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Jedan od indikatora kvalitete je plan otpusta palijativnog pacijenta iz zdravstvene ustanove. Zbog učestalih promjena u društvu i zdravstvenom sustavu sve više se pažnje posvećuje kvalitetnom planu otpusta, naročito palijativnih pacijenata. Pravovremenim prepoznavanjem pacijenta koji ima potrebu za palijativnom skrbi i upisom u registar palijativne skrbi pridajemo važnost kvaliteti života pacijenta. Palijativni timovi u zdravstvenim ustanovama procjenjuju stanje pacijenta i sukladno tome uključuju obitelj u plan otpusta. Otpust se počinje planirati već pri samom prijemu pacijenta u zdravstvenu ustanovu. U kirurgiji palijativni zahvati imaju cilj smanjiti tegobe i patnje pacijenta te su u radu nabrojani palijativni zahvati. Na kirurškim odjelima kod otpusta palijativnog pacijenta veliku važnost pridajemo komunikaciji i edukaciji pacijenta i njegove obitelji / skrbnika. Procjenjuju se potrebe i želje pacijenta u planiranju otpusta. Kod otpusta pacijentu se daje otpusna dokumentacija, koja mora biti kvalitetno, detaljno i cjelovito sastavljena kako bi se nastavio kontinuitet skrbi kakvu je pacijent imao u bolnici. Kvalitetnim planom otpusta poboljšavamo kontinuitet i dostupnost skrbi za pacijenta., One of quality indicators is discharge planing for palliative patients. Significant and frequent changes in society and health systems require better quality of discharge summaries, especially for palliative patients. Recognizing the patient who needs palliative care, and adding them into register, we add value to quality of life for those patients. Palliative teams in health institutions asses condition of patient and include family into discharge plans. Discharge is planned from the moment patient is admitted to a hospital. In surgical specialties, palliative procedures aim to reduce discomfort and suffering of patient, and this paper is describing them. On surgical wards we emphasis importance of communication and education of patient and family involved in care when we plan discharge. We always consider and embrace needs and wishes of our patient. When discharged, patient has his discharge letters which need to be properly written in details and with all explanation needed so level of care remains the same, even not in hospital environment. Proper discharge planing improves continuity and availability of patient nursing care.

The thesis deals with evaluating scales used in palliative patients. Palliative care has become a quickly developing field of study. To ensure individualized high-quality care for palliative patients, it is important for the nurse to be able to work according to the latest nursing procedures, which include, among other things, work with evaluating scales. The aim of this bachelor thesis is to find out whether nurses use specific evaluating scales in palliative patients and in what way these evaluating scales are of use to a nurse taking care of a palliative patient. The theoretical part of this thesis helps the reader get a basic preview of the issue of evaluating scales in palliative care. First, the history and division of palliative care are described. Further, the way of how palliative care works in the Czech Republic is outlined, what roles nurses hold in palliative care as well as what needs patients in palliative care have. The second chapter deals with tools used for evaluating the needs of palliative patients. The empirical part of this thesis was carried out via a qualitative research survey. Processing was done using a semi-structured interview with 10 nurses at chosen hospice facilities. First, the nurses´ identification was carried out. The interview itself consisted of 14 open-ended questions organised so that research questions would get answered. Data found out via survey was further processed using the open-coding ´pen-and-paper´ method and dividided into 4 logical categories further divided into sub-categories. A difference was found out between nurses from mobile hospice care and bed hospices in terms of the type of evaluating scales used. Evaluating scales serve nurses as an indicator of care and a quick review of problems in palliative patients. Further, information obtained via evaluating scales is consulted with doctors who may, thanks to this information, adjust their patient´s healthcare plan.

Kao što postoji zdravstvena skrb pri izlječenju tako je potrebna skrb i u završnoj fazi života. Kad se vidi da medicinski tretmani ne mogu više dovesti do izlječenja potrebno je osigurati pacijentu dostojanstven i bezbolan odlazak. Spokoj na kraju života donosi mir i pacijentu i njegovoj obitelji što pokazuje kolika je važnost palijativne njege. Usprkos današnjoj tehnologiji i napretku svih znanosti pa tako i medicine još uvijek postoje stanja i bolesti koje se ne mogu izliječiti. Kada osoba prođe sve metode liječenja te iste nisu dale učinka i kada pacijent i njegova obitelj to stanje teško podnose tada se primjenjuje palijativna skrb. Razvijanje mreže palijativne skrbi bi trebalo omogućiti mirnu i ljudsku smrt kod bolesnika sa teškim bolestima. Jako je važna timska suradnja stručnjaka u provođenju palijativne skrbi. Medicinske sestre zauzimanju posebno mjesto, obzirom da se njihova profesija temelji na holističkom pristupu, zadovljavanju ljudskih potreba, postizanjem samostalnosti, komunikacijom, te pružanjem podrške obiteljima. Strateški plan razvoja palijativne skrbi u Hrvatskoj predviđa uspostavljanje organizacije palijativne skrbi kroz nekoliko različitih modela od kojih su najvažniji županijski koordinacijski centri palijativne skrbi, te stacionarna skrb po županijama. Specijalizirana palijativna skrb je treća razina palijativne skrbi i trebaju je pružati profesionalci, a to podrazumijeva stacionarne jedinice palijativne skrbi, hospicijski dnevni boravci, bolnice u kući, bolnički te mobilni timovi za palijativnu skrb. Just as there is health care during recovery, care is also needed in the final phase of life. When it is seen that medical treatments can no longer lead to a cure, it is necessary to ensure a dignified and painless departure for the patient. Peace at the end of life brings peace to both the patient and his family, which shows the importance of palliative care. Despite today's technology and the progress of all sciences, including medicine, there are still conditions and diseases that cannot be cured. When a person has gone through all the treatment methods and they did not work, and when the patient and his family can hardly bear the condition, then palliative care is applied. Developing a network of palliative care should enable a peaceful and humane death for patients with serious and incurable diseases. The team cooperation of experts is very important in the implementation of palliative care. Nurses occupy a special place, given that their profession is based on a holistic approach, meeting human needs, achieving independence, communication, and providing support to families. The strategic plan for the development of palliative care in Croatia envisages the establishment of a palliative care organization through several different organizational models, the most important of which are county palliative care coordination centers and inpatient care by county. Specialized palliative care is the third level of palliative care and should be provided by professionals, which includes inpatient palliative care units, hospice day care centers, home hospitals, hospital and mobile palliative care teams.

Introduction. Comprehensive care for patients who no longer respond to treatment procedures is called palliative care. Palliative medicine does not delay or accelerate death, it promotes life, and considers dying as a normal process. In palliative medicine and care there is no place for hierarchy - teamwork, focus on the patient and respect for his autonomy are what is important. Aim. The conducted research shows the knowledge of nurses about palliative care at the primary, secondary and tertiary levels of health care. Methods. Prospective research in the Republic of Croatia at three levels of health care has been conducted. The sample included 150 nurses. The instrument used in the study was the Palliative Care Quiz for Nursing (PCQN). Results. The results showed that the nurses’ knowledge of palliative care is insufficient among the nursing population. Despite numerous training activities conducted over the past ten years, levels of knowledge are still lower than expected. Nurses at the primary level of health care have far greater knowledge than nurses at secondary and tertiary levels. Conclusion. Results of the study showed the need for quality education with real-life examples in order to achieve higher levels of empathy, spread knowledge about palliative care and about the importance of care for palliative patients. It is recommended to increase the number of educational activities in small groups, in the local language, adaptable and understandable to all health professionals., Uvod. Sveobuhvatnu brigu za bolesne koji više ne reagiraju na postupke liječenja nazivamo palijativnom skrbi. Palijativna medicina ne odgađa niti ubrzava smrt, ona promiče život, a umiranje smatra normalnim procesom. U palijativnoj medicini i skrbi nema mjesta za hijerarhiju, važan je timski rad, fokus na bolesnika i poštivanje njegove autonomije. Cilj. Provedeno istraživanje prikazuje znanje medicinskih sestara i tehničara o palijativnoj skrbi na primarnoj sekundarnoj i tercijarnoj razini zdravstvene zaštite. Metode. Provedeno je prospektivno istraživanje na području Republike Hrvatske na tri razine zdravstvene zaštite. U studiju je uključeno 150 ispitanika, a u istraživanju je primijenjen instrument PCQN (Palliative Care Quality Network, 1996.), anketni upitnik koji su izradile Margaret M. Ross i suradnice sa Sveučilišta Ottawa u Kanadi, koji je hrvatskom jeziku prilagodila Sandra Lovrić. Rezultati. Rezultati provedenog istraživanja pokazuju kako je znanje medicinskih sestara i tehničara o palijativnoj skrbi nedostatno bez obzira na brojne edukacije koje se provode unazad deset godina, ali da daleko veće znanje imaju medicinske sestre i tehničari na primarnoj razini zdravstvene zaštite nego na sekundarnoj i tercijarnoj. Zaključak. Prema rezultatima provedenog istraživanja možemo zaključiti da je potrebno provoditi kvalitetnije edukacije s primjerima iz stvarnog života kojima je cilj postizanje veće razine empatije, širenja znanja o palijativnoj skrbi i važnosti brige za palijativne bolesnike. Preporuka je povećanje broja edukacija u manjim grupama, na lokalnom jeziku, prilagodljivo i razumljivo svim zdravstvenim djelatnicima. Edukaciju moraju provoditi visokoobrazovani ljudi iz područja palijativne medicine i skrbi, kao i zdravstveni djelatnici koji rade na navedenom području.

ObjectivesWhile patients’ symptom experiences have been widely investigated, there is a lack of contextualized studies investigating how symptoms circulate in the medical consultation, how patients present them, what they convey, how physicians respond, and how patients and physicians negotiate with each other to find ways to address them. The aim of this study is to explore patients and physicians handling of symptoms throughout oncological consultations with a multiple case study approach.MethodsFive consultations, purposively selected from an existing dataset of audiotaped consultations with patients with advanced cancer, were analyzed by means of an inductive analytical approach based on a sensitive framework from the literature.ResultsPatients’ symptoms showed multiple dimensions such as medical, cognitive, emotional, psychological, interactional, symbolic, experiential, and existential.Significance of resultsDifferent symptom dimensions remained unnoticed and unaddressed in the consultations. The physician-centered symptom approach that was observed leads to consumed time and missed opportunities for relationship building with the patient. Physicians showed a lack of sensitivity regarding the multiple dimensions of symptoms. Based on the findings, strategies for a more comprehensive symptom approach can be conceived.

