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1.
BMJ Open ; 10(2): e034413, 2020 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-32024792

RESUMO

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.

4.
Bioethics ; 33(4): 411-420, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30957897

RESUMO

Studies that have explored the wish to hasten death (WTHD) in patients with advanced illness have found that the feeling of being a burden may trigger WTHD. Research suggests that both the feeling and the wish are indicators of multidimensional suffering whose meaning may depend on the patient's biographical background. Therefore, we carried out a systematic review and meta-ethnography. Fourteen qualitative studies, reported in 16 articles, met the inclusion criteria. The analysis identified two themes: the personal and social dimensions that could help to explain the feeling of being a burden in these patients. These dimensions reveal how this feeling is linked to physical, psychological/emotional, existential and social factors. The feeling of being a burden cannot be understood without considering patients' personal interpretation of their dependency or care needs, and hence it is also necessary to understand their biographical background. Such an understanding is crucial to inform clinical policies based on the moral duty to provide all patients with humane care.


Assuntos
Atitude Frente a Morte , Cuidadores , Emoções , Família , Relações Interpessoais , Estresse Psicológico , Assistência Terminal/psicologia , Morte , Humanos , Pesquisa Qualitativa , Autoimagem , Doente Terminal/psicologia
6.
Palliat Med ; 33(5): 500-509, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30761947

RESUMO

BACKGROUND: Family caregivers play a key role in the lives of patients with multiple myeloma. However, very little is known about the impact that the disease (its diagnosis, course and prognosis) has on the main family caregiver. AIM: To achieve a deeper understanding of the lived experience of individuals who are the primary caregiver of a relative with multiple myeloma and to shed light on their needs. DESIGN: Interpretative phenomenological study. SETTING AND PARTICIPANTS: A total of 12 individuals who were the main family caregivers of a relative with multiple myeloma who was under outpatient follow-up at a cancer unit in Barcelona were recruited via purposive sampling until data saturation was reached. In semi-structured in-depth interviews, participants described their experiences of caring for their relative with multiple myeloma. Interviews were recorded, transcribed and analysed using ATLAS.ti v7.2. The seven steps proposed by Colaizzi were used for data analysis, and the relationships among emerging themes were examined. FINDINGS: Four main themes emerged: (a) a new life, adapting to the disease, (b) commitment to the patient, (c) the emotional sphere and (d) experiences in relation to the care and support received. The analysis also revealed a core overarching theme: uncertainty. CONCLUSION: Primary family caregivers experienced intense uncertainty, and they described a strong need to air their feelings. Specific practical initiatives, targeting both health-related and logistical aspects of care, need to be developed in order to support family caregivers of myeloma patients.

7.
Palliat Med ; 33(6): 570-577, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30688146

RESUMO

BACKGROUND: An important concern of healthcare professionals when exploring the wish to hasten death with patients is the risk of causing them some type of distress. AIM: To assess the opinion of hospitalized patients with advanced cancer about the proactive assessment of the wish to hasten death. DESIGN: Descriptive, cross-sectional study. SETTING/PARTICIPANTS: We assessed 193 advanced cancer patients admitted to an oncology ward for the wish to hasten death using a semi-structured clinical interview. After the assessment the participants were surveyed to determine whether they found the interview upsetting and, if so to what extent, and also their opinion regarding the assessment's importance. RESULTS: The wish to hasten death was reported by 46 (23.8%) patients. The majority of patients (94.8%) did not find talking about the wish to hasten death to be upsetting, regardless of whether they presented it or not. The majority of patients (79.3%) considered that it was either quite or extremely important for the clinician to proactively assess the wish to hasten death and discuss this topic, regardless of whether they experienced it. CONCLUSIONS: In this study, most of the advanced cancer patients did not find the assessment of wish to hasten death to be upsetting, and a substantial proportion of patients in this study believe that it is important to routinely evaluate it in this setting. These findings suggest that healthcare professionals can explore the wish to hasten death proactively in routine clinical practice without fear of upsetting patients.

