Dimensions of good palliative nursing care: Expert panel consensus and perceptions of palliative professionals.

AIMS AND OBJECTIVES: To analyse the dimensions of quality of palliative nursing care and to explore the perceptions of professionals for the development and validation of the Palliative Nursing Care Quality Scale. BACKGROUND: The study of palliative nursing care quality has been approached from analysis of the competencies of palliative care nurses, based on various theoretical models. However, there are fewer qualitative empirical studies that have evaluated what good palliative nursing care is and what its dimensions are. DESIGN: Mixed-method, Delphi approach and exploratory qualitative study. METHODS: Consensus by a panel of experts using the Delphi technique and semi-structured interviews. The study was reported in a comprehensive manner following COREQ criteria. Data collection took place between January and June 2018. RESULTS: The eight-person expert panel reached consensus on the following dimensions of the Palliative Nursing Care Quality Scale: control and relief of symptoms, family and/or primary caregiver, therapeutic relationship, spiritual support and continuity of care. Thematic analysis of ten interviews identified four emergent themes related to good nursing care: (1) the patient and family as a whole; (2) finding meaning; (3) responsible communication; and (4) caring for the human element. CONCLUSIONS: The quality of palliative nursing care goes beyond providing comprehensive care; it means meticulously looking after every detail of what is important to the patient. The expectations of professionals are not as important. Instead, care should be based primarily on the needs and respect for the wishes of the patient and their family. RELEVANCE TO CLINICAL PRACTICE: Specifying the quality of nursing care in routine practice and reaching a consensus on its dimensions means moving towards excellence in care, as well as improving the professional profile of advanced practice palliative care nurses. PATIENT OR PUBLIC CONTRIBUTION: Two primary caregivers participated in the panel of experts and the semi-structured interview.

Quality of palliative nursing care: Meaning, death anxiety, and the mediating role of well-being.

BACKGROUND: There is increasing concern regarding the quality of palliative nursing care. However, despite the growing number of studies identifying related variables, there is still a paucity of studies analyzing models of how these variables interrelate. OBJECTIVE: The study aimed to identify the role played in the quality of palliative care of nursing professionals by the variables meaning and death anxiety and to investigate the mediating role of psychological well-being and engagement. METHOD: 176 palliative nursing professionals participated, selected by non-probabilistic convenience sampling using the snowball method. A simple mediation analysis and a multiple mediator model were performed in parallel, and data were collected using a paper and online questionnaire between January and May 2018. RESULTS: Well-being mediated the impact of meaning (indirect effect = 0.096, SE = 0.044, 95% confidence interval (CI): 0.028, 0.213) and death anxiety (indirect effect = -0.032, SE = 0.013, 95% CI: -0.064, -0.010) on the quality of care. Engagement, on the other hand, only mediated the impact of meaning (indirect effect = 0.185, SE = 0.085, 95% CI: 0.035, 0.372), while the indirect effect of death anxiety with the quality of care through engagement was not statistically significant (indirect effect = 0.008, SE = 0.009, 95% CI: -0.004, 0.032). SIGNIFICANCE OF RESULTS: Death anxiety is not directly related to the quality of care, but rather has an effect through psychological well-being, a variable acting as a mediator between the two. The effect of meaning on the quality of care is explained by the mediation of both engagement and psychological well-being, and its impact on the quality of care is thereby mediated by more variables than death anxiety.

Trait mindfulness, rumination, and well-being in family caregivers of people with acquired brain injury / Mindfulness como rasgo, la rumiación y el bienestar en los cuidadores de las personas con daño cerebral adquirido

This study examined the relationship between trait mindfulness, rumination, quality of life, anxiety, and depression in family caregivers of people with Acquired Brain Injury (ABI). Participants were 78 caregivers (75.6% women) aged between 22 and 80 years. The participants completed measures of behavioral and emotional problems in the person with ABI, trait mindfulness, symptoms of anxiety and depression, quality of life, and rumination. The results showed that mindfulness is associated with fewer symptoms of anxiety and depression and better quality of life, and that this is explained through less use of rumination. Likewise, behavioral and emotional problems of the person with ABI were associated with more depression and lower quality of life in the caregiver. Rumination explained part of this association. Finally, behavioral and emotional problems of the person with ABI were more strongly associated with depression in caregivers with low trait mindfulness. (AU)

Este estudio examinó la relación entre el rasgo de mindfulness, rumiación, calidad de vida, ansiedad y depresión en cuidadores de personas con daño cerebral adquirido (DCA). Participaron 78 cuidadores (75.6% mujeres) de edades comprendidas entre 22 y 80 años. Los participantes facilitaron medidas de problemas conductuales y emocionales de la persona con DCA, rasgo de mindfulness, síntomas de ansiedad y depresión, calidad de vida y rumiación. Los resultados mostraron que mindfulness se asocia a menos síntomas de ansiedad y depresión y más calidad de vida y que esto se explica a través de un menor uso de la rumiación. Asimismo, los problemas conductuales y emocionales de la persona con DCA se asocian a una mayor depresión y menor calidad de vida en el cuidador. La rumiación media parte de esta asociación. Finalmente, los problemas conductuales y emocionales de la persona con DCA se asocian más estrechamente a la depresión en los cuidadores con bajo nivel de mindfulness. (AU)

Good palliative nursing care: Design and validation of the palliative nursing care quality scale (PNCQS).

