How to Manage the Suffering of the Patient and the Family in the Final Stage of Life: A Qualitative Study.

BACKGROUND: The end of life and death have changed from being issues managed within the family, assumed as part of life, to occur within health institutions for the majority of patients. The amount of patients dying at home has decreased, and the roles of families and communities in death and dying have become involuted, threatening related traditions and knowledge. As a result, a need to promote the end of life at home in this new self-serving society has arisen. In that context, the main objective of this study was to find out what patients and their families need during the end-of-life process in order to feel effectively accompanied at this time. METHODS: With that objective, a descriptive qualitative study was conducted via the content analysis of data from semi-structured interviews and focus groups. This research adhered to the COREQ guidelines. The sample consisted of 36 informants selected via intentional sampling of family members and patients integrated into the Comprehensive Palliative Care Process (PAI Paliativos). RESULTS: The results suggest the existence of several common needs such as communication and presence, including the conspiracy of silence as an important factor generating suffering for both. However, there are specific needs such as autonomy, dignity, and respect for patients, which must be taken into account. CONCLUSIONS: The results of this study will allow us to establish intervention strategies for effective accompaniment of patients' family members at the end of life and the avoidance of ethnocentrism in this process. This study was retrospectively registered with the (nursrep-1194226) on the (21 April 2023).

Influence of the COVID-19 Pandemic on Medication Reconciliation in Frail Elderly People at Hospital Discharge: Perception of Healthcare Professionals.

The current demographic panorama in Spain corresponds to an aging population; this situation is characterized by the need to care for an elderly population, which contains polymedicated and pluripathological individuals. Polymedication is a criterion of frailty in the elderly and a risk factor for mortality and morbidity due to the increased risk of drug interactions and medication errors. There are numerous studies that measure reconciliation at hospital discharge and at admission, and even the methodology of reconciliation, but we have not found many studies that measure reconciliation in the context of the COVID-19 pandemic from the point of view of health professionals regarding difficulties and the strategies carried out, which is essential to begin to glimpse solutions. METHODS: This was a qualitative study based on 21 in-depth interviews and two discussion groups, conducted between January and April 2021 (13 nurses and 8 doctors, in rural and urban areas). The discourse was analyzed according to the Taylor-Bodgan model and processed using Atlas.ti software. RESULTS: The areas altered by the health crisis were access to patients, their reconciliation of medication, and changes in the care modality, including the greater use of telephone communication, changes in work organization, and time dedicated to patient care and family work. Difficulties encountered during COVID-19: change in medication format, the specific characteristics of the patient and their pathologies, and difficulties arising from communication with the patient and their family. The strategies applied: the collaboration of home assistants and caregivers, emphasis on patient-health professional communication, and the use of Information and Communication Technologies (ICT). CONCLUSION: The discharge was interrupted by the health crisis caused by COVID-19, in terms of both the traditional access of patients and by the remote care modalities generated by telemedicine.

[Approaching grief and death in family members of patients with COVID-19: Narrative review]. / Abordaje del duelo y de la muerte en familiares de pacientes con COVID-19: revisión narrativa.

OBJECTIVE: The objective of this review was to synthesize the possible evidence to establish recommendations on the approach of mourning and death in relatives of COVID-19 patients, as well as offering substitute resources for the necessary rituals and procedures in order to build up functional griefs and prevent complicated bereavements. METHOD: A bibliographic research was conducted in MEDLINE, EMBASE, SCIENCEDIRECT, WOS, CINAHL and CUIDEN databases, using MeSH terms, (family, patient, isolation hospitals, grief, death, ceremonial behavior, self-care, affects and social networks) with its corresponding boolean equation. The selected articles have been published in a critical reading through the Critical Assessment Skills Program in Spanish (CASPe). RESULTS: A total of 560 articles were initially found, after applying the selection criteria, 13 studies were included in the analysis, of which 8 were systematic reviews, 3 qualitative studies, 1 cross-sectional prospective pilot study and 1 clinical guide, which allowed identifying strategies for the approach grief and death attending to this moment of exceptionality covid19, influencing the competence management of health professionals in emotional support and accompaniment as well as the monitoring throughout the process, as well as in the communication with the family. CONCLUSION: In the final process of life in COVID-19's time, health professionals must work farewells, alternative funeral rites, spiritual care and early coping that will allow the prevention of complicated grief.

Spirituality in Patients at the End of Life-Is It Necessary? A Qualitative Approach to the Protagonists.

Spirituality is the most unknown aspect of palliative care despite being the need that is most altered in the last moments of life. OBJECTIVE: To identify on the one hand the spiritual needs of patients who are at the end of life and on the other hand, the way in which nursing professionals can work to provide effective accompaniment in this process. METHOD: A qualitative study was conducted which applied different data collection techniques. This was done to describe the phenomenon from a holistic perspective in relation to experts' perceptions of the competencies required by health professionals and palliative patients' spiritual needs. Semi-structured interviews were conducted within both populations. In order to analyze the qualitative data collected through interviews, discourse was analyzed according to the Taylor-Bodgan model and processed using Atlas.ti software. RESULTS: Three well-differentiated lines of argument are extracted from the discourse in each of the groups, on the one hand in the group of patients they define the concept of spirituality, system of values and beliefs, and the Factors that influence the spirituality of patients at the end of life (differentiating palliative care areas/other areas) and on the other, the professionals agree with the patients in the line of argument of concept of spirituality although they define more metaphysical categories and the other two lines of argument that result are the spiritual attention in this process and the need for formation in spirituality. CONCLUSIONS: The provision of spiritual care gives meaning to the actions of nursing professionals when it comes to providing end-of-life care, achieving holistic care, humanizing death, and promoting a dignified end.

