Impact of the COVID-19 Pandemic on the Perceived Quality of Palliative Care in Nursing Homes.

The Nursing Homes End-of-life Programme (NUHELP) was developed in 2017 and is based on quality standards of palliative care, but it was not implemented due to the outbreak of the COVID-19 pandemic. OBJECTIVES: To describe perceptions among staff at nursing homes and primary health care (PHC) centres regarding the relevance, feasibility, and degree of achievement of quality standards for palliative care in nursing homes and to determine the differences in these perceptions before and after the pandemic. METHODOLOGY: Cross-sectional descriptive study. Professionals at eight nursing homes and related PHC centres who participated in NUHELP development assessed 42 palliative care standards at two time points (2018 and 2022). The Mann-Whitney U test was applied to analyse differences in the scores between these two times and between perceptions at nursing homes and at PHC centres. RESULTS: The study population consisted of 58 professionals in 2018 and 50 in 2022. The standard regarding communication with persons affected by the death of a family member was considered less relevant (p = 0.05), and that concerning the culturally sensitive and dignified treatment of the body was less fully achieved (p = 0.03) in 2022 than in 2018. Social support (p = 0.04), sharing information among the care team (p = 0.04), patient participation (p = 0.04) and information about the treatment provided (p = 0.03) were all more poorly achieved in 2022 than in 2018. The perceptions of nursing home and PHC workers differed in several respects. CONCLUSIONS: Professional intercommunication and social support should be reinforced, and residents should be more actively involved in decision-making.

Psychometric Properties of the Spanish Version of the Fatigue Assessment Scale in Caregivers of Palliative Care Patients.

Symptoms of fatigue and lack of energy are very common in caregivers of palliative care (PC) patients, traditionally associated with variables such as burden or depression. There are no Spanish-language instruments validated for assessing fatigue levels in this population. The Fatigue Assessment Scale (FAS) is a useful and simple instrument for assessing fatigue in this group. The aim of this study was to examine its psychometric properties (factor structure, reliability and validity) in a sample of caregivers of PC patients. Instrumental design for instrument validation was performed. One hundred and eight caregivers of PC patients participated and completed measures of fatigue, family functioning, life satisfaction, caregiver burden, anxiety, depression, resilience and quality of life. A confirmatory factor analysis was performed; non-linear reliability coefficient and Pearson correlations and t-tests were conducted to assess evidence of reliability and validity. The Spanish version of the FAS was found to have a one-dimensional structure. Reliability was 0.88. Validity evidence showed that FAS scores were positively associated with levels of burden, anxiety and depression. They were negatively associated with family functioning, life satisfaction, resilience and quality of life. The Spanish version of the FAS in caregivers of PC patients shows adequate psychometric properties.

Levels and Determinants of Place-Of-Death Congruence in Palliative Patients: A Systematic Review.

Introduction: Congruence, understood as the agreement between the patient's preferred place of death and their actual place of death, is emerging as one of the main variables indicating the quality of end-of-life care. The aim of this research was to conduct a systematic literature review on levels and determinants of congruence in palliative patients over the period 2010-2021. Method: A systematic review of the literature in the databases of PubMed, Scopus, Web of Science, PsycINFO, CINAHL, Cuiden, the Cochrane Library, CSIC Indexes, and IBECS. Information was extracted on research characteristics, congruence, and associated factors. Results: A total of 30 studies were identified, mainly of retrospective observational design. The congruence values varied substantially between the various studies, ranging from 21 to 100%. The main predictors of congruence include illness-related factors (functional status, treatments and diagnosis), individual factors (age, gender, marital status, and end of life preferences), and environmental factors (place of residence, availability of health, and palliative care services). Conclusion: This review, in comparison with previous studies, shows that treatment-related factors such as physical pain control, marital status, having a non-working relative, age, discussing preferred place of death with a healthcare professional, and caregiver's preference have been associated with higher levels of congruence. Depending on the study, other factors have been associated with either higher or lower congruence, such as the patient's diagnosis, gender, or place of residence. This information is useful for designing interventions aimed towards greater congruence at the end of life.

Prospective Evaluation of Intensity of Symptoms, Therapeutic Procedures and Treatment in Palliative Care Patients in Nursing Homes.

