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espanolObjetivo: describir las caracteristicas de los pacientes con demencias y la calidad del cuidado (CDC) recibida tanto en aquellos sujetos que vivian en casa como en los que estaban institucionalizados, y evaluar las diferencias entre ambos entornos. Metodo: se realizo un estudio transversal analitico en el cual se incluyeron pacientes con demencia que vivian en casa o estaban institucionalizados. Se recogieron datos sociodemograficos, clinicos y relacionados con la demencia. La CDC se analizo mediante el cuestionario CLINT y se identificaron otras variables indicativas de la misma. Las variables recopiladas se compararon en funcion de los dos entornos de convivencia. Resultados: se incluyeron 287 pacientes con demencia. El 39,4% institucionalizados y el 60,6% vivia en el domicilio. Los sujetos presentaban una media de edad (desviacion tipica) de 83,2 (7,1) anos. El principal tipo de demencia fue el alzheimer, que representaba el 71%. Los pacientes institucionalizados presentaban peor estado cognitivo (12,2 frente a 16,1; p= 0,001) y funcional (1,1 frente a 3,1; p= 0,001) que los pacientes con demencia que vivian en el domicilio familiar. La CDC fue similar en ambos grupos, pero los sujetos institucionalizados presentaban mayor porcentaje de ulceras y caidas, mas medidas de contencion y mayor soporte del sistema sanitario, en general. Conclusiones: el cuidado de la demencia es complejo y la calidad del cuidado de estos pacientes sigue siendo baja tanto en el ambito de las medidas fisicas generales como las basadas en el soporte del sistema sanitario, tanto a enfermos como cuidadores informales. EnglishObjective: to describe the characteristics of patients with dementia and the quality of care (QoC) received by patients living at home and by those institutionalized, and to evaluate the differences between both settings. Methods: an analytical cross-sectional study was conducted, including patients with dementia living at home or institutionalized. Sociodemographical and clinical data were collected, as well as data associated with dementia. QoC was analyzed through the CLINT questionnaire, and other variables of reference were identified. There was a comparison of the variables collected, based on the two living settings. Results: the study included 287 patients with dementia: 39.4% were institutionalized and 60.6% lived at home. The subjects were 83.2-year-old (7.1) as mean age (standard deviation). The main type of dementia was Alzheimer, representing 71% of cases. Institutionalized patients presented worse cognitive (12.2 vs. 16.1; p= 0.001) and functional status (1.1 vs. 3.1; p= 0.001) than patients with dementia living in the family home. QoC was similar in both groups, but institutionalized subjects presented in general a higher proportion of ulcers and falls, more containment measures, and higher support by the healthcare system. Conclusions: care for dementia is complex, and the quality of care for these patients is still low, both in the setting of general physical measures and regarding the support by the healthcare system for nurses and casual caregivers.

Normative ethics includes ethical behaviour health care professionals should uphold in daily practice. This study assessed the degree to which primary health care (PHC) professionals endorse a set of ethical standards from these norms. Health care professionals from an urban area participated in a cross-sectional study. Data were collected using an anonymous, self-administered questionnaire. We examined the level of ethical endorsement of the items and the ethical performance of health care professionals using a Rasch multidimensional model. We analysed differences in ethical performance between groups according to sex, profession and knowledge of ethical norms. A total of 452 Professionals from 56 PHC centres participated. The level of ethical performance was lower in items related to patient autonomy and respecting patient choices. The item estimate across all dimensions showed that professionals found it most difficult to endorse avoiding interruptions when seeing patients. We found significant differences in two groups: nurses had greater ethical performance than family physicians (p

Summary Objectives To analyse the level of exposure of nurses to ethical conflict and determine the relationship between this exposure, sociodemographic variables and perceptions of the clinical environment. Design and setting Prospective and descriptive correlational study conducted at 10 intensive care units in two tertiary hospitals affiliated to the University of Barcelona. Sociodemographic and professional data were recorded from a questionnaire and then the previously validated Ethical Conflict in Nursing Questionnaire-Critical Care Version was administered to obtain data regarding experiences of ethical conflict. Results Two hundred and three nurses (68.6%) participated in the study, of whom only 11.8% had training in bioethics. Exposure to ethical conflict was moderate with a x ¯ = 182.35 (SD = 71.304; [0–389]). The realisation that analgesia is ineffective and the administration of treatment without having participated in the decision-making process were the most frequently reported ethical conflicts. Professionals who perceived their environment as supportive for dealing with ethical conflicts reported lower levels of these events (p = 0.001). Conclusions Ethical conflict is an internal problem but it is strongly influenced by certain variables and environmental conditions. The involvement of nurses in the decision-making processes regarding the care of critically ill patients emerges as a factor that protects against ethical conflicts.

