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1.
Aging Clin Exp Res ; 24(5): 537-47, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-22960350

RESUMO

BACKGROUND AND AIMS: In Italy there is a paucity of empirical data on practices concerning end-of-life decisions (ELDs) in geriatrics. We aimed to investigate the frequency and characteristics of ELDs made by Italian physicians and nurses in the geriatric setting. METHODS: In 2009, an anonymous questionnaire was sent to 54 geriatric units, 21 hospices, and 382 nursing homes in the Veneto and Trentino Alto Adige regions, and to professionals in the area who are members of the Italian Gerontology and Geriatrics Association. RESULTS: This paper reports the results of 552 questionnaires answered by 171 physicians, 368 nurses and 13 professionals who did not state their profession. Death was preceded by decisions to start or continue treatments likely to prolong the patients' life in 51.3% of cases. The proportion of deaths preceded by a decision to end life (DEL) was 20.8%; 18% of DELs concerned non-treatment decisions. There were 9 cases of ending of life without patient's explicit request. No cases of doctor-assisted suicide were reported, while there were 2 cases of euthanasia, one reported by a physician and one by a nurse. CONCLUSION: In geriatrics, DELs often precede the deaths of terminally-ill Italian patients. Nurses report making DELs more often than physicians, especially in incompetent patients. Continuous deep sedation was adopted by 39.5% of the Italian physicians for deaths not occurring suddenly and unexpectedly. Our report on physicians' and nurses' experiences of ELD making in geriatric settings can offer a valuable contribution to the current debate on end-of-life treatment, an issue that goes beyond national borders.


Assuntos
Tomada de Decisões , Geriatria/métodos , Enfermeiras e Enfermeiros , Médicos , Padrões de Prática Médica , Assistência Terminal/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Eutanásia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Hospitais para Doentes Terminais , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Cuidados Paliativos/métodos , Inquéritos e Questionários
2.
Assist Inferm Ric ; 25(4): 220-6, 2006.
Artigo em Italiano | MEDLINE | ID: mdl-17328482

RESUMO

AIM: Specific instruments to measure patients satisfaction for home care are missing in Italy. A questionnaire was devised, based on two well known and validated instruments (La Monica-Oberst Patient Satisfaction Scale (LOPSS) and the The Patient Satisfaction With Health Care Provider Scale (PSHCPS) and validated. METHODS: The questionnaire was discussed with nurses and psychologists. The questionnarie was initially administered to a sample of 25 patients home care patients, not cognitively impaired, and to their caregivers. The concordance was measured with the K di Cohen, Sperman tau of Cograduation and tau of Kendall coefficiencies, with very satisfactory results (K = 0.68, p = 0.72, tau = 0.61). After 30 days the questionnaire was administered to the same patients and relatives, to test stability/reliability and internal coherence. Finally, it was administered to a stratified sample of 139 patients (or to their relatives) to assess validity with factorial analysis, and again internal coherence. RESULTS: The final questionnaire has 20 closed ended and three open questions. Concordance between patients and relatives on closed questions was good, therefore the questionnaires can be administered to patients or relatives. The test retest showed also a good stability (K 0.83). The factorial analysis identified two sub scales: one that measures patients satisfaction for the organization and for the interpersonal relationship between patients and nurses. CONCLUSIONS: The questionnaire has good psychometric properties and can be reliably administered also to caregivers. Some questions with higher number of missing answers could be improved.


Assuntos
Serviços de Assistência Domiciliar , Relações Enfermeiro-Paciente , Satisfação do Paciente , Inquéritos e Questionários , Idoso , Idoso de 80 Anos ou mais , Cuidadores , Interpretação Estatística de Dados , Feminino , Humanos , Itália , Masculino , Psicometria
3.
J Palliat Med ; 17(10): 1143-9, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25188766

RESUMO

BACKGROUND: Although their benefits are controversial, artificial nutrition and hydration are often administered as a form of basic care to terminally ill patients. An important reason for this may be that these treatments have strong emotional and psychological meanings. AIMS: In the present article we investigated the opinions of Italian physicians and nurses on the administration of artificial nutrition and hydration to terminally ill patients with advanced dementia. We also investigated the antecedents of these opinions, considering feelings and thoughts related to death, ethical issues and training in palliative care. METHOD: A questionnaire was administered to Italian physicians (n=288) and nurses (n=763). We analyzed the percentages of agreement with the administration of artificial nutrition and hydration and, using multivariate logistic regressions, the possible antecedents of these opinions. RESULTS: Agreement with the provision of artificial hydration was higher (73%) than for artificial nutrition (48%), suggesting that artificial hydration may be seen as a form of basic care. Agreement with their administration was generally lower among professionals in northern Italy working in geriatrics wards who had received training in palliative care. We also found that death-related feelings and thoughts and ethical issues played a different part for physicians and nurses. CONCLUSIONS: Our findings suggest that opinions concerning artificial nutrition and hydration not only derive from scientific background, but also relate to cultural, ethical, and psychological issues. Our results also reveal important differences between physicians' and nurses' opinions, providing useful information for interpreting and overcoming obstacles to the effective cooperation between these professionals.


Assuntos
Atitude do Pessoal de Saúde , Demência/terapia , Hidratação , Enfermeiras e Enfermeiros/psicologia , Apoio Nutricional , Médicos/psicologia , Assistência Terminal , Adulto , Feminino , Humanos , Itália , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Assistência Terminal/ética , Doente Terminal
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