–infant interaction as low SES solely. In this study, as previous studies have shown, maternal sensitivity and infant cooperative behavior were highly correlated, as was maternal control with infant compliance. Our results further indicate that, when maternal lack of responsiveness is high, the infant displays passive behavior, whereas when the maternal lack of responsiveness is medium, the infant displays difficult behavior. Indeed, our findings suggest that, in these cases, the link between types of maternal and infant interactive behavior is more dependent on the degree of maternal lack of responsiveness than it is on birth status or SES. The results will be discussed under a developmental and evolutionary reasoning

Estudo dos indicadores de qualidade e de risco na interaça o mãe-filho(a)

O presente estudo tem como principal objetivo identificar na interação mãe- bebés de 3 meses, indicadores de risco e de qualidade e, consequentemente, criar um guião que ajude os profissionais a identificar esses mesmos indicadores. Para o efeito observámos 30 díades mãe-filho(a) em jogo livre distribuídas em dois grupos: 1) 12 díades sem condições assinaláveis de risco e 2) 18 díades em risco socioeconómico. O comportamento interativo dos bebés e das mães foi avaliado através do Child-Adult Relashionship Experimental, designado pela autora de CARE-Index (Crittenden, 2003). Os comportamentos maternos e infantis foram cotados de acordo com os 7 aspetos do comportamento diádico: Expressão Facial, Expressão Verbal, Posição e Contato Corporal, Afetividade, Reciprocidade, Diretividade e Escolha da Atividade. Os resultados do nosso estudo revelam que as díades mãe-filho(a) sem condições assinaláveis de risco apresentam interações mais positivas, recíprocas e ajustadas à idade das crianças do que as díades sujeitas a condições de risco e que o comportamento materno sensível e responsivo surge associado ao comportamento cooperativo infantil e negativamente correlacionado com a dificuldade infantil, enquanto que uma postura controladora, diretiva ou punitiva da mãe surge positivamente correlacionada com a submissão e evitamento infantil. Por fim, encontramos associados a comportamentos maternos sensíveis uma variabilidade de comportamentos infantis desde satisfação, coerção, procura de proximidade ou evitamento. Na discussão dos resultados apresentamos um script dos indicadores de qualidade e de risco do comportamento materno. - Abstract This study main goal was to study mother-infant quality of interaction in dyads with 3 months babies. Moreover, our goal was to explore maternal and infant key behaviors that shape the quality of the interaction in order to organize a script that helps professionals to identify these critical interactive behaviors. To this end we observed 30 mother-child dyads (a) in free play interaction divided into two groups: 1) 12 dyads without any known risk condition and 2) 18 dyads at socioeconomic risk. The interactive behavior of infants and mothers was assessed using the Child-Adult Relationship Experimental, designated by the author of CARE-Index (Crittenden, 2003). The maternal and infant behaviors were rated according to seven aspects of dyadic behavior: Facial Expression, Verbal Expression, Position and Contact Body, Affection, Reciprocity, Directivity and Choice of Activity. Findings indicate that mother-child dyads without know risk conditions are more likely to present positive interactions, reciprocal and age-adjusted than dyads at risk. The sensitive and responsive maternal behavior emerges associated with children's cooperative behavior and negatively correlated with infant difficultness, while a controlling or punitive maternal behavior is positively correlated with infant compliance and avoidance. Finally, sensitive maternal behaviors were associated with a variability of child behaviors, from satisfaction, coercion, avoidance or proximity search. In the results discussion we present a script of the quality and risks indicators of maternal behavior.