[In Chile, the family at the heart of prevention and health promotion]

During a five-week placement in southern Chile, a nursing student learned about community health interventions. This immersion in the local, mainly Indian, population led her to discover the importance of family dynamics as a resource for supporting the patient in his or her care, as well as the tools supporting this approach. Remote feedback and perspective on her current practice as a neonatal nurse.

[The relational work of the psychiatric nurse: a self-commitment]

The young psychiatric nurse has to adapt his posture in order to identify the challenges of his profession. The relationship with the subject and the desire to understand the issues must be at the heart of his professional life. What skills should be required to build up oneself? If this work is essentially relational, how can the right professional distance be apprehended? This is based on a commitment, an assumption of responsibility centred on analysis, an understanding of the patient and the ability to motivate him. In this context, the contributions of Carl Rogers, the characteristics of the clinical interview and the techniques favouring communication are valuable tools.

Genetic cancer risk assessment: A screenshot of the psychosocial profile of women at risk for hereditary breast and ovarian cancer syndrome

OBJECTIVE

There is a lack of information describing Brazilian women at risk of hereditary breast and ovarian cancer syndrome (HBOC) who undergo genetic cancer risk assessment (GCRA). This study aims to characterize the psychosocial profile of women at risk for HBOC at their first GCRA to obtain an overview of their families' profiles and the challenges of the oncogenetics setting.

METHODS

This was a cross-sectional study in which interviews were conducted with 83 cancer-affected women at their first GRCA appointment after the pedigree draw. Tools to evaluate psychological outcomes were applied. The pedigree genogram and ecomap were constructed and analyzed with content analysis using the "life course perspective" theory.

RESULTS

Individuals perceived their breast/ovarian cancer risk to be equal to that of the general population, although they were highly concerned about developing cancer. No evidence of anxiety or depressive symptoms was identified. Participants used the coping strategy of searching for religiosity. The genograms and ecomaps resulted in five major themes: support and social support; attitudes, feelings and emotions; cancer causes; communication; and relationships with relatives. Individuals between 20-29 years of age and those with no family history of cancer tended not to communicate with relatives, which may indicate future problems in the GCRA process regarding genetic testing.

CONCLUSIONS

This study demonstrated that knowing the families who undergo the GCRA process can help professionals provide more individualized and thorough attention during GCRA and genetic testing, which results in better follow-up and prevention strategies.

Family Patterns and Suicidal and Violent Behavior among Adolescent Girls-Genogram Analysis

An increase in extreme self-destructive and aggressive behaviors in adolescents has been observed in recent years. Therapeutic effectiveness seems to depend on an adequate recognition of factors that might increase the risk of extreme destructive behaviors. The aim of this study was to identify the family patterns that should draw therapeutic attention due to their importance for suicidal or violent behaviors in adolescent girls. The study involved 140 participants, aged 13⁻17, including 40 girls after suicide attempts, 40 girls using violence, and 60 girls without destructive behavior at all. The Genograms were used to assess the family structure, relationships between family members, and family projections. The data was analyzed by polynomial logistic regression, analysis of variance, and discriminant analysis. Emotional distance and hidden projections (related to diseases) were the most significant predictors of suicidal behaviors in the studied adolescent girls. Alcohol abuse by significant family members, especially by male family members, and a lesser role of hidden projections, were the most significant predictors of violent behaviors. Interventions designed to reduce risk of destructive behaviors among adolescents need to take account of the specific family patterns.

[Psychogenealogy and its history]

The collective and transmittable unconscious, invisible loyalty, unconscious debts or family secrets are all concepts developed by thinkers such as Sigmund Freud, Françoise Dolto and Serge Tisseron. The genogram is a tool used by professionals to help families to identify themselves in their family constellations.

Updating genograms in the practice of preventive medicine

Family physicians uncover clues to genetic risk while they routinely sketch and add to patients' genograms. A symbolic international language identifies health conditions and shows inter- and intra-generational relationships of mating and descent. Time allotted to reviewing the genogram and follow-up carried out by the family physician and/or through referral to a genetics clinic lie well within the mandate to practise preventive medicine. Such vigilance is fundamental to the unwritten agreement between the family and the family physician to delay, moderate, or avoid health crises.