8.
Psychooncology ; 27(12): 2840-2846, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30251342

RESUMO

OBJECTIVE: The objective of the study is to test a model in which perceived loss of dignity and control are proposed, along with symptoms of depression and functional impairment, as risk factors for the wish to hasten death (WTHD) in advanced cancer patients. METHODS: This was a cross-sectional study of 193 patients in an oncology unit. Outcome measures included perceived control, performance status, symptoms of depression, perceived dignity, and the WTHD. Structural equation modeling was performed. RESULTS: Structural equation modeling showed that perceived loss of control (-0.402) and functional impairment (-0.21) were risk factors for perceived loss of dignity. Loss of control (-0.385) and functional impairment (-0.283) were also risk factors for symptoms of depression. Perceived loss of dignity and symptoms of depression were the most proximal determinants of the WTHD, on which they had a direct, positive, and significant effect (0.246 and 0.209, respectively). Therefore, both symptoms of depression and perceived loss of dignity independently predicted the WTHD and mediated the effects of perceived loss of control and functional impairment on this wish. CONCLUSIONS: The hypothesized model provides evidence for the impact of the four aforementioned factors on the WTHD. Our results suggest that personalized care plans which are able to enhance the sense of dignity and control among advanced cancer patients could help to reduce the likelihood or intensity of a WTHD.


Assuntos
Neoplasias/psicologia , Qualidade de Vida/psicologia , Respeito , Autoeficácia , Doente Terminal/psicologia , Adulto , Idoso , Atitude Frente a Morte , Estudos Transversais , Morte , Depressão/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Psicológicos , Neoplasias/mortalidade , Percepção , Estresse Psicológico/psicologia
9.
Med. paliat ; 25(3): 121-129, jul.-sept. 2018. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-180330

RESUMO

Objetivo: Analizar y sintetizar la literatura existente sobre guías, protocolos y recomendaciones clínicas que den respuesta a un paciente que manifiesta deseo de adelantar la muerte (DAM). Método: Revisión de la literatura. Se diseñó una estrategia de búsqueda que se implementó en MEDLINE PubMed y en el metabuscador Google Académico. Se incluyeron en la revisión los artículos, protocolos, guías o procedimientos en los que se aportaban recomendaciones sobre el modo en que los profesionales deberían abordar el DAM, publicados hasta noviembre de 2015. Se extrajeron las distintas recomendaciones con una matriz de datos que sirvió para analizar y categorizar la información. Resultados: Se incluyeron las recomendaciones publicadas en una guía clínica, un capítulo de libro, 5 artículos científicos y una página web. Las categorías obtenidas fueron: el contexto legal, el contexto de la comunicación con el paciente, temas a informar, aspectos a consensuar, habilidades de comunicación del profesional y responsabilidades del profesional. Conclusiones: La síntesis de recomendaciones puede facilitar la práctica clínica a la hora de abordar el DAM


Objective: To conduct an analysis and synthesis of the literature on guidelines, protocols and recommendations that respond to a patient manifesting a wish to hasten death (WTHD). Method: Literature review, a search strategy was designed of MEDLINE PubMed and Google Scholar meta-search engine. Articles, protocols, guidelines and procedures published up until November 2015 and offering recommendations on how professionals should address the WTHD were classified and the various recommendations were extracted in a matrix which served to analyse and categorise the data. Results: Recommendations published in a clinical guide, a book chapter, five scientific articles and a website were obtained. It was noted that the experts attach importance to: legal context, communication context, issues to be informed, and issues for consensus, communication skills and professional duties. Conclusions: A synthesis of recommendations can facilitate clinical practice in addressing the WTHD


Assuntos
Humanos , Cuidados Paliativos na Terminalidade da Vida , Atitude Frente a Morte , Pessoal de Saúde/ética
10.
Rev Esp Salud Publica ; 922018 08 08.
Artigo em Espanhol | MEDLINE | ID: mdl-30088496

