Faculty of Health Sciences Schoolof Nursing Thearpeutic Sciences 0210998w 0842097202 / In order for caregivers to be better able to work with dying patients, they need to confront their fears about their own mortality and explore their feelings about their personal and professional losses. The importance of death anxiety research rests on the premise that death is an eventuality that everyone faces and how health professionals, specifically, deal with death anxiety is of considerable relevance as to the quality of care given to the terminally ill patient. The purpose of this study was to identify, explore and describe nurses’ personal fear of death (death anxiety) and explore whether an association exists between death anxiety and their attitudes towards dying patients in a private acute care hospital in Johannesburg. A quantitative, descriptive correlational survey was conducted to examine the relationship between death anxiety and nurses’ attitudes toward terminally ill patients in a private acute care hospital in the province of Gauteng in South Africa. Various extraneous variables have been identified and defined. No attempt was made to control or manipulate the situation as it was currently occurring. The study population comprised of all nurses working in this hospital who fulfilled the stipulated selection criteria. Data were obtained from nurses through the use of a self-administered questionnaire. The response rate was 42% of the expected population. A total of 93 responses were received. Descriptive statistics were used to analyze data and the significance of the relationships between variables was determined using the Fishers exact test (p-value of 0.05). The findings of this study were consistent to that of similar studies. Findings suggest high levels of death anxiety within the study population with correlating negative death attitudes. This may be associated with the fact that a significant proportion of the study sample was younger and less experienced as opposed to those who demonstrated lower levels of death anxiety and positive death attitudes and were more experienced and older. v A strong association was found between death anxiety and death attitudes. Statistically significant relationships between age and length of nursing experience/exposure were found. No significant relationships between sex, institutional support, death anxiety and death attitudes were found. Of import, the need for ongoing terminal care education was identified in this study.

No description available.

As inquietações por estudar esta temática apreendendo quais significados atribuem os enfermeiros ao cuidar do paciente idoso, hospitalizado, em fase terminal, surgiu a partir de experiências pessoais. Minha inquietação aumentou com a prática profissional, notando que, o pessoal que atendia aos idosos, em fase terminal, em sua maioria, era auxiliar de enfermagem, sem nenhuma formação específca para este cuidado. Assim, ao surgir a oportunidade de ingressar no doutorado em enfermagem, emergiu, novamente, a inquietação que há muitos anos vinha se instalando: O quê significa para a enfermeira o cuidado do idoso, em seu encontro com a morte, no mundo hospitalar? Desta forma, a proposta foi possibilitar que suas experiências, manifestadas por meio do discurso verbal e não verbal, pudessem aproximar-me do mundo que elas habitam nos hospitais e saber quais significados atribuem a esta experiência para propor um novo pensar sobre este cuidado. Tratou-se de um estudo conduzido segundo uma abordagem qualitativa, pertinente às questões muito particulares de um objeto cuja natureza não pode ser quantificada. A investigação foi desenvolvida com enfermeiros que trabalham nos hospitais públicos, na cidade de Celaya, Guanajuato, pelo fato de atenderem à maioria da população idosa. A coleta de dados foi realizada por meio de 12 entrevistas, conduzidas segundo a abordagem fenomenológica, a partir de uma questão norteadora proposta aos enfermeiros. Durante a investigação, pude apreender que, para eles, a vivência do cuidado do paciente, enquanto profissionais de enfermagem, envolve vários aspectos como as especificidades da pessoa da qual se cuida, como suas características físicas, emocionais, sociais e espirituais. Foi descrito ainda como sendo o ato de ajudar o paciente a morrer. No entanto, muitas vezes, procuram realizá-lo de forma a protelar a morte, como um impulso para conservar a vida daquele