Parents' Experiences About Support Following Stillbirth and Neonatal Death.

BACKGROUND: Stillbirth and neonatal death are one of the most stressful life events, with negative outcomes for parents. Society does not recognize this type of loss, and parental grieving is particularly complicated and intense. PURPOSE: The aim of this study was to describe and understand the experiences of parents in relation to professional and social support following stillbirth and neonatal death. METHODS: This was a qualitative study based on Gadamer's hermeneutic phenomenology. Twenty-one semistructured interviews were carried out. Inductive analysis was used to find themes based on the data. RESULTS: Twenty-one parents (13 mothers and 8 fathers) from 6 families participated in the study. The analysis identified 2 main themes: (1) "professional care in dealing with parents' grief," with the subthemes "important aspects of professional care," "continuing of pathways of care"; and (2) "effects of social support in parental grief," including the subthemes "the silence that surrounds grieving parents," "family and other children: a key element," and "perinatal loss support groups: a reciprocal help." IMPLICATIONS FOR PRACTICE: Counseling and support according to parents' requirements by an interdisciplinary team of professionals educated in perinatal loss and ethical family-centered care is needed. A social support system for families is necessary to avoid negative emotional consequences. IMPLICATIONS FOR RESEARCH: Further research is needed to analyze midwives' and nurses' experience as facilitators to improve parental grief and the difficulties experienced by the family, other children, and friends of parents with perinatal loss in providing support.

Experience of parents who have suffered a perinatal death in two Spanish hospitals: a qualitative study.

BACKGROUND: Perinatal grief is a process that affects families in biological, psychological, social and spiritual terms. It is estimated that every year there are 2.7 million perinatal deaths worldwide and 4.43 deaths for every 1000 births in Spain. The aim of this study is to describe and understand the experiences and perceptions of parents who have suffered a perinatal death. METHODS: A qualitative study based on Gadamer's hermeneutic phenomenology. The study was conducted in two hospitals in the South of Spain. Thirteen mothers and eight fathers who had suffered a perinatal death in the 5 years prior to the study participated in this study. In-depth interviews were carried out for data collection. Inductive analysis was used to find themes based on the data. RESULTS: Eight sub-themes emerged, and they were grouped into three main themes: 'Perceiving the threat and anticipating the baby's death: "Something is going wrong in my pregnancy"'; 'Emotional outpouring: the shock of losing a baby and the pain of giving birth to a stillborn baby'; "We have had a baby": The need to give an identity to the baby and legitimise grief'. CONCLUSION: The grief suffered after a perinatal death begins with the anticipation of the death, which relates to the mother's medical history, symptoms and premonitions. The confirmation of the death leads to emotional shock, characterised by pain and suffering. The chance to take part in mourning rituals and give the baby the identity of a deceased baby may help in the grieving and bereavement process. Having empathy for the parents and notifying them of the death straightaway can help ease the pain. Midwives can help in the grieving process by facilitating the farewell rituals, accompanying the family, helping in honouring the memory of the baby, and supporting parents in giving the deceased infant an identity that makes them a family member.

Characterization, conservation and loss of dignity at the end-of- life in the emergency department. A qualitative protocol.

AIMS: To explore and understand the experiences of terminally ill patients and their relatives regarding dignity during end-of-life care in the emergency department. BACKGROUND: The respect given to the concept of dignity is significantly modifying the clinical relationship and the care framework involving the end-of-life patient in palliative care units, critical care units, hospices and their own homes. This situation is applicable to in-hospital emergency departments, where there is a lack of research which takes the experiences of end-of-life patients and their relatives into account. DESIGN: A phenomenological qualitative study. METHODS: The protocol was approved in December 2016 and will be carried out from December 2016-December 2020. The Gadamer's philosophical underpinnings will be used in the design and development of the study. The data collection will include participant observation techniques in the emergency department, in-depth interviews with terminally ill patients and focus groups with their relatives. For the data analysis, the field notes and verbatim transcriptions will be read and codified using ATLAS.ti software to search for emerging themes. DISCUSSION: Emerging themes that contribute to comprehending the phenomenon of dignity in end-of-life care in the emergency department are expected to be found. This study's results could have important implications in the implementation of new interventions in emergency departments. These interventions would be focused on improving: the social acceptance of death, environmental conditions, promotion of autonomy and accompaniment and assumption (takeover) of dignified actions and attitudes (respect for human rights).

Impact of Perinatal Death on the Social and Family Context of the Parents.