The aim of the study is to evaluate the intensity of symptoms, and any treatment and therapeutic procedures received by advanced chronic patients in nursing homes. A multi-centre prospective study was conducted in six nursing homes for five months. A nurse trainer selected palliative care patients from whom the sample was randomly selected for inclusion. The Edmonton Symptoms Assessment Scale, therapeutic procedures, and treatment were evaluated. Parametric and non-parametric tests were used to evaluate month-to-month differences and differences between those who died and those who did not. A total of 107 residents were evaluated. At the end of the follow-up, 39 had (34.6%) died. All symptoms (p < 0.050) increased in intensity in the last week of life. Symptoms were more intense in those who had died at follow-up (p < 0.05). The use of aerosol sprays (p = 0.008), oxygen therapy (p < 0.001), opioids (p < 0.001), antibiotics (p = 0.004), and bronchodilators (p = 0.003) increased in the last week of life. Peripheral venous catheters (p = 0.022), corticoids (p = 0.007), antiemetics (p < 0.001), and antidepressants (p < 0.05) were used more in the patients who died. In conclusion, the use of therapeutic procedures (such as urinary catheters, peripheral venous catheter placement, and enteral feeding) and drugs (such as antibiotics, anxiolytics, and new antidepressant prescriptions) should be carefully considered in this clinical setting.

Nursing Professionals' Attitudes, Strategies, and Care Practices Towards Death: A Systematic Review of Qualitative Studies.

PURPOSE: To explore the attitude of nursing professionals towards death. DESIGN: Systematic qualitative review methods were used. METHODS: A search was conducted in the PubMed, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and CUIDEN databases. This study included 17 articles. FINDINGS: Thirteen categories emerged, which were grouped into three themes: meanings and feelings during the dying process; coping strategies in the face of death; and the importance of training, experience, and providing a dignified death. In the different accounts of the participants, it was found that death had a large negative emotional impact on them, that the participants complained about the lack of previous training in the care of dying patients, and that avoiding these complex situations was one of the strategies most commonly used by professionals to face the death of a patient. CONCLUSIONS: The lack of training in the basic care of terminally ill patients, as well as today's preconceived negative idea about death, both cause health professionals to experience situations of great stress and frustration resulting, on many occasions, in resorting to avoidance of these situations, thus preventing dying with dignity. CLINICAL RELEVANCE: In this article, we explore the consequences of this process for nursing professionals, common coping strategies, and possible areas for improvement, such as the need for the training of nursing professionals in the care of terminally ill patients and their families.

Palliative Care Symptoms, Outcomes, and Interventions for Chronic Advanced Patients in Spanish Nursing Homes with and without Dementia.

The aim of this study was to compare the symptomatology, palliative care outcomes, therapeutic procedures, diagnostic tests, and pharmacological treatments for people with dementia (PWD) and without dementia (PW/OD) admitted to Spanish nursing homes. DESIGN: This was a cross-sectional study which is part of a long-term prospective follow-up of elderly people performed in nursing homes to measure end-of-life care processes. PARTICIPANTS: 107 nursing home patients with advanced or terminal chronic diseases were selected according to the criteria of the Palliative Care Spanish Society. SETTING: Two trained nurses from each nursing home were responsible for participant selection and data collection. They must have treated the residents and had a minimum seniority of 6 months in the nursing home. MEASUREMENTS: Sociodemographic data; Edmonton Symptom Assessment Scale; Palliative Care Outcome Scale; and prevalence of diagnostic tests, pharmacological treatments, and therapeutic procedures were evaluated. RESULTS: Pain, fatigue, and nausea were found to be significantly higher in the nondementia group and insomnia, poor appetite, and drowsiness were significantly higher in the dementia group. Patient anxiety, support, feeling that life was worth living, self-worth, and practical matters management were higher in the nondementia group. Regarding drugs, use of corticoids was higher in the nondementia group, while use of anxiolytics was higher in the dementia group. Diagnostic procedures such as urine analysis and X-ray were higher in the dementia group. CONCLUSIONS: Differences in symptom perception, diagnostic tests, and pharmacological procedures were found between patients with and without dementia. Specific diagnostic tools need to be developed for patients with dementia.

Understanding the Occupational Adaptation Process and Well-Being of Older Adults in Magallanes (Chile): A Qualitative Study.

