El daño cerebral en los estadios crónicos y la importancia de la calidad de vida como eje de trabajo / Brain damage in chronic stages and the importance of quality of life as an axis of work

El Daño Cerebral Adquirido (DCA) supone una situación de gran trascendencia personal, familiar y social. Sus secuelas implican dificultades en la integración normalizada del individuo, con respecto a su vida previa al daño y dificulta su participación en la sociedad, donde ha cambiado su rol. Las estrategias de atención al DCA varían atendiendo al momento y ámbito en que se sitúan. Durante la fase aguda, la subaguda y la atención crónica, las estrategias están muy ligadas a su etiología, pero una vez superadas estas fases, otras variables como el contexto psicosocial y laboral del afectado/a y su familia pasan a tomar relevancia. Se deben revisar las situaciones personales y familiares para atender a su grado de dependencia. Este análisis debe incluir instrumentos de evaluación que, desde una perspectiva integral, engloben todas las áreas de la vida que son importantes para las personas, y analice la calidad de vida de éstas. Es fundamental en este momento, construir conjuntamente con las personas con DCA, sus familias y los profesionales sociosanitarios, un nuevo proyecto de vida centrado en el bienestar emocional, físico y social, desde las diversas alternativas de recursos para los estadios crónicos con los que se cuenta actualmente en España (AU)

A stroke is a situation of great personal, family, and social significance. The sequel cause problems to integrate the individual at his life before the stroke, and this is difficult to participate in society, where his role has changed. The strategies, in case of accident, are differents depending on time and ambit. The etiology is very important in the acute phase, post acuse phase and chronic phase, however, after chronic phase the etiology less important and the variables such as the psychosocial and work context of the affected person and his family are more important. Personal and family situations should be reviewed to pay attention to the degree of dependency. The analysis must include evaluation instruments that, from a integrative perspective, includes all areas of life important to people, and analyze their quality of life. At this time, it is essential to build a life proyect for people with stroke and their families, focused on emotional, physical and social aspects, using the resource and alternatives that are in Spain to people with a chronic stroke

El concepto del confort en el cuidado de enfermería / The Concept of Comfort in Nursing Care

Introducción: Para enfermería, el confort es un objetivo de cuidado en los múltiples escenarios del actuar disciplinario, lleva a la formulación de teorías con perspectiva holística y logra aplicar el confort desde una mirada física, psicoespiritual, ambiental y social. Objetivo: Identificar los atributos del concepto confort entendido por enfermería en los diferentes escenarios de cuidado. Métodos: Revisión integrativa, con estrategia de búsqueda: "Confort" AND "Nursing", en las bases de datos Scopus, Google Académico, BVS, EBSCO, Cochrane, Ovid y Medline. Los criterios de elegibilidad fueron: estudios primarios, a texto completo, publicados entre 2009-2019, en español, inglés y portugués. Se utilizó el diagrama prisma para el análisis crítico de diseños experimentales, revisiones y cualitativos, se emplearon las plantillas del Critical Appraisal Skills Programme (Caspe). Para los demás diseños se aplicaron las listas de chequeo del Joanna Briggs Institute, quedaron incluidos 16 artículos. Conclusión: El confort está ligado a temas que enmarcan la realidad física, social, psíquica y ambiental de la persona, determinado por los atributos: 1. Alivio físico del dolor mediante intervenciones farmacológicas y de elementos externos en contacto con el cuerpo. 2. Soporte social con cercanía de los familiares, lo que facilita la adaptación al ambiente hospitalario y reduce la ansiedad. 3. Relaciones con el personal sanitario de acompañamiento y acceso a información sobre la condición del paciente. 4. Ambiente adaptado para favorecer la recuperación y alivio. 5. Descanso que incluye reposo y sueño, generando alivio; y 6. Salud mental con alivio de ansiedad, estrés y adecuada recuperación mental(AU)

