Definition and validation of the nursing diagnosis label "wish to die": a research protocol.

BACKGROUND: Euthanasia has been incorporated into the health services of seven countries. The legalisation of these practices has important repercussions for the competences of nurses, and it raises questions about their role. When a patient with advanced disease expresses a wish to die, what is expected of nurses? What are the needs of these patients, and what kind of care plan do they require? What level of autonomy might nurses have when caring for these patients? The degree of autonomy that nurses might or should have when it comes to addressing such a wish and caring for these patients has yet to be defined. Recognising the wish to die as a nursing diagnosis would be an important step towards ensuring that these patients receive adequate nursing care. This study-protocol aims to define and validate the nursing diagnosis wish to die in patients with advanced disease, establishing its defining characteristics and related factors; to define nursing-specific interventions for this new diagnosis. METHODS: A prospective three-phase study will be carried out. Phase-A) Foundational knowledge: an umbrella review of systematic reviews will be conducted; Phase-B) Definition and validation of the diagnostic nomenclature, defining characteristics and related factors by means of an expert panel, a Delphi study and application of Fehring's diagnostic content validation model; Phase-C) Definition of nursing-specific interventions for the new diagnosis. At least 200 academic and clinical nurses with expertise in the field of palliative care or primary health care will be recruited as participants across the three phases. DISCUSSION: The definition of the wish to die as a nursing diagnosis would promote greater recognition and autonomy for nurses in the care of patients who express such a wish, providing an opportunity to alleviate underlying suffering through nursing-specific interventions and drawing attention to the needs of patients with advanced disease. The new diagnosis would be an addition to nursing science and would provide a framework for providing care to people with advanced disease who express such a wish. Nurses would gain professional autonomy about identifying, exploring and responding clinically to such a wish.

Effectiveness of resilience-based interventions in schools for adolescents: a systematic review and meta-analysis.

Introduction: Resilience has been identified as a dynamic process that provides capabilities to face adversity. Considering the many protective factors involved in resilience and that the school is a key context to promote resilience, this review aimed to examine the effect of school-based interventions on resilience in adolescents. Methods: A systematic literature review and meta-analysis were conducted in July 2021 on four databases. The risk of bias was assessed using the Cochrane risk of bias tool. Random-effects meta-analysis was used to obtain pooled estimates. Stratified analyses were done according to population type (general, at risk), intervention type, and follow-up assessments. Results: Of the 1,667 articles obtained, 27 were included in the systematic review and 16 in the meta-analysis. The random effects indicated a significant increase in resilience after the intervention [SMD = 0.58, 95% CI (0.29-0.87)]. Subgroup analysis showed effectiveness only in the population at risk [SMD = 1.28, 95% CI (0.53-2.03)] and early adolescence [SMD = 1.28, 95% CI (0.42-2.14), PI (-7.44 to 10.33)]. Multicomponent intervention [SMD = 1.45, 95% CI (0.11-2.80)] and Cognitive Behavioural Therapy (CBT) [SMD = 0.20, 95% CI (0.06-0.34)] demonstrated substantial effectiveness. Significant results were observed within 8-week follow-ups or less [SMD = 1.55, 95% CI (0.61-2.48)]. Discussion: These findings provide evidence that multicomponent and CBT interventions increase resilience in early at-risk adolescents only in the short term. Developing resilience interventions is useful in schools exposed to unfavourable socioeconomic contexts. Furthermore, long-term interventions should be redesigned to improve their effectiveness. Systematic review registration: PROSPERO [CRD42021277493].

Development of a Guide to Multidimensional Needs Assessment in the Palliative Care Initial Encounter (MAP).

