Actitudes de los médicos de un hospital pediátrico de tercer nivel ante la muerte / Attitudes of physicians in a tertiary care children's hospital in the face of death

Introducción. La muerte involucra, para los médicos, un análisis complejo que determina su actitud hacia el paciente, principalmente los comportamientos en situaciones de diagnóstico, tratamiento y la relación médico-paciente. Objetivos. 1) Describir las actitudes del personal médico de un hospital pediátrico ante la muerte. 2) Explorar si existen factores asociados a esas actitudes. Población y métodos. Estudio transversal, por encuesta. Se invitó a los médicos de un hospital pediátrico de tercer nivel de la Ciudad Autónoma de Buenos Aires, Argentina, a completar el Cuestionario de actitud ante la muerte (CAM). Se investigaron variables sociodemográficas, categoría profesional y área laboral, haber presenciado la muerte de pacientes, autopercepción de actitud positiva ante la muerte y actitud ante la muerte según CAM. Resultados. Entre el 01 de junio de 2021 y el 01 de junio de 2022 se incluyeron 362 participantes, con edad media de 39,88 (± 11,56) años y experiencia médica asistencial de 14,06 (± 11,97) años. Presentaron actitud positiva 35 (9,67 %). Encontramos significancia estadística para mayor probabilidad de actitud positiva en edad ≥ 40 años (p = 0,02, IC95 % 1,1-3,9), experiencia médica asistencial ≥ 14 años (p = 0,042, IC95 % 1-4,1), creencia religiosa (p = 0,003, IC95 % 1,4-10,5), práctica religiosa activa (p <0,001, IC95 % 1,6-6,9) y autopercepción positiva ante la muerte (p = 0,002, IC95 % 1,7-30,8). Conclusiones. El 9,67 % de los encuestados presentó actitud positiva ante la muerte. Los factores asociados a ella fueron edad ≥ 40 años, experiencia médica asistencial ≥ 14 años, creencia religiosa, práctica religiosa activa y la autopercepción personal de actitud positiva ante la muerte.

Introduction. For physicians, death involves an intricate analysis that determines their attitude towards the patient. Objectives. 1) To describe the attitudes towards death among medical staff working at a children's hospital. 2) To explore factors associated with such attitudes. Population and methods. Cross-sectional, survey study. The physicians working at a tertiary care children's hospital completed the Questionnaire of attitudes towards death (QAD). Sociodemographic variables, professional category, work setting, having witnessed the death of patients, self-perception of a positive attitude towards death, and attitude towards death according to the QAD were studied. Results. Between June 1st, 2021 and June 1st, 2022, 362 participants were included; mean age: 39.88 years (± 11.56), health care experience: 14.06 years (± 11.97). A positive attitude was observed in 35 (9.67%). A statistical significance was observed for a greater probability of a positive attitude among those who were ≥ 40 years old (p = 0.02, 95% CI: 1.1­3.9), had health care experience for ≥ 14 years (p = 0.042, 95% CI: 1­4.1), had a religious belief (p = 0.003, 95% CI: 1.4­10.5), actively practiced their religion (p < 0.001, 95% CI: 1.6­6.9), and had a positive self-perception in the face of death (p = 0.002, 95% CI: 1.7­30.8). Conclusions. A positive attitude towards death was observed in 9.67% of surveyed participants. Associated factors were age ≥ 40 years, health care experience for ≥ 14 years, religious belief, active religious practice, and self-perception of a positive attitude towards death.

Attitude of undergraduate nursing interns in regard to death and the influencing factors.

OBJECT: To explore the influencing factors of attitudes about death among undergraduate nursing interns. METHODS: The study subjects were selected from the full-time fourth year undergraduate nursing interns in Jiangxi University of Technology from January to March 2021 by convenience sampling method. The general information questionnaire was designed by our hospital, and attitude towards death referred to the Chinese version of Death Attitude Depiction Scale (Revised) (DAP-R). Univariate and multivariate Logistic regression analysis was performed on the factors that may affect nursing interns. RESULTS: A total of 210 nursing undergraduate interns were investigated in this study. The total score of DAP-R scale was (89.27±7.26) with a range of 72 and 112. Dimensions were ordered according to the average scores for the items of natural acceptance, escaping from death, fear, approaching acceptance and fleeing acceptance. Univariate and multivariate logistic regression analyses were conducted to analyze the factors that might affect the attitude. Items with statistical significance in univariate analysis, including religious belief, death of the patients cared for during the internship, reading the books related to death and the family's open discussion on the topic of death were entered into the regression model (all P<0.05). The formula of DAP-R total score prediction model was as follows: DAP-R total score = 62.980 + 3.056 * religious belief + 4.381 * death of patients cared for during internship + 5.727 * reading books on death + 3.531 * family open discussion on the topic of death. CONCLUSION: The undergraduate nursing interns in our school have a good attitude towards death, but still exhibit a negative attitude in fearing death.

Attitudes of physicians in a tertiary care children's hospital in the face of death. / Actitudes de los médicos de un hospital pediátrico de tercer nivel ante la muerte.

Introduction. For physicians, death involves an intricate analysis that determines their attitude towards the patient. Objectives. 1) To describe the attitudes towards death among medical staff working at a children's hospital. 2) To explore factors associated with such attitudes. Population and methods. Cross-sectional, survey study. The physicians working at a tertiary care children's hospital completed the Questionnaire of attitudes towards death (QAD). Sociodemographic variables, professional category, work setting, having witnessed the death of patients, self-perception of a positive attitude towards death, and attitude towards death according to the QAD were studied. Results. Between June 1st, 2021 and June 1st, 2022, 362 participants were included; mean age: 39.88 years (± 11.56), health care experience: 14.06 years (± 11.97). A positive attitude was observed in 35 (9.67%). A statistical significance was observed for a greater probability of a positive attitude among those who were ≥ 40 years old (p = 0.02, 95% CI: 1.1-3.9), had health care experience for ≥ 14 years (p = 0.042, 95% CI: 1-4.1), had a religious belief (p = 0.003, 95% CI: 1.4-10.5), actively practiced their religion (p < 0.001, 95% CI: 1.6-6.9), and had a positive self-perception in the face of death (p = 0.002, 95% CI: 1.7-30.8). Conclusions. A positive attitude towards death was observed in 9.67% of surveyed participants.Associated factors were age ≥ 40 years, health care experience for ≥ 14 years, religious belief, active religious practice, and self-perception of a positive attitude towards death.