Introduction: For nursing, comfort is a care-related objective in the multiple settings of professional performance; it leads to the formulation of theories with a holistic perspective and manages to be applied from a physical, psychospiritual, environmental and social point of view. Objective: To identify the attributes of the concept of comfort understood by nursing in different care settings. Methods: Integrative review carried out in the Scopus, Google Scholar, VHL, EBSCO, Cochrane, Ovid and Medline databases, using the following search strategy: "Comfort" AND "Nursing". The eligibility criteria considered primary studies, full texts, published between 2009 and 2019, in Spanish, English or Portuguese. The PRISMA diagram was used for the critical analysis of experimental, review and qualitative studies, using the templates of the Critical Appraisal Skills Program (Caspe). For the other designs, the checklists of the Joanna Briggs Institute were applied and sixteen articles were included. Conclusion: Comfort is related to issues that enclose the physical, social, psychic and environmental reality of a person, determined by the following attributes: physical relief of pain through pharmacological interventions and external elements in contact with the body; social support with the closeness of family members, which facilitates adaptation to the hospital environment and reduces anxiety; relationships with the accompanying health personnel and access to information on the patient's condition; an adapted environment to favor recovery and relief; rest including sleep and generating relief; and mental health with relief of anxiety, stress and adequate mental recovery(AU)

Intravenous administration of anakinra in children with macrophage activation syndrome.

BACKGROUND: Subcutaneous anakinra is an interleukin-1 inhibitor used to treat juvenile idiopathic arthritis. Recent reports suggest anakinra can be a valuable addition to the treatment of COVID-19 associated cytokine storm syndrome and the related multisystem inflammatory syndrome (MIS-C) in children. Herein, we describe our experience with intravenously administered anakinra. FINDINGS: 19 Patients (9 male) received intravenous (IV) anakinra for treatment of macrophage activation syndrome (MAS) secondary to systemic lupus erythematosus (SLE), systemic JIA (SJIA) or secondary hemophagocytic lymphohistiocytosis (sHLH). In most cases the general trend of the fibrinogen, ferritin, AST, and platelet count (Ravelli criteria) improved after initiation of IV anakinra. There were no reports of anaphylaxis or reactions associated with administration of IV anakinra. CONCLUSION: Intravenous administration of anakinra is an important therapeutic option for critically ill patients with MAS/HLH. It is also beneficial for those with thrombocytopenia, subcutaneous edema, neurological dysfunction, or very young, hospitalized patients who need multiple painful subcutaneous injections.

Comfort Care Homes: Pressures and Protocols in End-of-Life Care During the COVID-19 Pandemic.

Comfort care homes are community-run, residential homes that provide end-of-life care to terminally ill individuals who lack safe, secure housing and a reliable caregiver system. As nonprofit, non-medical facilities, these homes have faced both new and magnified challenges due to the COVID-19 pandemic. This article highlights the value of collaborative interagency partnerships and shares reflections on the unique pandemic pressures faced by comfort care homes. Innovative ideas for improving community-based end-of-life care and implications for social work practice are included.

Trends in Restricting Symptoms at the End of Life from 1998 to 2019: A Cohort Study of Older Persons.

