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Nowadays, the offer of specialized palliative care has been overcome by the demand, reason why care to patients with terminal illness or in end-of-life period is usually in charge of the doctor from primary care level. In that sense, primary palliative care includes the diagnosis, palliative treatment, early planning, administration and coordination of multidisciplinary interventions and referring to specialized care when it is necessary and the service is available. In this respect, some elements on the topic are shortly exposed in this work and, also, a practical and easy implementation algorithm in primary care is proposed that will allow identifying population suffering from pain in those stages, with differentiation as for neoplastic or non neoplastic affections. [ABSTRACT FROM AUTHOR]

Objetivo: Determinar el nivel de incertidumbre del cuidador familiar (CF) de la persona hospitalizada en fase terminal y su asociación con carga de síntomas y funcionalidad del paciente. Materiales y método: Estudio observacional de tipo corte transversal, donde se identificó la prevalencia de incertidumbre en el CF de pacientes hospitalizados en fase terminal usando la escala de incertidumbre. Adicionalmente, se evaluó la carga de síntomas mediante escala Edmonton del paciente terminal hospitalizado en una institución de salud de alta complejidad. Resultados: La muestra incluyó información de 69 CF y pacientes terminales hospitalizados. El 85,51% de los cuidadores tuvo un nivel de incertidumbre medio. Se observó un nivel estadísticamente significativo de incertidumbre menor en el CF, a mayor intensidad de dolor del paciente (p=0,04), al igual que en náuseas (p=0,0004), depresión (p=0,03) y ansiedad (p=0,025) según carga de síntomas. Discusión: La vivencia del cuidador de un paciente terminal, reflejada en la incertidumbre frente a la enfermedad de este, se relaciona principalmente con la dependencia funcional del enfermo, debido probablemente al impacto que su falta de suficiencia puede generar en las rutinas diarias del cuidador familiar, lo cual, puede alterar completamente la dinámica familiar y generar sobrecarga, estrés, ansiedad y trastornos en la comunicación. Conclusión: La mayoría de CF de pacientes terminales son mujeres en edad productiva, con carga familiar, y con nivel de incertidumbre medio alto frente a la enfermedad del paciente. La incertidumbre del cuidador familiar es diferente según los síntomas que presenta el paciente.

En la actualidad, la oferta de cuidados paliativos especializados ha sido superada por la demanda, por lo cual la atención a pacientes con enfermedades en estado terminal o en fase final de la vida suele estar a cargo del médico del nivel primario de asistencia. En ese sentido, los cuidados paliativos primarios incluyen el diagnóstico, el tratamiento paliativo, la planificación anticipada, la gestión y coordinación de intervenciones multidisciplinarias y la transferencia a cuidados especializados cuando sea necesario y haya disponibilidad para ello. Al respecto, en este artículo se exponen brevemente algunos elementos sobre el tema y se propone, además, un algoritmo práctico y fácil de aplicar en la atención primaria, que permitirá identificar a la población aquejada por dolencias en esas etapas, con diferenciación en cuanto a afecciones neoplásicas o no neoplásicas.

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Copyright of Revista Bioetica is the property of Conselho Federal de Medicina and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista de Enfermagem e Atenção à Saúde (REAS) is the property of Revista de Enfermagem e Atencao a Saude - Reas and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

this integrative review of the literature aims to highlight and discuss the bioethical aspects of end-of-life patient care in the Brazilian context. Specifically, it seeks to identify the circumstances related to these bioethical aspects and their triggering factors. Publications by Brazilian authors published between 2014 and 2020 were selected. The search was conducted in October 2020 through PubMed and SciELO electronic databases. Of the 231 articles found, 24 were selected. Two categories comprising bioethical aspects emerged from the thematic analysis: "(not) dying with dignity" and "therapeutic obstinacy and futility." Six circumstances related to these bioethical aspects and 15 triggering factors were identified. The aspects were mainly associated with the non-acceptance of death, failures in the academic training of health professionals, and insufficient knowledge about palliative care concepts and practices. Therefore, integrating bioethics teaching in professional training and practice becomes fundamental for the care of patients at the end of life. [ABSTRACT FROM AUTHOR]