Palijativna skrb se može definirati kao pristup pomoću kojeg se bolesniku koji boluje od teške neizlječive bolesti može pomoći poboljšati kvaliteta života od dijagnoze pa sve do smrti. Djeluje multiprofesionalnim i interdisciplinarnim timskim načinom rada na tri razine kao palijativni pristup, opća palijativne skrb i specijalistička palijativna skrb te se kao četvrta razina spominju centri izvrsnosti. Zdravstvena njega bolesnika s potrebom palijativne skrbi je specifična zbog specifičnosti raznih malignih oboljenja. Rad po procesu zdravstvene njege s individualnim, holističkim pristupom je temelj za dobru palijativnu skrb. Koordiniranje, rukovođenje timom, utvrđivanje potreba, planiranje, provođenje i evaluacija ciljeva zdravstvene njege kompetencije su kojima se vodi medicinska sestra/tehničar u palijativnoj skrbi. SPIKES protokol koji se primjenjuje prilikom priopćavanja loših vijesti služi kako bi se prikupile informacije, prenijela medicinska saznanja, pružila podrška bolesniku, pridobilo njegovo povjerenje za daljnju suradnju i na kraju izradila strategija za buduće intervencije. Medicinska sestra/tehničar zajedno s bolesnikom i njegovom obitelji prolaze kroz sve faze koje su potrebne da bi bolesnik prihvatio svoju bolest i da bi se mogao pripremiti za dostojanstvenu smrt. Psihološka podrška palijativnom bolesniku se temelji na fizičkoj pomoći i dobroj komunikaciji kojom se u ovoj skrbi postižu zacrtani ciljevi, a prema izrađenim planovima, provodi se palijativna skrb s kontinuiranom evaluacijom. Važna zadaća medicinske sestre je da sudjeluje u skrbi za bolesnika na način da mu pomaže u prepoznavanju, razvijanju i primjeni strategija za suočavanje s neizlječivom bolešću. U skrb za bolesnika s potrebom za palijativnom skrbi te njegovom obitelji palijativna skrb uključuje duhovnu dimenziju skrbi te je medicinska sestra nakon smrti podrška cijeloj obitelji u procesu žalovanja. Palliative care can be defined as a specific approach that can help a patient suffering from severe incurable diseases to improve their quality of life from diagnosis to death. It operates in a multi-professional and interdisciplinary team way of working on three levels as a palliative approach, general palliative care and specialist palliative care, and centers of excellence are mentioned as the fourth level. The health care of a palliative patient is specific due to the specificity of various malignant diseases. Working through a health care process with an individual, holistic approach is the foundation for good palliative care. Coordination, team management, needs identification, planning, implementation and evaluation of health care goals are the competencies of a palliative care nurse / technician. The SPIKES protocol used to communicate bad news serves to gather information, impart medical knowledge, provide support to the patient, gain his trust for further cooperation, and ultimately develop a strategy for future interventions. The nurse / technician, together with the patient and his family, goes through all the stages necessary for the patient to accept his illness and to be able to prepare for a dignified death. Psychological support for the palliative patient is based on physical assistance and good communication, which achieves the set goals in this care. According to the developed plans, palliative care is carried out with continuous evaluation. The nurse / technician, together with the patient and his family, goes through all the stages necessary for the patient to accept his illness and to be able to prepare for a dignified death. Psychological assistance to the patient in accepting the disease, and during treatment, and assistance to the family after the loss is the task of every nurse / technician. The nurse / technician has a significant role to play in the mourning phase. Quality communication with the family both during the patient's illness and after his death should be continuous.

Bolesnici sa potrebama za palijativnom skrbi imaju visok rizik za malnutriciju, jer su prošli dugotrajni terapijski tretman bolesti koja nije reagirala na liječenje, a potom slijedi borba sa novonastalim simptomima. U tom kontekstu, nutritivna potpora je u svijetu još uvijek kontroverzna tema, zbog različitih stadija bolesti. Situacija postaje složenija kada nastupe simptomi i patnja, pa se postavlja pitanje ,,Pomažemo li ili štetimo bolesniku kada planiramo i provodimo intervencije?“. U kontekstu prehrane, traži se odgovor „Do kada treba ustrajati na nutritivnoj potpori?“. Promijenjen nutritivni status, učestalo prati palijativne bolesnike na njihovom putu borbe sa bolešću. Iako postoje univerzalni standardi nutritivne potpore, pristup bolesniku mora biti holistički, a intervencije individualizirane. Ne postoji shema po kojoj se rješavaju problemi bolesnika, pa niti nutritivna terapija, nego svakom bolesniku treba pristupiti kao osobi koja je posebna, jedinstvena i specifična. Oralni unos hrane treba preferirati dok god je to moguće u skladu sa bolesnikovim stanjem ali i odlukom. Nutritivna potpora je medicinski tretman, a njegova primjena u praksi zahtijeva od kliničara i članova tima poznavanje koncepta palijativne skrbi usmjerenog na bolesnika, etička načela, religiju i kulturu. Palijativni bolesnici mogu imati čitav spektar simptoma koji mogu utjecati i na prehranu bolesnika. Zbog toga je važna sveobuhvatna procjena bolesnika, kako bi se djelovalo na uzroke, a samim tim na smanjenje simptoma, što je jedan od glavnih ciljeva kvalitetne palijativne skrbi. Danas su na raspolaganju brojni testovi, nutritivne intervencije, dodaci prehrani, što uz dobro poznavanje istih i primjenu holističkog pristupa može uvelike pomoći zdravstvenim profesionalcima u postizanju olakšanja patnje bolesnika. Patients with palliative care needs are at high risk for malnutrition, as they have undergone long-term therapeutic treatment for a disease that has not responded to treatment, followed by a struggle with emerging symptoms. In this context, nutritional support is still a controversial topic in the world, due to the different stages of the disease. The situation becomes more complicated when symptoms and suffering occur, so the question arises "do we help or harm the patient when we plan and carry out interventions?" In the context of nutrition, an answer is sought as to when to insist on nutritional support? The nutritional status changed, often the expected part of the course of the disease. Although there are universal standards of nutritional support, access to the patient must be holistic and interventions individualized. There is no scheme by which patients' problems are solved, including nutritional therapy, but every patient should be approached as a person who is special, unique and specific. Oral food intake should be preferred as long as possible in accordance with the patient's condition and also in the decision. Nutritional support is a medical treatment, and its application in practice requires clinicians and team members to know the concept of palliative care aimed at the patient, ethical principles, religion and culture. Palliative patients may have a full range of symptoms that can also affect the patient's diet. For this reason, a comprehensive assessment of patients is important, in order to act on the causes, and therefore on reducing symptoms, which is one of the main goals of quality palliative care. Today, numerous tests, nutritional interventions, dietary supplements are available, which with good knowledge of them and the application of a holistic approach can greatly help health professionals to achieve relief of patient suffering.

