Legacy in End-of-Life Care: A Concept Analysis.

Comprehending the significance of legacy in end-of-life (EoL) situations helps palliative care professionals enhance person-centered outcomes for those with a life-threatening illness and their families. Our purpose was to conduct a concept analysis of legacy in EoL care. By employing Walker and Avant's approach, we identified the concept's defining characteristics. Subsequently, we established the antecedents, consequences, and empirical referents. After conducting a thorough review of titles and abstracts, a total of 30 publications were analyzed. These articles were sourced from three databases (CINAHL, Medline via PubMed, and Scopus) from 2002 to 2023. Our analysis identified several core attributes of legacy: (a) leave behind something of value that transcends death; (b) determine how people want to be remembered; (c) build and bestow across generations; (d) integrate advance care planning through EoL conversations and shared decision-making; and (e) develop strategies of dignity-conserving care. The consequences are related to improvements in spiritual and subjective well-being; coping with inevitable EoL existential issues; decreases in EoL suffering; engendering self-awareness, hope, gratitude, and peace; achieving and maintaining dignity; creating good memories; promoting mutually constructive and transformative relationships; and fostering the adjustment of bereaved people. Nevertheless, further effort is required to implement the key attributes of legacy that form the basis for creating legacy-oriented interventions near the EoL.

Death Unpreparedness Due to the COVID-19 Pandemic: A Concept Analysis.

The COVID-19 pandemic imposed changes upon the capacity of healthcare systems, with significant repercussions on healthcare provision, particularly at end-of-life. This study aims to analyze the concept map of death unpreparedness due to the COVID-19 pandemic, capturing the relationships among the attributes, antecedents, consequences, and empirical indicators. Walker and Avant's method was used to guide an analysis of this concept. A literature search was performed systematically, between May 2022 and August 2023, using the following electronic databases on the Elton Bryson Stephens Company (EBSCO) host platform: Medical Literature Analysis and Retrieval System Online (Medline), Psychological Information Database (PsycINFO), Cumulative Index to Nursing and Allied Health Literature (CINAHL) Complete, Cochrane Library, and Nursing and Allied Health Collection. Thirty-four articles were retrieved. The unexpected and unpredictable impositions associated with inexperience and unskillfulness in dealing with COVID-19 configured challenges for healthcare professionals, family/caregivers, and even the dying person. Nine key attributes emerged in three main domains: (1) Individual: (a) disease-related conditions, (b) separation distress, and (c) scarcity of death and grief literacy; (2) Relational: (a) Dying alone, (b) poor communication, and (c) existential issues; and (3) Contextual: (a) disrupted collective mourning and grieving, (b) disrupted compassionate care and, (c) pandemic social stigma. This study contributed a full definition of death unpreparedness in a global pandemic scenario such as COVID-19. In this sense, feeling unprepared or unready for death brought new challenges to the bioecological resources of those affected. It is essential to embrace strategies capable of providing emotional and spiritual support in the dying process and to respect patient wishes. The lessons learned from COVID-19 should be applied to events with a comparable impact to minimize their consequences.

Promoção do Autocuidado: Ferramentas que cuidam de mim para cuidar de ti / Self-care promotion: Tools that take care of me to take care of you!

Este relatório é realizado no âmbito do mestrado com especialização em enfermagem de saúde mental e psiquiátrica, e com ele pretende-se evidenciar o desenvolvimento e consolidação de competências comuns e da prática especializada do enfermeiro especialista em enfermagem de saúde mental e psiquiátrica. Foi realizada uma breve contextualização dos contextos da prática clínica onde foram desenvolvidos os diferentes ensinos clínicos ­ ensino clínico em unidade de internamento de agudos, numa unidade de cuidados na comunidade e numa unidade de cuidados diferenciados ­ seguindo-se a análise crítico-reflexiva acerca dos processos de aprendizagem e desenvolvimento profissional. Na segunda parte apresenta-se um projeto de melhoria dos cuidados de enfermagem que surge a partir da identificação de um problema experienciado na prática clínica em ensino clínico. A promoção do autocuidado foi encarada como intervenção protetora do desenvolvimento de fenómenos laborais como o absentismo, presentismo, fadiga por compaixão e Burnout, que resultam em elevados custos sociais e para a saúde individual, em especial para a saúde mental. Foram por isso dirigidas intervenções cientificamente validadas a um conjunto de focos de saúde mental (autoeficácia, resiliência, relacionamentos, autocuidado, autoconhecimento e esperança) que podem constituir-se como mediadores do surgimento dos fenómenos apresentados. A experiência decorrente do exercício nas diferentes realidades de ensino clínico, face à multiplicidade de oportunidades de aprendizagem em ambiente supervisado, permitiu a mobilização de vastas competências numa atitude de constante desenvolvimento, científico, técnico e humano. Terminado este percurso, concluo que se revelou enriquecedor pela oportunidade de desenvolvimento profissional de acordo com as orientações científicas capazes de sustentar uma prática de segurança, qualidade e prossecutora da excelência.

This report is conducted within the scope of the master's degree with specialisation in mental health and psychiatric nursing, and aims to highlight the development and consolidation of common skills and the specialised practice of the nurse specialist in mental health and psychiatric nursing. A brief contextualisation of the clinical practice contexts where the different clinical teachings were developed - clinical teaching in an acute inpatient unit, a community care unit and a differentiated care unit - was followed by a critical-reflective analysis of the learning and professional development processes. The second part presents a project to improve nursing care that emerged from the identification of a problem experienced in clinical practice during clinical teaching. The promotion of self-care was seen as a protective intervention against the development of labour phenomena such as absenteeism, presenteeism, compassion fatigue and Burnout, which result in high social and individual health costs, particularly in terms of mental health. Therefore, scientifically validated interventions were directed to a set of mental health foci (self-efficacy, resilience, relationships, self-care, self-knowledge and hope) that may constitute mediators of the emergence of the phenomena presented. The experience resulting from the exercise in the different realities of clinical teaching, given the multiplicity of learning opportunities in a supervised environment, allowed for the mobilisation of vast skills in an attitude of constant scientific, technical and human development. At the end of this journey, I conclude that it was enriching because of the opportunity for professional development in accordance with the scientific guidelines capable of sustaining a practice of safety, quality and pursuit of excellence.

Coaching as a Model for Facilitating the Performance, Learning, and Development of Palliative Care Nurses.

Palliative care nurses experience huge pressures, which only increased with coronavirus disease 2019 (COVID-19). A reflection on the new demands for nursing care should include an evaluation of which evidence-based practices should be implemented in clinical settings. This paper discusses the impacts and challenges of incorporating coaching strategies into palliative care nursing. Evidence suggests that coaching strategies can foster emotional self-management and self-adjustment to daily life among nurses. The current challenge is incorporating this expanded knowledge into nurses' coping strategies. Coaching strategies can contribute to nurses' well-being, empower them, and consequently bring clinical benefits to patients, through humanized care focused on the particularities of end-of-life patients and their families.