RESUMO

OBJECTIVE: The patient safety culture (PSC) in health institutions depends on various organizational and human factors. Our aim was to evaluate, as a teaching strategy, the knowledge in patient safety and perceptions about the PSC. METHODS: A convenience sample, with 122 health professionals from Regional Minister of Health's patient safety courses attendees in 2015. Be- fore each course, were delivered a knowledge questionnaire about patient safety (own elaboration) and a validated PSC questionnaire (estimating 3 dimensions: managerial support, perception of safety and expectations / actions). Valuations on CSP were recategorized in positive, negative and neutral, identifying strengths (greater than or equal to 75% of positive evaluations) and opportunities for improvement (greater than or equal to 50% of negative evaluations). At the end of each course an anonymous satisfaction questionnaire was delivered. RESULTS: 60% responded correctly to questions about knowledge in patient safety, identifying areas for improvement in safe practices (hand hygiene and microorganisms resistant to antibiotics, with 66% and 61% of incorrect answers, respectively), and in management of health risks (investigation and identification of adverse events, with 62% and 56% of incorrect answers, respectively). 80% considered the institutional PSC positive, and the perception of safety as an opportunity for improvement (63.9% of negative evaluations). Thus, 88% admitted worrying about patient safety only after adverse incidents, and 65% felt afraid to talk about them. The satisfaction with the teaching methodology was 9.3 points out of 10. CONCLUSIONS: The overall assessment of PSC was mostly positive, identifying specific areas for improvement that allowed orienting the training in patient safety, motivating the participants and suggesting intervention strategies to improve patient safety in our organizations.


Assuntos
Atitude do Pessoal de Saúde , Competência Clínica , Pessoal de Saúde/educação , Cultura Organizacional , Segurança do Paciente , Gestão da Segurança , Estudos Transversais , Humanos , Espanha , Inquéritos e Questionários , Ensino
11.
Blood ; 132(4): 413-422, 2018 07 26.
Artigo em Inglês | MEDLINE | ID: mdl-29769262

RESUMO

Mantle cell lymphoma (MCL) is an aggressive B-cell malignancy, but some patients have a very indolent evolution. This heterogeneous course is related, in part, to the different biological characteristics of conventional MCL (cMCL) and the distinct subgroup of leukemic nonnodal MCL (nnMCL). Robust criteria to distinguish these MCL subtypes and additional biological parameters that influence their evolution are not well defined. We describe a novel molecular assay that reliably distinguishes cMCL and nnMCL using blood samples. We trained a 16-gene assay (L-MCL16 assay) on the NanoString platform using 19 purified leukemic samples. The locked assay was applied to an independent cohort of 70 MCL patients with leukemic presentation. The assay assigned 37% of cases to nnMCL and 56% to cMCL. nnMCL and cMCL differed in nodal presentation, lactate dehydrogenase, immunoglobulin heavy chain gene mutational status, management options, genomic complexity, and CDKN2A/ATM deletions, but the proportion with 17p/TP53 aberrations was similar in both subgroups. Sequential samples showed that assay prediction was stable over time. nnMCL had a better overall survival (OS) than cMCL (3-year OS 92% vs 69%; P = .006) from the time of diagnosis and longer time to first treatment. Genomic complexity and TP53/CDKN2A aberrations predicted for shorter OS in the entire series and cMCL, whereas only genomic complexity was associated with shorter time to first treatment and OS in nnMCL. In conclusion, the newly developed assay robustly recognizes the 2 molecular subtypes of MCL in leukemic samples. Its combination with genetic alterations improves the prognostic evaluation and may provide useful biological information for management decisions.