Anxieties, depression, fear, depressive disorders are symptoms, which may be the part of physiological feeling with incurable disease, especially when the diagnosis is informed. Sometimes, the assumption of difficult news, related to worsening of health and even risk to life can lead to fatal consequences. For family physicians and other professionals, who are involved in palliative care, it is important to be able to diagnose the worsening of patients’ psycho-emotional state in time, in order to provide professional psychological support. In this article, the results of research of level of difficulty of depressive disorders in palliative patients depending on different demographic and social data are presented, which can be modified with changing attitudes towards these patients (when ensuring correct communication and managing of the palliative patient by the family physician). The research has shown that socio-demographic indicators significantly affect the forming of state of depression in palliative patients, and require appropriate communication between the family physician and the patient, and the organization of additional measures for managing these patients. Special attention should be given to some results of research when providing palliative care, in particular: depression of different level of difficulty, based on the PHQ-9 scale was found in 81 % of palliative patients; it was set that 90 % of people, aged of 75–90 years had depression of different level of difficulty; it was determined that all patients with high income had depression, among them 16.7 % of light and 58.3 % of moderate level of difficulty, that can be considered as a neurotic reaction of incurable disease. Depression was found in all unmarried patients, among them 35 % of light and 35 % of moderate level of difficulty, and 30 % of patients with high level as well, that significantly predominate over the number of married people (4.1 %) and widows 14 %), that may indicate character traits, which complicate the adaptation of behavioral reactions on stress factors , including to the disease. Depression was found in all unmarried patients, among them 35 % of light and 35 % of moderate level of difficulty, and 30 % of patients with high level as well, that significantly predominate over the number of married people (4.1 %) and widows 14 %), that may indicate character traits, which complicate the adaptation of behavioral reactions on stress factors, including to the disease. Such patients need additional psychological support for reducing their suffering, in particular for preventing of mental genesis pains. According to the indicators of various socio-demographic parameters, the portrait of the most vulnerable palliative patients was determined: they are women of age group 75–89 years, living in the city, by civil state – single (additional depressive factor can be assumed – long-term loneliness), by social status – pensioners with Higher Education and high income, based on a scale of PHQ-9 >20 points, that corresponds to the diagnosis: depressive syndome of heavy level., Тревожность, подавленность, страх, депрессивные расстройства – симптомы, которые могут быть частью физиологического переживания при неизлечимой болезни, особенно при сообщении диагноза. Иногда принятие тяжелой новости, связанной с ухудшением здоровья и даже угрозой для жизни, может привести к фатальным последствиям. Для семейных врачей и других специалистов, привлеченных к оказанию паллиативной помощи, важно уметь вовремя диагностировать ухудшение психоэмоционального состояния пациентов с целью предоставления профессиональной психологической поддержки. В данной статье приводятся результаты исследования степени тяжести депрессивных расстройств у паллиативных пациентов в зависимости от различных демографических и социальных данных, которые можно модифицировать путем изменения отношения к этим пациентам (при обеспечении правильной коммуникации и курации паллиативного пациента семейным врачом). Проведенное исследование показало, что социально-демографические показатели существенно влияют на формирование депрессивного состояния у паллиативных пациентов, нуждаются в соответствующей коммуникации семейного врача с пациентом и организации дополнительных мероприятий курации этих больных. Особого внимания при предоставлении паллиативной помощи заслуживают некоторые результаты исследования. В частности, депрессию различной степени тяжести по шкале PHQ-9 выявлено у 81 % паллиативных пациентов. Установлено, что 90 % лиц возрастной группы 75–90 лет имели депрессию разной степени тяжести; определено, что все пациенты с высоким уровнем дохода имели депрессию, среди них 16,7 % легкой и 58,3 % умеренной степени тяжести, что можно расценивать как невротическую реакцию на неизлечимое заболевание. Выявлено депрессию у всех пациентов, не состоявших в браке, среди которых 35 % лиц с легкой и 35 % с умеренной степенью тяжести, а также 30 % пациентов с тяжелой степенью, что достоверно преобладает над количеством женатых лиц (4,1 %) и вдовцов (14,8 %) и может указывать на черты характера, которые затрудняют адаптацию поведенческих реакций на стрессовые раздражители, в том числе к болезни. Такие пациенты нуждаются в дополнительной психологической поддержке для уменьшения их страдания, в частности, для предотвращения боли психического генеза. По изученным показателям различных социально-демографических параметров был определен общий портрет наиболее уязвимых паллиативных пациентов: это женщины возрастной группы 75–89 лет, проживающие в городе, по гражданскому состоянию – не состоящие в браке (можно допустить дополнительный депрессивный фактор – долговременное одиночество), по социальному положению – пенсионерки с высшим образованием и высоким уровнем дохода, по показатели шкалы PHQ-9 >20 баллов, что соответствует диагнозу депрессивного синдрома тяжелой степени., Тривожність, пригнічення, страх, депресивні розлади – симптоми, які можуть бути частиною фізіологічного переживання при невиліковній хворобі, особливо при повідомленні діагнозу. Іноді прийняття тяжкої новини, пов’язаної з погіршенням здоров’я і навіть загрозою для життя, може призвести до фатальних наслідків. Для сімейних лікарів та інших фахівців, які залучені до надання паліативної допомоги, важливо уміти вчасно діагностувати погіршення психоемоційного стану пацієнтів з метою надання професійної психологічної підтримки. У даній статті подаються результати вивчення ступеня тяжкості депресивних розладів у паліативних пацієнтів залежно від різних демографічних та соціальних даних, які можна модифікувати через зміну ставлення до цих пацієнтів (при забезпеченні правильної комунікації та курації паліативного пацієнта сімейним лікарем). Проведене дослідження показало, що соціально-демографічні показники суттєво впливають на формування депресивного стану у паліативних пацієнтів, потребують відповідної комунікації сімейного лікаря з пацієнтом і організації додаткових заходів курації цих хворих. Особливої уваги при наданні паліативної допомоги заслуговують деякі результати дослідження, зокрема: депресію різного ступеню тяжкості за шкалою PHQ-9 виявлено у 81 % паліативних пацієнтів. Встановлено, що 90 % осіб вікової групи 75–90 років мали депресію різного ступеня тяжкості; визначено, що усі пацієнти з високим рівнем доходу мали депресію, серед яких 16,7 % легкого і 58,3 % помірного ступеня тяжкості, що можна розцінювати як невротичну реакцію на невиліковне захворювання. Виявлено депресію у всіх неодружених пацієнтів, серед яких 35 % осіб з легким і 35 % з помірним ступенем тяжкості, а також 30 % пацієнтів з тяжким ступенем, що достовірно переважає над кількістю одружених осіб (4,1 %) та вдівців (14,8 %), що може вказувати на риси характеру, які ускладнюють адаптацію поведінкових реакцій, у тому числі до хвороби. Такі пацієнти потребують додаткової психологічної підтримки для зменшення їхнього страждання, зокрема, для запобігання болю психічного генезу. За показниками різних соціально-демографічних параметрів було визначено портрет найбільш уразливих паліативних пацієнтів: це жінки вікової групи 75–89 років, які проживають у місті, за цивільним станом – неодружені (можна допустити додатковий депресивний чинник – довготривала самотність), за соціальним станом – пенсіонерки з вищою освітою і високим рівнем доходу, показники за шкалою PHQ-9 >20 балів, що відповідає синдромальному діагнозу депресивного синдрому тяжкого ступеню.

Anxieties, depression, fear, depressive disorders are symptoms, which may be the part of physiological feeling with incurable disease, especially when the diagnosis is informed. Sometimes, the assumption of difficult news, related to worsening of health and even risk to life can lead to fatal consequences. For family physicians and other professionals, who are involved in palliative care, it is important to be able to diagnose the worsening of patients’ psycho-emotional state in time, in order to provide professional psychological support. In this article, the results of research of level of difficulty of depressive disorders in palliative patients depending on different demographic and social data are presented, which can be modified with changing attitudes towards these patients (when ensuring correct communication and managing of the palliative patient by the family physician). The research has shown that socio-demographic indicators significantly affect the forming of state of depression in palliative patients, and require appropriate communication between the family physician and the patient, and the organization of additional measures for managing these patients. Special attention should be given to some results of research when providing palliative care, in particular: depression of different level of difficulty, based on the PHQ-9 scale was found in 81 % of palliative patients; it was set that 90 % of people, aged of 75–90 years had depression of different level of difficulty; it was determined that all patients with high income had depression, among them 16.7 % of light and 58.3 % of moderate level of difficulty, that can be considered as a neurotic reaction of incurable disease. Depression was found in all unmarried patients, among them 35 % of light and 35 % of moderate level of difficulty, and 30 % of patients with high level as well, that significantly predominate over the number of married people (4.1 %) and widows 14 %), that may indicate character traits, which complicate the adaptation of behavioral reactions on stress factors , including to the disease. Depression was found in all unmarried patients, among them 35 % of light and 35 % of moderate level of difficulty, and 30 % of patients with high level as well, that significantly predominate over the number of married people (4.1 %) and widows 14 %), that may indicate character traits, which complicate the adaptation of behavioral reactions on stress factors, including to the disease. Such patients need additional psychological support for reducing their suffering, in particular for preventing of mental genesis pains. According to the indicators of various socio-demographic parameters, the portrait of the most vulnerable palliative patients was determined: they are women of age group 75–89 years, living in the city, by civil state – single (additional depressive factor can be assumed – long-term loneliness), by social status – pensioners with Higher Education and high income, based on a scale of PHQ-9 >20 points, that corresponds to the diagnosis: depressive syndome of heavy level.

U Isusovim prispodobama i poukama pronalazimo korijene hospicijskog duha, već tada kreće briga za nemoćnog čovjeka. Sveobuhvatnu brigu za bolesne koji više ne reagiraju na postupke liječenja nazivamo palijativnom skrbi. Palijativna medicina ne odgađa niti ubrzava smrt, ona promiče život, a umiranje smatra normalnim procesom. Glavni cilj ovog istraživanja koje je provedeno na području Republike Hrvatske na tri razine zdravstvene zaštite primarnoj, sekundarnoj i tercijarnoj prvenstveno je bio ispitati i prikazati znanje medicinskih sestara/tehničara o palijativnoj skrbi. Korišten je PCQN anketni upitnik, distribuiran u papirnatom obliku s priloženim pristancima za sudjelovanje u istraživanju. Istraživanje je bilo anonimno. Upitnikom koji je bio namijenjen medicinskih sestrama/tehničarima ispitivalo se znanje o palijativnoj skrbi. Istraživanje je uključilo 150 sudionika, 136 žena (90,7%) i 14 muškaraca (9,3%). Dobivenim rezultatima ovog istraživanja provedenog na primarnoj, sekundarnoj i tercijarnoj razini zdravstvene zaštite u kojem su sudjelovali medicinske sestre/tehničari nalazimo značajnu razliku u znanju, što je poražavajuće s obzirom na brojne edukacije o palijativnoj skrbi. Značajan nedostatak ovog istraživanja je nedovoljan broj sudionika muškog spola 14(9,3%) za usporedbu znanja po muškom/ženskom spolu, te nedostatan broj visokoobrazovanih medicinskih sestara za usporedbu znanja po stupnju obrazovanja. Svrha ovoga rada je utvrditi znanja o palijativnoj skrbi, na temelju čijih rezultata bi se mogao organizirati veći broj edukacija te osvijestiti medicinske sestre / tehničare o važnosti palijativne skrbi i ostvariti bolju suradnju između zdravstvenih i ne zdravstvenih djelatnika koji sudjeluju u pružanju palijativne skrbi. In Jesus' parables and teachings we find the roots of the hospice spirit, and even then the care for the helpless man begins. Comprehensive care for patients who no longer respond to treatment procedures is called palliative care. Palliative medicine does not delay or accelerate death, it promotes life, and dying is considered a normal process. The main goal of this research, which was conducted in the Republic of Croatia at three levels of primary, secondary and tertiary health care, was primarily to examine and present the knowledge of nurses / technicians about palliative care. A PCQN survey questionnaire was used, distributed in paper form with attached consents for participation in the research. The survey was anonymous. A questionnaire for nurses / technicians examined knowledge of palliative care. The study included 150 respondents, 136 women (90.7%) and 14 men (9.3%). The results of this research conducted at the primary, secondary and tertiary levels of health care, in which nurses / technicians participated, we find a significant difference in knowledge, which is devastating given the numerous educations on palliative care. A significant shortcoming of this research is the insufficient number of male respondents 14 (9.3%) to compare knowledge by male / female, and the insufficient number of highly educated nurses to compare knowledge by level of education. The purpose of this paper is to determine knowledge about palliative care, based on the results of which more trainings could be organized and to make nurses / technicians aware of the importance of palliative care and to achieve better cooperation between health and non-health professionals involved in palliative care.