que está morrendo. Esse cuidado é proporcionado em um mundo concreto - geralmente, o hospital - e é um desafio manifestado pelos enfermeiros de forma a permitir o respeito às decisões do paciente e de sua família. Da mesma forma, as políticas das instituições de saúde pública necessitam serem revistas para que o familiar possa permanecer próximo do idoso em fase terminal, pois é seu direito morrer em companhia dos seus, de forma a ter uma morte digna. Reconhece-se, cada vez mais, que este cuidado é uma especialidade de enfermagem que requer conhecimentos e capacidades profissionais específicos e uma determinada estrutura de carreira profissional. / The restlessness for studying this theme, and learn about the meanings that nurses assign to caring for dying older patients, aroused from personal experiences. My restlessness increased with professional practice, and I noticed that the majority of the staff who cared for older, terminal patients were auxiliary nurses, with no specific training for this particular health care practice. Hence, when I ran across the opportunity to enter the nursing doctorate program, this restlessness, which had been present for many years, emerged once again: What does it mean, for nurses, to care for older individuals, as they face death, in the hospital environment? Therefore, the purpose was to permit that their experiences, reported both verbally and non-verbally, could bring me closer to the world they inhabit in the hospitals, and learn about the meanings that they assign to this experience. That way, I would be able to propose a new thought concerning this care. This study used a qualitative approach, pertinent to the very specific issues of an object whose nature cannot be quantified. The research was developed with nurses working in public hospitals in the city of Celaya, Guanajuato, because they care for the majority of the elderly population. Data collection occurred through 12 interviews, conducted according to the phenomenological approach, based on a guiding question directed to nurses. During the research, I learned that, for the nurses, the experience of caring for the patients involves various aspects like the specificities of the person being cared for, as well as his or her physical, emotional, social, and spiritual characteristics. Nurses also reported that their work was the act of helping the patient to die. However, nurses often seek to, through their work, postpone death, as an impulse to preserve the life of who is dying. This care is provided in a concrete world - usually the hospital - and nurses state that it is a challenge to respect patients\' and their family\'s decisions. Similarly, public health institution policies should be reviewed so as to permit relatives to stay close to terminal patients, since it is their right to die in the company of their loved ones, as a way of having a dignified death. It has been more and more recognized that his care is a nursing specialty that requires specific professional knowledge and skills, besides a particular professional career structure.

Det är svårt att bedöma hur lång tid en människa har kvar i livet och brytpunkten för när en patients döende fas inleds kan vara otydlig (Ellershaw & Ward, 2003). Det är viktigt att den sista tiden blir så bra som möjligt och här spelar sjuksköterskan en viktig roll. Syftet med studien var att belysa sjuksköterskors upplevelser av att vårda döende patienter på en akutvårdsavdelning. Metoden som användes var kvalitativa fokusgruppintervjuer och data analyserades med induktiv innehållsanalys. Ett övergripande tema för studien kan benämnas vårdens vågskålar, dilemman och tillfredställelse, vilket speglar den dubbelbottnade natur vården har. Intervjuerna resulterade i tio koder, vilka delades in i tre kategorier. Under kategorin känsla av att räcka till fanns koderna behov av tid, etiska ställningstaganden, anhörigkontakt samt det goda döendet. Den andra kategorin var strukturer i vården och innehöll koderna organisationen, vårdplanens betydelse samt förbättringsmöjligheter. Den sista kategorin personliga dilemman innehöll koderna påverkan på sjuksköterskans person, våga tala om döden samt uppföljning. Det sjuksköterskorna framhöll behov av tid för att kunna ge en optimal vård. De beskrev ett glapp mellan vad de upplevde som god vård vid livets slut och de resurser de hade för att förverkliga detta. Resultatet styrks av tidigare forskning.