Background: Aging and longevity are important topics nowadays. Purpose: To describe how older adults perform the occupational adaptation process in the extreme region of Magallanes (Chile), and to identify the factors that might contribute to successful occupational adaptation and well-being. Method: Qualitative study, with a phenomenological interpretative approach. In-depth interviews were carried out with 16 older adults, with high or low levels of well-being, assessed with the Ryff Scale. An inductive content analysis according to Elo and Kyngäs was performed. Findings: Resilience, self-esteem and interdependence with significant others are key elements that promote well-being. Participants develop strategies to minimize the effects of environmental factors. The occupation's function in terms of socialization, use of time, and social participation is revealed as a conditioning factor of occupational adaptation. Implications: Interventions with older people to achieve a successful occupational adaptation process must take into consideration the commitment to meaningful activities.

Establecimiento de la situación de enfermedad terminal en enfermedades oncológicas y no oncológicas: estudio retrospectivo con historias clínicas / Indentifying terminal illness situation in cancer and non cancer diseases: A retrospective study using clinical records

OBJETIVO: Conocer cómo y en qué momento del proceso de enfermedad se identifica la situación terminal en las historias clínicas de pacientes con enfermedades avanzadas oncológicas y no oncológicas; las expresiones y argumentos registrados para definirla y la presencia de factores pronósticos. MÉTODO: Estudio observacional y retrospectivo de las historias clínicas de los pacientes que fallecieron en 4 hospitales de Granada (España) en el año 2010, por enfermedad oncológica, enfermedad pulmonar crónica/EPOC, insuficiencia cardiaca crónica, enfermedad hepática avanzada e insuficiencia renal crónica. Se revisaron los informes clínicos de ingreso, el informe de alta y la evolución médica y enfermera correspondientes a los últimos 3 meses de vida del paciente. Se registraron los datos sociodemográficos, clínicos y específicos relacionadas con el pronóstico de enfermedad terminal. RESULTADOS: Se revisaron 202 historias clínicas. En un 51,5% de los casos consta el establecimiento de la situación de enfermedad terminal. Un 33,6% han sido registrados como paciente en situación terminal entre los 7 días y las últimas 48h antes del fallecimiento. Se produce una mayor identificación de situación terminal en pacientes oncológicos (p = 0,004). Las expresiones que más se emplean en las historias son «enfermedad terminal» (32,7%) en el caso de pacientes de cáncer y «mal pronóstico» (41,3%) en pacientes no oncológicos. Los argumentos que más se emplean son cuestiones relativas a un mal pronóstico (42,2%) y al estadio de la enfermedad (39,8%), especialmente en los pacientes de cáncer. No existen diferencias entre los pacientes identificados como en situación terminal y aquellos que no, en relación con la edad, el sexo, la comorbilidad y el tiempo de evolución de la enfermedad. CONCLUSIONES: Este trabajo muestra la dificultad de los clínicos en identificar la fase terminal de forma temprana y una actitud poco favorable a registrarla en las historias clínicas. Esta conducta puede constatarse por la frecuente utilización de expresiones ambiguas y por la falta de criterios y argumentos para señalar la situación terminal

AIM: To know how and when terminal illness situation is identified in advanced cancer and non-cancer patients in medical records, and which expressions and arguments are used when this situation is established, as well as the presence of prognosis factors. METHOD: Observational, retrospective study of medical records of patients who died of oncological disease, COPD disease, chronic heart failure, advanced liver disease, and chronic renal failure in 4 hospitals in Granada (Spain). Medical records including hospitalisation reports, discharge documents, and medical and nurse evaluations of the last 3 months of life were reviewed. Sociodemographic, clinical, and specific data related to the prognosis of terminal illness were recorded. RESULTS: From the 202 medical records reviewed, 51.5% patients were identified as in terminal illness situation. One third (33.6%) of them were identified between 7 days and the last 48h before death. Doctors tend to identify more cancer-patients than non-cancer patients as in terminal illness situation (P=.004). The most used expressions in medical records are 'terminal disease' in cancer patients (32.7%) and 'poor prognosis' in non-cancer patients (41.3%). The arguments most used are related to poor prognosis (42.2%), and related to the stage of the disease (39.8%), especially in cancer PATIENTS: There are no statistical differences between patients identified as terminally ill, and patients not identified, related to age, gender, comorbidity and time of evolution. CONCLUSIONS: This paper shows how difficult it is for clinicians to identify terminal illness at an early stage, and an unfavourable attitude towards reporting it in medical records. This attitude could be confirmed by the frequent use of ambiguous expressions regarding terminally ill, the lack of criteria and arguments to identify this situation