Treball Final de Grau en Medicina. Codi: MD1158. Curs acadèmic: 2019/2020 Introducción: en la actualidad, la disnea es un síntoma muy prevalente entre los enfermos paliativos y más en estadios terminales. Aunque la mayoría de las guías clínicas apoyan el uso de los opioides para el alivio de la disnea, existe ciertas lagunas por las que su uso no es respaldado por todos los colectivos. Objetivos: definir la evidencia que existe sobre la eficacia de los opioides en el alivio de la disnea así como averiguar, de forma secundaria, en qué enfermedades podría ser más útil, a qué dosis y a través de qué vías. Metodología: se ha realizado una exhaustiva búsqueda en las bases de datos de PubMed, The Cochrane Library, IBECS e ÍnDICEs CSIC, siempre siguiendo una estrategia de búsqueda previamente planificada. Se sintetizó los datos mediante tablas independientes para los ensayos clínicos y para las revisiones y se analizó la calidad metodológica así como el nivel de evidencia de los estudios incluidos. Resultados: cuatro de los siete estudios concluyeron a favor de los opioides; una revisión encontró efectos pobres; y dos ensayos clínicos no encontraron diferencias respecto al placebo. Conclusión: existe evidencia de que los opioides sistémicos son eficaces en el alivio de la disnea. No obstante, se necesita estudios más homogéneos y con muestras más grandes para conseguir una evidencia con mayor solidez. Introduction: nowadays, dyspnea is a very prevalent symptom among palliative patients and more in terminal stages. Although most clinical guidelines support the use of opioids to relief dyspnea, there are certain gaps for which their use is not supported by all groups. Objectives: to define the existing evidence about the efficacy of opioids in the relief of dyspnea as well as to find out, secondarily, in which diseases it could be more useful, at what dose and by what route. Methodology: an exhaustive research has been carried out in the databases of PubMed, The Cochrane Library, IBECS and ÍnDICEs CSIC, always following a previous planned search strategy. Data were synthesized using different tables for clinical trials and reviews, and methodological quality as well as level of evidence from included studies were analysed. Results: four out of the seven studies, concluded in favour of opioids; a review found poor effects; and two clinical trials didn’t find out differences from placebo. Conclusion: there is evidence that systemic opioids are effective in dyspnea treatment. However, it is needed more homogeneous studies and larger samples to make this evidence stronger.

Palijativna skrb je disciplina kojoj je cilj poboljšati kvalitetu života pacijenata i obitelji. Ona je posvećena rješavanju emocionalnih, fizičkih, edukacijskih i egzistencijskih potreba. U liječenju palijativnog bolesnika sudjeluje multidisciplinirani tim kojeg čine liječnici različitih profesija, medicinske sestre/tehničari, socijalni radnici, psiholozi, volonteri te različite udruge. Palijativna skrb usmjerena je na liječenje simptoma koje prate osnovnu bolest. Istraživanje na temu „Stavovi o palijativnoj skrbi u Republici Hrvatskoj“ provedeno je u razdoblju od 21. do 31. svibnja 2019. godine putem Google obrasca na Internetu. Sastojao se od 19 pitanja, kojim se željelo ispitati znanje sudionika o palijativnoj skrbi. Također, željelo se ispitati osobno iskustvo sudionika te njihovo mišljenje o palijativnoj medicini i palijativnim ustanovama. U istraživanju sudjelovalo je 630 ispitanika, od čega je više od 90 % ispitanika bilo ženskog spola. Više od 30 % ispitanika bilo je u dobi od 26 do 35 godina. Najviše ispitanika bilo je sa završenim srednjoškolskim obrazovanjem njih 45 %.Ispitanici su iskazali različite stavove. Oko 70 % ispitanika smatra kako je palijativni bolesnik osoba koja umire, dok više od 80 % smatra kako palijativna medicina nije razvijena grana medicine. Ispitanici navode kako obitelj ima važnu ulogu u liječenju bolesnika. Također smatraju da na palijativnom odjelu treba vladati pozitivno raspoloženje. Palliative care is a discipline whose aim is to improve the quality of the patient's life and the life of his family. It is devoted to the solution of emotional, physical, informational and existential need. A multidisciplinary team of doctors from different professions, nurses / technicians, social workers, psychologists, volunteers and various associations is involved in the treatment of palliative patients. Palliative care is aimed at treating the symptoms that accompany the underlying disease. The questionnaire “Attitudes on palliative care in the Republic of Croatia” was conducted in the period from 21 to 31 May 2019 via the Google Form on the Internet. The questionnaire consisted of 19 questions, which sought to examine participants' knowledge of palliative care. Also, the purpose was to examine the personal experience of the participants and their opinion on palliative care and palliative care facilities. The study involved 630 participants, of whom 92.2% were female. The majority of participants were between 26 and 35 years old, 31,75 % of them, and with a completed high school education 45.08% of them. The participants showed different opinions about the specific claims. 69.68% of the participans believe that a palliative patient is a dying person, while 85.56% believe that palliative medicine is not a developed branch of medicine. Participants stated that family plays an important role in the treatment of patients. They also believe that at the palliative department should be ruled a positive mood.

Palijativna skrb je sveobuhvatna (zdravstvena, psihološka, socijalna i duhovna) skrb s ciljem pružanja potrebne njege bolesnicima s neizlječivom bolešću koja značajno skraćuje životni vijek. Povećanje broja bolesnika kojima je potrebna palijativna skrb, bez obzira radi li se o oboljelima od maligne bolesti ili drugih kroničnih, neizlječivih bolesti, zahtijeva cjelovit i interdisciplinarni pristup uključujući različite specijaliste, psihologe, psihijatre, sociologe i medicinske sestre čiju ulogu posebno treba istaknuti. Medicinska sestra u palijativnoj skrbi višestruki je aktivni sudionik koji neposredno provodi zdravstvenu njegu, koordinira i rukovodi cjelokupnim procesom skrbi. Odgovorna je za planiranje, provođenje i evaluaciju zdravstvene njege uz kontinuiranu procjenu, evaluaciju, edukaciju bolesnika i obitelji, te suradnju s ostalim članovima interdisciplinarnog tima. Ona je čvrst oslonac bolesniku, ali i obitelji. Osim u bolnici, bolesnik može boraviti u hospicijima ili kod kuće, stoga je bitno da medicinska sestra dobro educira obitelj. Iako se smatra da palijativna skrb nudi široki spektar usluga, ciljevi palijativnog liječenja su jasni: smanjenje patnje, uklanjanje boli te drugih neugodnih simptoma, psihološka i duševna skrb, podrška pojedincu kako bi živio što aktivnije te podrška obitelji. U ovom radu će se govoriti o samoj prehrani i načinima prehrane palijativnih bolesnika jer je palijativni bolesnik suočen sa brojnim problemima a jedan od njih je i smanjeno uzimanje hrane i tekućine. Osim prehrane vrlo je bitna i hidracija palijativnog bolesnika kako bi se spriječile neželjene komplikacije. Palliative care is a comprehensive (health, psychological, social and spiritual) care with the aim of providing the necessary care to patients with an incurable disease that significantly shortens life expectancy. The increase in the number of patients requiring palliative care, regardless of whether they are suffering from malignancies or other chronic, incurable diseases, requires a holistic and interdisciplinary approach including various specialists, psychologists, Psychiatries, sociologists and nurses whose role should be emphasized. The nurse in palliative care is a multiple active participant who directly translates health care, coordinates and manages the entire care process. It is responsible for planning, conducting and evaluating health care with continuous evaluation, education of patients and families, and cooperation with other members of the interdisciplinary team. She's a firm backbone to a sick man, but also a family. In addition to the hospital, the patient can stay in hospice or at home, so it is essential that the nurse well educates the family. Although palliative care is considered to offer a wide range of services, the goals of palliative treatment are clear: reducing suffering, eliminating pain and other unpleasant symptoms, psychological and mental care, supporting the individual in order to live as actively as you can, and family support . In this paper I will talk about the diet itself and the ways of eating palliative patients because the palliative patient is confronted with a number of problems and one of them is reduced intake of food and fluids. In addition to nutrition it is very important to hydrate a palliative patient to prevent unwanted complications.

У статті проаналізовано законодавство України з питання паліативної допомоги. Висвітлено актуальні проблеми державного регулювання у сфері паліативної допомоги в Україні. Проаналізовано та окреслено недоліки нормативно-правового регулювання паліативної допомоги. Визначено поняття «паліативна допомога», «паліативні хворі», «евтаназія». Окреслено основні ознаки та складові паліативної допомоги. З’ясовано, що евтаназія – це заборонна тема в Україні, вона призводить до смерті пацієнта та має на меті усунення болю та страждань хворого на його прохання. Зроблено висновок, що Україна є цивілізованою та гуманною країною, тому надається паліативна допомога паліативним хворим. Встановлено, що основними проблемами розвитку паліативної допомоги є недостатнє фінансування, недосконала нормативно-правова база, недостатня кількість знеболювального та нерозуміння населенням, яку важливу роль займає дана допомога, а саме проблеми світоглядного та ціннісного, духовного характеру, її ролі та місця в сучасній медицині та суспільстві, а також саме ставлення суспільства до таких хворих. З метою покращення ситуації запропоновано запровадити та вдосконалити низку заходів через організаційні механізми державного управління, основними з яких є: прийняття єдиного нормативного акту, поінформованість населення, належне фінансування, належна реалізація права особи на паліативну допомогу (забезпечення достатньою кількістю знеболювального, ліжок, фінансовою допомогою тощо), забезпечення можливості участі паліативних хворих та членів їх сім’ї, які зіткнулися з даною проблемою, у процесі ухвалення важливих рішень у вирішенні проблем паліативної допомоги. В статье проанализировано законодательство Украины по вопросу паллиативной помощи. Освещены актуальные проблемы государственного регулирования в сфере паллиативной помощи в Украине. Проанализированы и намечены недостатки нормативно-правового регулирования паллиативной помощи. Определено понятие «паллиативная помощь», «паллиативные больные», «эвтаназия». Определены основные признаки и составляющие паллиативной помощи. Выяснено, что эвтаназия - это запретная тема в Украине, она приводит к смерти пациента и имеет целью устранение боли и страданий больного по его просьбе. Сделано заключение, что Украина является цивилизованной и гуманной страной, поэтому предоставляется паллиативная помощь паллиативным больным. Установлено, что основными проблемами развития паллиативной помощи является недостаточное финансирование, несовершенная нормативно-правовая база, недостаточное количество обезболивающего и непонимание населением, какую важную роль занимает данная помощь, а именно проблемы мировоззренческого и ценностного, духовного характера, ее роли и места в современной медицине и обществе, а также само отношение общества к таким больным. С целью улучшения ситуации предлагается ввести и усовершенствовать ряд мероприятий по организационным механизмы государственного управления, основными из которых являются: принятие единого нормативного акта, осведомленность населения, надлежащее финансирование, надлежащая реализация права человека на паллиативную помощь (обеспечение достаточным количеством обезболивающего, кроватей, финансовой помощью и т.д.), обеспечение возможности участия паллиативных больных и членов их семьи, столкнувшиеся с данной проблемой, в процессе принятия важных решений в решении проблем паллиативной помощи. There is analyzed the legislation of Ukraine palliative care in the article. The topical issues of state regulation in palliative care of Ukraine are highlighted in the article also. The shortcomings of the regulatory regulation of palliative care are analyzed and outlined by authors. There are defined the concepts of «palliative care», «palliative patients», «euthanasia» in the research. The main features and components of palliative care are outlined in the article. The author also found that euthanasia is a prohibitive topic in Ukraine, it leads to the death of a patient and aims to eliminate the pain and suffering of the patient at his request. It is concluded that Ukraine is a civilized and humane country, so palliative care is provided to palliative patients. It is established that the main problems of palliative care development are insufficient funding, inadequate regulatory framework, insufficient amount of pain medication. The problem is also insufficient understanding of the population of Ukraine about the important role of this assistance, namely: problems of ideological and value, spiritual character, its role and place in modern medicine and society, as well as the society's attitude to such patients. In order to improve the situation, it is proposed to introduce and improve a number of measures through organizational mechanisms of public administration, the main of which are: adoption of a single regulatory act, information work with the population of Ukraine on the importance of palliative care, adequate financing of this branch of medicine, proper exercise of the person's right to palliative care (providing sufficient pain medication, beds, financial assistance, etc.), providing the opportunity for the participation of palliative patients and their family members.