As inquietações por estudar esta temática apreendendo quais significados atribuem os enfermeiros ao cuidar do paciente idoso, hospitalizado, em fase terminal, surgiu a partir de experiências pessoais. Minha inquietação aumentou com a prática profissional, notando que, o pessoal que atendia aos idosos, em fase terminal, em sua maioria, era auxiliar de enfermagem, sem nenhuma formação específca para este cuidado. Assim, ao surgir a oportunidade de ingressar no doutorado em enfermagem, emergiu, novamente, a inquietação que há muitos anos vinha se instalando: O quê significa para a enfermeira o cuidado do idoso, em seu encontro com a morte, no mundo hospitalar? Desta forma, a proposta foi possibilitar que suas experiências, manifestadas por meio do discurso verbal e não verbal, pudessem aproximar-me do mundo que elas habitam nos hospitais e saber quais significados atribuem a esta experiência para propor um novo pensar sobre este cuidado. Tratou-se de um estudo conduzido segundo uma abordagem qualitativa, pertinente às questões muito particulares de um objeto cuja natureza não pode ser quantificada. A investigação foi desenvolvida com enfermeiros que trabalham nos hospitais públicos, na cidade de Celaya, Guanajuato, pelo fato de atenderem à maioria da população idosa. A coleta de dados foi realizada por meio de 12 entrevistas, conduzidas segundo a abordagem fenomenológica, a partir de uma questão norteadora proposta aos enfermeiros. Durante a investigação, pude apreender que, para eles, a vivência do cuidado do paciente, enquanto profissionais de enfermagem, envolve vários aspectos como as especificidades da pessoa da qual se cuida, como suas características físicas, emocionais, sociais e espirituais. Foi descrito ainda como sendo o ato de ajudar o paciente a morrer. No entanto, muitas vezes, procuram realizá-lo de forma a protelar a morte, como um impulso para conservar a vida daquele que está morrendo. Esse cuidado é proporcionado em um mundo concreto - geralmente, o hospital - e é um desafio manifestado pelos enfermeiros de forma a permitir o respeito às decisões do paciente e de sua família. Da mesma forma, as políticas das instituições de saúde pública necessitam serem revistas para que o familiar possa permanecer próximo do idoso em fase terminal, pois é seu direito morrer em companhia dos seus, de forma a ter uma morte digna. Reconhece-se, cada vez mais, que este cuidado é uma especialidade de enfermagem que requer conhecimentos e capacidades profissionais específicos e uma determinada estrutura de carreira profissional. / The restlessness for studying this theme, and learn about the meanings that nurses assign to caring for dying older patients, aroused from personal experiences. My restlessness increased with professional practice, and I noticed that the majority of the staff who cared for older, terminal patients were auxiliary nurses, with no specific training for this particular health care practice. Hence, when I ran across the opportunity to enter the nursing doctorate program, this restlessness, which had been present for many years, emerged once again: What does it mean, for nurses, to care for older individuals, as they face death, in the hospital environment? Therefore, the purpose was to permit that their experiences, reported both verbally and non-verbally, could bring me closer to the world they inhabit in the hospitals, and learn about the meanings that they assign to this experience. That way, I would be able to propose a new thought concerning this care. This study used a qualitative approach, pertinent to the very specific issues of an object whose nature cannot be quantified. The research was developed with nurses working in public hospitals in the city of Celaya, Guanajuato, because they care for the majority of the elderly population. Data collection occurred through 12 interviews, conducted according to the phenomenological approach, based on a guiding question directed to nurses. During the research, I learned that, for the nurses, the experience of caring for the patients involves various aspects like the specificities of the person being cared for, as well as his or her physical, emotional, social, and spiritual characteristics. Nurses also reported that their work was the act of helping the patient to die. However, nurses often seek to, through their work, postpone death, as an impulse to preserve the life of who is dying. This care is provided in a concrete world - usually the hospital - and nurses state that it is a challenge to respect patients\' and their family\'s decisions. Similarly, public health institution policies should be reviewed so as to permit relatives to stay close to terminal patients, since it is their right to die in the company of their loved ones, as a way of having a dignified death. It has been more and more recognized that his care is a nursing specialty that requires specific professional knowledge and skills, besides a particular professional career structure.