AIMS: Develop and psychometrically assess the Palliative Nursing Care Quality Scale (PNCQS, escala de Calidad del Cuidado Enfermero Paliativo, CCEP, in Spanish). An interview-based qualitative study (1) was conducted to verify construct validity evidence, with psychometric properties of reliability and validity verified by two quantitative studies (2 & 3). DESIGN: Quantitative instrumental, correlational, and cross-sectional study. METHODS: Study 1 was carried out with 10 key informants. For Study 2, a sample of 103 nursing professionals was obtained and 176 nurses from palliative care resources in Spain participated in Study 3. Data were collected between May 2017 - May 2018. RESULTS: Evidence of adequate reliability (internal consistency) and validity was found. The confirmatory factor model yielded a single latent factor for the 20 items, with adequate goodness-of-fit indices. The convergent validity data showed that the highest correlations were with the Dedication subscale of the Utrecht Work Engagement Scale and the Personal Growth subscale of Psychological Well-being, with values of 0.35 and 0.34, respectively (p < 0.01 in both cases). CONCLUSION: The scale shows good psychometric properties, with high internal consistency and evidence of internal and convergent validity. IMPACT: Proposing a valuable instrument which identifies good nursing in different areas of palliative care while also establishing quality indicators to guide nursing practice entails the recognition of autonomy in care. The resulting work tool can be used to systematize the assessment of nursing care in a process of open and continuous improvement.

Quality of life, psychological well-being, and resilience in caregivers of people with acquired brain injury (ABI).

Aim: The study aims to examine whether characteristics of patients with Acquired Brain Injury-ABI (time elapsed since injury, level of dependence and behavioral problems) and resilience factors of the caregiver predicted caregiver well-being (quality of life, anxiety,depression and positive aspects of caregiving).Methods: 78 voluntary family caregivers (75.6% female) of patients with ABI completed the Barthel Index, Head Behavior Injury Scale, Questionnaire of Resilience in Caregivers of Acquired Brain Injury, WHOQOL-BREF, Hospital Anxiety and Depression Scale,and Positive Aspects of Caregiving Scale. Correlation analysis and stepwise regression were carried out.Results: Time elapsed since injury showed a negative relationship with positive aspects of caregiving. On the other hand, care-recipients' behavioral problems showed significant associations with all caregiver variables: negatively with quality of life and positive aspects of caregiving, and positively with anxiety and depression. Regarding resilience, we found a positive relationship with quality of life and positive aspects of caregiving, and a negative association with anxiety and depression, showing better predictive power with depression.Conclusions: We confirm the relevance of developing multidisciplinary caregiver intervention programmes focused on positive ways to handle care-recipients' behavioral problems and developing positive coping skills, such as positive reinterpretation, acceptance and seeking social support, that may optimize caregiver resilience.

Emotional Impact of COVID-19 Lockdown Among the Spanish Population.

BACKGROUND: The COVID-19 pandemic has resulted in some populations being confined to their homes as part of infection control measures. This situation can be hard to cope with due to separation from loved ones, prohibition of regular activities, fear of infection, loss of freedom, and so on. These negative impacts cause considerable psychological stress, and all the more so when the situation continues for an extended period, as was the case in Spain. The present study was aimed at investigating the effects of COVID-19 quarantine on the emotional functioning of confined Spanish individuals after 8 weeks of lockdown by means of a cross-sectional study. The possible associations between changes in emotional functioning and demographic variables (age and sex), health habits (physical exercise, following a routine, and smoking), social support, and resilience were also analyzed. METHODS: A total of 906 Spanish adults completed an online survey to gather information about their prevailing mood and affects (before and after 8 weeks of lockdown), using the Positive and Negative Affect Schedule (PANAS) (Watson et al., 1988), and other variables related to their habits and protective factors. FINDINGS: As expected, the data indicated an increase in negative affects (e.g., "upset," "afraid," "distressed") and a decrease in positive affects after 8 weeks under lockdown, as well as a general decline in overall mood. The largest increases in negative affects were observed in young adults (18-35 years) and women. We did not find any differences between people who were or were not diagnosed with COVID-19. Adhering to a routine, maintaining the same weight, and moderate physical exercise were associated with fewer negative affects, which indicates they are important protective factors, as are perceived social support and resilience. CONCLUSION: In order to mitigate the psychological impact of confinement, it is important to develop psychoeducational measures that encourage subjects to adhere to health habits and promote social support and resilience as protective factors. A special preventive focus should be placed on the most vulnerable population groups, namely women and young adults. For a public health lockdown to succeed, its negative consequences must be minimized insofar as possible through adequate knowledge of the risk factors and protective factors, and by means of prevention-oriented organization.