Introducción. La muerte involucra, para los médicos, un análisis complejo que determina su actitud hacia el paciente, principalmente los comportamientos en situaciones de diagnóstico, tratamiento y la relación médico-paciente. Objetivos. 1) Describir las actitudes del personal médico de un hospital pediátrico ante la muerte. 2) Explorar si existen factores asociados a esas actitudes. Población y métodos. Estudio transversal, por encuesta. Se invitó a los médicos de un hospital pediátrico de tercer nivel de la Ciudad Autónoma de Buenos Aires, Argentina, a completar el Cuestionario de actitud ante la muerte (CAM). Se investigaron variables sociodemográficas, categoría profesional y área laboral, haber presenciado la muerte de pacientes, autopercepción de actitud positiva ante la muerte y actitud ante la muerte según CAM. Resultados. Entre el 01 de junio de 2021 y el 01 de junio de 2022 se incluyeron 362 participantes, con edad media de 39,88 (± 11,56) años y experiencia médica asistencial de 14,06 (± 11,97) años. Presentaron actitud positiva 35 (9,67 %). Encontramos significancia estadística para mayor probabilidad de actitud positiva en edad ≥ 40 años (p = 0,02, IC95 % 1,1-3,9), experiencia médica asistencial ≥ 14 años (p = 0,042, IC95 % 1-4,1), creencia religiosa (p = 0,003, IC95 % 1,4-10,5), práctica religiosa activa (p <0,001, IC95 % 1,6-6,9) y autopercepción positiva ante la muerte (p = 0,002, IC95 % 1,7-30,8). Conclusiones. El 9,67 % de los encuestados presentó actitud positiva ante la muerte. Los factores asociados a ella fueron edad ≥ 40 años, experiencia médica asistencial ≥ 14 años, creencia religiosa, práctica religiosa activa y la autopercepción personal de actitud positiva ante la muerte.

Estrategias del equipo de salud para afrontar la muerte de niños y adolescentes con cáncer / Strategies by the Health Team for Coping with the Death of Children and Adolescents with Cancer

Introducción: La muerte en niños y adolescentes por cáncer suele ser difícil de afrontar por los profesionales de salud. Si no cuentan con modos adecuados para transitar estos duelos, pueden generarse problemas psicológicos, emocionales y físicos, exponiéndose a Burnout. Objetivo: Develar las estrategias utilizadas por profesionales y técnicos de salud de hospitales públicos chilenos para afrontar la muerte de infantes con cáncer. Métodos: Investigación cualitativa fenomenológica, realizada en cinco hospitales públicos en Santiago de Chile, entre mayo-septiembre del 2017. Población de 37 profesionales y técnicos de salud que vivenciaron morir niños y adolescentes con cáncer. Se efectuaron entrevistas en profundidad, guiadas por la pregunta "¿Cómo ha afrontado usted la muerte de los pacientes en su unidad?" Las narrativas se transcribieron y analizaron según las etapas de Streubert, se triangularon los datos hasta alcanzar la saturación. Resultados: Las principales estrategias fueron participar de ritos de despedida ante la muerte, realizar actividades recreativas con miembros del equipo fuera de la jornada laboral, hacer cambios en la rutina de trabajo, separar aspectos personales y profesionales. Al percibir un bajo apoyo de la institución, propusieron facilitar la asistencia al funeral, desarrollar intervenciones formales de apoyo en duelo, realizar intervenciones de autocuidado e incorporar el tema de la muerte en las inducciones laborales. Conclusión: Los profesionales y técnicos cuentan con estrategias para afrontar sus duelos. Sin embargo, requieren de apoyo formal de la institución, junto con capacitación continua en la temática. Es fundamental que la institución se implique en esta problemática(AU)

Introduction: Cancer deaths among children and adolescents are often difficult for health professionals to cope with. If they do not have adequate ways to deal with this grief, psychological, emotional and physical problems may arise, exposing them to burnout or the so called burned-out worker syndrome. Objective: To reveal the strategies used by health professionals and technicians in Chilean public hospitals to cope with the death of children with cancer. Methods: Qualitative and phenomenological research carried out in five public hospitals in Santiago, Chile, between May and September 2017. The population was made up of 37 health professionals and technicians who experienced the death of children and adolescents with cancer. In-depth interviews were conducted, guided by the following question: How have you coped with the death of patients in your unit? The narratives were transcribed and analyzed according to the stages described by Streubert. In addition, the data were triangulated until saturation was reached. Results: The main strategies were to participate in farewell rites in the face of death, to carry out recreational activities with team members outside the workday, to make changes in the work routine, as well as to separate personal and professional aspects. When perceiving low support from the institution, they proposed facilitating attendance at the funeral, developing formal bereavement support interventions, carrying out self-care, and incorporating the matter of death into work inductions. Conclusion: Professionals and technicians have strategies to cope with their bereavement. However, they need formal support from the institution, together with continuous training on the matter. It is essential for the institution to become involved in this issue(AU)

[Professional and family perception on care and compliance with the end of life regulations. A qualitative study.] / Percepción profesional y familiar sobre la atención y cumplimiento de la normativa sobre el final de la vida. Un estudio cualitativo.

OBJECTIVE: The scope and types of health interventions in the dying process are the subject of a social and professional debate that has been increasing in recent years. The objective of the study was focused on analyzing the perceptions of professionals and relatives of patients who have recently died and assessing the degree of compliance with the rights established in the current legislation on this subject. METHODS: Qualitative research with a hermeneutical phenomenological approach carried out in 2019 by conducting and analyzing two discussion groups with health professionals from hospital and primary care, and four groups with relatives of recently deceased patients, divided by age ranges: 18- 30 years old, 31-45, 46-60 and over 60. RESULTS: The total number of people included in the study was 28 participants. Family members and professionals find it difficult to communicate with each other in the context of health care at the end of life. Family members and professionals agree on their preference to die at home. There are specific deficiencies in knowledge about the terminology used at the end of life. The term "euthanasia" is the one best known by family members. CONCLUSIONS: Deficiencies in knowledge of the rights established in the regulations related to the death process have been detected, both in relatives of patients and in professionals. These deficiencies contribute to breaches of legal regulations. Communication difficulties related to death between the professionals-patient-family trinomial are the most relevant related factor.

OBJETIVO: El alcance y los tipos de intervenciones sanitarias en el proceso de la muerte están siendo motivo de un debate social y profesional que se ha acrecentado en los últimos años. El objetivo del estudio se centró en analizar las percepciones de profesionales y familiares de pacientes que han fallecido recientemente y evaluar el grado de cumplimiento de los derechos establecidos en la legislación vigente a este respecto. METODOS: Investigación cualitativa de enfoque fenomenológico hermenéutico llevada a cabo en 2019 mediante la realización y análisis de dos grupos de discusión con profesionales de salud de atención hospitalaria y atención primaria, y cuatro grupos con familiares de pacientes fallecidos recientemente, divididos por rangos de edad: 18-30 años, 31-45, 46-60 y más de 60. RESULTADOS: El total de personas incluidas en el estudio fue de 28 participantes. Familiares y profesionales encuentran dificultades para comunicarse entre sí en el contexto de la atención sanitaria al final de la vida. Familiares y profesionales coinciden en su preferencia de fallecer en su domicilio. Existen carencias puntuales en el conocimiento sobre la terminología empleada en el final de la vida. El término "eutanasia" es el más conocido por los familiares. CONCLUSIONES: Se han detectado carencias en el conocimiento de los derechos establecidos en la normativa relativa al proceso de la muerte, tanto en familiares de pacientes como en profesionales. Estas carencias contribuyen a incumplimientos de la normativa legal. Las dificultades comunicativas relacionadas con la muerte entre el trinomio profesionales-pacientes-familiares son el factor relacionado más relevante.