Dificultades y factores favorables para la atención al final de la vida en residencias de ancianos: un estudio con grupos focales / Facilitators and barriers regarding end of life care at nursing homes: A focus group study

OBJETIVO: Identificar las dificultades y factores favorables experimentados por los profesionales, relacionados con el final de la vida en las residencias de ancianos. DISEÑO: Estudio cualitativo descriptivo, desde una perspectiva fenomenológica mediante análisis del contenido. Emplazamiento: Residencias de ancianos del Distrito de Atención Primaria Granada (España). PARTICIPANTES: Quince profesionales asistenciales con un mínimo de 6 meses de experiencia en residencias y sin formación específica en cuidados paliativos. MÉTODOS: Se realizaron 3 grupos focales con profesionales de diferentes disciplinas y residencias. Las conversaciones fueron grabadas y transcritas literalmente. Se realizó una codificación abierta y axial para identificar las categorías más relevantes. RESULTADOS: Los profesionales identifican dificultades en la comunicación con las familias, relacionadas con sentimientos de culpa de los familiares, dificultad para comprender el deterioro, y un abordaje tardío del tema de la muerte. En cuanto a la toma de decisiones, los profesionales reconocen que no fomentan la participación de los pacientes. Las voluntades anticipadas son valoradas como una herramienta necesaria, pero no contemplan su implementación de manera sistemática. Otras dificultades que los profesionales destacan son la falta de coordinación con otros profesionales, relacionada con la falta de comprensión de las necesidades de los pacientes, así como la falta de formación y de recursos materiales y humanos. Como factor favorable, destacan las relaciones con los equipos de atención primaria. CONCLUSIÓN: Es necesario mejorar la comunicación entre los profesionales, las familias, los pacientes y otros trabajadores de la salud

AIM: To identify the facilitators and barriers experienced by professional related to end of life care in nursing homes. DESIGN: Descriptive qualitative research with phenomenological orientation, through content analysis. Placement: Nursing Homes at Primary Care District in Granada (Spain). PARTICIPANTS: Fifteen clinical professionals with, at least 6 months of experience in nursing homes, without specific background in palliative care. METHODS: Three focus groups were undertaken with professionals of different disciplines and nursing homes. Interviews were recorded and transcribed literally. An open and axial coding was performed to identify relevant categories. RESULTS: Professionals identified difficulties in the communication with families related to relatives' feelings of guilt, difficulty in understanding the deterioration of their relative, and addressing too late the issue of death. Regarding decision making, professionals recognized that they do not encourage participation of patients. Advance directives are valued as a necessary tool, but they do not contemplate implementing them systematically. Other difficulties that professionals highlighted are lack of coordination with other professionals, related to misunderstanding of patients' needs, as well as lack of training, and lack of material and human resources. Facilitators include relationships with primary care teams. CONCLUSION: It is necessary to improve communication among nursing homes professionals, families, patients and other health workers

[Facilitators and barriers regarding end of life care at nursing homes: A focus group study]. / Dificultades y factores favorables para la atención al final de la vida en residencias de ancianos: un estudio con grupos focales.

AIM: To identify the facilitators and barriers experienced by professional related to end of life care in nursing homes. DESIGN: Descriptive qualitative research with phenomenological orientation, through content analysis. PLACEMENT: Nursing Homes at Primary Care District in Granada (Spain). PARTICIPANTS: Fifteen clinical professionals with, at least 6 months of experience in nursing homes, without specific background in palliative care. METHODS: Three focus groups were undertaken with professionals of different disciplines and nursing homes. Interviews were recorded and transcribed literally. An open and axial coding was performed to identify relevant categories. RESULTS: Professionals identified difficulties in the communication with families related to relatives' feelings of guilt, difficulty in understanding the deterioration of their relative, and addressing too late the issue of death. Regarding decision making, professionals recognized that they do not encourage participation of patients. Advance directives are valued as a necessary tool, but they do not contemplate implementing them systematically. Other difficulties that professionals highlighted are lack of coordination with other professionals, related to misunderstanding of patients' needs, as well as lack of training, and lack of material and human resources. Facilitators include relationships with primary care teams. CONCLUSION: It is necessary to improve communication among nursing homes professionals, families, patients and other health workers.