Abordaje del duelo y de la muerte en familiares de pacientes con COVID-19: revisión narrativa / Approaching grief and death in family members of patients with COVID-19: Narrative review

OBJETIVO: Realizar una síntesis de la evidencia disponible para establecer recomendaciones sobre el abordaje del duelo y la muerte en familiares de pacientes con COVID-19, así como ofrecer recursos sustitutivos de los rituales y procedimientos necesarios con el fin de favorecer duelos funcionales y prevenir duelos complicados. MÉTODO: Se realizó búsqueda bibliográfica en bases de datos MEDLINE, EMBASE, SCIENCEDIRECT, WOS, CINAHL y CUIDEN, utilizando términos MeSH (family, patient, isolation hospitals, grief, death, ceremonial behavior, self care, affects y social networking) con su ecuación booleana correspondiente. Los artículos seleccionados se sometieron a una lectura crítica a través del Critical Apraisal Skill Programme en español. RESULTADOS: Se encontraron 560 artículos atingentes; tras aplicar los criterios de selección 13 estudios se incluyeron en el análisis, de los cuales 8 eran revisiones sistemáticas, 3 estudios cualitativos, un estudio piloto prospectivo transversal y una guía clínica, que permitieron identificar estrategias para el abordaje del duelo y la muerte atendiendo a este momento de excepcionalidad de la COVID-19, incidiendo en el manejo competencial de los profesionales sanitarios en apoyo emocional y en el acompañamiento, así como en el seguimiento durante todo el proceso y en la comunicación con la familia. CONCLUSIÓN. En el proceso final de la vida en tiempos de la COVID-19 los profesionales sanitarios deben trabajar despedidas, los ritos fúnebres alternativos, la atención espiritual y el afrontamiento precoz que permitirán a su vez la prevención del duelo complicado

OBJECTIVE: The objective of this review was to synthesize the possible evidence to establish recommendations on the approach of mourning and death in relatives of COVID-19 patients, as well as offering substitute resources for the necessary rituals and procedures in order to build up functional griefs and prevent complicated bereavements. METHOD: A bibliographic research was conducted in MEDLINE, EMBASE, SCIENCEDIRECT, WOS, CINAHL and CUIDEN databases, using MeSH terms, (family, patient, isolation hospitals, grief, death, ceremonial behavior, self-care, affects and social networks) with its corresponding boolean equation. The selected articles have been published in a critical reading through the Critical Assessment Skills Program in Spanish (CASPe). RESULTS: A total of 560 articles were initially found, after applying the selection criteria, 13 studies were included in the analysis, of which 8 were systematic reviews, 3 qualitative studies, 1 cross-sectional prospective pilot study and 1 clinical guide, which allowed identifying strategies for the approach grief and death attending to this moment of exceptionality covid19, influencing the competence management of health professionals in emotional support and accompaniment as well as the monitoring throughout the process, as well as in the communication with the family. CONCLUSION: In the final process of life in COVID-19's time, health professionals must work farewells, alternative funeral rites, spiritual care and early coping that will allow the prevention of complicated grief

El componente cultural de la muerte: acompañando a Fabala Dambele / The cultural component of death: accompanying Fabala Dambele

Las personas provenientes de diferentes culturas en el tramo final de sus vidas experimentan el fenómeno de la diferencia, ya que su forma de entender la muerte no se corresponde con la de la cultura occidental. La muerte no es gestionada desde la diversidad, y está sometida a las costumbres sociales dominantes. La investigación plantea la necesidad de respetar estas diferentes actitudes frente a la muerte, y así conseguir una competencia cultural en el ámbito de los cuidados paliativos. Los objetivos del presente trabajo son analizar, a partir de un caso, los problemas específicos que encontramos al trabajar con población inmigrante con enfermedad avanzada y/o terminal. Para ello, utilizaremos una metodología cualitativa, empleando como instrumento de recogida de datos la entrevista en profundidad, técnica cualitativa que nos permite llegar al emic del sujeto entrevistado gracias a su discurso. El análisis se realizará siguiendo el modelo de Taylor-Bodgan. El sobreesfuerzo que esto supone nos lleva a un enriquecimiento en un mundo en el que cada vez confluyen más formas diferentes de enfocar la situación terminal (AU)

People from different cultures suffer the phenomenon of difference at the end of their lives, because their understanding of death is not consistent with Western culture. Death is not managed through diversity, and is subject to the prevailing social customs. This study raises the need to respect these different attitudes towards death, achieving cultural experience in the field of palliative care. The objectives of this study are to analyse, using a case, the specific problems encountered in working with an immigrant population with advanced and/or terminal disease. Qualitative methodology was used, with data being collected by in-depth interview, a qualitative technique that allows us to emic of the subjects interviewed through their discourse. The analysis was performed following the model of Taylor-Bogdan. The extra effort that this entails leads to an enrichment in a world in which the increasing diversities merge to approach the end-of-life situation (AU)