Reframing care while enduring the traumatic nature of witnessing disrupted family-patient-nurses' relationships during COVID-19.

AIM: To describe the lived experiences of nurses caring for patients and families in the context of COVID-19 in Brazil and United States. DESIGN: A phenomenological philosophical approach following the van Manen analysis method. METHODS: Participants were recruited in Brazil and the United States, including nurses working in health care settings caring for COVID-19 patients. Recruitment used purposive and snowball sampling. Participants completed a demographic survey and semi-structured interviews that were audio-recorded and transcribed for analysis. A cross-cultural examination occurred among researchers from each country. RESULTS: The result was described (n = 35) by the themes, representing the essences of each lifeworld (relationship, time, space and body). The nurses' lived experience was one of reframing care while enduring repeated trauma of witnessing disrupted patient-family-nurse relationships. Themes were as follows: (a) Living a silent and lonely experience; (b) Providing connectedness for disrupted patient and family relationships; (c) Feeling the burden of the demands; (d) Being a helping connector; (e) Reshaping spaces amidst evolving interventions and policies; (f) Creating safe spaces, surrounded by turmoil, threat, and distress within an unsafe environment; (g) Reorganizing care and reframing time; (h) Reconciling losses, regrets, victories and lessons. CONCLUSION: The nurses' lived experience of caring for patients and families during the COVID-19 pandemic prompted the need to respond to repeated traumas and distress posed by interrupted patient-family and nurse-own family relationships, vulnerable bodies, threatened space and dynamic and volatile time. IMPACT: Cultural nuances were discovered depending on the practice setting, political discourse and the autonomy of the nurse. Innovative models of care that create structures and processes to support nurses in caring for patients in threatening environments and the commitment to connecting family members have potential to contribute to the ongoing health of the nursing profession.

Factors associated with sleep quality during chemotherapy: An integrative review.

Aim: To identify the most important factors associated with sleep pattern changes in patients with cancer during chemotherapy treatment. Design: An integrative review of the literature was performed between December 2017-August 2018. Methods: Two independent reviewers searching the National Library of Medicine (PubMed/MEDLINE), Cumulative Index of Nursing and Allied Health Literature (CINAHL) and Latin American and Caribbean Literature in Health Sciences (LILACS), Scopus and Scielo. The process followed the recommendations of the PRISMA tool. A total of 16 articles were selected for the final study sample, including 11 cohort studies and 5 cross-sectional studies. Results: The predisposing factors for the most prevalent sleep disturbances were precipitants related to the disease and the treatment, such as fatigue, pain, depression, anxiety and distress. Predisposing factors related to lifestyle and demographic characteristics have a significant correlation with sleep disturbances.

Parental expectations of support from healthcare providers during pediatric life-threatening illness: A secondary, qualitative analysis.

PURPOSES: To explain parental expectations of support from healthcare providers for their parenting roles and goals during a child's life-threatening illness (LTI). DESIGN AND METHODS: Qualitative interpretive study guided by the Family Adjustment and Adaptation Response Model. Thematic analyses were conducted with data from 31 semi-structured interviews of parents of children with LTI using systematic strategies to ensure rigor including audit trails and prolonged engagement. RESULTS: We identified three themes and one meta-theme or overall theme: (1) "Help us survive this," (2) "Let's fight together: please fight with me, not against me, to care for my family," and (3) "Guide me through the darkness: I am suffering." Overall, the parents conveyed that they expect mutuality with the health care providers and system in order to keep Fighting together for my family survival. CONCLUSIONS: In the daily work of caring for their families, parents of children with LTI consider survival on multiple levels. They consider the life, illness, and potential death of one child while considering the on-going survival and sustenance of family relationships. PRACTICE IMPLICATIONS: Parents are distressed and grapple with conflicted feelings about managing competing needs of various family members. Relationships with health care providers can influence parents' management of the situation and be a source of support as their parenting role changes over the illness trajectory, time, and in response to adversity.

The family's experience of the child and/or teenager in palliative care: fluctuating between hope and hopelessness in a world changed by losses.

OBJECTIVES: to understand the family's experience of the child and/or teenager in palliative care and building a representative theoretical model of the process experienced by the family. METHODOLOGY: for this purpose the Symbolic Interactionism and the Theory Based on Data were used. Fifteen families with kids and/or teenagers in palliative care were interviewed, and data were collected through semi-structured interviews. RESULTS: after the comparative analysis of the data, a substantive theory was formed "fluctuating between hope and hopelessness in a world changed by losses", composed by: "having a life shattered ", "managing the new condition", "recognizing the palliative care" and "relearning how to live". Hope, perseverance and spiritual beliefs are determining factors for the family to continue fighting for the life of their child in a context of uncertainty, anguish and suffering, due to the medical condition of the child. Along the way, the family redefines values and integrates palliative care in their lives. CONCLUSION: staying with the child at home is what was set and kept hope of dreaming about the recovery and support of the child's life, but above all, what takes it away even though temporarily is the possibility of their child's death when staying within the context of the family.

The process of end-of-life care delivery to the families of elderly patients according to the Family Health Strategy.

OBJECTIVE: To understand the process of end-of-life care delivery to the families of elderly patients according to a Family Health Strategy (FHS) team, to identify the meanings the team attributes to the experience and to build a theoretical model. METHOD: Symbolic Interactionism and Grounded Theory were applied. Fourteen professionals working in an FHS located in a country town in the state of São Paulo were interviewed. RESULTS: Through comparative analysis, the core category overcoming challenges to assist the family and the elderly during the dying process was identified, and it was composed of the following sub-processes: Identifying situational problems, Planning a new care strategy, Managing the care and Evaluating the care process. CONCLUSION: the team faces difficulties to achieve better performance in attending to the biological and emotional needs of families, seeking to ensure dignity to the elderly at the end of their lives and expand access to healthcare.

[Dignified death for children: perceptions of nurses from an oncology unit]. / Morte digna da criança: percepção de enfermeiros de uma unidade de oncologia.

The objective of this study was to identify the meaning of dignified death and the interventions employed by nurses in pediatric oncology to promote dignified death for children. We used Symbolic Interaction Theory as the theoretical framework and narrative research methods. The data were collected from eight nurses in the pediatric oncology unit of a public hospital in Sao Paulo through semi-structured interviews. The data analysis revealed five categories: feeling no autonomy in decision-making, caring for the family, offering physical comfort, valuing humanized care and learning to deal with death and dying. This study helps to extend the understanding of this process of care and postulates a theoretical framework that integrates the knowledge and actions that constitute care that transcends clinical and biological needs.