A correlation study between nursing staff's knowledge level of hospice care and the psychology, emotion and attitude towards deaths.

OBJECTIVE: We investigated the relationship between nursing staff's knowledge of hospice care and psychological states, including grief and attitude towards death. METHODS: From October 2018 to December 2018, a total of 1900 professional nursing staff of secondary and tertiary levels in Qinghai Province were chosen as the research subjects. Professional questionnaires were used to evaluate their knowledge level of Hospice Care (HC), psychological states, grief and attitude towards death, while the correlation between HC knowledge level and the latter three were analyzed. RESULTS: In Qinghai Province, the nursing staff had the highest scores in terms of knowledge levels of HC symptom control with a score of 4.48±1.65, and the lowest score of 1.79±1.12 in terms of knowledge levels of death education. In the Death Attitude Profile-Revised (DAP-R) scale, there was a negative correlation between fear of death, death avoidance, escape acceptance, and HC knowledge total score (P<0.05), while there was a positive correlation between natural acceptance and HC knowledge score (P<0.05). There was no statistical correlation between the total score of approach acceptance and HC knowledge (P>0.05). In the Grief Experience Questionnaire (GEQ) questionnaire, there were negative correlations between the total score of HC knowledge and body reaction, general grief response, seeking to explain and respond to special death forms (P<0.05). Hamilton anxiety scale (HAMA) and Hamilton depression scale (HAMD) were negatively correlated with HC knowledge scores (P<0.05). CONCLUSION: There is a correlation between nursing staff's knowledge level of hospice care and the psychological state, partial grief and attitudes towards death. The improvement of levels of nursing staff's HC knowledge plays a positive role in maintaining their healthy psychological state, alleviating their grief and helping them to actively face death.

Death Anxiety and Attitudes towards Death in Patients with Multiple Sclerosis: An Exploratory Study.

BACKGROUND: Death and the anxiety of it becomes more apparent when confronted with a chronic disease. Even though multiple sclerosis (MS) is a treatable condition today, it is still accompanied by a multitude of impairments, which in turn may intensify of death anxiety. OBJECTIVE: The aim of this study is to explore the relationship between depression, anxiety and death anxiety in individuals with MS. METHODS: Fifty-six MS patients were recruited at the Department of Neurology of the University Clinic in Basel. Death anxiety was assessed using the Bochumer Questionnaire on attitude to death and death anxiety 2.0 (BOFRETTA 2.0). RESULTS: Scores of death anxiety towards it in MS patients were low. Only disability (EDSS) was moderately correlated with death anxiety. Depression in MS was significantly correlated with fatigue and disability, but not with the BOFRETTA 2.0. CONCLUSION: Scores of death anxiety and the attitude towards death are low in this MS cohort. It was shown that both psychopathological and neurological deficits impact the subject of death with respect to multiple sclerosis.

The Relationship Between Turkish Nursing Students' Perceptions of Spiritual Care and their Attitudes Towards Death.

This study aimed to examine the relationship between nursing students' perception of spiritual care and their attitudes towards death. This cross-sectional study was conducted in Turkey between March and April 2021 with 601 nursing students using the Google Forms questionnaire. The "Spirituality and Spiritual Care Rating Scale (SSCRS)" and "Attitude towards Death Scale (ATDS)" were utilised to assist with data collection and analysis. While there was no relationship between the students' total SSCRS and total ATDS scores, there was a positive relationship between the total SSCRS and the Neutral Acceptance-Approach Acceptance Subscale (r = 0.129, p = 0.002), and a negative relationship between SSCRS and the Fear of Death and Avoidance of Death Subscale (r = - 0.097, p = 0.017). Providing support in terms of spiritual care and viewing spiritual care as related to nursing were related to the total SSCRS score. Alcohol use, viewing spiritual care as related to nursing, self-perceptions of spirituality, and fear of death were associated with the total ATDS score (p < 0.05). It is recommended that spiritual care and death perceptions be addressed more comprehensively in the educational curriculum of nursing students.

Representação social da morte para estudantes de enfermagem / Representación social de la muerte para estudiantes de enfermería / Social representation of death for nursing students

RESUMO Objetivo: identificara estrutura das representações sociaisda morte para estudantes de enfermagem. Método: pesquisa descritiva, fundamentada pela Teoria do Núcleo Central. Utilizou-se a Associação Livre de Palavras com 91 estudantes de enfermagem do último ano de graduação, entre abril e junho de 2019, em uma universidade pública do estado do Rio de Janeiro. Os dados foram processados pelo software EVOC, que gerou um quadro com quatro quadrantes, onde se pode localizar o provável núcleo central e sistema periférico. Resultados: o núcleo central foi integrado pelos elementos fim, triste e dor, na primeira periferia saudade e na segunda descanso, perda, sofrer, eternidade, vida, angústia e choro. A zona de contraste foi constituída por medo e ciclo. Conclusão: esta representação reforça a necessidade da inserção da temática nos cursos de saúde e da criação de espaços que propiciem a reflexão e escuta, ajudando os alunos a melhor elaborar as perdas.

RESUMEN: Objetivo: identificar la estructura de las representaciones sociales de la muerte para estudiantes de Enfermería. Método: investigación descriptiva, fundamentada en la Teoría del Núcleo Central. Se utilizó la Asociación Libre de Palabras con 91 estudiantes del último año de la carrera de grado de Enfermería, entre abril y junio de 2019, en una universidad pública del estado de Rio de Janeiro. Los datos se procesaron en el software EVOC, que generó un cuadro con cuatro cuadrantes, donde se pueden localizar el probable núcleo central y el sistema periférico. Resultados: el núcleo central quedó integrado por los elementos fin, triste y dolor; en la primera periferia, nostalgia; y en la segunda, descanso, pérdida, sufrir, eternidad, vida, angustia y llanto. La zona de contraste quedó constituida por miedo y ciclo. Conclusión: esta representación refuerza la necesidad de incorporar la temática a las carreras universitarias de salud y de crear espacios que propicien la reflexión y y la escucha, ayudando así a que los alumnos elaboren mejor las pérdidas.

ABSTRACT Objective: to identify the structure of the social representations of death for Nursing students. Method: descriptive research, based on the Central Nucleus Theory. Free Word Association was used with 91 Nursing students from the last year of the undergraduation course, between April and June 2019, at a public university in the state of Rio de Janeiro. The data was processed by the EVOC software, which generated a chart with four quadrants, where the probable central nucleus and peripheral system can be located. Results: the central nucleus was integrated by the elements end, sad and pain; in the first periphery, longing; and, in the second, rest, loss, suffering, eternity, life, anguish and crying. The contrast zone was constituted by fear and cycle. Conclusion: this representation reinforces the need to insert the theme in the health courses and to create spaces that propitiate reflection and listening, helping the students to better elaborate the losses.