Introduction: The end of life (OL) implies a period in which a certain disease or other situation leads to an inexorable path towards death. The clinical situation makes the approach to VF very complex, especially in those stages where the parenteral route is the only way to provide nutritional support. Method: A narrative bibliographic review was carried out based on the search in different databases such as Medline, Science Direct and Scopus of all the articles published until March 2021 that show a series of nutritional and technological considerations of supplemented parenteral nutrition (PN) and your possible benefits at EOL. Results: It is necessary to carry out adequate monitoring of FV with PN to determine the importance of adding nutritional supplements, due to their beneficial effects, such as glutamine, arginine, zinc, chromium, citrulline, selenium, zinc or coenzyme Q to attenuate the alterations typical of FV and avoid new complications. Also, a series of technological criteria must be considered to guarantee the stability of the NP and its nutrients. Conclusions: The supplemented PN that is administered in the FV involves controlling a series of factors that are involved in its stability. Beneficial actions have been observed with NP supplemented with zinc, selenium, chromium and taurine. [ABSTRACT FROM AUTHOR]

Introducción: Los cuidados paliativos según la Organización Mundial de Salud, son cuidados que se brindan al final de la vida, su objetivo es aconsejar, sugerir, proponer y calmar el desconsuelo a través de la identificación precoz, la valoración y el tratamiento del sufrimiento entre otras complicaciones que se pueden presentar durante la enfermedad pueden ser emocionales y espirituales. Objetivo: Describir la actividad científica sobre los cuidados paliativos más implementados en las intervenciones de enfermería. Metodología: Revisión sistemática, basada en las recomendaciones del método PRISMA para búsqueda de literatura científica, se examinaron las bases bibliográficas: Redalyc, Science Direct, Scielo, REBID, Mendeley y Google académico. La muestra fueron 9 artículos científicos, para la estrategia de búsqueda se establecieron los DeCS y MeSH, se validó la calidad de la literatura. Resultados: Se encontró efectividad en las intervenciones realizadas para mejorar la calidad de vida, alivio del sufrimiento, dolor y acompañamiento de los familiares. De los artículos revisados la muestra fueron 644 pacientes en fase terminal, en su mayoría femeninas, promedio de edad de 45.42 años DE±15.9. Conclusiones: Las intervenciones de enfermería en cuidados paliativos fueron positivas, con un alto grado de evidencia científica, para ayudar la subsistencia de la persona enferma - familia, así mismo en contribuir en disminuir, desaparecer molestias ocasionadas por la enfermedad garantizando un progreso en etapa terminal.

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El cáncer es una enfermedad multisintomática que afecta a gran parte de la población a nivel mundial y en los últimos años ha ido en aumento. La experiencia de los familiares cuidadores proporciona información acerca del cuidado y atención que recibe el enfermo terminal. Se propuso como marco interpretativo la fenomenología hermenéutica de Heidegger. El objetivo de este artículo fue conocer, a partir del relato de los familiares, las necesidades médicas, psicológicas, sociales, espirituales de los pacientes con cáncer terminal. Se realizaron 11 entrevistas a familiares en la Ciudad de México. Se llevaron a cabo transcripciones y se utilizó el análisis temático y el método de van Manen. Se encontró que los cuidados paliativos en la etapa final de la enfermedad no son proporcionados en todos los casos. Se da prioridad por cubrir las necesidades médicas que se centran en el control del dolor, dejando de lado las necesidades psicológicas, sociales y espirituales. Estas últimas son solucionadas por la propia familia. Es necesaria atención integral a los enfermos desde diversas disciplinas, siempre velando por la dignidad y bienestar al final de la vida.