Palijativna skrb definirana je kao aktivna i potpuna skrb za pojedinca sa uznapredovanom i neizlječivom bolešću, njegovu obitelj i zajednicu. Naglasak skrbi je na očuvanju kvalitete života, suzbijanju boli i drugih promjena sa kojima se pacijent suočava. Obitelj oboljelog ima ključnu ulogu u brizi za oboljelog člana. Oboljeli koji se nalaze u terminalnoj fazi bolesti žele svoje posljednje dane provesti u poznatoj okolini, svojem domu, zajedno sa svojim voljenima. Nerijetko zbog težine bolesti oboljeli moraju biti smješteni u ustanovu za pružanje palijativne skrbi. Oboljeli tu dobivaju cjelovitu skrb zahvaljujući posebno educiranom multidisciplinarnom timu. Cilj ovog rada i istraživanja bio je ispitati zadovoljstvo kvalitetom pružene palijativne skrbi u Općoj bolnici Varaždin, Službi za produženo liječenje i palijativnu skrb iz perspektive obitelji pacijenata te ispitati postoji li povezanost između informiranosti, spola člana obitelji palijativnog pacijenta, duljine bolesti i zadovoljstva kvalitetom pružene palijativne skrbi. U istraživanju je korišten anketni upitnik „Kvaliteta skrbi palijativnog pacijenta iz perspektive obitelji“, koji je bio u potpunosti anoniman. U istraživanju je sudjelovalo 74 ispitanika. Više od polovice ispitanika (68,9%) bilo je ženskog spola, dok je 31,1% bilo muškog spola. Najmlađi od ispitanika je, u trenutku istraživanja, imao 22 godine, a najstariji 78 godina. Rezultati istraživanja pokazuju da su članovi obitelji palijativnih pacijenata zadovoljni skrbi zdravstvenog osoblja na odjelu. Postoji statistički značajna pozitivna povezanost između informiranosti o bolesti, tijeku i ishodu oboljelog člana obitelji i zadovoljstva skrbi zdravstvenog osoblja na odjelu. Što se ispitanici smatraju bolje informiranima to su zadovoljniji skrbi zdravstvenog osoblja na odjelu. Ne postoji statistički značajna razlika u zadovoljstvu skrbi na odjelu ovisno o tome koliko dugo član obitelji boluje od palijativne bolesti. Postoji statistički značajna razlika u informiranosti o bolesti, tijeku i ishodu oboljelog člana obitelji ovisno o spolu ispitanika. Ženske ispitanice se izjašnjavaju kao bolje informirane od muških ispitanika. Palliative care is defined as active and complete care for individuals with advance and incurable disease, his family and community. The emphasis of care is on preserving the quality of life, pain suppressing and other changes that the patient is facing. Patient’s family have a key role in caring for a sick member. Patients who are in terminal phase of disease want to spend their last days in a familiar environment, their home, with their loved ones. Often due to the severity of the illness, patients must be placed in a palliative care facility. Patients in that facility receive comprehensive care thanks to the specially educated multidisciplinary team. The aim of this paper and research was to examine satisfaction with the quality of palliative care provided at the Varaždin General hospital, extension care and palliative care Service from the perspective of the patient's family member, length of illness and satisfaction with the quality of provided palliative care. In this research was used a survey questionnaire „Quality of care for a palliative patient from a family perspective“, which was completely anonymous. 74 respondents participated in the research. More than half of the respondents (68,9%) were female, while 31,1% were male. The youngest respondent, at the time of the research was 22 years old and the oldest was 78 years old. The results of the research show that family members of palliative patients are satisfied with the care of the health care staff at the ward. There is statistically significant positive connection between awareness of the disease, course and outcome of the affected family member and satisfaction with the care of health care staff at the ward. The more well informed the respondents were, the more satisfied they were with the care of health care staff at the ward. There is no statistically significant difference in the satisfaction of ward care depending on how long a family member has been suffering from palliative disease. There is statistically significant difference in information about the disease, course and outcome of the affected family member, depending on the gender of the respondents. Female respondents declare themselves better informed than male respondents.

Relatório de Estágio do Mestrado Integrado em Ciências Farmacêuticas apresentado à Faculdade de Farmácia Esta monografia aborda o controlo da dor no contexto dos cuidados paliativos. O doentepaliativo é, por norma, um doente com quadro clínico e sintomatologia complexos, que requerum acompanhamento especializado e multidisciplinar.A dor é um sintoma transversal e determinante na qualidade de vida do doente, impactando,não só na vertente física, como também na psicológica e social. Deste modo deve ser um focoprincipal na terapêutica paliativa, de modo a permitir algum conforto ao doente e à família. Otratamento da dor é conseguido através da utilização de fármacos com propriedadesanalgésicas (analgésicos não-opioides, anti-inflamatórios não esteroides e/ou opioides maisfármacos adjuvantes) e/ou de medidas não farmacológicas (interventivas ou não).Os cuidados paliativos estão em crescimento a nível mundial, sendo ainda algo escasso nonosso país e que tem sido foco de trabalho, investigação e legislação nas últimas duas décadas.A inclusão do farmacêutico nas equipas de cuidados paliativos como membro ativo épertinente na medida em que este pode ser uma mais valia, prestando o seu contributo narevisão da terapêutica, identificação de interações farmacológicas, avaliação da necessidade dealteração de prescrições ou mesmo desprescrição de fármacos, ajuste de doses, cálculo dedoses equianalgésicas e educação do doente e cuidadores para o uso racional do medicamento.O Estágio Curricular é uma ferramenta decisiva e essencial para a finalização do MestradoIntegrado em Ciências Farmacêuticas. Permite-nos consolidar os conhecimentos adquiridosdurante o período letivo, ficar a conhecer ao pormenor aquela que é ainda uma das saídasprofissionais exclusivas do Farmacêutico e o impacto da sua intervenção na saúde pública.Alerta-nos ainda para a Farmácia Comunitária como ponto de encontro dos vários atosfarmacêuticos, o elo final de uma longa cadeia, e o ponto de encontro com a população. Nestesentido, o trabalho desta estrutura é essencial para a promoção da literacia em saúde e douso consciente e correto do medicamento.O estágio na Farmácia Estádio foi, sem dúvida, profícuo e considero que elevou os meusconhecimentos e experiência sobre o mundo da Farmácia Comunitária. Tive umacompanhamento sólido e rico, permitindo-me ficar a par das várias atividades e processos aílevados a cabo, preparando-me da melhor maneira para o futuro. This monograph deals with pain control in the context of palliative care. The palliative patient is, ingeneral, a patient with a complex clinical history and symptomatology, requiring specialized andmultidisciplinary follow-up.Pain is a transversal and determinant symptom in the quality of life of any patient, impacting not onlyin its physical but also in the psychological and social aspects. This way, it should be a major focus inpalliative care, so as to allow some comfort to the patient and their family. Treatment of pain isachieved through the use of drugs with analgesic properties (non-opioid analgesics, non-steroidal anti-inflammatorydrugs and/or opioids with adjuvant drugs) and/or non-pharmacological measures(interventive or non-interventive).Even though palliative care is growing worldwide, it is still scarce in our country and has been the focusof work, research and legislation in the last two decades. The inclusion of the pharmacist in palliativecare teams, as an active member, is pertinent and can be an asset, contributing to the revision of thetherapy, identification of pharmacological interactions, assessment of the need to change prescriptionsor even dose adjustment, calculation of equianalgesic doses and education of the patient and caregiversfor rational drug use.The Curricular Internship is an essential and decisive tool for finishing the Integrated Masters in Pharmaceutical Sciences. It allows us to cement the knowledge acquired during the degree, getting to know the professional area that is still exclusive of the pharmacists and their impact on public health. It also alerts us to the Pharmacy as a meeting point for all the pharmaceutical chain, and its meeting point with the population.So being, the work of this structure is essential for the promotion of literacy in health and the rational use of medicine. The internship in the Pharmacy was clearly profitable and elevated my knowledge and experience of this activity and all its processes, preparing me for the future.