Assuntos
Biomarcadores Tumorais/genética , Leucemia/genética , Leucemia/patologia , Linfoma de Célula do Manto/genética , Linfoma de Célula do Manto/patologia , Mutação , Estudos de Coortes , Feminino , Perfilação da Expressão Gênica , Genômica , Humanos , Leucemia/classificação , Linfoma de Célula do Manto/classificação , Masculino , Prognóstico , Taxa de Sobrevida
12.
Front Pharmacol ; 9: 294, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29651244

RESUMO

Some persons with advanced disease but no significant cognitive impairments consciously decide to stop taking food and fluids orally, even though they remain physically able to do so. The question is to what extent voluntarily stopping eating and drinking (VSED) may be considered an expression of a wish to hasten death, in the sense that the latter has been defined recently. We analyze the data reported in some studies in relation to primary care patients who died as a result of VSED and examine their results in light of the qualitative findings of patients that expressed a wish to die. In our view, VSED can be understood as a response to physical/psychological/spiritual suffering, as an expression of a loss of self, a desire to live but not in this way, a way of ending suffering, and as a kind of control over one's life. Thus, VSED is consistent with the wish to hasten death. Prior to interpreting this act as a deliberate expression of personal autonomy, it is important to explore all possible areas of suffering, including physical symptoms, psychological distress, existential suffering, and social aspects. Failure to do so will mean that we run the risk of abandoning a fellow human being to his or her suffering.

14.
Psychooncology ; 27(6): 1538-1544, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29490118

RESUMO

INTRODUCTION: The Desire for Death Rating Scale (DDRS) and the short form of the Schedule of Attitudes toward Hastened Death (SAHD-5) are different approaches to assessing the wish to hasten death (WTHD). Both have clinical threshold scores for identifying individuals with a meaningfully elevated WTHD. However, the agreement between the 2 measures and patient opinions about assessment of the WTHD are unknown. OBJECTIVES: To compare the DDRS and SAHD-5 and to analyze patient opinions about assessment of the WTHD. METHODS: The WTHD was assessed in 107 patients with advanced cancer using both the DDRS and SAHD-5. Patients were subsequently asked their opinion about this assessment. RESULTS: Correlation between scores on the SAHD-5 and the DDRS was moderate, Spearman rho = 0.67 (P < .01). The SAHD-5 identified 13 patients (12.1%) at risk of the WTHD, and the DDRS identified 6 patients (5.6%) with a moderate-high WTHD (P > .05). Concordance between the DDRS and SAHD-5 in identifying individuals with an elevated WTHD was poor when using recommended cut-off scores, κ = 0.37 (P < 0.01) but could be improved by using different thresholds. Only 4 patients (3.8%) regarded the assessment questions as bothersome, and 90.6% considered it important that health-care professionals inquire about the WTHD. CONCLUSIONS: The SAHD-5 and DDRS appear to be appropriate methods for assessing the WTHD and could provide complementary information in clinical practice: the SAHD-5 to screen for risk of the WTHD and the DDRS as a clinical interview to explore it in greater detail. Assessment of the WTHD is well accepted by palliative care cancer patients.


Assuntos
Neoplasias/psicologia , Qualidade de Vida/psicologia , Inquéritos e Questionários/normas , Doente Terminal/psicologia , Idoso , Atitude Frente a Morte , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos/psicologia
15.
Ciênc. Saúde Colet ; 23(1): 41-50, Jan. 2018.
Artigo em Espanhol | LILACS-Express | ID: biblio-890496

RESUMO

Resumen El objetivo fue conocer el significado del término "enfermería" para las enfermeras docentes de las universidades españolas. El diseño fue cualitativo. Como estrategia se utilizó la inducción analítica. El muestreo fue teórico y enfocado en la selección de casos extremos. La técnica de recogida de datos fue la entrevista en profundidad. El análisis se llevó a cabo mediante la técnica específica de la Teoría Fundamentada. Se establecieron estrategias para asegurar la credibilidad, transferibilidad, confirmabilidad y auditabilidad. A partir del análisis de los datos se identificaron tres categorías que dieron respuesta al objetivo planteado: es una "actividad humana vinculada a la maternidad", una "vocación de ayuda al otro que tienen algunas personas" y una "actividad que atiende las necesidades de los demás respetando su identidad". Se puede concluir que en las universidades españolas se está transmitiendo un modelo de enfermera donde el rol propio de cuidado es inherente al género femenino y a la vocación de servicio al otro que tienen algunas personas. Esto es causa de que la Real Academia de la Lengua Española sólo identifique el rol de asistencia técnica a la medicina como elemento profesional de la enfermería.


