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[Resumen] La muerte podría definirse como el fin de la vida. El desenlace de un cuerpo vivo que se había creado a partir del nacimiento. Las personas conviven con el miedo a la muerte, pero los profesionales sanitarios están continuamente enfrentados a la muerte de pacientes y en contacto continuo con ella. Una de las funciones de los profesionales de enfermería es velar por las necesidades de los pacientes en situación terminal. La muerte, como fenómeno inevitable, afecta a actitudes y comportamientos incidiendo en la calidad de los cuidados del profesional de enfermería. El afrontamiento del dolor y la muerte genera un gran impacto en el equipo de enfermería, produciendo impotencia, frustración y pena, que pueden llegar a causar el síndrome de Burnout y la fatiga de compasión. Por ello, es necesario, que los profesionales dispongan de recursos que les permitan afrontar óptimamente las situaciones de impacto emocional. El objetivo principal del presente estudio, es evaluar el nivel de afrontamiento del personal de enfermería ante la muerte, con el fin de mejorar la relación terapéutica y disminuir el estrés de los profesionales. Es una investigación cualitativa de carácter fenomenológico, ya que, se pretende recabar datos acerca de las experiencias vividas por el personal de enfermería con pacientes moribundos. La investigación se llevará a cabo en las unidades de Medicina Interna (MI) del EOXI de Ferrol. La recogida de datos será mediante entrevistas abiertas, hasta alcanzar la saturación., [Resumo] A morte podría definirse como o fin da vida. O desenlace dun corpo vivo creado a partir do nacemento.As persoas conviven co a norte, pero or profesionais sanitarios están continuamente enfrontados a morte dos seus pacientes, e en contacto contínuo con ela. Unha das función dos profesionais de enfermería é velar polas necesidades dos pacientes en situación terminal. A morte, como fenómeno inevitable, afecta a actitudes e comportamentos incidindo na calidade dos coidados do profesional de enfermería. O afrontamento da dor e a morte xera un gran impacto no equipo de enfermería, producindo impotencia, frustración e pena, que poden chegar a causar o síndrome de Burnout e a fatiga de compaixón. Por iso, é necesario, que os profesionais dispoñan de recursos que lles permitan afrontar óptimamente as situacións de impacto emocional. O obxectivo principal do presente estudo, é avaliar o nivel de afrontamento do persoal de enfermería ante a morte, co fin de mellorar a relación terapéutica e diminuír a tensión dos profesionais. É unha investigación cualitativa de carácter fenomenolóxico, xa que, preténdese solicitar datos acerca das experiencias vividas polo persoal de enfermería con pacientes moribundos. A investigación levarase a cabo nas unidades de Medicina Interna do EOXI de Ferrol. A recollida de datos será mediante entrevistas abertas, ata alcanzar a saturación., [Abstract] Death can be defined as the end of the life. The ending of a living body that had been created from the birth. People cope with the fear of death, but health care professionals face every day their patients’ death and are in contact with this situation. One of their roles is to look out for the needs of the patients in their terminal. Death, as an unavoidable phenomenon, concerns attitudes and behaviors and has an impact in the quality of health care professionals’ work. Confronting pain and death causes a great impact in nursing staff and brings about depression, frustration and sadness. These feelings could be at the origin of the Burnout syndrome and the compassion fatigue. For this reason, resources that shows them how to cope with emotional situations must be available for nursing staff must. The main objective of the present study is to assess the level of nursing staff’s confrontation faced with death, in order to improve the therapeutic relationship and to reduce the professionals stress. This is a qualitative research with a phenomenological nature, since it is pretended to collect data about the experiences lived by the nursing staff with patients in their terminal. The research will be carried out in the Internal Medicine service (MI) of the Ferrol EOXI. Data will be collected through open interviews until the saturation.

Respect for human life is central to medicine. In terminal patients, refractory symptoms are a niche of palliative sedation. This paper identi es, based on scienti c evidence, the survival in patients who received palliative sedation as compared to those who didn’t. We conducted a search for systematic reviews from 2000 to 2016, which were methodologically analyzed, and the results were then compared. For methodological reasons, meta-analysis could not be performed. It is concluded that terminal palliative sedation does not shorten patients’ lives. The implementation of the principle of double effect related to the possible shortening of life was reformulated; the unwanted evil is the loss of consciousness., O respeito pela vida humana é primordial na atuação médica. Em pacientes terminais, os sintomas refratários são lugar de sedação paliativa. Este artigo identi ca, a partir de evidência cientí ca, a sobrevida em pacientes com sedação paliativa em comparação com aqueles que não a receberam. Foi realizada uma busca de revisões sistemáticas de 2000 a 2016, os resultados foram analisados me- todologicamente e comparados. Por razões metodológicas, não foi possível realizar metanálise. Conclui-se que a sedação paliativa terminal não encurta a vida dos pacientes. A aplicação do princípio de duplo efeito relacionado com o possível encurtamento da vida é reformulada; o mal indesejado é a perda de consciência., El respeto por la vida humana es central en el acto médico. En pacientes terminales, los síntomas refractarios son nicho de sedación paliativa. Este artículo identifica, a partir de evidencia científica, la sobrevida en pacientes con sedación paliativa en comparación con aquellos que no la recibieron. Se realizó́ búsqueda de revisiones sistemáticas de 2000 a 2016, se analizaron metodológicamente y se compararon los resultados. Por razones metodológicas no se pudo realizar meta-análisis. Se concluye que la sedación paliativa terminal no acorta la vida de los pacientes. Se reformula la aplicación del principio de doble efecto relacionado con el posible acortamiento de la vida; el mal no deseado es la pérdida de la conciencia.