CONTEXT: Ensuring patient-centered palliative care requires a comprehensive assessment of needs beginning in the initial encounter. However, there is no generally accepted guide for carrying out this multidimensional needs assessment as a first step in palliative intervention. OBJECTIVES: To develop an expert panel-endorsed interview guide that would enable proactive and systematic Multidimensional needs Assessment in the Palliative care initial encounter (MAP). METHODS: A preliminary version of the MAP guide was drafted based on a published literature review, published semistructured interviews with 20 patients, 20 family carers, and 20 palliative care professionals, and a nominal group process with palliative care professionals and a representative of the national patient's association. Consensus regarding its content was obtained through a modified Delphi process involving a panel of palliative care physicians from across Spain. RESULTS: The published systematic literature review and qualitative study resulted in the identification of 55 needs, which were sorted and grouped by the nominal group. Following the Delphi process, the list of needs was reduced to 47, linked to six domains: Clinical history and medical conditions (n = 8), Physical symptoms (n = 17), Functional and cognitive status (n = 4), Psycho-emotional symptoms (n = 5), Social issues (n = 8), and Spiritual and existential concerns (n = 5). CONCLUSION: MAP is an expert panel-endorsed semi-structured clinical interview guide for the comprehensive, systematic, and proactive initial assessment to efficiently assess multiple domains while adjusting to the needs of each patient. A future study will assess the feasibility of using the MAP guide within the timeframe of the palliative care initial encounter.

What makes the palliative care initial encounter meaningful? A descriptive study with patients with cancer, family carers and palliative care professionals.

BACKGROUND: The palliative care initial encounter can have a positive impact on the quality of life of patients and family carers if it proves to be a meaningful experience. A better understanding of what makes the encounter meaningful would reinforce the provision of person-centred, quality palliative care. AIM: To explore the expectations that patients with cancer, family carers and palliative care professionals have of this initial encounter. DESIGN: Qualitative descriptive study with content analysis of transcripts from 60 semi-structured interviews. SETTING/PARTICIPANTS: Twenty patients with cancer, 20 family carers and 20 palliative care professionals from 10 institutions across Spain. RESULTS: Four themes were developed from the analysis of interviews: (1) the initial encounter as an opportunity to understand what palliative care entails; (2) individualised care; (3) professional commitment to the patient and family carers: present and future; and (4) acknowledgement. CONCLUSION: The initial encounter becomes meaningful when it facilitates a shared understanding of what palliative care entails and acknowledgement of the needs and/or roles of patients with cancer, family carers and professionals. Further studies are required to explore how a perception of acknowledgement may best be fostered in the initial encounter.

A teaching role practicum during the COVID-19 for final year nursing students in Spain: A qualitative study.

BACKGROUND: Due to the COVID-19 pandemic, suspension of face-to-face learning and clinical placements for nursing students in Spain led us to expand and adapt clinical training to a teaching role. Final-year nursing students conducted an online clinical training focused on developing their health education competence. PURPOSE: The aim of this study was to explore the experiences of final-year nursing students who completed their clinical training in a teaching role practicum during the pandemic outbreak (March-June 2020). METHOD: A qualitative content analysis of reflective journals from eighteen final-year nursing students was conducted. FINDINGS: Three themes were revealed: 1) An array of emotions due to not being able to complete their final clinical placement and deciding not to join the nursing workforce; 2) Perceived benefits of a teaching role such as being able to help, contributing to knowledge, acquiring competence, and learning support and companionship; and 3) Recognizing the teaching role as fundamental to the nursing profession and becoming aware of the importance of scientific evidence in clinical practice. DISCUSSION: Nursing students appreciated how teaching and health education are an integral part of the nurse's role. A teaching role allowed final-year students to acquire competence in a key nursing role during the pandemic outbreak providing a good practice for nursing education.

Nursing students on the frontline: Impact and personal and professional gains of joining the health care workforce during the COVID-19 pandemic in Spain.

BACKGROUND: Final-year nursing students in Spain augmented the health care workforce during the COVID-19 pandemic. PURPOSE: To understand the lived experience of nursing students who joined the health care workforce during the first wave of the COVID-19 outbreak (March-May 2020). METHOD: Qualitative content analysis of the reflective journals of 40 nursing students in Spain. FINDINGS: The analysis identified four main themes: 1) Willingness to help; 2) Safety and protective measures: Impact and challenges; 3) Overwhelming experience: Becoming aware of the magnitude of the epidemic; and 4) Learning and growth. DISCUSSION: The wish to help, the sense of moral duty, and the opportunity to learn buffered the impact of the students' lived experience. Despite the challenges they faced, they saw their experiences as a source of personal and professional growth, and they felt reaffirmed in their choice of career. Promoting opportunities for reflection and implementing adequate support and training strategies is crucial for building a nursing workforce that is capable of responding to future health crises.