Abstract The scope of this paper was to ascertain the meaning of the term "nursing" among teaching nurses at Spanish universities. The research was qualitative, and the strategy used was analytical induction. Sampling was theoretical and focused on the selection of extreme cases and the data collection technique was in-depth interviews. The analysis was carried out using the specific Grounded Theory technique. Strategies were established to ensure credibility, portability, confirmability and auditability. Based on the analysis of the data, three categories were identified that responded to the planned objective: it is a "human activity linked to motherhood," a "vocation to help others that some people have" and an "activity that takes care of the needs of others respecting their identity." It can be concluded that in Spanish universities a model of nurse is being transmitted where the proper role of care is inherent to the feminine gender and the vocation of service to others that some people have. This is the reason why the Spanish Royal Academy (RAE) only identifies the role of technical assistance to medicine as a professional element of nursing.

16.
Palliat Med ; 32(1): 79-105, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29130387

RESUMO

BACKGROUND: Palliative care was originally intended for patients with non-haematological neoplasms and relatively few studies have assessed palliative care in patients with haematological malignancies. AIM: To assess palliative care interventions in managing haematological malignancies patients treated by onco-haematology departments. DESIGN: Integrative systematic review with data extraction and narrative synthesis (PROSPERO #: CRD42016036240). DATA SOURCES: PubMed, CINAHL, Cochrane, Scopus and Web-of-Science were searched for articles published through 30 June 2015. Study inclusion criteria were as follows: (1) published in English or Spanish and (2) containing data on palliative care interventions in adults with haematological malignancies. RESULTS: The search yielded 418 articles; 99 met the inclusion criteria. Six themes were identified: (1) end-of-life care, (2) the relationship between onco-haematology and palliative care departments and referral characteristics, (3) clinical characteristics, (4) experience of patients/families, (5) home care and (6) other themes grouped together as 'miscellany'. Our findings indicate that palliative care is often limited to the end-of-life phase, with late referral to palliative care. The symptom burden in haematological malignancies patients is more than the burden in non-haematological neoplasms patients. Patients and families are generally satisfied with palliative care. Home care is seldom used. Tools to predict survival in this patient population are lacking. CONCLUSION: Despite a growing interest in palliative care for haematological malignancies patients, the evidence base needs to be strengthened to expand our knowledge about palliative care in this patient group. The results of this review support the need to develop closer cooperation and communication between the palliative care and onco-haematology departments to improve patient care.


Assuntos
Neoplasias Hematológicas/enfermagem , Serviços de Assistência Domiciliar/organização & administração , Cuidados Paliativos na Terminalidade da Vida/organização & administração , Cuidados Paliativos/organização & administração , Assistência Terminal/organização & administração , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Serviços de Assistência Domiciliar/estatística & dados numéricos , Cuidados Paliativos na Terminalidade da Vida/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos/estatística & dados numéricos , Assistência Terminal/estatística & dados numéricos
17.
Cien Saude Colet ; 23(1): 41-50, 2018 Jan.
Artigo em Espanhol | MEDLINE | ID: mdl-29267810

RESUMO

The scope of this paper was to ascertain the meaning of the term "nursing" among teaching nurses at Spanish universities. The research was qualitative, and the strategy used was analytical induction. Sampling was theoretical and focused on the selection of extreme cases and the data collection technique was in-depth interviews. The analysis was carried out using the specific Grounded Theory technique. Strategies were established to ensure credibility, portability, confirmability and auditability. Based on the analysis of the data, three categories were identified that responded to the planned objective: it is a "human activity linked to motherhood," a "vocation to help others that some people have" and an "activity that takes care of the needs of others respecting their identity." It can be concluded that in Spanish universities a model of nurse is being transmitted where the proper role of care is inherent to the feminine gender and the vocation of service to others that some people have. This is the reason why the Spanish Royal Academy (RAE) only identifies the role of technical assistance to medicine as a professional element of nursing.