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Copyright of Revista Bioetica is the property of Conselho Federal de Medicina and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Bioetica is the property of Conselho Federal de Medicina and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Bioetica is the property of Conselho Federal de Medicina and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objetivo: Describir experiencias internacionales de comunidades compasivas y dar a conocer los avances de la iniciativa desarrollada en Colombia llamada “Medellín compasiva, todos contigo”. Metodología: Se realizó una revisión narrativa de la literatura haciendo una búsqueda en Medline, Ovid, Sciencedirect, Embase, Mediclatina, Health source y Google, así como exploración manual. Se emplearon los términos: “comunidades compasivas” o “comunidades” o “redes de apoyo” y “cuidados paliativos” o “cuidados al final de la vida” y sus respectivos en idioma inglés. Resultados: El origen de las comunidades compasivas proviene de la propuesta de ciudades saludables adoptada por la Organización Mundial de la Salud, que ha permeado la salud pública y los cuidados paliativos; esta busca complementar la atención sanitaria promoviendo la responsabilidad ciudadana por el cuidado de sus enfermos y la generación de redes de apoyo. El artículo describe el desarrollo de las comunidades compasivas en cuidados paliativos, una serie de experiencias internacionales y la iniciativa llevada a cabo en Medellín, Colombia. Conclusiones: El principal objetivo de las comunidades compasivas en el mundo es mejorar la calidad de vida de las personas con enfermedades avanzadas, mediante el empoderamiento de su grupo social, ayuda en las tareas y satisfacción de las necesidades de cuidado. Las comunidades han surgido en diversas localizaciones y logran estos objetivos desde diferentes miradas y acciones. Esta estrategia es útil para empoderar a las comunidades del cuidado de sus enfermos y servir como un complemento eficaz en cuidados paliativos, particularmente en contextos donde estos están en fase de desarrollo.

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Introducción: Este artículo de revisión sistemática pretende examinar en detalle la evidencia cientifica para el abordaje desde la enfermería, en el manejo de síntomas desagradables, gastrointestinales tales como: síndrome anorexia caquexia, disfagia, náuseas y vómito enfocado al cuidado paliativo, basados en el referente teórico del modelo revisado del manejo de síntomas de Marylin J. Dodd. Materiales y Métodos: La estrategia que se realizó fue la del sistema PICO, metodológicamente se estableció una pregunta la cual se contesta con la selección de los artículos que se realizó, continuando con la revisión sistemática se aplica la declaración (PRISMA), la investigación de los artículos fue realizada en las bases de datos Medline, Cochrane Library, Scopus, Pubmed, Dialnet, Ebscohost, ProQuest y Elsevier. Dentro de los criterios de inclusión, se tuvo en cuenta principalmente los artículos que fomentan el manejo de los síntomas gastrointestinales en cuidado paliativo. Resultados: A pesar de que se evidencia los avances en conocimiento, se identifica que son insuficientes los estudios en este campo, mostrando la necesidad y la obligación de desarrollar el manejo y control de los síntomas desagradables gastrointestinales, el manejo del síntoma debe ser basado en: la experiencia del síntoma desde la percepción, evaluación y respuesta. Discusión: La evidencia muestra las diferentes maneras de abordar los síntomas desagradables gastrointestinales, con una mirada holística, en constante movimiento, resaltando que se debe intervenir, desde la dimensión espiritual, física y social. Conclusiones: La intención es contribuir con evidencia científica para abordar los síntomas desagradables gastrointestinales. Como citar este artículo: Jaramillo DMG, Muñoz CO, Nuvan ANS, Benavides FPA. Revisión sistemática para el abordaje de síntomas desagradables gastrointestinales en cuidados paliativos. Rev Cuid. 2019; 10(1): e615. http://dx.doi.org/10.15649/cuidarte.v10i1.615