End-of-life Decision-making and Religious Beliefs: Opinions and Attitudes towards Death and Euthanasia in Argentina / Toma de decisiones al final de la vida y Creencias Religiosas: opiniones y posturas en relación con la muerte y la eutanasia en Argentina / Tomada de decisões no fim da vida e crenças religiosas: opiniões e posicionamentos quanto à morte e à eutanásia na Argentina

Abstract: This paper analyzes the opinions on and attitudes towards the end of life among the population residing in Argentina. The data presented are taken from the Second National Survey of Religious Beliefs and Attitudes in Argentina, which was conducted on a multi-stage sample of 2421 cases in 89 districts throughout the country. Opinions about the end of life include positions in favor of euthanasia, requesting life extension through life support technologies, and leaving death to God's will. Religious beliefs and affiliations prove to be determining variables in the positions taken by Argentine citizens regarding the end of life, death, and euthanasia. Furthermore, among those without any religious affiliation, some positions of autonomy over their bodies stand out: prolonging life and bringing life to an end, which means that their support for euthanasia can be assumed. The data presented here intend to contribute to planning health policies about the end-of-life process. The different views on this process or, in other words, the beliefs, values, and needs of patients and their families have a unique relevance that must be considered in the organization of care settings in end-of-life contexts.

Resumen: el presente documento analiza las opiniones y actitudes hacia el final de la vida entre la población residente en Argentina. Los datos presentados fueron tomados de la Segunda Encuesta Nacional de Creencias y Posturas Religiosas en Argentina, que se realizó en una muestra en varias etapas para 2421 casos en 89 distritos de todo el país. Las opiniones sobre el final de la vida incluyen posiciones a favor de la eutanasia, la solicitud de prolongación de la vida por medio de tecnologías de soporte vital y dejar la muerte a la voluntad de Dios. Las creencias y afiliaciones religiosas demuestran ser variables determinantes en las posiciones tomadas por los ciudadanos argentinos en relación con el fin de la vida, la muerte y la eutanasia. Además, entre los que no tienen ninguna afiliación religiosa, destacan algunas posiciones de autonomía sobre sus cuerpos: prolongar la vida y poner fin a la vida, lo que significa que se puede asumir su apoyo a la eutanasia. Los datos presentados aquí tienen la intención de contribuir a la planificación de las políticas de salud sobre el proceso del final de vida. Las diferentes opiniones sobre este proceso o, en otras palabras, las creencias, valores y necesidades de los pacientes y sus familias tienen una relevancia única que debe considerarse en la organización de entornos de atención en contextos del final de la vida.

Resumo: Neste documento, analisam-se as opiniões e as atitudes no fim da vida entre a população residente na Argentina. Os dados apresentados foram coletados da Segunda Pesquisa Nacional de Crenças e Posicionamentos Religiosos na Argentina, que foi realizada numa amostra em várias etapas para 2.421 casos em 89 distritos de todo o país. As opiniões sobre o fim da vida incluem posicionamentos a favor da eutanásia, a solicitação de prolongação da vida por meio de tecnologias de apoio vital e deixar a morte à vontade de Deus. As crenças e as afiliações religiosas demonstram ser variáveis determinantes nos posicionamentos tomados pelos cidaçãos argentinos com relação ao fim da vida, à morte e à eutanásia. Além disso, entre os que não têm afiliação religiosa, destacam alguns posicionamentos de autonomia sobre seus corpos: prolongar a vida e dar fim a vida, o que significa que pode ser assumido seu apoio a eutanásia. Os dados apresentados aqui têm o objetivo de contribuir para planejar as políticas de saúde sobre o processo de fim da vida. As diferentes opiniões sobre esse processo ou, em outras palavras, as crenças, os valores e as necessidades dos pacientes e suas familias têm uma relevância única que deve ser considerado na organização de contextos de entornos de atenção em contextos no fim da vida.

El Miedo y la Ansiedad ante la muerte en los médicos de varios países latinoamericanos durante la pandemia del Covid-19

Resumen: Introducción: La pandemia del COVID 19 ha enfrentado a los médicos a situaciones complejas en las que el miedo y la ansiedad ante la muerte propia y del otro se han manifestado de manera importante entre los médicos peruanos y de algunos países latinoamericanos. Metodología: Estudio transversal analítico. Se utilizó la Escala Modificada de Miedo ante la muerte de Collet-Lester, y la Escala de Ansiedad ante la Muerte (DAS), elaborada por Templer. Las encuestas fueron aplicadas de forma virtual. Resultados. Se encuestaron a 219 médicos. El 52% fueron varones y 48% mujeres. De ellos, el 68% atendían pacientes con COVID-19 en primera línea. Las frecuencias del miedo a la muerte propia, al proceso de morir propio, miedo a la muerte de otro, al proceso del morir del otro y la ansiedad fueron de 56.2%; 79.5%; 90.4; 90% y 80.8%, respectivamente. Discusión: Los médicos se han enfrentado muchas veces a la muerte en el contacto con sus pacientes, pero no en la magnitud en la que la pandemia lo ha enfrentado. Esto le ha traído un sentimiento de miedo y de Instituto de Investigación en Ciencias Biomédicas, Universidad Ricardo Palma ansiedad de considerable magnitud. Ellos tienen miedo no solo a la propia muerte sino a la muerte del otro. Encontramos una alta frecuencia de ansiedad. Varios estudios latinoamericanos alertan de esta situación preocupante que deteriora la calidad de vida de los médicos. Conclusiones: Este estudio muestra altas frecuencias de miedo y ansiedad ante la muerte en los médicos durante este tiempo de pandemia para lo cual los médicos deben prepararse y las instituciones sanitarias donde laboran deben brindarles los medios para ayudarlos a superar estos cuadros.

Abstract: Introduction: The COVID 19 pandemic has confronted doctors with complex situations in which fear and anxiety about their own death and that of another have been manifested in an important way among Peruvian doctors and those of some Latin American countries. Methodology: Analytical cross-sectional study. The Collet-Lester Modified Fear of Death Scale and the Death Anxiety Scale (DAS), prepared by Templer, were used. The surveys were applied virtually. Results. 219 physicians were surveyed. 52% were male and 48% female. Of these, 68% were treating first-line COVID -19 patients. The frequencies of fear of one's own death, the process of dying one's own, fear of the death of another, the process of dying of the other and anxiety were 56.2%; 79.5%; 90.4; 90% and 80.8%, respectively. Discussion: Doctors have faced death many times in contact with their patients, but not to the extent that the pandemic has faced it. This has brought him a feeling of fear and anxiety of considerable magnitude. They are afraid not only of their own death but of the death of the other. We found a high frequency of anxiety. Several Latin American studies warn of this worrying situation that deteriorates the quality of life of doctors. Conclusion: This study shows high frequencies of fear and anxiety about death in doctors during this time of pandemic for which doctors must prepare and the health institutions where they work must provide them with the means to help them overcome these conditions.