Assuntos
Atitude do Pessoal de Saúde , Educação em Enfermagem , Papel do Profissional de Enfermagem , Enfermeiras e Enfermeiros/organização & administração , Feminino , Identidade de Gênero , Teoria Fundamentada , Humanos , Entrevistas como Assunto , Masculino , Modelos de Enfermagem , Relações Enfermeiro-Paciente , Enfermeiras e Enfermeiros/psicologia , Espanha , Terminologia como Assunto , Universidades
18.
Omega (Westport) ; 78(2): 120-142, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28092211

RESUMO

The Frommelt Attitude Toward Care of the Dying Scale (FATCOD) is designed to assess the attitudes of professionals and trainees toward caring for the dying patient and their family members. In this study the main aim is to adapt the FATCOD to a Spanish context (FATCOD-S). In addition, the relations between FATCOD-S, sociodemographic variables, emotional intelligence, and death attitudes have been analyzed. A sample of 669 Spanish nursing students from four Universities responded to a questionnaire. The exploratory factor analysis (EFA) concludes a structure composed of two significant factors. A confirmatory factor analysis (CFA) was carried out. The CFA supported a two-factor model. Students with past experience of death and those who had received training in palliative care scored significantly higher on both factors of the FATCOD-S ( p < 0.01). The FATCOD-S is an effective and valid tool for measuring the attitudes of Spanish nursing students toward caring for patients at the end of life.


Assuntos
Atitude do Pessoal de Saúde , Atitude Frente a Morte , Cuidados Paliativos/psicologia , Estudantes de Enfermagem/psicologia , Assistência Terminal/psicologia , Adolescente , Adulto , Estudos Transversais , Análise Fatorial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Psicometria , Espanha , Estudantes de Enfermagem/estatística & dados numéricos , Inquéritos e Questionários , Adulto Jovem
19.
Rev. esp. salud pública ; 92: 0-0, 2018. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-177593

RESUMO

Fundamentos: La cultura de seguridad del paciente (CSP) en las instituciones sanitarias depende de diversos factores organizativos y humanos. Nuestro objetivo fue evaluar, como estrategia docente, los conocimientos y percepciones sobre la CSP. Métodos: Muestra de conveniencia, con 122 profesionales sanitarios y no sanitarios, que asistieron en 2015 a cursos sobre seguridad del paciente organizados por la Consejería de Sanidad de Madrid. Antes de cada curso, autocompletaron un cuestionario de conocimientos sobre seguridad del paciente (elaboración propia) y otro cuestionario validado sobre CSP (estimando 3 dimensiones: apoyo directivo, percepción de seguridad y expectativas/acciones). Las valoraciones sobre la CSP se recategorizaron en positivas, negativas y neutras, identificando fortalezas (≥75% de valoraciones positivas) y oportunidades de mejora (≥50% de valoraciones negativas). Al finalizar cada curso, cumplimentaron un cuestionario anónimo de satisfacción. Resultados: El 60% respondió correctamente a las preguntas sobre conocimientos en seguridad del paciente, identificando áreas de mejora en prácticas seguras (higiene de manos y microorganismos resistentes a antibióticos, con 66% y 61% de respuestas incorrectas, respectivamente), y en gestión de riesgos sanitarios (investigación e identificación de eventos adversos, con el 62% y 56% de respuestas incorrectas, respectivamente). El 80% consideró positiva la CSP institucional, y la percepción de seguridad como oportunidad de mejora (63,9% de valoraciones negativas). Así, el 88% reconocía preocuparse por la seguridad del paciente sólo tras incidentes adversos, y el 65% sentía miedo a hablar sobre estos. La satisfacción con la metodología docente fue de 9,3 puntos sobre 10. Conclusiones: La valoración global de la CSP fue mayoritariamente positiva, identificándose áreas de mejora específicas utilizadas como estrategia docente para ilustrar conceptos, motivar a los participantes y sugerir estrategias de intervención para mejorar la cultura de seguridad del paciente en nuestras organizaciones