OBJECTIVES: To describe changes in the occurrence of restricting symptoms at the end of life from 1998 to 2019 and compare these changes according to the condition leading to death. DESIGN: Prospective longitudinal study. SETTING: Greater New Haven, CT. PARTICIPANTS: A total of 665 decedents from a cohort of 754 community-living persons, 70 years or older. MEASUREMENTS: The occurrence of 16 restricting symptoms was ascertained during monthly interviews. Information on the conditions leading to death was obtained from death certificates and comprehensive assessments that were completed every 18-months. For each restricting symptom, adjusted rates (per 100 person-months) were calculated separately for six multiyear time intervals. RESULTS: From 1998 to 2019, rates decreased for five (31.3%) restricting symptoms (difficulty sleeping; chest pain or tightness; shortness of breath; cold or flu symptoms; and nausea, vomiting, or diarrhea), increased for three (18.8%: arm or leg weakness; urinary incontinence; and memory or thinking problem), and changed little for the other eight (50.0%: poor eyesight; anxiety; depression; musculoskeletal pain; fatigue; dizziness or unsteadiness; frequent or painful urination; and swelling in feet or ankles). The decrease in rates was most pronounced for shortness of breath, with a reduction from 15.0 (95% credible interval = 11.7-18.6) in 1998 to 2001 to 8.2 (95% credible interval = 5.9-10.5) in 2014 to 2019, yielding a rate ratio (95% credible interval) of 0.92 (0.86-0.98). When evaluated according to the condition leading to death, the results were similar, with 10 of the 13 statistically significant rate ratios representing decreases in rates over time and only 3 representing increases. CONCLUSION: The occurrence of most restricting symptoms at the end of life has been decreasing or stable over the past two decades. These results suggest that end-of-life care has been improving, although additional efforts will be needed to further reduce symptom burden at the end of life.

Tradução e adaptação transcultural do instrumento evaluation of siderail usage / Traducción y adaptación transcultural del instrumento evaluation of siderail usage / Translation and cross-cultural adaptation of the evaluation of siderail usage instrument

Objetivo: traduzir e adaptar transculturalmente o instrumento Evaluation of Siderail Usage para a língua portuguesa do Brasil. Método: pesquisa metodológica de tradução e adaptação transcultural de um instrumento em quatro etapas. Resultados: na primeira etapa foram realizadas duas traduções; na segunda, foi realizada uma reunião consensual com duas tradutoras e as autoras do estudo para discutir discrepâncias e gerar uma versão síntese; na terceira etapa, a versão síntese foi retrotraduzida para o inglês por duas tradutoras para se verificar a equivalência com a versão original; e na quarta etapa, um comitê de 25 juízes profissionais da área de saúde analisaram a versão síntese. Os resultados demostraram um Índice de Validade de Conteúdo do instrumento de 0,97 e um Coeficiente de Validade de Conteúdo de 0,93. Conclusão: a tradução e adaptação do instrumento Evaluation of Siderail Usage para a língua portuguesa do Brasil apresentou bons índices de validade do conteúdo.

Objetivo: traducir y adaptar el instrumento Evaluation of Side Rail Usage al idioma portugués brasileño. Método: investigación metodológica de la traducción y adaptación transcultural de un instrumento en cuatro pasos. Resultados: en la primera etapa, se realizaron dos traducciones; en la segunda, se realizó una reunión consensuada con dos traductores y los autores del estudio para discutir discrepancias y generar una versión de síntesis; en la tercera etapa, la versión de síntesis fue retrotraducida al inglés por dos traductores para verificar la equivalencia con la versión original; y en la cuarta etapa, un comité de 25 jueces profesionales del área de salud analizó la versión de síntesis. Los resultados mostraron un índice de validez de contenido del instrumento de 0,97 y un Coeficiente de Validez de Contenido de 0,93. Conclusión: la traducción y adaptación del instrumento de Evaluation of Side Rail Usage al portugués brasileño presentó buenos índices de validez de contenido.

Objective: to translate and adapt cross-culturally the Evaluation of Side Rail Usage instrument to the Brazilian Portuguese. Method: methodological research with four-step translation and cross-cultural adaptation of an instrument. Results: in the first stage, two translations were performed; in the second, a consensual meeting was held with two translators and the authors of the study to discuss discrepancies and generate a synthesis version; in the third stage, the synthesis version was backtranslated into English by two translators to verify equivalence with the original version; and in the fourth stage, a committee of 25 professional judges from the health area analyzed the synthesis version. The results showed an instrument Content Validity Index of 0.97 and a Content Validity Coefficient of 0.93. Conclusion: the translation and adaptation of the Evaluation of Side Rail Usage instrument into Brazilian Portuguese presented good content validity indexes.