OBJECTIVETo identify the factors that influence the Intensive Care Unit nurse in the decision-making process in end-of-life situations.METHODEthnographic case study, which used the theoretical framework of medical anthropology. Data were collected through semi-structured interviews with 10 nurses.RESULTSThe inductive thematic analysis enabled us to identify four themes:The cultural context of the Intensive Care Unit: decision-making in situations of end-of-life; Beliefs and subjectivity of care in end-of-life situations; Professional experience and context characteristics of end-of-life care situations; and Humanization practices in end-of-life situations: the patient and family centered care.CONCLUSIONProfessional maturity, the ability to transmit information and the ability to negotiate are directly related to the inclusion of nurses in the decision-making process.

RESUMOObjetivo:caracterizar a produção científica nacional e internacional sobre as diretivas antecipadas de vontade aplicadas ao doente terminal.Método:a revisão integrativa, incluindo os artigos publicados no Portal Capes, SCIELO, LILACS, MEDLINE, Revista de Bioética e Bioethikos, a partir dos descritores: Diretivas antecipadas, Testamentos quanto à vida, Advance Directives, Living Will e Terminally Ill totalizando 44 artigos submetidos à análise de conteúdo.Resultados:emergiram três categorias: Estudantes e profi ssionais frente às diretivas antecipadas de vontade: percepções, opiniões e condutas; Receptividade dos pacientes às diretivas antecipadas de vontade; A família diante das diretivas antecipadas de vontade.Conclusão:evidenciou-se a relevância do tema como garantidor do respeito à dignidade e à autonomia do doente, bem como para a redução dos conflitos éticos enfrentados pelos familiares e profi ssionais da saúde frente aos cuidados em fi nal de vida.

O estudo objetivou investigar a atuação do enfermeiro no que concerne à comunicação de notícias difíceis ao paciente sem possibilidade de cura e a aos seus familiares. Trata-se de uma pesquisa descritiva, de natureza qualitativa, na qual participaram 28 enfermeiros assistenciais atuantes em unidades de internação de um hospital público da cidade de João Pessoa – PB, no período de agosto a outubro de 2012. Para a coleta dos dados utilizou-se um formulário. Os dados obtidos foram tratados mediante a técnica de análise de conteúdo. Da análise do material empírico, emergiram duas categorias temáti­cas: Comunicação de notícias difíceis ao paciente e aos seus familiares: participação do enfermeiro; e Estratégias adotadas por enfermeiros para facilitar a comunicação de notícias difíceis ao paciente e aos seus familiares. Conclui-se que o enfermeiro assume um papel essencial na comunicação de más notícias ao paciente sem possibilidades terapêuticas de cura e à sua família. ABSTRACT The study investigated the nurses’ role with regard to disclosing difficult news to incurable patients and their fami­lies. This qualitative, descriptive study involved 28 care nurses working on wards at a public hospital in João Pessoa, Paraíba, Brazil, from August to October 2012. A form was used to collect data, which was then analyzed by content analysis. Analysis of the empirical material revealed two thematic categories: giving difficult news to incurable patients and relatives: participa­tion by nurses; and strategies used by nurses to facilitate the giving of difficult news to patients and relatives. It was concluded that nurses play an essential role in breaking bad news to patients with no therapeutic possibility of cure and their relatives. RESUMEN El estudio objetivó investigar el papel de las enfermeras en relación a la comunicación de noticias difíciles a los pacientes sin posibilidades de cura y a sus familias. Se trata de un estudio descriptivo, cualitativo, en lo cual particparon 28 enfermeros que trabajan en las unidades de hospitalización de un hospital público, en la ciudad de João Pessoa – PB - Brasil, en el período de agosto a octubre de 2012. Para la recolección de datos se utilizó un formulario. Los datos fueron tratados mediante la técnica de análisis de contenido. Del análisis del material empírico, surgieron dos temas: La comunicación de malas noticias para los pacientes y sus famílias: participación del enfermeiro; y Estrategias adoptadas por enfermeros para facilitar la comunicación de noticias difíciles al paciente y a familias. Se concluye que el enfermero tiene un papel fundamental en la comunicación de malas noticias al paciente sin posibilidades terapéuticas de cura y a su familia. DOI: http://dx.doi.org/10.12957/reuerj.2014.5748