Resumo: Introdução: A pandemia COVID- 19 confrontou os médicos com situações complexas em que o medo e a ansiedade pela própria morte e a de outrem se manifestaram de forma importante entre os médicos peruanos e de alguns países da América Latina. Metodologia: Estudo transversal analítico. Foram utilizadas a Escala de Medo da Morte Modificada de Collet-Lester e a Escala de Ansiedade à Morte (DAS), elaborada por Templer. As pesquisas foram aplicadas virtualmente. Resultados. 219 médicos foram entrevistados. 52% eram homens e 48% mulheres. Destes, 68% estavam tratando pacientes com COVID de primeira linha. As frequências de medo da própria morte, do próprio processo de morrer, medo da morte do outro, do processo de morrer do outro e ansiedade foram de 56,2%; 79,5%; 90,4; 90% e 80,8%, respectivamente. Discussão: Os médicos já enfrentaram a morte muitas vezes no contato com seus pacientes, mas não na medida em que a pandemia a enfrentou. Isso lhe trouxe um sentimento de medo e ansiedade de magnitude considerável. Eles temem não apenas a própria morte, mas também a morte do outro. Encontramos uma alta frequência de ansiedade. Vários estudos latino-americanos alertam para essa situação preocupante que deteriora a qualidade de vida dos médicos. Conclusão: Este estudo mostra altas frequências de medo e ansiedade em relação à morte nos médicos neste período de pandemia para o qual os médicos devem se preparar e as instituições de saúde onde atuam devem fornecer-lhes os meios para ajudá-los a superar essas condições.

Attitudes in front of death: nurses' views in the hospital environment / Actitudes frente a la muerte: perspectivas de los profesionales de enfermería en el ámbito hospitalario / Atitudes frente a morte: olhares dos enfermeiros no meio hospitalar

ABSTRACT Objective: to analyze the relationship between personal characteristics and the profile of attitudes towards death among nurses in a Portuguese hospital. Method: a cross-sectional, quantitative, exploratory and descriptive study, carried out in a hospital in the North of Portugal, with 981 nurses, who answered a questionnaire composed by the scale of evaluation of the Profile of Attitudes about Death. Data collection was carried out in February and March 2018 in the services, and the findings went through descriptive and analytical statistical analysis with the aid of the SPSS software. Results: the nurses revealed to have the attitudes of approach (36.29 points), fear (27.82 points), neutrality (27.25 points), avoidance (17.48 points) and escape (15.52 points) in the face of death, and these were associated with the different socio-occupational characteristics of these professionals, including gender, marital status, age, having children, type of employment relationship, professional category, specialty, time of service, and the practice or belief of some religion. Conclusion: the profile of the nurses' attitudes towards death is influenced by their socio-professional characteristics, which points to the importance of rethinking training strategies in the academic environment, in health organizations and in services, favoring the better reception of patients and family members, but also in relieving the suffering of the professionals in the face of finitude.

RESUMEN Objetivo: analizar la relación entre las características personales y el perfil de las actitudes frente a la muerte entre profesionales de Enfermería de un hospital de Portugal. Método: estudio transversal y cuantitativo, del tipo exploratorio y descriptivo, realizado en un centro hospitalario de la región Norte de Portugal, con 981 profesionales de Enfermería, quienes respondieron un cuestionario compuesto por la escala de evaluación del Perfil de Actitudes Frente a la Muerte. La recolección de datos tuvo lugar en febrero y marzo de 2018 en los servicios, y los hallazgos fueron sometidos a análisis estadístico descriptivo y analítico con el auxilio del software SPSS. Resultados: los profesionales de Enfermería revelaron tener las siguientes actitudes: aproximación (36,29 puntos), miedo (27,82 puntos), neutralidad (27,25 puntos), evasión (17,48 puntos) y escape/fuga (15,52 puntos) frente a la muerte, y fueron asociadas a las diferentes características sociolaborales de estos profesionales, entre ellas: sexo, estado civil, edad, tener hijos, tipo de vínculo laboral, categoría profesional, especialidad, tiempo de servicio y la práctica o creencia en alguna religión. Conclusión: el perfil de las actitudes de los profesionales de Enfermería frente a la muerte se ven influenciado por sus características socioprofesionales, lo que señala la importancia de repensar estrategias de formación en el ámbito académico, en las organizaciones de salud y en los servicios, favoreciendo así una mejor recepción a los pacientes y familiares, como así también el alivio del sufrimiento de los profesionales frente a la muerte.

RESUMO Objetivo: analisar a relação entre as caraterísticas pessoais e o perfil de atitudes frente à morte entre enfermeiros de um hospital português. Método: estudo transversal, quantitativo, do tipo exploratório e descritivo, realizado em um centro hospitalar da região Norte de Portugal, com 981 enfermeiros, os quais responderam a um questionário composto pela escala de avaliação do Perfil de Atitudes Acerca da Morte. A coleta de dados foi realizada em fevereiro e março de 2018 nos serviços e os achados passaram por análise estatística descritiva e analítica com o auxílio de software SPSS. Resultados: os enfermeiros revelaram ter as atitudes de aproximação (36,29 pontos), medo (27,82 pontos), neutralidade (27,25 pontos), evitamento (17,48 pontos) e escape/fuga (15,52 pontos) frente à morte, e estas foram associadas às diferentes características sociolaborais destes profissionais, entre elas, sexo, estado civil, idade, possuir filhos, tipo de vínculo de trabalho, categoria profissional, especialidade, tempo de serviço e a prática ou crença de alguma religião. Conclusão: o perfil de atitudes dos enfermeiros diante da morte sofre influências de suas características socioprofissionais, o que sinaliza para a importância de repensar estratégias de formação em meio acadêmico, nas organizações de saúde e nos serviços, favorecendo o melhor acolhimento dos pacientes e familiares, mas também no alívio do sofrimento dos profissionais frente à finitude.