Effect on autonomic nervous activity of applying hot towels for 10 s to the back during bed baths.

BACKGROUND: Bed baths are a daily nursing activity to maintain patients' hygiene. Those may provide not only comfort but also relaxation. Notably, applying a hot towel to the skin for 10 s (AHT10s) during bed baths helped to reduce the risk of skin tears and provided comfort and warmth in previous studies. However, it is still unclear whether autonomic nervous system is affected by bed baths. Thus, this study investigated the effect on the autonomic nervous activity of applying hot towels for 10 s to the back during bed baths. METHODS: This crossover study had 50 participants (25 men and women each; average age 22.2 ± 1.6 years; average body mass index 21.4 ± 2.2 kg/m2) who took bed baths with and without (control condition: CON) AHT10s on their back. Skin temperature, heart rate variability (HRV), and blood pressure (BP) were measured. Subjective evaluations and the State-Trait Anxiety Inventory in Japanese were also performed. RESULTS: A significant interaction of time and bed bath type on skin surface temperature was observed (p < .001). Regarding the means of skin surface temperature at each measurement time point, those for AHT10s were significantly higher than those for CON. Although the total state-anxiety score significantly decreased in both the bed bath types after intervention, the mean values of comfort and warmth were higher for bed baths with AHT10s than for CON (p < .05) during bed baths; AHT10s was significantly higher in warmth than CON after 15 min (p = .032). The interaction and main effects of time on HRV and BP and that of bed bath type were not significant. CONCLUSION: Bed baths that involved AHT10s caused participants to maintain a higher skin temperature and warmer feeling than under the wiping-only condition; they also provided comfort during the interventions. However, the bed baths with AHT10s did not allow participants to reach a relaxed state; moreover, there was no change in autonomic nerve activity. This may be due to participants' increased anxiety from skin exposure and the intervention being limited to one part of the body.

Crawl positioning improves set-up precision and patient comfort in prone whole breast irradiation.

Prone positioning for whole-breast irradiation (WBI) reduces dose to organs at risk, but reduces set-up speed, precision, and comfort. We aimed to improve these problems by placing patients in prone crawl position on a newly developed crawl couch (CrC). A group of 10 right-sided breast cancer patients requiring WBI were randomized in this cross-over trial, comparing the CrC to a standard prone breastboard (BB). Laterolateral (LL), craniocaudal (CC) and anterioposterior (AP) set-up errors were evaluated with cone beam CT. Comfort, preference and set-up time (SUT) were assessed. Forty left and right-sided breast cancer patients served as a validation group. For BB versus CrC, AP, LL and CC mean patient shifts were - 0.8 ± 2.8, 0.2 ± 11.7 and - 0.6 ± 4.4 versus - 0.2 ± 3.3, - 0.8 ± 2.5 and - 1.9 ± 5.7 mm. LL shift spread was reduced significantly. Nine out of 10 patients preferred the CrC. SUT did not differ significantly. The validation group had mean patient shifts of 1.7 ± 2.9 (AP), 0.2 ± 3.6 (LL) and - 0.2 ± 3.3 (CC) mm. Mean SUT in the validation group was 1 min longer (P < 0.05) than the comparative group. Median SUT was 3 min in all groups. The CrC improved precision and comfort compared to BB. Set-up errors compare favourably to other prone-WBI trials and rival supine positioning.