O presente estudo teve como objetivo analisar o conceito de cuidados paliativos expresso na literatura das áreas de Enfermagem, Medicina, Psicologia e Bioética. A busca das publicações foi feita por acesso a base de dados LILACS, BDENF, AdSaude, todos pertencentes aos sites da Biblioteca Virtual em Saúde do Centro de Documentação Latino Americano e do Caribe em Ciências da Saúde (BIREME); no Banco de Dados Bibliográficos da USP – DEDALUS e no Portal da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior – CAPES; busca manual em tese, livros e artigos publicados sobre o assunto, no período de 1991 a 2002. Utilizou-se a análise de conceito na perspectiva evolucionária de Rodgers (2000), destacando os atributos essenciais, eventos antecedentes, eventos conseqüentes, termos substitutos e a apresentação de um caso modelo, elementos que constituem o cerne do conceito a ser analisado. Como resultados obteve-se que: os cuidados paliativos são expressos pelas características de assistência integral do ser humano; controle da dor crônica oncológica; equipe interdisciplinar; morte como processo natural: preparo do paciente para a morte; autonomia e ortotanásia; alívio do sofrimento; cenários de atendimento: hospital e domicílio; comunicação franca e honesta, e visa o cuidado e não a cura. Dentre os eventos antecedentes foram descritos: o paciente terminal; o sofrimento psicológico, espiritual, social e físico; o câncer e outras doenças crônicas; despreparo profissional e barreira cultural. Os eventos conseqüentes foram relacionados a: qualidade de vida; morte digna; formação profissional e criação de serviços e núcleos em cuidados paliativos. Identificou-se como termos substitutos o “hospice" e a medicina paliativa. Concluiu-se que o conceito de cuidados paliativos é uma construção complexa de elementos, dentre os quais destaca-se a assistência integral do ser humano fora de possibilidade de cura (unidade de cuidado paciente–família); cujo paradigma é o cuidado e não a cura; que prioriza o alívio da dor crônica, controlada por equipe interdisciplinar capacitada, que preserva a autonomia do paciente e proporciona a ortotanásia, aliviando o sofrimento da unidade de cuidado, seja no domicílio ou hospital, por meio de uma comunicação franca e honesta entre paciente, família e equipe; no preparo do paciente e familiar para a morte digna, tendo-a como um processo natural, visando enfim, a qualidade de vida. / The aim of this study was to analyze the concept of palliative care on Nursing, Medicine, Psychology and Bioethics literature. The search for publications was done based on LILACS, BDENF and Adsaude data bases concerning the sites of the Health Virtual Library Documentation in Health Sciences of Latin America and Caribbean (BIREME); on DEDALUS – the University of São Paulo Bibliographic Data Base, and on CAPES – Superior Level Personnel Improvement Coordination Portal; on thesis, books and non-published articles about the theme from 1991 to 2002. The concept analysis was based on Rodgers (2000) evolutionary perspective, pointing out the basic attributes, previous events, consequential events, substitute terms and the presentation of a model case, which compose the core of the concept to be analyzed. As a result it was found out that the palliative care are expressed by characteristics such as the holistic care of human being; chronic pain control in oncology; interdisciplinary team; death as a natural process; patient and family preparation for death; suffering relief; autonomy and ortotanasia; care settings; hospital and home; honest and sincere communication; with the aim of caring and not cure. Among the previous events it was pointed out: terminal patient; the psychological, spiritual, social and physical suffering; cancer and other chronic diseases; unprepared professional and cultural barriers. The consequential events were related to life quality; peaceful death; professional education and the creation of palliative care services. Hospice and palliative medicine were identified as substitute terms for palliative care. Is was highlighted the holistic care for human being with no cure possibility (patient-family care unity); the paradigm is caring and not cure; the priority is chronic pain relief which is controlled by interdisciplinary trained team; patient autonomy is preserved, providing ortothanasia and relieving the care unity suffering either at home of in hospital by means of honest and sincere communication among patient, family and team; patient and family are prepared for a peaceful death, considering this a natural process and taking into account the quality of life.