BACKGROUND: Perinatal death (PD) is a painful experience, with physical, psychological and social consequences in families. Each year, there are 2.7 million perinatal deaths in the world and about 2000 in Spain. The aim of this study was to explore, describe and understand the impact of perinatal death on parents' social and family life. METHODS: A qualitative study based on Gadamer's hermeneutic phenomenology was used. In-depth interviews were conducted with 13 mothers and eight fathers who had suffered a perinatal death. Inductive analysis was used to find themes based on the data. RESULTS: Seven sub-themes emerged, and they were grouped into two main themes: 1) perinatal death affects family dynamics, and 2) the social environment of the parents is severely affected after perinatal death. CONCLUSIONS: PD impacts the family dynamics of the parents and their family, social and work environments. Parents perceive that society trivializes their loss and disallows or delegitimizes their grief. IMPLICATIONS: Social care, health and education providers should pay attention to all family members who have suffered a PD. The recognition of the loss within the social and family environment would help the families to cope with their grief.

Flexibilidad psicológica y autoabandono del tabaco / Smoking self-quitting and psychological flexibility

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The prevalence of smoking in the general population remains high in spite of the extended acknowledgement of the well-documented health consequences of smoking and potential benefits of quitting. Only a minority of smokers who attempt to quit seeks professional treatment, yet most of the research on smoking cessation focuses on such form of quitting. Research on self-quitting is scarce, although most smokers who successfully quit, do so on their own. Recently, research has evidenced that psychological flexibility, a core concept in Acceptance and Commitment Therapy, is an important variable in predicting successful behavioral change in many clinically relevant areas. The goal of this study was to analyze the relationship between psychological flexibility and successful self-quitting from smoking. 277 participants who had attempted to quit on their own (217 successfully abstinent and 60 still smoking) provided information on their smoking history, quit attempts, nicotine dependence, and demographics, and were assessed with the Acceptance and Action Questionnaire-II. Abstinence status was measured through self-reports of continuous abstinence and confirmed by concentrations of expired carbon monoxide below 8 ppm. Results show a statistically significant difference (t= -8,775; p <.01) for the AAQ-II scores of successful (M= 18.39, SD= 7.76) and unsuccessful self-quitters (M= 27.17; SD= 6.88). Only 26% participants with high level of psychological inflexibility quitted successfully, compared to 94% participants with low levels of psychological inflexibility. These results show clear evidence that psychological flexibility is associated to successful self-quitting, and suggest that this variable could facilitate success in attempts to stop smoking without professional help. Implications and limitations of this study are discussed (AU)

Valores personales en estudiantes y profesionales de enfermería / Personal Values among Students and Nurses / Valores pessoais em estudantes e profissionais de enfermagem

El estudio explora el contraste intergeneracional entre valores personales en estudiantes y profesionales de enfermería y su ajuste a las predicciones de la teoría del cambio de valores. La muestra estuvo formada por 369 estudiantes y profesionales de enfermería distribuidos en tres grupos: estudiantes (n = 150), profesionales menores de 40 años (n = 114), y profesionales entre 41 y 60 años (n = 105). Los participantes informaron de sus valores en orden de prioridad en un cuestionario abierto. Los informes se organizaron en categorías de valores para analizar las diferencias entre grupos. Se encuentran dos tendencias en el informe de valores personales, que se ajustan en algunos casos a lo predicho por la teoría del cambio de valores y, en otros casos, la contradicen. Se discute la importancia de estos hallazgos y la necesidad de potenciar una formación orientada hacia los valores de la profesión de enfermería. El estudio contribuye al conocimiento del cambio de valores personales en profesionales de enfermería.

The study explores the generational contrast between personal values in students and nurses and their adjustment to the predictions of the theory of changing values. The sample was comprised of 369 students and nurses who were divided into three groups: students (n = 150), nurses under age 40 (n = 114), and nurses between 41 and 60 years of age (n = 105). The participants reported their values on an open questionnaire, in order of priority. The reports were organized into value categories to analyze the differences between groups. Two trends were found in the report on personal values: in some cases, they fit what is predicted by the theory of changing values; in others, they contradict it. The importance of these findings and the need to empower training oriented towards the values of the nursing profession is discussed. The study contributes to what we know about the change in personal values among nursing professionals.