Resumen Objetivo Revisar y evaluar sistematicamente las diferentes intervenciones de enfermeria en grupos de apoyo al paciente oncologico. Metodo Revision sistematica para evaluar la eficacia de las intervenciones de enfermeria. Resultados El apoyo grupal demostro mejorias significativas en las variables de estado emocional (depression y ansiedad), adaptacion a la enfermedad, calidad de vida y relaciones de pareja. Conclusiones Los grupos de apoyo a los pacientes oncologicos mejoran la adaptacion a la enfermedad y su calidad de vida. La mayor parte de las publicaciones sobre grupos de apoyo estan realizadas por investigadores norteamericanos, mientras que los pacientes espanoles podrian verse beneficiados de estas intervenciones de enfermeria.

El proposito de este trabajo es analizar el concepto de afrontamiento por parte del paciente oncologico en el contexto del tratamiento quimioterapico. El afrontamiento es un concepto clave para la teoria e investigacion en adaptacion y salud, y ocupa un lugar central en la ciencia de enfermeria

La Planificación Anticipada de Decisiones (PAD) la definió Teno en 1994 como un proceso de discusión entre personas, sus sustitutos y los profesionales acerca de los objetivos y la dirección deseada de la atención, sobre todo la atención al final de su vida útil, en el caso de que el paciente deje de ser competente para tomar decisiones. Una adecuada PAD posibilitaría el empoderamiento de las personas en su salud incluyendo esos momentos en los que sea incapaz para la toma de decisiones. La Enfermera Familiar y Comunitaria, desde su competencia de defender y promover la autonomía de las personas que cuida, está en la posición idónea para liderar proyectos que fomenten la participación activa, manteniendo la atención longitudinal y posibilitando el acceso a programas a toda la población. Aunque los programas PAD deberían ofrecerse a toda la población, existen grupos en los que los profesionales sanitarios deben ser más proactivos, como es el caso de la persona mayor de 75 años por su mayor proximidad el deterioro de la salud, la incapacidad y el final de la vida.

The authors carried out a systematic search in main data bases and a methodological content review by paired authors about selected publications. The authors reviewed and analyzed 332 articles about informal caretakers and they chose 182 which complied with their selection criteria. The profile for informal caretakers of persons aged over 65 in Spain is identified as well as the type of care he/she provides. It is worth highlighting the introduction of a new factor in caretaking for the elderly during recent years at a national Spanish level, and since the 1990s on an international level: paid non-professional immigrant caretakers. This phenomenon makes the different traits which ethnic minority caretakers have reflect on the dynamics and the results of this study.

Las enfermeras oncológicas tienen que afrontar los retos del cuidado oncológico dentro de una expectativa de calidad asistencial. La investigación de enfermería oncológica es necesaria para dar respuesta a problemas actuales o potenciales de los pacientes con cáncer. Además, el cuidado profesional de las enfermeras requiere la integración de la investigación como actividad fundamental, bien participando en proyectos de investigación o bien utilizando los resultados de la evidencia empírica en la práctica asistencial. Este trabajo presenta la estrategia para potenciar la investigación de enfermería centrándose en cuatro aspectos: Obtención de más financiación, aumento de la productividad científica, mejora de la diseminación de los resultados y potenciación del consumo de los resultados publicados por las enfermeras asistenciales. Oncology nurses have to COPE with the demands of the cancer within a reference framework of quality care. Oncology nursing research is needed to respond to actual or potential cancer patient problems. Besides, professional nursing care requires research as a fundamental activity. All nurses have to participate in research as generators of knowledge by participating in nursing research or as consumers of research results in focusing in four targeted aspects: Greater funding directed towards nursing research, increased production of clinical research, improved dissemination, enhanced consumption of research publications by clinicians.

The objective of this article is to analyze the concept of confrontation, especially how cancer patients apply it as related to their disease. To this end, the authors study empirical evidence from patients who are undergoing treatment for cancer. The authors evaluate the uses, attributes, antecedents and consequences of the concept of confrontation. Furthermore, the authors present different conceptual and operational definitions of confrontation.

Participation by nurses in support groups are beneficial for oncology patients and their families since they improve their degree of adaptation and they promote effective mechanisms to confront one's illness. This improvement in quality of life is reflected in patients emotional, physical, social and spiritual state; furthermore, in some cases this leads to an increase in their survival. Due to a nurse's role, oncology patients' families improve their adaptation to the situation; moreover, nurse's aid provides the necessary support to patients during their medical treatment. The authors review the existing literature about nurses' participation in support groups in order to improve a patient's and his/her family's adaptation to cancer and all it entails. With this objective in mind, the authors present the conceptual and empirical concepts of a support group along with their overall objectives and possible benefits. Finally, the authors document the role of nursing in support groups for oncology patients and their families. This study was financed by the Carlos III Health Institute as part of the Evaluation Studies of Health Technologies, reference FIS 00/10107.