O presente estudo teve como objetivo analisar o conceito de cuidados paliativos expresso na literatura das áreas de Enfermagem, Medicina, Psicologia e Bioética. A busca das publicações foi feita por acesso a base de dados LILACS, BDENF, AdSaude, todos pertencentes aos sites da Biblioteca Virtual em Saúde do Centro de Documentação Latino Americano e do Caribe em Ciências da Saúde (BIREME); no Banco de Dados Bibliográficos da USP – DEDALUS e no Portal da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior – CAPES; busca manual em tese, livros e artigos publicados sobre o assunto, no período de 1991 a 2002. Utilizou-se a análise de conceito na perspectiva evolucionária de Rodgers (2000), destacando os atributos essenciais, eventos antecedentes, eventos conseqüentes, termos substitutos e a apresentação de um caso modelo, elementos que constituem o cerne do conceito a ser analisado. Como resultados obteve-se que: os cuidados paliativos são expressos pelas características de assistência integral do ser humano; controle da dor crônica oncológica; equipe interdisciplinar; morte como processo natural: preparo do paciente para a morte; autonomia e ortotanásia; alívio do sofrimento; cenários de atendimento: hospital e domicílio; comunicação franca e honesta, e visa o cuidado e não a cura. Dentre os eventos antecedentes foram descritos: o paciente terminal; o sofrimento psicológico, espiritual, social e físico; o câncer e outras doenças crônicas; despreparo profissional e barreira cultural. Os eventos conseqüentes foram relacionados a: qualidade de vida; morte digna; formação profissional e criação de serviços e núcleos em cuidados paliativos. Identificou-se como termos substitutos o “hospice” e a medicina paliativa. Concluiu-se que o conceito de cuidados paliativos é uma construção complexa de elementos, dentre os quais destaca-se a assistência integral do ser humano fora de possibilidade de cura (unidade de cuidado paciente–família); cujo paradigma é o cuidado e não a cura; que prioriza o alívio da dor crônica, controlada por equipe interdisciplinar capacitada, que preserva a autonomia do paciente e proporciona a ortotanásia, aliviando o sofrimento da unidade de cuidado, seja no domicílio ou hospital, por meio de uma comunicação franca e honesta entre paciente, família e equipe; no preparo do paciente e familiar para a morte digna, tendo-a como um processo natural, visando enfim, a qualidade de vida. / The aim of this study was to analyze the concept of palliative care on Nursing, Medicine, Psychology and Bioethics literature. The search for publications was done based on LILACS, BDENF and Adsaude data bases concerning the sites of the Health Virtual Library Documentation in Health Sciences of Latin America and Caribbean (BIREME); on DEDALUS – the University of São Paulo Bibliographic Data Base, and on CAPES – Superior Level Personnel Improvement Coordination Portal; on thesis, books and non-published articles about the theme from 1991 to 2002. The concept analysis was based on Rodgers (2000) evolutionary perspective, pointing out the basic attributes, previous events, consequential events, substitute terms and the presentation of a model case, which compose the core of the concept to be analyzed. As a result it was found out that the palliative care are expressed by characteristics such as the holistic care of human being; chronic pain control in oncology; interdisciplinary team; death as a natural process; patient and family preparation for death; suffering relief; autonomy and ortotanasia; care settings; hospital and home; honest and sincere communication; with the aim of caring and not cure. Among the previous events it was pointed out: terminal patient; the psychological, spiritual, social and physical suffering; cancer and other chronic diseases; unprepared professional and cultural barriers. The consequential events were related to life quality; peaceful death; professional education and the creation of palliative care services. Hospice and palliative medicine were identified as substitute terms for palliative care. Is was highlighted the holistic care for human being with no cure possibility (patient-family care unity); the paradigm is caring and not cure; the priority is chronic pain relief which is controlled by interdisciplinary trained team; patient autonomy is preserved, providing ortothanasia and relieving the care unity suffering either at home of in hospital by means of honest and sincere communication among patient, family and team; patient and family are prepared for a peaceful death, considering this a natural process and taking into account the quality of life.