Experiencias de donación de leche humana en Andalucía-España: un estudio cualitativo / Experiences of human milk donation in Andalucía-Spain: a qualitative study

Introducción: Los beneficios de la lactancia materna para los bebés han sido bien documentados. Recoger el exceso de leche humana de madres lactantes es un servicio social importante. Los bancos dependen de las donaciones de madres lactantes, por ello la importancia de conocer los aspectos subjetivos que interfieren en la donación. Objetivo: Conocer las vivencias, creencias, motivaciones y dificultades respecto la donación de leche de un grupo de mujeres donantes en el Banco de Leche Humano de Granada-Andalucia. Métodos: Estudio descriptivo, con abordaje cualitativo, realizado en el período de mayo y junio de 2013. La muestra estuvo constituida por 7 mujeres que donaron leche en el banco de leche humana del Hospital Virgen de las Nieves de Granada. Para la recogida de datos se utilizaron entrevistas semi-estructuradas. Resultados: Las informantes tenían en su mayoría más de treinta años, con nivel universitario, casadas y con uno o dos hijos como máximo. De los discursos de las madres emergieron las siguientes categorías: Decisión de hacerse donante; Motivaciones donación; Apoyo donación y Dificultades donación. Conclusión: Como se evidencia, el banco de leche es todavía poco conocido. Todavía existen pocos bancos de leche en España, intentar ampliar esa red sería fundamental para cientos de prematuros que necesitan de esa leche (AU)

Introduction: The benefits of feeding human milk to infants have been well-documented. Collecting excess human milk from lactating mothers is an important social service. The Human Milk Banks depend on donors, and knowing the subjective aspects of donors seems quite important. Objective: Compiling the experiences, beliefs, motivations and difficulties concerning milk donation in a group of donors belonging to the Human Milk Bank of Granada- Andalucia. Methods: A descriptive qualitative study was conducted from May to June of 2013. The sample consisted of 7 women who donated milk to the Human Milk Bank located in the Virgen de las Nieves hospital of Granada. Data was collected using a semi-structured interview. Results: Most of the interviewees were over thirty years olºd, had completed or were in the process of completing university, married, and had one or two children. During the interview, the following subjects were discussed with the mothers: Decision of becoming a donor, support to the donor, motivation for donating, and difficulties donating. Conclusion: The results of our study suggest that many mothers are still not aware that there are milk banks present in their location. Expanding the number of milk banks in Spain is essential for hundreds of premature babies who are in need of this necessary resource (AU)

Efectividad de un plan de apoyo a cuidadores en dos hospitales públicos de Granada (España) / Effectiveness of a Plan to Support Caregivers at Two Public Hospitals in Granada (Spain) / Efetividade de um plano de apoio a cuidadores em dois hospitais públicos de Granada (Espanha)

Objetivo: dos hospitales granadinos realizan una experiencia pionera implementando medidas de apoyo innovadoras para personas cuidadoras. Transcurridos dos años desde su implantación se plantea: ¿Las medidas implementadas han logrado los beneficios esperados en personas cuidadoras en hospitalización? Para responder se realiza un estudio con el objetivo de evaluar la efectividad de las medidas de apoyo a personas cuidadoras incluyendo propuestas de mejora. Materiales y métodos: estudio cualitativo, interpretativo, basado en la Teoría Fundamentada. Se realizaron 45 entrevistas en profundidad a personas cuidadoras con distintos perfiles, en los hospitales Virgen de las Nieves y Baza. Se ha seguido como estrategia de análisis la comparación constante y la codificación abierta y axial. Se contó con el apoyo del software Atlas.ti®. Resultados: las personas cuidadoras valoran positivamente la mayoría de las medidas, destacando personalización, educación, hostelería y accesos prioritarios. La identificación de enfermera y auxiliar referentes no siempre ha funcionado bien. La utilización de zonas de descanso habilitadas ha sido escasa, debido principalmente a su ubicación. Conclusiones: las medidas implementadas han mejorado el bienestar y la autoestima de las personas cuidadoras durante la hospitalización. Aportan una evidencia que anima a extenderlas a otros hospitales y mejorar el trato y el apoyo a este colectivo.