Conocimientos y actitudes acerca de la eutanasia y el suicidio asistido en estudiantes y profesionales del área de salud del Hospital de Clínicas, San Lorenzo, Paraguay

RESUMEN Introducción: El suicidio asistido y la eutanasia son prácticas realizadas para acortar la vida de los pacientes que sufren de manera insoportable. Objetivo: Valorar la actitud del personal de blanco y estudiantes de un hospital universitario acerca del suicidio asistido y la eutanasia, asimismo demostrar el grado de conocimiento de estos, establecer su postura, identificar las razones por las cuales algunos están en desacuerdo con su legalización y contrastar sus actitudes acerca de la realización de eutanasia o suicidio asistido a pacientes terminales y la realización de dichas prácticas sobre su persona en caso de padecer enfermedades terminales. Metodología: Estudio observacional, descriptivo de corte transversal con muestreo no probabilístico por conveniencia llevado a cabo de febrero a marzo del 2020. La muestra fue 300. Se utilizó un cuestionario de autocumplimiento, distribuido digitalmente a los participantes. Resultados: El 10% ha recibido peticiones de pacientes para acelerar la muerte, el 42,7% ha considerado la idea de acelerar la muerte para terminar con el sufrimiento. El 63,3% aceleraría su muerte en caso de padecer enfermedad terminal. El 32% y 38% está totalmente de acuerdo en legalizar el suicidio asistido y la eutanasia, respectivamente, en caso de enfermedades terminales. El 12,7% lo está en caso de Alzheimer o esclerosis lateral amiotrófica. El 16,7% está a favor de la legalización de la eutanasia en casos de tetraplejía. El motivo de desacuerdo más común (32%) para su legalización fueron las razones persona-les. El 20% y 15,3% cometerían eutanasia y suicidio asistido, respectivamente, en caso de padecer enfermedades terminales. El 34% probablemente cometería eutanasia a un paciente en caso de ser legal. Discusión: La respuesta profesional, científica y humana a las múltiples necesidades durante la fase final está en la medicina paliativa, que es la respuesta frente al derecho de todo ser humano al alivio del sufrimiento.

ABSTRACT Introduction: Assisted suicide and euthanasia are practices carried out to shorten the lives of patients who suffer unbearably. Objectives: Assess the attitude of white staff and students of a university hospital about assisted suicide and euthanasia, also to demonstrate the degree of knowledge of these, establish their position, identify the reasons why some disagree with their legalization and contrast their attitudes about performing euthanasia or assisted suicide to terminally ill patients and the performance of such practices on their person in case of terminal illnesses. Methodology: An observational, descriptive crosssectional study with nonprobability sampling for convenience was carried out from February to March 2020. The sample was 300. A selfcompliance questionnaire was used, distributed digitally to the participants. Results: 10% have received requests from patients to accelerate death, 42.7% have considered the idea of accelerating death to end suffering. 63.3% would accelerate their death in case of terminal illness. 32% and 38% fully agree to legalize assisted suicide and euthanasia, respectively, in case of terminal illness. 12.7% is in case of Alzheimer or amyotrophic lateral sclerosis. 16.7% fully agree with the legalization of euthanasia in cases of tetraplegia. The most common reason for disagreement (32%) for its legalization was personal reasons. 20% and 15.3% would commit euthanasia and assisted suicide, respectively, if they suffer from terminal illnesses. 34% would probably euthanize a patient if it were legal. Discussion: The professional, scientific and human response to the multiple needs during the final phase is in palliative medicine, which is the response to the right of every human being to alleviate suffering.

Do Perceptions of Spiritual Care Affect Attitudes Towards Care for Dying Patients in a Group of Turkish Nursing Students?

The present study was designed to determine the relation between attitudes to death and perceptions of spiritual care in nursing students. It is a descriptive study and included 290 fourth-year nursing students (intern students). Data were collected with a descriptive characteristics form, Frommelt Attitude Towards Care of the Dying Instrument and Spirituality and Spiritual Care Rating Scale. SPSS version 21 was used for data analysis. There was a significant positive relation between the mean scores for Spirituality and Spiritual Care Rating Scale and Frommelt Attitude Towards Care of the Dying Instrument. It can be recommended that courses about death and spiritual care should be offered and integrated into nursing curricula.

Pacientes oncológicos com doença avançada: preocupações e expectativas vivenciadas na terminalidade da vida / Cancer patients with advanced disease: concerns and expectations experienced in end-of-life / Pacientes de cáncer con enfermedad avanzada: preocupaciones y expectativas experimentadas al final de la vida

Objetivo: evidenciar as preocupações vivenciadas por pacientes com câncer em estágio avançado. Metodologia: estudo qualitativo desenvolvido com 11 pacientes oncológicos em cuidados paliativos. Os dados foram coletados em Maringá ­ PR, no período de 2016 a 2017, mediante entrevistas abertas, abordando as experiências e enfrentamentos vivenciados durante o processo de terminalidade da vida, das quais foram extraídos os discursos e submetidos à análise de conteúdo após aprovação pelo Comitê de Ética em Pesquisa. Resultados: o medo de tornar-se um incômodo e as incertezas de como a vida continuará após sua partida foram questões hegemônicas dos pacientes, que encontraram na aceitação da morte um momento de reflexão sobre a vida, despontando como uma probabilidade positiva de resiliência e esperança. Conclusão: as principais preocupações manifestadas foram: viver melhor o agora, aproximar-se mais daqueles que lhes fazem bem, preocupando-se com o bem-estar de seus familiares e como eles ficarão após sua partida, transcendendo assim o seu próprio sofrimento.

Objective: to highlight the concerns experienced by patients with advanced cancer. Methodology: qualitative study developed with 11 cancer patients in palliative care. The data were collected in Maringá - PR, from 2016 to 2017, through open interviews, addressing the experiences and confrontations experienced during the terminal life process, from which the speeches were extracted and submitted to content analysis after approval by the Committee Research Ethics. Results: the fear of becoming a nuisance and the uncertainties of how life will continue after his departure, were hegemonic issues of the patients, who found in the acceptance of death a moment of reflection on life, emerging as a positive probability of resilience and hope. Conclusion: the main concerns expressed were: to live better now, to get closer to those who do them well, worrying about the well-being of their families and how they will be after their departure, thus transcending their own suffering.

Objetivo: resaltar las preocupaciones experimentadas por los pacientes con cáncer avanzado. Metodología: estudio cualitativo desarrollado con 11 pacientes con cáncer en cuidados paliativos. Los datos se recopilaron en Maringá - PR, de 2016 a 2017, a través de entrevistas abiertas, abordando las experiencias y confrontaciones experimentadas durante el proceso de vida terminal, de donde se extrajeron los discursos y se sometieron a análisis de contenido después de la aprobación del Comité Ética de Investigación. Resultados: el miedo a convertirse en una molestia y las incertidumbres de cómo continuará la vida después de su partida, fueron problemas hegemónicos de los pacientes, quienes encontraron en la aceptación de la muerte un momento de reflexión sobre la vida, emergiendo como una probabilidad positiva de resiliencia y Espero Conclusión: las principales preocupaciones expresadas fueron: vivir mejor ahora, acercarse a quienes son buenos para ellos, preocuparse por el bienestar de su familia y cómo estarán después de su partida, trascendiendo así su propio sufrimiento.