Este estudo explora o contraste intergeracional entre valores pessoais em estudantes e profissionais de enfermagem e seu ajuste às predições da teoria da mudança de valores. A amostra esteve conformada por 369 estudantes e profissionais de enfermagem distribuídos em três grupos: estudantes (n = 150), profissionais menores de 40 anos (n = 114) e profissionais entre 41 e 60 anos (n = 105). Os participantes informaram sobre seus valores em ordem de prioridade num questionário aberto. Os relatórios foram organizados por categorias de valores para analisar as diferenças entre grupos. Constataram-se duas tendências no relatório de valores pessoais que se ajustam, em alguns casos, ao dito pela teoria da mudança de valores; em outros casos, contradizem-na. Discute-se a importância dessas constatações e a necessidade de potencializar uma formação orientada aos valores da profissão de enfermagem. O estudo contribui para o conhecimento da mudança de valores pessoais em profissionais de enfermagem.

Intergenerational Differences in Materialist and Post-materialist Values in a Sample of Hispanic New York City Residents / Diferencias intergeneracionales en valores materialistas y post-materialistas en una muestra de residentes hispanos de la ciudad de Nueva York

The present study evaluates the personal values reported by a sample of New York Hispanic residents using an open evaluation format in which the participants identified and prioritized their personal values. Four hundred and forty-five participants were assigned to one of three groups: Young (N= 159), Adult (N= 168) and Senior (N= 118). The values reported were categorized into post-materialist, materialist or non-classifiable. The Percentage Difference Index between post-materialist and materialist values was calculated in order to determine the value profile for each age group. The results showed that reports of personal values and values attributed to the participants' own generation were similar in Adult and Senior groups, but were very different in the Young Group, with a differential report of post-materialist values. Furthermore, exposure to American culture did not appear to have a significant effect on the reported values of NYC Hispanics. To confirm these findings, we need to conduct additional studies with larger samples of culturally diverse populations.

Se exploran los valores en una muestra de hispanos de New York, empleando un formato abierto en el que los participantes identifican y priorizan su valores personales y los de su generación. Los 445 participantes se distribuyeron en tres grupos: Jóvenes (N = 159), Adultos (N = 168) y Mayores (N = 118). Los informes de valores se categorizaron como postmaterialistas, materialistas o no clasificables, y se calculó el Percentage Difference Index entre valores postmaterialistas y materialistas para determinar el perfil de valores de cada grupo. Los resultados mostraron que los informes de valores personales y generacionales fueron similares en los grupos Adulto y Mayor, y diferentes en el Grupo Joven con un reporte diferencial entre valores personales y generacionales. Por otro lado, el tiempo vivido bajo la influencia de la cultura norteamericana parece no tener un efecto significativo en el informe de valores para esta población. Para confirmar estos hallazgos son necesarios estudios adicionales con muestras más amplias y en poblaciones culturalmente diversas.

The clinical seminar as a learning methodology: an evaluation of nursing students' views

OBJECTIVE: To explore students' assessments of the clinical seminar as a complementary teaching method to the clinical practicum experience. METHODS: This was a qualitative study based on the hermeneutic phenomenology of Gadamer. Twenty-three open-ended interviews were conducted from among the 132 first-year students who attended an initial clinical practicum. We performed a qualitative analysis of the data using ATLAS.ti software. RESULTS: The students agreed that the clinical seminar gave them the opportunity to learn about procedures, nursing care and interpersonal relationships. They also found it very helpful when they encountered challenging stressful situations as they performed their practice, and believed it allowed them to make a connection between the theory in the classroom and the clinical practice. CONCLUSIONS: These seminars can contribute to reducing levels of stress during clinical practice. They can also help students obtain significant learning from their fellows and reduce the theory-practice gap.

OBJETIVO: Avaliar a importância que os alunos atribuem ao seminário clínico como método de ensino complementar às práticas clínicas em estágio. MÉTODO: Estudo qualitativo baseado na fenomenologia hermenêutica de Gadamer. Foram realizadas 23 entrevistas abertas entre um universo de 132 alunos do primeiro ano da licenciatura de enfermagem, que assistiram a um seminário clínico, durante o seu primeiro ensino clínico/estágio. Foi realizada uma análise qualitativa dos dados através do software ATLAS.ti. RESULTADOS: Os entrevistados coincidiram na opinião de que o seminário lhes deu oportunidades de aprendizagem sobre procedimentos, cuidados de enfermagem e relações interpessoais. Referiram também que o mesmo foi útil para lidar com situações estressantes e relacionar os conteúdos teóricos com a prática. CONCLUSÕES: Este tipo de seminários pode contribuir para a redução dos níveis de estresse durante a prática clínica, para a aquisição e partilha de aprendizagens significativas em grupo e para colmatar lacunas teórico-práticas.