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Relatório de Prática Clínica apresentado à Escola Superior de Saúde Dr. Lopes Dias do Instituto Politécnico de Castelo Branco para cumprimento dos requisitos necessários à obtenção do grau de Mestre em Cuidados Paliativos. Submitted by Lurdes Grilo (lurdesgrilo@ipcb.pt) on 2019-04-24T14:26:45Z No. of bitstreams: 1 trabalho final Ana Oliveira_A.pdf: 11663661 bytes, checksum: c78fbce42722f359c969152e6f5ceedd (MD5) Approved for entry into archive by Lurdes Grilo (lurdesgrilo@ipcb.pt) on 2019-04-24T14:27:42Z (GMT) No. of bitstreams: 1 trabalho final Ana Oliveira_A.pdf: 11663661 bytes, checksum: c78fbce42722f359c969152e6f5ceedd (MD5) Made available in DSpace on 2019-04-24T14:31:53Z (GMT). No. of bitstreams: 1 trabalho final Ana Oliveira_A.pdf: 11663661 bytes, checksum: c78fbce42722f359c969152e6f5ceedd (MD5) Previous issue date: 2019-03-26

S obzirom da je sve veća potreba za palijativnom skrbi potrebno je mnogo više od pasivne skrbi kako bi se osigurala dostojanstvena smrt. Danas palijativna skrb nastoji pomoći pacijentima da dostojanstveno žive sve do smrti. Palijativna skrb je pristup koji poboljšava kvalitetu života bolesnika. Također palijativna skrb je holistički usmjerena ne samo na bolesnika već i na njegovu obitelj/bližnje, a provodi ju multidisciplinarni tim u kojem se nalaze i volonteri. Volonteri imaju bitnu ulogu jer doprinose kvaliteti palijativne skrbi. Cilj ovog rada je istražiti informiranost ljudi o volontiranju, palijativnoj njezi te njihovom odnosu. Ispitivanje je provedeno na uzorku od 208 ispitanika s područja Međimurske i Varaždinske županije, od kojih je 85,6% ženskih, a 14,4% muških ispitanika. Najviše ispitanika je u starosti između 18 i 30 godina (73,2%). Istraživanje je provedeno pomoću anketnog upitnika, putem društvenih mreža. U radu će se analizirati značenje pojma volontiranja, stajalište o doprinosu volontiranja, zašto se volontira, odnosno ne volontira, znanje o palijativnoj skrbi i ulozi volontera u palijativnoj skrbi te kako bi ispitanici unaprijedili volontiranje. Dobiveni rezultati govore da su ispitanici upoznati s pojmovima volontiranja, palijativne skrbi, palijativnog pacijenta i uloge volontera. Volontiranje se smatra humanom djelatnošću, koja doprinosi osobnom zadovoljstvu volontera, razvoju samopoštovanja, stjecanju znanja i vještina te upoznavanju novih i zanimljivih ljudi. Također smatra se kako su ljudi pasivni i nemaju ambicija za volontiranje, no ispitanici su upoznati s mjestima gdje se može volontirati. O palijativnom pacijentu i skrbi većina ispitanika izrazila je vrlo dobro znanje, što je pozitivni pokazatelj upućenosti ispitanika. Pozitivno se ocjenjuju volonteri u palijativnoj skrbi te ispitanici znaju koje su zadaće volontera. Rezultati pokazuju kako je unapređenje volontiranja moguće uz veću medijsku pozornost i veću edukaciju stanovništva. Due to the increasing need for palliative care requires much more than passive care to ensure a pleasant death. Today, palliative care strives to help patients live well until his death. Palliative care is an approach that improves the quality of life of patients. Also, palliative care is holistic directed not only to patients but also to his family / loved ones, and carried out by a multidisciplinary team in which there are volunteers. Volunteers play an important role because they contribute to the quality of palliative care. The aim of this paper is to check the awareness of people about volunteering, palliative care and their relationship. Testing was conducted on a sample of 208 subjects in the Međimurje and Varaždin, of which 85.6% female and 14.4% of men. Most subjects in the age between 18 and 30 years (73.2%). The study was conducted by a questionnaire. An analysis of the meaning of volunteering, the view on the contribution of volunteering, why volunteer or not to volunteer, knowledge of palliative care and the role of volunteers in palliative care and to help participants enhance volunteering. The results show that they are acquainted with the concepts of volunteering, palliative care, palliative patient and the role of volunteers. Volunteering is considered a human activity that contributes to the personal satisfaction of volunteers, developing self-esteem, acquire knowledge and skills and meeting new and interesting people. Also it is believed that people are passive and have no ambition for volunteering, but the respondents are familiar with the places where you can volunteer. A palliative patient care and the majority of respondents expressed a very good knowledge, which is a positive indicator of familiarity of respondents. Positively evaluated the volunteers in palliative care and the respondents know that the tasks of volunteers. The results show that the promotion of volunteering as possible with more media attention and higher education population.

Introduction: Transferring palliative patients between care settings hospital, hospital’s palliative care unit, home and nursing home, is challenging and often hampers integrated care. These transfers are common due to the complexity of palliative care, demographic changes increased prevalence of multimorbidity and higher life expectancy and social changes more people living alone. As a result, transfers require efficient and effective collaboration in order to provide good quality of care. This study is part of a larger research project on integrated care for palliative patients, in a regional palliative care network in Belgium. The study aim was: - to explore healthcare professionals’ experiences of interprofessional collaboration - to explore their perceived factors influencing the continuity of care during palliative patients’ transfer of care setting. Methods: Nine focus group discussions were held, with various professionals GPs, nurses, specialists, psychologists, dieticians, social workers, coordinators. N: 53 from different palliative care settings. Constant comparative analysis was used. Results: Knowing each other personally positively influenced the interprofessional collaboration. Perceptions of hierarchy negatively influenced the interprofessional collaboration, within and between the settings. Timely and sufficient information flow between all professionals involved was considered fundamental. A perceived barrier for interprofessional collaboration was the lack of a shared electronic health record. Efficient multi-disciplinary team meetings with shared care goals were regarded essential, though often lacking. Participants reported that specialists informed the patients on disease stage and prognosis late and insufficiently. This hampered open communication on end-of-life decisions and impeded a timely transfer to the home situation or the palliative care unit. The complexity of patient’s case interfered with the hospitalization length and timely organizing optimal home care the moment of discharge. When transfer to a nursing home was deemed necessary, waiting lists negatively influenced the continuity of care Discussion: Our research shows that several clinical, organisational and service aspects of care at micro-, meso- and macro-level can be improved. At micro-level: insufficient open and timely communication towards the patient, hampers other healthcare professionals’ involvement. Together with absence of shared care goals, this negatively influences a timely referral to other settings. At meso-level: the current electronic health record system does not provide enough opportunities to share and exchange information for professionals involved, within and between the different care settings. At macro-level: continuity of care is hampered when appropriate supply of services lack: e.g., when referral to a nursing home is needed. Conclusions and lessons learned: Doctors should be trained more in bad news delivery and shared decision making. Interprofessional education modules may enhance collaboration and the discussing of shared care goals. Policy makers should invest in sufficient supply of palliative care services and the development of an electronic health record system to provide efficient and effective information transfers between settings. Limitations: We focused on only 1 palliative care network, therefor we are careful to generalize our results. Suggestions for future research: Interventions aiming to improve integrated care within the region will be evaluated.

Gubitak zdravlja za svakog pojedinca je jedan od najtežih gubitaka, no nažalost to se odnosi i na njegovu obitelj. Palijativna zdravstvena njega je novija grana u medicini koja je multidisciplinarna, i po tome posebna. Nakon saznanja o bolesti, potrebno je izraditi plan zdravstvene njege, koji će biti usmjeren na održavanju normalnih fizioloških funkcija i prevenciji komplikacija drugim zdravstvenim stanjima. Bolesnika suočen sa nepovratnom dijagnozom, potrebna je sveobuhvatna zdravstvena njega. U ovomu radu dotaknuti ću se prehrane i hidracije palijativnoga pacijenta, ponajviše kao se stvara ironija na kraju života. Cijeli život ne možemo bez hrane i bez vode, a na samom kraju nam je potrebna toliko malo hrane i vode, a srdačan i iskren stisak ruke na veoma znači. U zadnjem stadiju života potrebno je sagledati nekoliko čimbenika o prehrani i hidraciji. Cilj je koliko sam pacijent može uzeti oralno prehranu i tekućinu, koliko je on zainteresiran sudjelovati u tim radnjama, kako se pacijent osjeća priliko hranjena, kako se osjeća njegova obitelj u tim nesvakidašnjim situacijama, i prema tome intervenirati i nadopuniti prehranu i hidraciju sa drugim potpomognutim metodama. Medicinska sestra je punopravni član multidisciplinarnog tima, pa time sa svojem znanjem i umijećem motivira pacijenta na suradnju koliko je moguće. Veoma je bitno poštivati pacijentove zahtjeve i na taj način pridobiti pacijenta povjerenje. Obitelji je veoma bitno objasnit koliko, je zapravo bitno njegovoj omiljeni osobi hrana i piće, a pritom biti empatičan i stvoriti povjerenje njima nepoznatoj situaciji. Loss of health for each individual is one of the most serious losses, but unfortunately this also applies to his family. Palliative medical care is a newer branch of medicine that is multidisciplinary, and in that special. After learning about the disease, it is necessary to make the health care plan, which will be focused on how much the maintenance of normal physiological function and prevention of complications of other medical conditions. Patients faced with irreversible diagnosis requires a comprehensive health it.On this article I will touch nutrition and hydration palliative patients, particularly as it creates an irony at the end of life. All my life, can not do without food and without water, and at the end we need so little food and water, a cordial and sincere handshake at the very means. In the last stage of life it is necessary to consider several factors about nutrition and hydration. The aim is to look at how many patients can not take oral nutrition and fluids, as far as he is interested to participate in these actions, how the patient feels parable fed, how he feels his family in these unusual situations, and therefore intervene and complement the nutrition and hydration with other assisted methods. The nurse is a full member of the multidisciplinary team, and thus with their knowledge and skills to motivate the patient to co-operate as much as possible. It is very important to respect the patient's requirements and thus obtain the patient's trust. The family is very important to explain how much is actually essential to his favorite person food and drink, while being empathic and create trust them ambiguous situation.