Health Professionals' Mental Health: A Look at their Suffering / A Saúde Mental dos Profissionais da Saúde: Um Olhar ao Sofrimento de quem Cuida / La Salud Mental de los Profesionales de la Salud: Una Mirada al sufrimiento de quien Cuida

Abstract This study aimed to recognize the characteristics of work within the hospital context and their potential effects on mental health of professionals who provide health care for end-of-life patients. The descriptive and qualitative study relied on interviews and observations. Thirty-four physicians and nurses who work in clinical medicine or emergency medical services in a teaching hospital in Rio Grande do Sul were interviewed. The results, obtained through content analysis, showed that in clinical medicine health professionals suffer more when patients die or their condition gets worse, such suffering being a threat to mental health. In emergency medical services, death causes suffering only when it is traumatic. Intercurrences which are characteristic of emergency medical services and work organization are the major source of stress for such professionals, thus affecting their mental health. Therefore, the mental health of these professionals is weakened due to the demands in health care work. It is thus necessary to rethink the institution's organization, redefine attitudes and implement procedures that are coherent with the professionals' needs, in search of better working conditions and improved mental health.

Resumo Este estudo teve como objetivo conhecer as características do trabalho no contexto hospitalar e os possíveis efeitos na saúde mental dos profissionais que realizam o cuidado de pacientes no fim de vida. Realizou-se um estudo descritivo e qualitativo com base em entrevistas e observações. Foram entrevistados 34 médicos e enfermeiros que atuam nas unidades de clínica médica e pronto-socorro em um hospital de ensino do Rio Grande do Sul. Os resultados, obtidos a partir da análise de conteúdo, mostraram que na clínica médica há maior sofrimento quando acontece a morte ou a piora do paciente, fontes de prejuízo à saúde mental. No pronto-socorro, a morte gera sofrimento apenas quando traumática. As intercorrências próprias da emergência e da organização do trabalho são as maiores fontes de estresse para os profissionais, afetando sua saúde mental. Logo, a saúde mental dos profissionais encontra-se fragilizada frente às exigências do trabalho em saúde. É necessário repensar a organização institucional, redefinir ações e agir coerentemente com as necessidades dos profissionais, buscando melhorias no trabalho e na saúde mental.

Resumen El objetivo de este estudio fue conocer las características del trabajo en el contexto hospitalario y los posibles efectos en la salud mental de los profesionales que realizan el cuidado de pacientes al final de la vida. Se realizó un estudio descriptivo y cualitativo basado en entrevistas y observaciones. Se entrevistó a 34 médicos y enfermeros que actúan en las unidades de clínica médica y de servicios médicos de urgencia en un hospital de enseñanza de Rio Grande do Sul. Los resultados, obtenidos a partir del análisis de contenido, mostraron que en la medicina clínica hay mayor sufrimiento cuando ocurre la muerte o el empeoramiento del paciente, factores de daño a la salud mental. En los servicios médicos de urgencia, la muerte genera sufrimiento solamente cuando es traumática. Las intercurrencias propias de la emergencia y de la organización del trabajo son las mayores fuentes de estrés para los profesionales, afectando su salud mental. Por lo tanto, la salud mental de los profesionales se encuentra debilitada ante las exigencias del trabajo en salud. Es necesario repensar la organización institucional, redefinir acciones y actuar coherentemente con las necesidades de los profesionales, buscando mejoras en el trabajo y en la salud mental.

Attitude of the medical personnel of a pediatrics department towards patient death. / Actitud del personal médico de un servicio de pediatría ante la muerte de los pacientes.

Introduction: Tertiary care hospitals' physicians require high emotional competence, since they are faced with the demands of terminally ill patients and their families. Objective: to assess the attitude of physicians of a pediatrics department towards patient death. Method: Pediatrics staff and resident physicians anonymously answered the Attitudes Towards Death (ATD) questionnaire. Absolute frequencies, percentages, means, standard deviations, Student's t-test and the chi-square test were used. Statistical significance was considered with p < 0.05. Results: The questionnaire was answered by 38 physicians, 26 (68.4%) were residents and 12 (37.6%) staff physicians; 15 (39.4%) were males and 23 (60.6%) females. Four residents (15.4%) had a positive attitude versus 2 staff physicians (16.7%) (p = 0.920). Statistical significance was found in items 1 (69.2% of residents versus 100% of staff physicians, p = 0.03), 16 (23% of residents versus 100% of staff physicians, p = 0.001) and 19 (92.3% of residents versus 58.3% of staff physicians, p = 0.01), corresponding to the avoidance, acceptance and professional perspective dimensions. Conclusion: Less than 20% of pediatric physicians have a positive attitude towards death. Most didn't value death as a passage or transition to a better life, or as a solution to life's problems.

Introducción: Los médicos de hospitales de tercer nivel requie-ren alta competencia emocional, ya que enfrentan las de-mandas de enfermos terminales y sus fami-liares. Objetivo: Evaluar la actitud de médicos de un servicio de pediatría ante la muerte de los pacientes. Método: Médicos adscritos y residentes de pediatría contestaron anónimamente el Cuestionario de Actitudes ante la Muerte (CAM). Se utilizaron frecuencias absolutas, porcentajes, medias, desviaciones estándar, t de Student y chi cuadrado. Se consideró significación estadística con p < 0.05. Resultados: Contestaron el cuestionario 38 médicos, 26 (68.4 %) residentes y 12 (37.6 %) adscritos; 15 (39.4 %) hombres y 23 (60.6 %) mujeres. Cuatro residentes (15.4 %) tuvieron actitud positiva versus dos médicos adscritos (16.7 %) (p = 0.920). Se encontró significación estadística en los ítems 1 (69.2 % de residentes versus 100 % de adscritos, p = 0.03), 16 (23 % de residentes versus 100 % de adscritos, p = 0.001) y 19 (92.3 % de residentes versus 58.3 % de adscritos, p = 0.01), correspondientes a las dimensiones evitación, aceptación y perspectiva profesional. Conclusión: Menos de 20 % de los médicos de pediatría tiene una actitud positiva ante la muerte. La mayoría no valoró la muerte como un pasaje o tránsito hacia una vida mejor, ni como una salida a los problemas de la vida.

Effects of a "silent mentor" initiation ceremony and dissection on medical students' humanity and learning.

OBJECTIVES: Many medical schools in Taiwan have adopted a dignified "silent mentor" initiation ceremony to strengthen student's medical humanity and increase their learning attitudes. This ceremony consists of introductions of the body donor's conduct and deeds, wreath-laying, and a tea party. However, few empirical studies have examined the influences of the ceremony and dissection on medical humanity. This study explored if the initiation ceremony and the course can help students care more about others, develop more positive attitudes toward death, improve learning effectiveness in the course, and decrease negative emotions the first time they see a cadaver. METHODS: The Attitudes Towards Death and Love and Care subscales of the life attitude inventory, Learning Effectiveness of Gross Anatomy Laboratory Scale (LEGALS), and Emotional Reactions Towards Cadavers Scale were adopted to examine differences before (T1) and after (T2) medical students attended an initiation ceremony at a university in northern Taiwan. Whether these effects lasted to the end of the semester (T3) was also tested. RESULTS: After the ceremony, students' attitudes towards death increased, negative emotions towards cadavers decreased, but love and care and the LEGALS did not significantly change. Data from T3 showed a similar pattern, but high-level emotions (e.g., being respected, cherished, and grateful) and the LEGALS were significantly higher than those at T1. DISCUSSION: The initiation ceremony, which showed a body donor's deeds and attitudes toward life and death when they were alive, could help medical students gain more mature attitudes towards death and decreased negative emotions. Learning between T2 and T3 might have caused significant changes in high-level emotions and the LEGALS at T3. Arranging reflective writing with guided discussion by a teacher before and after the ceremony is highly recommended.