OBJETIVO: Evaluar la importancia atribuida por los alumnos al seminario clínico como método de enseñanza complementaria a las prácticas clínicas. MÉTODO: Estudio cualitativo basado en la fenomenología hermenéutica de Gadamer. Se realizaron 23 entrevistas abiertas entre un universo de 132 alumnos del primer año del pregrado en enfermería, que asistieron a un seminario clínico, durante su primera enseñanza clínica/práctica. Se llevó a cabo un análisis cualitativo de los datos a través del software ATLAS.ti. RESULTADOS: Los entrevistados coincidieron en la opinión de que el seminario les dio oportunidades de aprendizaje sobre procedimientos, cuidados de enfermería y relaciones interpersonlaes. Refirieron también que el mismo fue útil para lidiar con situaciones estresantes y relacionar los contenidos teóricos con la práctica. Conclusiones: Este tipo de seminarios puede contribuir en la reducción de los niveles de estrés durante la práctica clínica, para adquirir y compartir aprendizajes significativos en grupo y para corregir lagunas teórico-prácticas.

Profile of Personal Values for Health Sciences Students

This study explores the personal values reported by Nursing, Physiotherapy and Social Work students and analyzes to what extent they fit the predictions made by the theory of intergenerational value change regarding the predominance of post-materialist values in younger generations. The participants stated their values in order of priority in an open-ended questionnaire. The sample was divided into three groups: A Nursing Students Group (NSG), made up of 150 participants; a Physiotherapy Students Group (PSG) represented by 150 participants, and a Social Work Students Group (SWSG) comprised of 150 participants. The results showed differences between the groups in the prioritized value categories and in each group’s resultant value profiles. The Physiotherapy and Social Work students’ values fitted the theory of value change predictions better, consequently giving post-materialist group profiles whilst the nursing students did not show results in line with the predictions, displaying an obviously materialist profile. Here, we discuss the results and their importance for the assessment of social change (AU)

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Implicaciones éticas en la aplicación de los procedimientos especiales enfermeros / Ethical implications in the application of special nursing procedures

Los dilemas éticos son aspectos inherentes al ser humano que le acompañan amodo de constante a lo largo de su vida. Los enfermeros/as se ven sometidosen el desarrollo de su vida profesional a toda una serie de planteamientos éticosy morales, situaciones ante las que deben de tomar decisiones y donde su formacióny principios tienen un papel esencial. Siguiendo el Proceso de Atenciónde Enfermería, pero centrándonos más específicamente en los procedimientosenfermeros, realizamos un recorrido en la detección de estos dilemas en cadauna de sus fases, aspecto de vital importancia dentro de la dinámica de las accionesindependientes

Ethical dilemmas are aspects inherent to the human being that are always presentthroughout the life of a person. Nurses are subject in the unfolding oftheir professional careers to a whole series of ethical and moral dilemmas, situationswhich they must decide upon, where their training and principles playan essential role. Following the Process in Nursing Care, but focusing morespecifically on the nursing procedures commonly performed, we conduct a surveyon the detection of such dilemmas in each of their phases, an aspect ofoutmost importance within the dynamics of independent actions

Cuidados de enfermería a pacientes geriátricos con problemas médico-quirúrgicos / Geriatrics nursing care for patients with medical-surgical problems

Los autores abordan consideraciones específicas que atañen a la aplicación de cuidados de enfermería a personas ancianas con problemas médico-quirúrgicos. Se trata de un compendio de medidas esenciales en su cuidado, y que afectan directamente tanto a las técnicas empleadas, como a la propia relación enfermera-paciente. Su aplicación protocolizada repercute en forma positiva en el proceso cuidador (AU)

Cuidados de enfermería a pacientes geriátricos con problemas médico-quirúrgicos / Geriatric's nursing care for patients with medical-surgical problems

Los autores abordan consideraciones específicas que atañen a la aplicación de cuidados de enfermería a personas ancianas con problemas médico-quirúrgicos. Se trata de un compendio de medidas esenciales en su cuidado, y que afectan directamente tanto a las técnicas empleadas, como a la propia relación enfermera-paciente. Su aplicación protocolizada repercute en forma positiva en el proceso cuidador