Teoretična izhodišča: Podhranjenost predstavlja vse večji problem. Opaža se v različnih starostnih skupinah. Pomanjkanje hranil in pomembnih mikroelementov vpliva na osnovne fiziološke procese in posledično privede do poslabšanja bolezenskega stanja. Namen raziskave je bil ugotoviti prehransko ogroženost pri paliativnih bolnikih. Raziskovalna metodologija: V teoretičnem delu smo uporabili deskriptivni metodi dela, in sicer metodo deskripcije in metodo kompilacije. Kot raziskovalni instrument smo uporabili anonimni standardizirani anketni vprašalnik »Mini Nutritional Assessment (MNA)« oziroma v prevodu»Mini prehranska anamneza« (www.mna-elderly.com), ki je bil sestavljen iz dveh delov. Za vključitev v raziskavo smo prepoznali 40 paliativnih bolnikov. Iz medicinske dokumentacije smo pridobili potrebne podatke laboratorijskih preiskav za hemoglobin, kalij, natrij in holesterol, ter jih primerjali z orientacijskimi vrednostmi. Za predstavitev smo uporabili opisno statistiko. Za potrditev oziroma ovržbo postavljenih hipotez smo uporabili eksaktni binomski statistični test, ker je bil testiran manjši vzorec. Rezultati: V raziskavi smo s statistično analizo podatkov ugotovili, da je večina anketirancev, to je 54,3%, podhranjenih, 31,4% kaže tveganje podhranjenosti in 14,3% ima normalno prehranjenost. Iz analize rezultatov drugega dela anketnega vprašalnika sledi ocena prehranjenosti, ki kaže, da je večina anketirancev (63%) podhranjenih, pri 28% se kaže tveganje podhranjenosti in le pri 9% je normalna prehranjenost. Iz statistične obdelave podatkov izhaja, da znaša vrednost signifikance < 0,000 (p < 0,05). V drugem delu raziskave smo izvedli laboratorijske preiskave za hemoglobin, kalij, natrij in holesterol. S statistično analizo podatkov smo ugotovili, da povezava med prehranskim statusom in parametri laboratorijskih preiskav pri paliativnih bolnikih na področju hemoglobina, kalija, natrija in holesterola ne obstaja. Sklep:Več kot polovica paliativnih bolnikov je ob sprejemu v bolnišnico podhranjenih. Potrebna je skrb za prehrano bolnika, individualna obravnava in izvajanje prehranske podpore. Povezava med prehranskim statusom in parametri laboratorijskih preiskav ni bila dokazana. Na tem področju je še potrebno narediti dodatne raziskave. Theoretical starting points: Malnutrition is an increasing problem. It is observed in different age groups. The lack of nutrients and important microelements affects the basic physiological processes and consequently leads to a worsening of the disease state. The purpose of the study was to determine the nutritional risk in palliative patients. Research methodology: In the theoretical part, we used the descriptive method of work, namely the method of description and the method of compilation. An anonymous standardized questionnaire »Mini Nutritional Assessment« (MNA), (www.mna-elderly.com), which consisted of two parts, was used as a research instrument. For inclusion in the study were identified by 40 palliative patients. From the medical documentation, we obtained the necessary data of laboratory tests for hemoglobin, potassium, sodium and cholesterol and compared them with the orientation values. Descriptive statistics were used for the presentation. In order to confirm or refute hypotheses, we used an exact binomial statistical test, because a smaller sample was tested. Results: In the study, a statistical analysis of data revealed that most respondents, that is 54.3%, are malnourished, 31.4% showed a risk of malnutrition and 14.3% had normal nutrition. The analysis of the results of the second part of the questionnaire is followed by a nutritional assessment showing that most respondents (63%) are malnourished, with 28% showing the risk of malnutrition, and only 9% have normal nutrition. statistical data processing shows that the significance value is 0,000 (p

Palijativna skrb je pristup koji poboljšava kvalitetu života bolesnika i njihovih obitelji suočenih s problemima povezanim s neizlječivom bolesti. Cilj zdravstvene njege palijativnog bolesnika je umanjiti ili odgoditi patnju i bol, osigurati bolesniku kvalitetan život, omogućiti dostojanstven proces umiranja te pružiti podršku obitelji koja sudjeluje u zbrinjavanju bolesnika. Proces provođenja palijativne skrbi je kompleksan i zahtijeva angažman cijelog tima dobro educiranih stručnjaka, a to su liječnici, medicinske sestre, fizioterapeut, psiholog, socijalni radnik i duhovnik. Tim je glavno sredstvo djelovanja, a upravo su interakcijski procesi među članovima od vitalne važnosti za uspjeh. Procjenjuje se da je neki oblik palijativne skrbi potreban kod 50% do 89% umirućih pacijenata, što bi za Republiku Hrvatsku iznosilo između 26000 do 46000 pacijenta godišnje. SB za produženo liječenje Duga Resa je ustanova koja pruža produženo liječenje, palijativnu skrb i djelatnosti specijalističko konzilijarne zdravstvene zaštite. U bolnicu se primaju bolesnici koji boluju od teških kroničnih bolesti, nakon prethodne akutne hospitalizacije, kako bi im se poboljšala kvaliteta života i omogućio što brži povratak u obitelj. Bolnica ima dugu tradiciju i mnogo iskustva u pružanju dugotrajnog liječenja, osim toga, od 2012. godine ima registrirane postelje za palijativnu skrb, a od 2015. godine i zaseban odjel. To je najveća ustanova u Karlovačkoj županiji koja pruža takvu skrb. Osim bolesnika iz Karlovačke županije i bolesnici iz drugih susjednih županija česti su korisnici skrbi i liječenja koje nudi SB Duga Resa. SB Duga Resa ima realnu praksu, posjeduje odgovarajuće resurse i znanje, postoje velike potrebe za usluge koje pruža te postoje mogućnosti i potrebe za daljnji razvoj., Palliative care is an approach that improves the quality of patients' lives and the lives of their families, facing problems associated with a life-threatening disease. The aim of palliative care is to reduce or delay pain and suffering, to ensure quality of life for the patient, to enable patients to die with dignity and to support the family that takes care of the patient. The process of palliative care is complex and requires the engagement of a whole team of educated specialists, such as doctors, nurses, physical therapists, psychologists, social workers and priests. It is of vital importance for an efficient palliative care to be provided in the first place by a professional team of specialists who work together. It is estimated that between 50% and 89% of all dying patients require some form of palliative care. In the Republic of Croatia that would mean between 26 000 and 46 000 patients per year. It is estimated that in Karlovac County approximately 4 300 patients will require some form of palliative care during a period of three years. Special hospital Duga Resa is a hospital that provides long-term treatment, palliative care, and specialist conciliar health care. Patients who are diagnosed with a severe chronic disease, after previous treatment in acute hospital, are hospitalized to improve the quality of their life and to prepare them for a return to their homes. The hospital has a long tradition and a lot of experience in providing long-term treatment. What is more, since 2012 it has had registered beds for palliative care, and since 2015 a separate hospital ward for palliative care. It is the biggest hospital in Karlovac County which provides such care. Special hospital Duga Resa provides care not only for patients from Karlovac County but also for patients from other, neighbouring counties. Special hospital Duga Resa possesses the right resources and knowlege, also, there is great demand for the service it provides. In the future further development is expected.

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Sarrera: Era azkar eta aurreratuan eboluzionatzen ari den gizartean bizi garen arren, heriotza oraindik ezkutuan dagoen gaia da. Gizartearen eboluzio honetan, aldaketa sozialak, demografikoak eta familiarrak ere aurkitzen ditugu eta honekin batera, zaintzailearen rol tradizionala. Heriotza etxeetatik ospitalera pasa den arren, azken urteetan, garrantzia ematen ari zaio, tradizionalki egiten zen bezala, gaixo terminalak beren familiaren intimitatean eta etxean, azken egunak eta uneak igarotzeko. Izan ere, gaixoak horretarako eskubidea dauka. Gaixo terminalak etxean igarotzen baditu azken egunak, familiaz gain, erizaina izango da zainketak era integral eta holistikoan eskainiko duen osasun-langilea. Helburuak: Helburu nagusia, erizainaren papera aztertzea da bizitzaren azken etapa etxean igarotzen ari den gaixo terminalarekin. Bigarren mailako helburuak ere garatuko dira, hala nola, gaixo terminalen hiltzeko lekuari dagokion lehentasunak deskribatuko dira, hauen hiltzeko lekua zein den aztertuko da eta heriotza tokian eragiten duten faktore ezberdinak aztertuko dira. Metodologia: Errebisio narratiboa egiteko Pubmed, Scielo, Dialnet eta BVS datubaseetan bilaketa egin da eta guztira 45 artikulu aukeratu dira. Honetaz gain, erreferentzia diren eta gaiarekin lotuta dauden web-guneak eta aldizkariak ere erabili dira. Emaitzak: 45 artikulu bildu dira, zainketa plan bat, osasun plan bat, sei berrikuspen sistematiko, zazpi kohorte ikerketa, bi ikerketa kuaxiesperimental, bi kasu eta kontrol, bi kasu serie, sei berrikuspen narratibo, zazpi ikerketa kualitatibo, zortzi ikerketa deskriptibo, iritzi artikulu bat, Osakidetzako dokumentu ofizial bat eta lege bat. Ondorioak: Gaixo terminal gehienak etxean hiltzeko lehentasuna dute, hala ere, lehentasunak askotan hutsean gelditzen dira eta Europan gaixo terminalen erdiak baino gehiago ospitalean hiltzen dira. Heriotza tokian eragiten duten faktoreak anitzak dira eta gehiengoak gaixoaren esku ez dauden faktoreak dira. Erizainaren papera azken egunak etxean igarotzen duten gaixoarentzat eta familiarentzat ezinbestekoa eta garrantzitsua da. Erizainak funtzio ugari izango ditu, beti ere, gaixoaren aspektu fisikoak, emozionalak, sozialak eta espiritualak kontuan hartuz.