Cuidado para el bienestar de personas con diabetes tipo 2 con heridas en miembros inferiores según la teoría de Kristen Swanson / Care for the well-being of people with Diabetes Mellitus type 2 and lower limb injuries based from Kristen Swanson theory

El cuidado brindado a las personas con diabetes mellitus tipo 2 (DM2) y heridas en miembros inferiores (MM II) se ha dirigido a la curación de las lesiones. Se requiere reorientar las acciones de los profesionales de enfermería para obtener una intervención más eficaz. OBJETIVO: Desarrollar un proyecto de gestión del cuidado, orientado por la teoría "Cuidado para el bienestar" de Kristen Swanson. METODOLOGÍA:Se empleó la herramienta del marco lógico para la atención de los pacientes con DM2 que tienen heridas en MM II. Se presenta el proceso en los tres momentos de cuidado dispuestos por la teoría: conocer; mantener la fe y estar con; y hacer por y permitir. RESULTADOS: Se evidencia el desconocimiento sobre la DM2 que tienen las personas y el trabajo realizado para superar esta limitación, acompañarlos en su desarrollo y favorecer su capacidad de cuidado, incluida la adherencia al tratamiento. CONCLUSIONES: La intervención de "Cuidado para el bienestar" mostró resultados positivos en los indicadores propuestos dentro de los tres momentos y generó conductas que favorecieron la adherencia al cuidado de la salud y el de sus heridas, logrando así mejorar el bienestar de las personas con DM2 y un beneficio para la institución, al innovar en esquemas de cuidado dirigidos

Care that is given to those who have type II diabetes mellitus (DM2) and wounds in lower limbs mainly focuses on the healing of said wounds, but there is a call for nursing professionals to reorient their actions towards more efficient interventions. AIM: Developt a management project of care, focused on the theory of caring by Kristen Swanson. METHODOLOGY: This project, which uses the tool of a logic framework for the care of patients with lower limb wounds and DM2. The process is divided into three moments of care, which are given by the theory: to know; maintaining belief; and doing for and enabling the patient. RESULTS: Lack of knowledge towards DM2 and towards the work put into overcoming this limitation, following the development of it, and encouraging the capacity of care, including adherence to treatment. CONCLUSIONS: The intervention of Care for wellness showed positive results in proposed indicators during the tree moments, which in turn generated conducts that favored the adherence to the care for their health and their wounds and, by doing so, achieving an improvement in the wellness of people with DM2 and a benefit for the institution, by innovating the schemes of directed care

Acute Cerebellar Strokes with Anoxic Brain Injury After a Cardiopulmonary Arrest in SARS-CoV-2 Patient.

Neurological complications from novel coronavirus is becoming more common. These patients usually have primary pulmonary problem of acute lung injury. Presentation in the form of encephalitis, meningitis, Guillain-Barre syndrome and seizures are noted. It is also noted that SARS-CoV-2 has predilection for brain stem leading to patient not feeling extensive pulmonary injury. Here we share another neurological presentation.

Risky Behavior: Hospital Transfers Associated with Early Mortality and Rates of Goals of Care Discussions.

INTRODUCTION: Inter-hospital transfer (IHT) patients have higher in-hospital mortality, higher healthcare costs, and worse outcomes compared to non-transferred patients. Goals of care (GoC) discussions prior to transfer are necessary in patients at high risk for decline to ensure that the intended outcome of transfer is goal concordant. However, the frequency of these discussions is not well understood. This study was intended to assess the prevalence of GoC discussions in IHT patients with early mortality, defined as death within 72 hours of transfer, and prevalence of primary diagnoses associated with in-hospital mortality. METHODS: This was a retrospective study of IHT patients aged 18 and older who died within 72 hours of transfer to Wake Forest Baptist Medical Center between October 1, 2016-October 2018. Documentation of GoC discussions within the electronic health record (EHR) prior to transfer was the primary outcome. We also assessed charts for primary diagnosis associated with in-hospital mortality, code status changes prior to death, in-hospital healthcare interventions, and frequency of palliative care consults. RESULTS: We included in this study a total of 298 patients, of whom only 10.1% had documented GoC discussion prior to transfer. Sepsis (29.9%), respiratory failure (28.2%), and cardiac arrest (27.5%) were the top three diagnoses associated with in-hospital mortality, and 73.2% of the patients transitioned to comfort measures prior to death. After transfer, 18.1% of patients had invasive procedures performed with 9.7% undergoing major surgery. Palliative care consultation occurred in only 4.4%. CONCLUSION: The majority (89.9%) of IHT patients with early mortality did not have GoC discussion documented within EHR prior to transfer, although most transitioned to comfort measures prior to their deaths, highlighting that additional work is needed in this area.