Context. In addition to the effectiveness of terminal care, policy makers and health care payers are concerned about the costs of treating terminal patients in a context of spiraling health care costs and limited resources. Objectives. This article aims to review the international literature on the costs of treating terminal patients. Methods. Studies were identified by searching PubMed, Centre for Reviews and Dissemination databases, Cochrane Database, and EconLit, up to April 2009. Studies were included that contrasted costs in different health care settings and that compared palliative care with alternative therapeutic approaches for terminal patients. Results. The few studies that focused on treatment of terminal patients across health care settings showed that hospitalization costs represent the principal component of palliative care costs. In the hospital setting, palliative care tends to be cheaper than usual care or care delivered in units other than the palliative care unit. Palliative care costs depend on patient characteristics, such as diagnosis, status of disease, and age. Also, different care models appear to target different patient groups and offer varied packages of services. Finally, there is some evidence pointing to cost advantages of palliative care at home as compared with alternative care models, although this needs to be corroborated by further research. Conclusion. Different approaches to deliver palliative care are not substitutes of each other and, thus, have different costs. From a cost perspective, hospitals need to pay attention to admitting patients to the palliative care unit at the right time. J Pain Symptom Manage 2010;40:436-448. (C) 2010 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

The Palliative cares consist of the global attention of the patients whose disease does not respond to curativo treatment. Its aim is the profit of the best quality of life for the patients and their family. The patient as the relative must be informed and educated to be able to face the changes that take place in the course of the terminal disease. An educative program will improve the prevention of problems and will facilitate the correct accomplishment of well-taken care of on the part of the main caretaker. Objectives. To value the impact that the formation of the main caretakers has on the attention of the terminal oncológicos patients, controlled by the Unit of Palliative Cares of the General Hospital of Great Canary for the first time in the month of January of year 2003. Subjects and method. Studied 65 patients and their respective main caretakers.Descriptive, prospectivo, longitudinal Study. The project begins the 2 of January and finalizes the 15 of April of the 2003. The educative program for caretakers was centered in two symptoms: The pain and the dry mouth, following the protocols of the SECPAL and NATIONAL CANCER INSTITUTE. Valuing the difficulties and programming Interventions according to the protocol of the Nursing Interventions Classification, valuing itself the results at the beginning and the month of initiate the program. Results. Diminution in a 70% the difficulties presented/displayed in the performance before the pain. Diminution in a point at the moment for administering dose of rescue for control of the pain in Visual Analogic Scale. Diminution in a 30% of the patients who presented/displayed dry mouth. Increase of 30% in the patients whom buccal hygiene makes after each meals. Conclusions.In our study the formation of the caretakers improved the prevention of problems and facilitated the correct accomplishment of the cares., Los Cuidados Paliativos consisten en la atención global de los pacientes cuya enfermedad no responde a tratamiento curativo. Su fin es el logro de la mejor calidad de vida para los pacientes y su familia. El paciente como el familiar deben estar informados y educados para poder enfrentarse a los cambios que se produzcan en el curso de la enfermedad terminal. Un programa educativo mejorará la prevención de problemas y facilitará la realización correcta de cuidados por parte del cuidador principal. Objetivos. Valorar el impacto que la formación de los cuidadores principales tiene sobre la atención de los pacientes oncológicos terminales, controlados por la Unidad de Cuidados Paliativos del Hospital General de Gran Canaria por primera vez en el mes de enero del año 2003. Sujetos y método. Se estudiaron 65 pacientes y sus respectivos cuidadores principales. Estudio descriptivo, prospectivo, longitudinal. Se inicia el proyecto el 2 de enero y finaliza el 15 de abril del 2003. El programa formativo para cuidadores se centró en dos síntomas: El dolor y la boca seca, siguiendo los protocolos de la SECPAL y del NATIONAL CANCER INSTITUTE. Valorándose las dificultades y programando Intervenciones según el protocolo de La Nursing Interventions Classification, analizando los resultados al inicio y al mes de iniciado el programa.Resultados. Disminución en un 70% las dificultades presentadas en la actuación ante el dolor. Disminución en un punto en el momento de administrar dosis de rescate para control del dolor en Escala Visual Analógica ( EVA). Disminución en un 30% de los pacientes que presentaban boca seca. Aumento del 30% en los pacientes que realizan la higiene bucal después de cada comida. Conclusiones. En nuestro estudio la formación de los cuidadores mejoró la prevención de problemas y facilitó la realización correcta de los cuidados.

Palliative cures take its importance when a patient has no treatment and the disease leads to death in less than 6 months. In these cases there are many symptoms that must be treated, but specially there is a new situation that the patient and the family must understand. Palliative cures must cope with physical, psychological, social and spiritual needings of both patient and family. To cure and to care can be the two basic premises. In a time that the 25% of total deaths are caused by cancer, and where is a growing problem with other terminal diseases, like AlDS, palliative care is everyday more accepted in many hospitals in Europe and USA.

Palliative cures take its importance when a patient has no treatment and the disease leads to death in less than 6 months. In these cases there are many symptoms that must be treated, but specially there is a new situation that the patient and the family must understand. Palliative cures must cope with physical, psychological, social and spiritual needings of both patient and family. To cure and to care can be the two basic premises. In a time that the 25% of total deaths are caused by cancer, and where is a growing problem with other terminal diseases, like AlDS, palliative care is everyday more accepted in many hospitals in Europe and USA.