The context of care as a supporting axis for comfort in a palliative care unit.

Background: The context of care determines and organizes practices through its structures and guiding principles. It is sometimes a space that generates tension and multiple choices, variable in the provision of different care and uncertain in its duration. We can consider that the construction of the comfort process does not only depend on the will of its actors and the situation itself, but is also conditioned by the professional, cultural, and social context in which it is inserted. This article is part of a doctoral study in the field of comfort in a palliative care unit, and these are some of the partial results that emerged. Design: Qualitative study using ethnographic approach. Methods: We conducted semistructured interviews with 18 patients at the end of life and their matched significant family members (18) and 21 health professionals. We also conducted a participant observation of care situations. Results/discussion: The context of action, where meanings and practices are learned, is linked to a certain identity that is related to practical, contextual knowledge, linked to a collective and to a feeling of belonging. The relationship between the various factors that shape the Care Context in the palliative care unit studied, constitute the three domains of this topic, specifically: the integrative and inclusive environment, the conceptions of care, and the inclusive factors of organizational culture. Conclusion: The specific context was determinant as a supporting axis for comfort in this palliative care unit. The context of care, where objects and provisions support the construction of the comfort process as an entity that integrates culture, established conceptions of care, allowing the deepening of knowledge.

Ways and means to comfort people at the end of life: how is the nurse a privileged player in this process?

Background: Comfort is a necessity throughout life, and it is a key element in the practice of nursing care for the patient at the end of life. A particular human need and a state related to the experience and culture of the person at the end of life constitute the target of attention and nursing intervention, being a very relevant indicator of the quality of health care. This article is part of a doctoral study in the field of comfort in a palliative care unit, and these are some of the partial results that emerged. Objectives: To understand the ways and means of comfort perceived by the person at the end-of-life hospitalized in a palliative care unit, their family, and health staff as well as the value of the nurse in this process. Design: Qualitative study using an ethnographic approach. Methods: We conducted semistructured interviews with 18 patients at the end of life and their matched significant family members (18) and 21 health professionals. We also conducted participant observation of care situations. Results/Discussion: The ways and means of providing comfort are centered on strategies developed by the entire multidisciplinary team. During this whole process, one of the categories that emerged from the ethnography was the nurse as a privileged player, representing an absolutely essential role in all phases. The results revealed that nurses play a very important role in end-of-life comfort, which is based on a predisposition for end-of-life care (active listening, empathy, congruence, and biographical narrative) and focused attention (global care, attention to detail, family support, and opposition to therapeutic obstinacy). Conclusions: The different ways and means of providing comfort aim to increase care, relieve, and invest in potential different forms of comfort and nurses are recognized by all those involved in this process as someone essential to providing comfort care.