Practical Considerations for Radiologists in Implementing a Patient-friendly MRI Experience.

For many patients, numerous unpleasant features of the magnetic resonance imaging (MRI) experience such as scan duration, auditory noise, spatial confinement, and motion restrictions can lead to premature termination or low diagnostic quality of imaging studies. This article discusses practical, patient-oriented considerations that are helpful for radiologists contemplating ways to improve the MRI experience for patients. Patient friendly scanner properties are discussed, with an emphasis on literature findings of effectiveness in mitigating patient claustrophobia, other anxiety, or motion and on reducing scan incompletion rates or need for sedation. As shorter scanning protocols designed to answer specific diagnostic questions may be more practical and tolerable to the patient than a full-length standard-of-care examination, a few select protocol adjustments potentially useful for specific clinical settings are discussed. In addition, adjunctive devices such as audiovisual or other sensory aides that can be useful distractive approaches to reduce patient discomfort are considered. These modifications to the MRI scanning process not only allow for a more pleasant experience for patients, but they may also increase patient compliance and decrease patient movement to allow more efficient acquisition of diagnostic-quality images.

Gentle Touch: Noninvasive Approaches to Improve Patient Comfort and Cooperation for Pediatric Imaging.

Pediatric imaging presents unique challenges related to patient anxiety, cooperation, and safety. Techniques to reduce anxiety and patient motion in adults must often be augmented in pediatrics, because it is always mentioned in the field of pediatrics, children are not miniature adults. This article will review methods that can be considered to improve patient experience and cooperation in imaging studies. Such techniques can range from modifications to the scanner suite, different ways of preparing and interacting with children, collaborating with parents for improved patient care, and technical advances such as accelerated acquisition and motion correction to reduce artifact. Special considerations for specific populations including transgender patients, neonates, and pregnant women undergoing fetal imaging will be described. The unique risks of sedation in children will also be briefly reviewed.

Making Magnets More Attractive: Physics and Engineering Contributions to Patient Comfort in MRI.

Patient comfort is an important factor of a successful magnetic resonance (MR) examination, and improvements in the patient's MR scanning experience can contribute to improved image quality, diagnostic accuracy, and efficiency in the radiology department, and therefore reduced cost. Magnet designs that are more open and accessible, reduced auditory noise of MR examinations, light and flexible radiofrequency (RF) coils, and faster motion-insensitive imaging techniques can all significantly improve the patient experience in MR imaging. In this work, we review the design, development, and implementation of these physics and engineering approaches to improve patient comfort.

Significados atribuidos al envejecimiento: una revisión integrativa / Meanings attributed to aging: an integrative review

OBJETIVO: Conocer y analizar aquellas publicaciones que se orientan en explorar los significados que el adulto mayor atribuye al envejecimiento y su vejez. MÉTODO: La revisión fue realizada en bases de datos; las que se consultaron fueron APS physics, EBSCO, Elsevier, Scopus y Wiley. Se incluyeron investigaciones de tipo cualitativas y mixtas, publicadas en el periodo entre 2008 a 2018. RESULTADOS: Se encontraron un total de 265 artículos, llegando a una muestra final de 12; fueron evidentes las diversas temáticas que se exploraron, siendo los significados del bienestar de la vejez los más destacados. CONCLUSIÓN: Tener una mayor comprensión de la vejez en sus diversas facetas contribuye a la creación de mejores vínculos entre el profesional de enfermería y el adulto mayor, lo que facilita otorgar cuidados de enfermería que respondan a sus necesidades particulares