Cuidado del paciente moribundo: una confrontación entre mostrar sentimientos y desempeño profesional / Dying Patient Care: The Conflict between Showing Feelings and Professional Performance / Cuidado do paciente terminal: um confronto entre demonstrar sentimentos e desempenhar-se como profissional

RESUMEN Objetivo: comprender el significado que las enfermeras le dan al cuidado del paciente ad portas de la muerte. Método: se realizaron entrevistas a 23 enfermeras que han cuidado a pacientes ad portas de la muerte y se realizó observación participante en un hospital de tercer nivel de Medellín, Colombia. Los datos se analizaron por proceso inductivo para obtener categorías y subcategorías. Resultados: el cuidado del paciente que está ad portas de la muerte significa una confrontación interna, pues ellas tienen la concepción que mostrar sentimientos por la muerte no es profesional, pero al no hacerlo sienten que ejercen una práctica profesional poco humanizada. Discusión: cuando un paciente va a morir, las enfermeras evalúan qué tan profesional es mostrar sentimientos y qué tan deshumanizado es no hacerlo. Conclusión: cuidar a un paciente ad portas de morir significa ejercer una profesión humanística que deben aceptar.

ABSTRACT Objective: The objective of the study was to understand the meaning nurses afford to the care of patients who are on the verge of death. Method: Interviews were carried out with 23 nurses who have cared for dying patients, and participant observation was done at a third level hospital in the city of Medellín (Colombia). The data were analyzed through an inductive process to establish categories and subcategories. Results: Caring for a patient who is on the brink of death implies an internal conflict, since nurses believe that showing their feelings in the face of death is unprofessional. However, when they fail to do so, they sense their professional practice is less humane. Discussion: When a patient is about to die, nurses evaluate how professional it is to show their feelings and how inhumane it is not to do so. Conclusion: Caring for a dying patient calls for exercising the humanistic aspects of the profession that must be accepted.

RESUMO Objetivo: compreender o significado que as enfermeiras dão ao cuidado do paciente na fase terminal. Método: foram realizadas entrevistas com 23 enfermeiras que cuidaram de pacientes em fase terminal e foi realizada observação participante num hospital de nível terciário em Medellín (Colômbia). Os dados foram analisados por processo indutivo para obter categorias e subcategorias. Resultados: o cuidado do paciente em fase terminal significa um confronto interno, pois elas acreditam que mostrar sentimentos pela morte não é profissional, mas ao não fazer isso sentem que exercem uma prática profissional pouco humanizada. Discussão: quando um paciente está prestes a morrer, as enfermeiras avaliam que tão profissional é mostrar sentimentos e que tão desumanizado é não fazer isso. Conclusões: cuidar de um paciente em fase terminal significa exercer uma profissão humanizada que os enfermeiros devem aceitar.

Avaliação do perfil de atitudes acerca da morte: estudo com graduandos da área de saúde / Evaluación del perfil de actitudes acerca de la muerte: estudio con graduandos del área de salud / Evaluation of the death attitude profile-revised: a study with health science undergraduate students

RESUMO Objetivo: identificar o perfil de atitudes frente à morte pelos graduandos da área de saúde. Método: estudo transversal realizado com graduandos de seis cursos de saúde de uma universidade pública do Distrito Federal. Aplicou-se a Escala de Avaliação do Perfil de Atitudes Acerca da Morte e um questionário sociodemográfico. Resultados: participaram da pesquisa 1.005 estudantes. A atitude de aceitação neutra obteve maiores médias dentre os graduandos da amostra, médias mais elevadas na dimensão medo da morte apresentam-se em graduandos mais jovens e médias mais baixas de evitamento da morte em graduandos com maior idade, que cursavam os primeiros semestres da graduação. As dimensões aceitação de escape e religiosa obtiveram médias mais elevadas nos graduandos do sexo masculino. Observou-se que 59,9% dos participantes não tiveram experiência prévia de perda e 75,4% referiram não ter participado de discussões acerca da morte e do morrer. Conclusão: com base nos resultados encontrados na pesquisa, reforça-se a necessidade de discussões sobre a temática da morte e do morrer desde os primeiros semestres na graduação, com a finalidade de oportunizar uma atitude positiva frente à morte e o exercício de um cuidado mais qualificado entre os futuros profissionais de saúde.

RESUMEN Objetivo: identificar el perfil de actitudes frente a la muerte por los graduandos del área de salud. Método: estudio transversal realizado con graduandos de seis cursos de salud de una universidad pública del Distrito Federal. Se aplicó la Escala de Evaluación del Perfil de Actitudes Acerca de la Muerte y un cuestionario sociodemográfico. Resultados: participaron de la investigación 1005 estudiantes. La actitud de aceptación neutra obtuvo mayores promedios entre los graduandos de la muestra, las medias más elevadas en la dimensión miedo a la muerte se presentan en graduandos más jóvenes y medias más bajas de evitación de la muerte en graduandos con mayor edad, que cursaban los primeros semestres de la graduación. Las dimensiones aceptadas de escape y religiosa obtuvieron promedios más altos en los graduandos del sexo masculino. Se observó que el 59,9% de los participantes no tuvieron experiencia previa de pérdida y el 75,4% dijo que no había participado en discusiones sobre la muerte y el morir. Conclusión: con base en los resultados encontrados en la investigación, se refuerza la necesidad de discusiones sobre la temática de la muerte y del morir desde los primeros semestres en la graduación, con la finalidad de proveer una actitud positiva frente a la muerte y el ejercicio de un cuidado más calificado entre los futuros profesionales de la salud.

ABSTRACT Objective to identify the profile of attitudes towards death in undergraduate students from in the health science area. Method a cross-sectional study performed with undergraduates from six healthcare courses of a public university in the Federal District. The Death Attitude Profile Assessment Scale and a sociodemographic questionnaire were applied. Results a total of 1,005 students participated in the study. The neutral acceptance attitude obtained higher average scores among the undergraduate students, higher averages in the fear of death dimension are presented in younger students and lower means of avoidance of death in older students, who attended the first semester of the undergraduate course. The acceptance and approach acceptance dimensions obtained higher averages in male undergraduate students. It was observed that 59.9% of the participants had no prior experience of loss and 75.4% reported not having participated in any discussions about death or dying. Conclusion: based on the results found in the research, the need for discussions on the subject of death and dying beginning in the first semesters in undergraduate courses is reinforced, this is in order to provide a positive attitude towards death and future health professionals exercise their care in a more qualified manner