Background: The patient safety culture (PSC) in health institutions depends on various organizational and human factors. Our aim was to evaluate, as a teaching strategy, the knowledge in patient safety and perceptions about the PSC. Methods: A convenience sample, with 122 health professionals from Regional Minister of Health's patient safety courses attendees in 2015. Before each course, were delivered a knowledge questionnaire about patient safety (own elaboration) and a validated PSC questionnaire (estimating 3 dimensions: managerial support, perception of safety and expectations / actions). Valuations on CSP were recategorized in positive, negative and neutral, identifying strengths (≥75% of positive evaluations) and opportunities for improvement (≥50% of negative evaluations). At the end of each course an anonymous satisfaction questionnaire was delivered. Results: 60% responded correctly to questions about knowledge in patient safety, identifying areas for improvement in safe practices (hand hygiene and microorganisms resistant to antibiotics, with 66% and 61% of incorrect answers, respectively), and in management of health risks (investigation and identification of adverse events, with 62% and 56% of incorrect answers, respectively). 80% considered the institutional PSC positive, and the perception of safety as an opportunity for improvement (63.9% of negative evaluations). Thus, 88% admitted worrying about patient safety only after adverse incidents, and 65% felt afraid to talk about them. The satisfaction with the teaching methodology was 9.3 points out of 10. Conclusions: The overall assessment of PSC was mostly positive, identifying specific areas for improvement that allowed orienting the training in patient safety, motivating the participants and suggesting intervention strategies to improve patient safety in our organizations


Assuntos
Humanos , Segurança do Paciente/normas , Cultura Organizacional , Gestão da Segurança/métodos , Educação Médica/tendências , Conhecimentos, Atitudes e Prática em Saúde , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos , Pessoal de Saúde/organização & administração , Estudos Transversais
20.
BMJ Open ; 7(9): e016659, 2017 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-28965095

RESUMO

OBJECTIVES: Patients with advanced disease sometimes express a wish to hasten death (WTHD). In 2012, we published a systematic review and meta-ethnography of qualitative studies examining the experience and meaning of this phenomenon. Since then, new studies eligible for inclusion have been reported, including in Europe, a region not previously featured, and specifically in countries with different legal frameworks for euthanasia and assisted suicide. The aim of the present study was to update our previous review by including new research and to conduct a new analysis of available data on this topic. SETTING: Eligible studies originated from Australia, Canada, China, Germany, The Netherlands, Switzerland, Thailand and USA. PARTICIPANTS: Studies of patients with life-threatening conditions that had expressed the WTHD. DESIGN: The search strategy combined subject terms with free-text searching of PubMed MEDLINE, Web of Science, CINAHL and PsycInfo. The qualitative synthesis followed the methodology described by Noblit and Hare, using the 'adding to and revising the original' model for updating a meta-ethnography, proposed by France et al. Quality assessment was done using the Critical Appraisal Skills Programme checklist. RESULTS: 14 studies involving 255 participants with life-threatening illnesses were identified. Five themes emerged from the analysis: suffering (overarching theme), reasons for and meanings and functions of the WTHD and the experience of a timeline towards dying and death. In the context of advanced disease, the WTHD emerges as a reaction to physical, psychological, social and existential suffering, all of which impacts on the patient's sense of self, of dignity and meaning in life. CONCLUSIONS: The WTHD can hold different meanings for each individual-serving functions other than to communicate a genuine wish to die. Understanding the reasons for, and meanings and functions of, the WTHD is crucial for drawing up and implementing care plans to meet the needs of individual patients.


Assuntos
Atitude Frente a Morte/etnologia , Doente Terminal/psicologia , Antropologia Cultural , Medo , Humanos , Modelos Psicológicos , Estresse Psicológico/psicologia
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