OBJECTIVE: To know and analyze those publications that focus on exploring the meanings that older adults attribute to aging. METHOD: the revision was made in different Databases; those consulted were APS physics, EBSCO, Elsevier, Scopus and Wiley. Qualitative and mixed researches were included, published in the period that corresponded between 2008 to 2018.RESULTS: A total of 265 articles were found, reaching a final sample of 12, the various themes that were explored were evident, with the meanings of the well-being of old age being the most prominent. CONCLUSION: Have a greater understanding of old age in its various facets contributes to the creation of better relationships between the nurse and the elderly, facilitating to grant nursing care that responds to their particular needs

Comfort of the child in intensive pediatric therapy: perception of nursing professionals.

OBJECTIVES: o analyze the concept of comfort in a Pediatric Intensive Care Unit from the perspective of nursing professionals. METHODS: descriptive research, with qualitative-quantitative approach, conducted in an Intensive Care Unit. Data collection occurred between January and May 2017; 40 nursing professionals participated in the study. The textual data obtained in the semi-structured interviews was processed in the Iramuteq 7.2 software. The Descending Hierarchical Classification and Bardin analysis were used for the discussion. Katharine Kolcaba's concepts were used as theoretical framework. RESULTS: three categories emerged: the environment that promotes (dis)comfort; feasible actions to promote comfort; uncomfortable actions in care. Final Considerations: it was possible to identify that comfort is offered by providing measures that favor the well-being, warmth, safety and tranquility of hospitalized children. The study brings a reflection about the nursing care provided to severely ill hospitalized children.

Close to Home: Perinatal Palliative Care in a Community Hospital.

BACKGROUND: Advances in prenatal testing and diagnosis have resulted in more parents learning during pregnancy that their child may die before or shortly after birth. These advances in testing and diagnosis have also resulted in more parents choosing, despite the diagnosis, to continue their pregnancies and pursue a palliative approach to their infant's short life. Perinatal hospice and palliative care is a growing model of care developed in response to these parents' previously unmet needs. A seldom-discussed opportunity to provide this care exists in outlying community hospitals, which are ideally placed to provide care close to home for families who have chosen comfort measures and time with their child. PURPOSE: This article reviews the definition and utility of perinatal palliative care, the population it serves, attempts to support a rational for development of community-based programs, and describes one community hospital's experience with perinatal palliative care in their community. METHODS/SEARCH STRATEGY: This article describes the development and processes of a perinatal palliative care program at a community hospital in Fredericksburg, Virginia. IMPLICATIONS FOR PRACTICE: Perinatal palliative care can be developed with the assistance of already existing training materials, resources, and staff. While the cohort of patients may be small, implementing perinatal palliative care in a community setting may result in wider availability of this care and more accessible options for these families. IMPLICATIONS FOR RESEARCH: Research possibilities include developing a template for creating a perinatal palliative care program at community hospitals that could be replicated elsewhere; assessing parental satisfaction and quality indicators of perinatal palliative care at community hospitals and at referral hospitals; and assessing outcomes in various settings.

Conceptually Redefining Neonatal Palliative Care.

BACKGROUND: First defined in 2002 by Catlin and Carter, neonatal palliative care (NPC) is a relatively new model of care in neonatal pediatrics, first appearing in the medical literature in the early 1980s. PURPOSE: The purpose of this article is to suggest a conceptual definition of NPC that encompasses all the essential concepts as a way of moving NPC forward by having a consistent approach. METHODS: Following a review of the NPC literature, a thematic analysis as a method for identifying, analyzing, and interpreting patterns of meaning in the definitions ("themes") within the literature was undertaken. FINDINGS: The major themes identified included philosophies of care, support, culture and spirituality, the team, and clinical management. IMPLICATIONS FOR RESEARCH: At the heart of NPC is the primacy of maintaining quality of life, while providing ethical and humane care that supports a "good death." The extensive elements presented in this article are considered essential to a comprehensive and conceptual definition of NPC proposed here.