U novije vrijeme sve se više otvoreno govori i sa znanstvene strane izučava proces umiranja i smrti neizlječivo bolesnih osoba. Palijativna skrb daje odgovore na pitanja kako kvalitetno živjeti do samoga kraja. Takva je skrb posvećena stvaranju okolnosti u kojima proces umiranja, a i sama smrt postaje dostojanstven i prihvatljiv trenutak. Palijativni je pristup utemeljen na empatiji, razumijevanju, očuvanju dostojanstva pacijenta, otvorenoj dvosmjernoj komunikaciji te brizi o obitelji pacijenta. Palijativna skrb fokusirana je na poboljšanje kvalitete preostalog života bolesnika i njegove obitelji. Ona započinje kada su iscrpljene sve klasične metode liječenja. U Republici Hrvatskoj je palijativna medicina još uvijek u začetcima, iako zakonska osnova za osnivanje palijativne skrbi postoji još od 2003. godine. Ipak, postoje brojni primjeri dobre prakse, koji egzistiraju bez prave organizacijske i formalne podrške. Ukoliko se na pravo na palijativnu skrb gleda kao na posebno ljudsko pravo, može se zaključiti kako Republika Hrvatska značajno zaostaje za razvijenim zemljama po tom pitanju. Filozofija palijativne skrbi počiva na skupu zajedničkih vrijednosti, a jedna od tih vrijednosti je dostojanstvo. Umiruća osoba ima snažnu potrebu sačuvati svoje dostojanstvo tijekom razdoblja umiranja i u samoj smrti. Dostojanstvo podrazumijeva očuvanje samopoštovanja, individualnosti i ljudskosti pacijenta. Kod umirućih bolesnika često se javljaju psihološki simptomi poput tjeskobe i depresije, zbog čega je jako bitna briga o njihovim psihološkim potrebama. No, ipak je primarni cilj palijativne skrbi ukloniti bol te na taj način utjecati na očuvanje kvalitete bolesnikova života. Značajnu ulogu u provođenju palijativne skrbi ima medicinska sestra koja neposredno provodi zdravstvenu njegu te je odgovorna za njezino planiranje, provođenje i evaluaciju, u suradnji s ostalim članovima multidisciplinarnog tima. Svrha je ovog rada, pregledom dostupne literature na hrvatskom i engleskom jeziku, objediniti pojedine elemente dostojanstva kod palijativnih pacijenata, sa posebnim naglaskom na komunikaciju, duhovnost, obitelj palijativnog pacijenta te etičke probleme koji se pritom javljaju. More recently, it is more and more openly concerned with the scientific foreign research of the process of dying and dying of incurable sick people. Palliative care provides answers to the questions of how to live right to the very end. Such care is devoted to creating the circumstances in which the dying process is, and death itself becomes a dignified and acceptable moment. Palliative approach is based on empathy, understanding, preservation of patient dignity, open two-way communication and care of a family patient. Palliative care is focused on improving the quality of the remaining life of the patient and his / her family. It begins when all the classic methods of treatment are exhausted. In the Republic of Croatia, palliative medicine is still in its infancy, although the legal basis for the establishment of palliative care has existed since 2003. However, there are numerous examples of good practices that exist without proper organizational and formal support. If the right to palliative care is viewed as a special human right, it can be concluded that the Republic of Croatia significantly lags behind the developed countries on this issue. The philosophy of palliative care rests on a set of common values, and one of these values is dignity. A dying person has a strong need to preserve his dignity during the period of death and death itself. Dignity implies the preservation of self-esteem, individuality and humanity of the patient. Psychological symptoms such as anxiety and depression often occur in patients, which is why they care about their psychological needs. No, however, the primary goal of palliative care is to eliminate pain and thus affect the preservation of the quality of a patient's life. A significant role in palliative care is provided by her nurse who is directly involved in health care and is responsible for planning, conducting and evaluating her, in cooperation with other members of the multidisciplinary team. The purpose of this paper, an overview of available literature in Croatian and English, brings together elements of dignity in palliative patients, with particular emphasis on communication, spirituality, family palliative patient, and ethical problems that arise.

This article outlines the linguistic validation of the Good Death Inventory (GDI) translation into Spanish, used to assess the quality of care at the end of a patient’s life. A standardized procedure was followed to do this that included a blind back translation process and an exploration of the conceptual adaptation of the scale into Spanish through six cognitive interviews with relatives of deceased patients. The translation of the scale (54 items) showed indicators of low difficulty. Six items required syntactic changes, 12 required semantic changes and only one item required syntactic and semantic changes. All items were considered applicable to the Spanish context. The degree of difficulty was higher for the back translation than for the translation itself. The cognitive interviews highlighted the difficulty of choosing between seven answers, especially those that were formulated as negative. Five items were difficult to understand. The Spanish version of the GDI has been adapted well to the Spanish context. Este artículo presenta la validación lingüística española del Good Death Inventory (GDI), para la evaluación de la calidad de los cuidados al final de la vida. Se llevó a cabo un proceso estandarizado de traducción y retrotraducción ciegas y se examinó la adecuación conceptual de la escala al contexto español a través de seis entrevistas cognitivas a familiares de pacientes fallecidos. La traducción de la escala (54 ítems) mostró indicadores de dificultad bajos. Seis ítems precisaron cambios sintácticos, 12 cambios semánticos y sólo un ítem precisó cambios sintácticos y semánticos. Todos los ítems fueron considerados aplicables al contexto español. El grado de dificultad de la retrotraducción fue superior al de la traducción. Las entrevistas cognitivas mostraron dificultad para discriminar entre las siete alternativas de respuesta, especialmente en los ítems formulados en negativo. Cinco ítems presentaron dificultades de comprensión. La versión española del GDI presenta una buena adecuación al contexto español.

This article outlines the linguistic validation of the Good Death Inventory (GDI) translation into Spanish, used to assess the quality of care at the end of a patient's life. A standardized procedure was followed to do this that included a blind back translation process and an exploration of the conceptual adaptation of the scale into Spanish through six cognitive interviews with relatives of deceased patients. The translation of the scale (54 items) showed indicators of low difficulty. Six items required syntactic changes, 12 required semantic changes and only one item required syntactic and semantic changes. All items were considered applicable to the Spanish context. The degree of difficulty was higher for the back translation than for the translation itself. The cognitive interviews highlighted the difficulty of choosing between seven answers, especially those that were formulated as negative. Five items were difficult to understand. The Spanish version of the GDI has been adapted well to the Spanish context.

This article outlines the linguistic validation of the Good Death Inventory (GDI) translation into Spanish, used to assess the quality of care at the end of a patient’s life. A standardized procedure was followed to do this that included a blind back translation process and an exploration of the conceptual adaptation of the scale into Spanish through six cognitive interviews with relatives of deceased patients. The translation of the scale (54 items) showed indicators of low difficulty. Six items required syntactic changes, 12 required semantic changes and only one item required syntactic and semantic changes. All items were considered applicable to the Spanish context. The degree of difficulty was higher for the back translation than for the translation itself. The cognitive interviews highlighted the difficulty of choosing between seven answers, especially those that were formulated as negative. Five items were difficult to understand. The Spanish version of the GDI has been adapted well to the Spanish context. Este artículo presenta la validación lingüística española del Good Death Inventory (GDI), para la evaluación de la calidad de los cuidados al final de la vida. Se llevó a cabo un proceso estandarizado de traducción y retrotraducción ciegas y se examinó la adecuación conceptual de la escala al contexto español a través de seis entrevistas cognitivas a familiares de pacientes fallecidos. La traducción de la escala (54 ítems) mostró indicadores de dificultad bajos. Seis ítems precisaron cambios sintácticos, 12 cambios semánticos y sólo un ítem precisó cambios sintácticos y semánticos. Todos los ítems fueron considerados aplicables al contexto español. El grado de dificultad de la retrotraducción fue superior al de la traducción. Las entrevistas cognitivas mostraron dificultad para discriminar entre las siete alternativas de respuesta, especialmente en los ítems formulados en negativo. Cinco ítems presentaron dificultades de comprensión. La versión española del GDI presenta una buena adecuación al contexto español.

Medicinske sestre djeluju na svim razinama zdravstvene zaštite primarnoj, sekundarnoj i tercijarnoj, ali i izvan zdravstvenog sustava pružajući pomoć u očuvanju i unapređenju zdravlja i njegujući bolesne. Od iznimne je važnosti uloga medicinske sestre u pružanju pomoći bolesnicima koji su na kraju životnog puta kako bi im se osigurala bezbolna i dostojanstvena smrt. Teorije zdravstvene njege opisuju sestrinske modele koji su usmjereni pružanju bolje i kvalitetnije skrbi za umiruće bolesnike. Usvajanjem procesa zdravstvene njege kao sustavnog i logičnog pristupa u dijagnosticiranju i rješavanju problema umirućih bolesnika, sestrinske dijagnoze postale su neizostavan dio svakodnevne sestrinske prakse. Povijesno definiranje uloge medicinske sestre pod nazivom njega bolesnika naglasilo je različitost uloge medicinske sestre od promocije zdravlja do sprečavanja komplikacija u posljednjim danima života bolesnika. Teorije zdravstvene njege su nastale pod utjecajem specifičnog obrazovanja, stavova, iskustva i okruženja medicinskih sestara koje su ih implementirale u praksu, ali im je zajednička skrb za umiruće bolesnike. Danas zahvaljujući suvremenim pristupima u prihvaćenosti procesa zdravstvene njege medicinske sestre imaju mogućnosti procjenjivati potrebe umirućih bolesnika, dijagnosticirati probleme i prilagoditi intervencije koje će osigurati najveću razinu kvalitete zdravstvene njege. Nurses are working at all levels of care - primary, secondary and tertiary, and outside the health care system by providing assistance in maintaining and improving health and fostering ill. It is extremely important role of nurses in assisting patients who are living in the end times in order to ensure a painless and dignified death. Theories of health care describe nursing models that are directed to providing more and better care for dying patients. By adopting the process of health care as a systematic and logical approach to diagnose and resolve problems of dying patients, nursing diagnoses have become an indispensable part of everyday nursing practice. Historically, defining the role of a nurse called "care" stressed the diversity of the role of nurses from health promotion to prevent complications in the last days of life. Theories of health care are under influence of specific education, attitudes, experiences and environments of nurses that were implemented in practice but there is a common concern for dying patients. Today, thanks to modern approaches in the acceptance process of health care nurses are able to assess the needs of dying patients, diagnose problems and adjust interventions that ensure the highest level of quality health care.