La calidad del cuidado enfermero en el ámbito paliativo / The quality of nursing care in the palliative field / A qualidade de enfermagem no âmbito dos cuidados paliativos

El cuidado es la esencia de la profesión enfermera y cobra todo su sentido en el ámbito de paliativos. La enfermería de paliativos adquiere un papel relevante en la relación con el paciente y/o familia y acompañamiento en el sufrimiento. Analizar si los cuidados enfermeros proporcionados al paciente con enfermedad terminal y familiares, son o no de calidad, supone aspirar a una mejora continua y excelencia profesional. El objetivo de nuestro estudio es realizar una revisión teórica sobre la calidad del cuidado enfermero en el ámbito paliativo. Para ello, se consultó en las bases de datos Academic Search Complet, PsycInfo, CINAHL, CUIDEN y MEDLINE. Los resultados nos indican que la calidad de los cuidados enfermeros parece un campo poco investigado, y que los instrumentos de medida evalúan la calidad percibida desde la satisfacción del paciente, sólo en el ámbito hospitalario. Existe un amplio consenso sobre las dimensiones esenciales para evaluar la calidad de los cuidados paliativos, pero no se han encontrado escalas que midan específicamente la calidad del cuidado enfermero paliativo. La calidad se evalúa, por tanto, a través de las competencias enfermeras avanzadas y valores del profesional enfermero en paliativos

Care is the essence of the nursing profession and takes full meaning in the field of palliative care. Palliative nursing acquires an important role in the relationship with the patient and/or family and accompaniment in suffering. Analysing whether there is quality or not in the nursing care provided to the patient with terminal illness and his family, helps to build continuous improvement and professional excellence. The aim of our study is to carry out a theoretical review on the quality of nursing care in the field of palliative care. For this purpose, we worked with the databases Academic Search Complet, PsycInfo, CINAHL, CUIDEN and MEDLINE. The results indicate that the quality of nursing care seems to be a poorly researched field, and that the instruments of measurement evaluate the perceived quality from patient satisfaction, only in the hospital setting. There is a broad consensus on the essential dimensions for assessing the quality of palliative care, but no scales have been found that specifically measure the quality of nursing palliative care. Quality is therefore evaluated through advanced nursing competencies and nursing professional values in palliative care

O cuidado é a essência da profissão enfermeira e cobra todo o seu sentido na área de paliativos. A enfermeira de paliativos adquire um papel relevante na relação com o paciente e/ou família bem como no acompanhamento no sofrimento. Analisar se os cuidados proporcionados fornecidos ao paciente com doença terminal e familiares, têm ou não qualidade, supõe aspirar a uma melhora continua e à excelência profissional. O objetivo do nosso estudo é realizar uma revisão teórica sobre a qualidade da assistência do enfermeiro no âmbito dos cuidados paliativos. Com esse objetivo, se consultaram as bases de dados da Academic Search Complet, PsycInfo, CINAHL, CUIDEN y MEDLINE. Os resultados nos indicam que a qualidade dos cuidados enfermeiros parece ser um campo pouco investigado, e que os instrumentos de medida que avaliam a qualidade percebida a partir da satisfação do paciente, são apenas no âmbito hospitalário. Existe um amplio consenso sobre as dimensões essenciais para avaliar a qualidade dos cuidados paliativos, mas não se encontrou as escalas para medir especificamente a qualidade do cuidado do enfermeiro paliativo. A qualidade se avalia, por tanto, através das competências enfermeiras avançadas e valores do profissional enfermeiro em paliativos

Contexto laboral y malestar docente en una muestra de profesores de Secundaria / Work environment and uneasiness a sample of Secondary teacher’s

La investigación tiene como objetivo profundizar en el estudio de las relaciones entre algunas de las manifestaciones más importantes del malestar docente (síntomas psicopatológicos, depresión, burnout, estrés de rol y absentismo) y determinadas variables relacionadas con el contexto laboral (años de experiencia docente, tipo de centro, número de alumnos,tipo de contrato, puestos desempeñados, etc). La muestra está formada por 71 profesores de enseñanza Secundaria, a los que se aplica tres instrumentos estandarizados (BDI, CBP-R y SCL-90-R) y un cuestionario que recoge información sobre el contexto laboral. Los resultados más relevantes muestran el elevado nivel de malestar psicológico de la muestra, las altas tasas de absentismo laboral, y algunas asociaciones significativas entre lasvariables del contexto laboral estudiadas y las distintas manifestaciones del malestar docente (en especial, la insatisfacción con las condiciones organizacionales y la escasa correspondencia entre el área de formación del profesor y el área en que imparte docencia)

The aim of this paper is to gain a deeper understanding of the relationship between relevant signs of educational uneasiness (psychopathological symptoms, depression, burnout, role stress and absenteeism) and certain work environment variables (years of educationalexperience, type of school, number of students, type of work contract, previous positions, etc.). The sample consisted of 71 secondary teachers, who completed three standardized instruments (BDI, CBP-R and SCL-90-R) and one questionnaire that collects informationabout work environment variables. Results show a high level of psychological uneasiness and high rates of labor absenteeism. Besides that, we found significant associations between work environment variables and the different signs of educational uneasiness –especially teacher dissatisfaction with organizational conditions and a poor correspondence between teacher academic background and the subject he/she teaches