Purpose: Two hospitals in Granada are involved in a pioneering experience to implement innovative measures to support caregivers. Two years after the onset of that initiative, the question is: Are the measures implemented achieving the expected benefits for caregivers during hospitalization? A study was conducted to answer that question by evaluating the effectiveness of those measures, including suggestions for improvement. Study Materials and Methods: This is a qualitative, interpretive study based on grounded theory. Forty-five (45) in-depth interviews were conducted at the Virgen de las Nieves and Baza hospitals with caregivers who have different profiles. The strategy for analysis involved constant comparison and open and axial coding, supported by Atlas.ti® software. Results: The caregivers reacted positively to most of the measures, highlighting personalization, education, accommodation and priority access. Use of the term nurse and auxiliary nurse as a form of identification has not always worked well. Only limited use has been made of the areas outfitted for rest and relaxation, mainly due to their location. Conclusions: The measures implemented have improved the well-being and self-esteem of caregivers during hospitalization. Moreover, they provide evidence that encourages their extension to other hospitals to improve the way this group is treated and the support it receives.

Objetivo: dois hospitais granadinos realizam uma experiência pioneira implementando medidas de apoio inovadoras para pessoas cuidadoras. Transcorridos dois anos de sua implantação, propõe-se: as medidas implantadas têm atingido os benefícios esperados em pessoas cuidadoras em hospitalização? Para responder a essa pergunta, realiza-se um estudo com o objetivo de avaliar a efetividade das medidas de apoio a pessoas cuidadoras em que são incluídas propostas de melhoria. Materiais e métodos: estudo qualitativo, interpretativo, baseado na Teoria Fundamentada. Realizaram-se 45 entrevistas em profundidade a pessoas cuidadoras com diferentes perfis, nos hospitais Virgen de las Nieves e Baza. Como estratégia de análise, foi seguida a comparação constante e a codificação aberta e axial. Contou-se com o apoio do software Atlas.ti®. Resultados: as pessoas cuidadoras valorizam positivamente a maioria das medidas e destacam: personalização, educação, hotelaria e acessos prioritários. A identificação de enfermeira e auxiliar referentes nem sempre tem funcionado bem. A utilização de áreas de descanso habilitadas é escassa, devido, principalmente, a sua localização. Conclusões: as medidas implantadas têm melhorado o bem-estar e a autoestima das pessoas cuidadoras durante a hospitalização. Além disso, estimulam sua extensão a outros hospitais e melhoram o tratamento e o apoio a esse coletivo.

Psychological responses of terminally ill patients who are experiencing suffering: A qualitative study.

BACKGROUND: Suffering is not only characterized by the feeling of being threatened, but also by the feeling of impotence to deal with such a threat. Literature identifies a terminal illness as a period during which several experiences implying an intense suffering are endured, but little attention has been paid to the psychological responses when reacting to threats. OBJECTIVE: Identify the psychological responses that terminally ill patients put in place to face up to the demands of the end of life, as a foundation for future nursing interventions. DESIGN: Qualitative methodology with an interpretative phenomenological approach. SETTINGS: Different hospitals health centers around the region of Granada (Spain). PARTICIPANTS: Twenty-four participants were finally chosen to take part in the research. The sampling procedure was intentional, and it was made taking into account exclusion and inclusion criteria. Patients with a cognitive impairment, who had been diagnosed with psychiatric alterations, who at that time suffered from uncontrollable symptoms such as intense pain were excluded from the sample. METHODS: The patients were interviewed following a script (semistructured interview) carried out using the suggested theoretical framework. The interviews were analyzed using the sequence suggested by Strauss and Corbin: Open, axial and selective codification. RESULTS: The analysis of the participants' answers to the different questions of the semi-structured interview has allowed us to identify a main category "To realize that life is short". There are three categories where the different ways of facing up to the end of life concentrate: "Re-Evaluation of life", "Opportunity for growth", "Resignation/Acceptance". CONCLUSIONS: Nurses, have to try to alleviate the impact the terminal illness has on the subject, not only by controlling the symptoms but also encouraging the patients responses, by promoting the feeling of satisfaction in life, providing honest and sensitive information, establishing with the patient realistic goals, and facilitating a quality communication between patients and their family.