What defines the comprehensive assessment of needs in palliative care? An integrative systematic review.

BACKGROUND: The comprehensive assessment of needs in palliative care identifies where patients most want attention to guide clinical decisions that tailor care provision from their first encounters. AIM: To define how and what needs are identified by the comprehensive assessment of needs in the original peer-reviewed articles in the field of palliative care. DESIGN: An integrative systematic review as outlined by Whittemore and Knafl. Quality appraisal performed using the Mixed Methods Appraisal Tool. DATA SOURCES: PubMed, CINAHL, PsycINFO, Web of Science databases searched through May 2019 and updated in July 2020. RESULTS: Forty-nine articles met inclusion criteria for original articles in English or Spanish reporting comprehensive assessment of needs of adult patients receiving palliative care. The majority (41/49) of studies were moderate to high quality. Two themes were identified: (1) How a comprehensive assessment of needs should be carried out in palliative care, which reflected a preference to develop structured tools for assessment; (2) What needs of patients should be assessed in the comprehensive assessment of needs in palliative care, which conveyed a trend to assess beyond core domains - physical, psychological, social, spiritual - with information and practical most prevalent, but with substantial variation in specifying and classifying needs into domains. CONCLUSIONS: The assessment of needs in palliative care is comprehensive but lacks consensus on the needs and domains that should be assessed by the palliative care team. Future studies should better define what needs can be standardized into the assessment to improve process of care and patient satisfaction.

Experiences and needs of nursing students during pandemic outbreaks: A systematic overview of the literature.

BACKGROUND: Recent epidemics have placed overwhelming demands on health systems, leading at times to the deployment of nursing students during the crisis. Little is known about the impact this experience has on students. Although studies have explored nursing students' knowledge about infection control, there are no specific recommendations regarding how these issues should be addressed in nurse education. PURPOSE: To conduct a comprehensive systematic overview of the literature concerning nursing students in the context of emerging infectious disease epidemics or pandemics caused by zoonotic viruses. METHODS: Systematic overview. RESULTS: Forty-eight articles were included. Five themes were identified: education; knowledge, concern about risk and preventive behaviour; willingness to work during a pandemic outbreak; experiences and emotional impact; and ethical dilemmas. CONCLUSIONS: There is a need to enhance nurse education to ensure that students have adequate education in infection prevention and control and the opportunity to develop the skills and attitudes required to provide care to infected patients during a pandemic. The outcomes of these education programmes would need to be evaluated using valid and reliable instruments so as to enable comparisons to be made to prepare future nurses to deal with new pandemics in an increasingly globalized world.

Proactive and systematic multidimensional needs assessment in patients with advanced cancer approaching palliative care: a study protocol.

INTRODUCTION: The benefits of palliative care rely on how healthcare professionals assess patients' needs in the initial encounter/s; crucial to the design of a personalised therapeutic plan. However, there is currently no evidence-based guideline to perform this needs assessment. We aim to design and evaluate a proactive and systematic method for the needs assessment using quality guidelines for developing complex interventions. This will involve patients, their relatives and healthcare professionals in all phases of the study and its communication to offer clinical practice a reliable approach to address the palliative needs of patients. METHODS AND ANALYSIS: To design and assess the feasibility of an evidence-based, proactive and systematic Multidimensional needs Assessment in Palliative care (MAP) as a semistructured clinical interview guide for initial palliative care encounter/s in patients with advanced cancer. This is a two-phase multisite project conducted over 36 months between May 2019 and May 2022. Phase I includes a systematic review, discussions with stakeholders and Delphi consensus. The evidence gathered from phase I will be the basis for the initial versions of the MAP, then submitted to Delphi consensus to develop a preliminary guide of the MAP for the training of clinicians in the feasibility phase. Phase II is a mixed-methods multicenter feasibility study that will assess the MAP's acceptability, participation, practicality, adaptation and implementation. A nested qualitative study will purposively sample a subset of participants to add preliminary clues about the benefits and barriers of the MAP. The evidence gathered from phase II will build a MAP user guide and educational programme for use in clinical practice. ETHICS AND DISSEMINATION: Ethical approval for this study has been granted by the university research ethics committee where the study will be carried out (approval reference MED-2018-10). Dissemination will be informed by the results obtained and communication will occur throughout.