Aim: to analyze the ethical problems experienced by intensive care nurses in situations of hospitalization by judicial order in the perspective of moral deliberation. Method: qualitative research carried out between January and December 2016, through semi-structured interviews with 42 intensive care nurses from South and Southeast regions of Brazil. Interpreted through Discursive Textual Analysis. Results: the analysis resulted in three categories that present in their content the priority of deliberation, the moral suffering of nurses and the nurse's advocacy. Final considerations: health judicialization brings significant changes in social and institutional relations. Nurses must realize that, facing the different possibilities of decision-making in the face of ethical problems, important moral values are in conflict. [ABSTRACT FROM AUTHOR]

Objective: To understand how doctors and family caregivers understand the applicability of the Advance Directives to end-of-life care. Method: qualitative, descriptive and exploratory research, conducted with seven doctors of a university hospital in southern Brazil and seven family caregivers of patients at the end-of-life, from October to December 2014, from semi-structured interviews, submitted to discursive textual analysis. Results: two categories emerged: Advance Directives: the right to personal autonomy and conflicts and dilemmas in the applicability of Advance Directives. Conclusion: The Advance Directives are related to the respect of personal autonomy, professional support and reduction of the anguish and suffering of family care in view of the decision-making processes that involve the end of life. However, it is a practice surrounded by fears and concerns about its applicability and compliance by the professional. [ABSTRACT FROM AUTHOR]

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La Tanatología es la disciplina encargada de encontrar sentido al proceso de la muerte, con un método científico que la ha convertido en un arte y en una especialidad. Su objetivo principal está centrado en proporcionar calidad de vida al enfermo terminal buscando que sus últimos días transcurran de la mejor forma posible, fomentando el equilibrio de y entre los familiares. Además se ocupa de todos los duelos derivados de pérdidas significativas que no tienen que ver con la muerte ni con los enfermos moribundos.

Objective. This work seeks to describe the experiences endured by third- and fourth-year nursing students upon their first care encounter with a terminally ill patient. Methodology. This was a descriptive qualitative study with methodology of analysis of contents of written testimonies at the end of the care experience. The study had the participation of 65 students from a private university in Santiago, Chile. Results. Emerging themes were classified into seven categories: life learning is accomplished, feelings regarding the encounter, loving care, interdisciplinary work with comprehensive care, sense to nursing, incorporation of the family in caring, and development of communication skills. Conclusion. The experiences of the nursing students show they have difficulties in facing the care of an individual in process of death. Educational strategies should be posed to improve undergraduate formation on end-of-life care.

This integrative literature review aimed to characterize scientific articles on health-related quality of life – HRQoL – among patients with advanced cancer from national and international literature, and summarize those factors evidenced in the literature that contributed to the improvement or worsening of HRQoL among patients with advanced cancer. The search for materials was conducted in the following databases: CINAHL, EMBASE, PubMed, SciELO and LILACS. Among the 21 articles in the sample, 13 showed an improvement of HRQoL among patients with advanced cancer related to the development of physical, emotional and spiritual interventions. In eight studies, we identified predictive symptoms of low HRQoL, such as pain, fatigue, sleep disorders, depression, nutritional changes, and others. The results showed that clinical manifestations, which many times were inherent in cancer, such as factors that can lower patients’ HRQoL, while physical, psychological and spiritual benefits resulting from therapeutic interventions may promote its improvement.

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Copyright of Revista Bioetica is the property of Conselho Federal de Medicina and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Gaucha de Enfermagem is the property of Revista Gaucha de Enfermagem and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Avances en Enfermería is the property of Editorial Universidad Nacional de Colombia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)