Efectos de un programa de formacion en cuidados paliativos sobre el afrontamiento de la muerte / The effects of a training program on coping with death in palliative care

Objetivos: Evaluar el efecto de un programa de formación en cuidados paliativos dirigido a estudiantes de ciencias de la salud, usando la escala de Bugen de afrontamiento de la muerte. Método: Estudio cuasi-experimental. Se desarrolló un programa de formación dirigido a futuros profesionales de la salud (enfermería, medicina, psicología, terapia ocupacional y fisioterapia)que participaron voluntariamente y cuyo único criterio de selección es que no hubiesen tenido formación previa en cuidados paliativos. La duración del curso fue de 45 horas, distribuidas en15 semanas, desde octubre de 2008 a febrero de 2009. Iniciaron el programa 90 participantes, de los cuales tres abandonaron la formación, finalizando 87. Al inicio y al final del mismo se administró la «escala de Bugen de afrontamiento de la muerte» a los 87 participantes para determinar su grado de afrontamiento de la muerte en cada uno de los momentos. Resultados: De los 87 participantes un 74% son mujeres y el resto hombres. La edad media es de 21,35 años. La mayoría de los participantes son de enfermería (64%), seguidos de terapia ocupacional (23,6%), psicología (5,6%), por último medicina y fisioterapia (2,2%). Se encontraron diferencias significativas respecto al afrontamiento de la muerte tras el programa formativo(p = 0,000). Antes del mismo la media era de 121,46 ± 19,7 y tras el curso la media fue de (..) (AU)

Objective: To evaluate a training program in palliative care for Health Science students using Bugen’s Coping with Death Scale. Method: Quasi-experimental research. A training program was designed for future health professionals (nursing, medicine, psychology, occupational therapy and physiotherapy). Students’ participation was voluntary. The sole selection criterion was not having previous training in palliative care. The course duration was 45 hours over 15 weeks from October 2008 to February2009. A total of 90 participants started the program, and 87 completed it (three stopped attending). Bugen’s Coping with Death Scale was filled in by all participants both at the beginning and at the end of the program in order to establish their coping skills before and after the program. Results: Of the 87 participants, 74% were female, with the rest being male. The mean age was21.35 years. Most participants were nurses (64%), followed by occupational therapy (23.6%),psychology (5.6%), and finally medicine and physiotherapy (2.2%). A clear difference could be observed in coping skills before and after the program (p=.000). Before the training program the average score was 121.46 ± 19.7, while after the course it was 158.16 ± 20.6. The Scale’s minimum score is 30, the maximum being 210. Values below 105 (percentile 50) indicate inadequate (..) (AU)

Vivencias y experiencias de duelo en madres tras un proceso de enfermedad oncológica de sus hijos / Grieving experiences in mothers after the death of a child due to cancer

Objetivo: Conocer las vivencias y experiencias de duelo en madres que sufrieron la pérdida de sus hijos tras un proceso de enfermedad oncológica. Método: Estudio descriptivo cualitativo, de corte fenomenológico. Las madres fueron seleccionadas de entre las que habían sido atendidas en la Delegación de Granada de la AECC. Los criterios de inclusión fueron el tiempo desde el fallecimiento del hijo (entre uno y tres años) y la aceptación a participar en el estudio. Para la recogida de datos se utilizó la entrevista semiestructurada, a partir de un guión de preguntas elaborado «ad hoc». El análisis se hizo en base a la propuesta de Taylor y Bogdan: descubrimiento de temas, codificación e interpretación. Resultados: Cuatro madres accedieron a participar en el estudio. De acuerdo a las categorías de análisis, encontramos: Proceso clínico: El retraso en la identificación del proceso de fin devida de sus hijos lleva a las madres a mantener una constante actitud de lucha contra la enfermedad de sus hijos y a la activación de un mecanismo de «negación» como afrontamiento de la situación. Fallecimiento: Agradecen el haber estado presentes durante los últimos momentos (..) (AU)

Aim: To determine the experiences of grieving in mothers who suffered the loss of their child after a cancer disease process. Method: This is a descriptive and a qualitative research with a phenomenological approach. The mothers were selected among those who were treated in a cancer control unit in Granada. The selection criteria for including them were: the time elapsed since the death of their child(one to three years) and the acceptance in participating in this research. In order to collect data, we used a semi-structured interview based on a number of questions ‘‘ad hoc’’. The analysis was based on the Tylor and Bogdan method: discovery of topics, codification and interpretation. Results: Four mothers agreed to participate in the research. According to the analysis category we can find: Clinical process: the delay in identifying the end of life process of children leads mothers to maintain an attitude of struggling against the disease, and the activation of a ‘‘denial’’ mechanism to cope with the situation. Death: They appreciate the fact of being (..) (AU)