Bakgrund: Döendet är naturlig del i livet som berör alla människor. Sjuksköterskor möter döende patienter i vården. Anhöriga beskriver att den döende närstående är i behov av information och närvaro från vårdpersonal. Ibland beskriver anhöriga att vårdpersonal brister i kommunikation och tillgänglighet i den döendes vård. Syfte: Att beskriva sjuksköterskors erfarenheter av att vårda döende patienter. Metod: Elva artiklar analyserades med kvalitativ metod genom systematisk litteraturstudie med beskrivande syntes. Resultat: Två teman och fem tillhörande subteman framkom. Temat Relationella utmaningar med tre subteman Att samspela med patienter, Att samspela med anhöriga och Att samspela i vårdteamet. Det framkom att det ibland var utmanande för sjuksköterskor att samspela med patienter, anhöriga och andra professioner. Temat Existentiella utmaningar synliggjorde två subteman Att vara närvarande och Att bli personligt påverkad. Det framkom att sjuksköterskor blev påverkade i vården av döende patienter och hade varierande sätt att bearbeta sina emotioner. Slutsats: Sjuksköterskornas samspel med döende patienter, anhöriga och vårdteamet var av betydelse för bemötande. Sjuksköterskornas närvaro främjade trygghet hos döende patienter. Sjuksköterskor blev ofta personligt påverkade av relationen till döende patienter och dess anhöriga som bearbetades genom exempelvis fysisk aktivitet. / Background: Dying is natural and affects all people; nurses will face dying in the care of patients. The relatives' perspective is that the dying person is in need of, among other things, information and the presence of healthcare staff. Relatives sometimes describe that care staff lack communication and accessibility in the dying person's care. Aim: To describe nurses' experiences of caring for dying patients. Method: Eleven articles were analyzed by a qualitative method through systematic literature study with descriptive synthesis. Results: Two themes and five associated sub-themes emerged. The theme Relationship Challenges, which provided three sub-themes: Interacting with patients, Interacting with relatives and Interacting in the care team. It was discovered that it was sometimes challenging for nurses to interact with patients, relatives and other professions. The theme Existential Challenges highlighted two sub-themes Being Present and Being Influenced. Analysis showed that nurses were influenced in the care of dying patients and had varying ways of processing their emotions. The presence of nurses created security for dying patients. Conclusion: The nurses' interaction with dying patients, relatives and the care team was important in meeting their varying needs. The presence of the nurses promoted the safety of dying patients. Nurses' risk of being personally affected by the relationship with dying patients. The personal impact was processed through, for example, physical activity.

Bakgrund: De flesta som dör är gamla och sjuka och många dör på sjukhus. En del döende patienter är rädda och ensamma och behöver stöd från andra samt utrymme att tala om sina tankar och känslor. På sjukhus arbetar sjuksköterskan i team med andra och leder omvårdnadsarbetet och i sjuksköterskans roll ingår det att vårda döende patienter.Syfte:Att beskriva sjuksköterskors upplevelser av att vårda döende patienter på sjukhus. Metod: En litteraturöversikt som inkluderar 10 vetenskapliga artiklar, 9 kvalitativa och 1 kvantitativ, från CINAHL Complete och PubMed. Dataanalys enligt Friberg.   Resultat: Sjuksköterskorna upplevde att de visste vad en god vård för döende patienter innebar och vad som krävdes för att ge det, exempelvis närvaro, att skapa en relation, respekt och samtal med patient och närstående. Samtidigt förhindrades sjuksköterskorna att utöva en god vård, på grund av olika faktorer, vilket ledde till bland annat känslor av maktlöshet och skuld hos sjuksköterskorna. Sammanfattning: När sjuksköterskor förhindras att utöva en god vård innebär det en risk för patientsäkerheten samt en risk för ett ökat lidande hos patienter. Sjuksköterskor riskerarar också att drabbas av moralisk stress och utmattningssyndrom på grund av det, vilket kan ha en negativ påverkan på deras hälsa samt leda till att sjuksköterskor lämnar sin arbetsplats eller byter yrke. / Background: Most people who die are old and sick and many die in hospitals. Some dying patients are scared and lonely and need support from others as well as space to talk about their thoughts and feelings. In hospitals, the nurse works in teams with others and leads the nursing work, and the nurse´s role includes caring for dying patients. Aim: To describe nurses' experiences of caring for dying patients in hospitals. Method: A literature review including 10 scientific articles, 9 qualitative and 1 quantitative, obtained from CINAHAL Complete and PubMed. Analyze according to Friberg.  Results: The nurses felt that they knew what good care for dying patients meant and what was required to provide it, for example presence, to create a relationship with the patient, respect and conversation with the patient and relatives. At the same time, the nurses were prevented from providing good care, due to various factors, which led to, among other things, a sensation of powerlessness and guilt among the nurses.  Conclusion: When nurses are prevented from providing good care, it entails a risk to patient safety and can increase the suffering of patients. Nurses are also at risk of suffering from moral stress and fatigue syndrome because of it, which can have a negative impact on their health and lead to nurses leaving their workplace or changing professions.

No description available.