Purpose To explore the attitude of nursing professionals towards death. Design Systematic qualitative review methods were used. Methods A search was conducted in the PubMed, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and CUIDEN databases. This study included 17 articles. Findings Thirteen categories emerged, which were grouped into three themes: meanings and feelings during the dying process; coping strategies in the face of death; and the importance of training, experience, and providing a dignified death. In the different accounts of the participants, it was found that death had a large negative emotional impact on them, that the participants complained about the lack of previous training in the care of dying patients, and that avoiding these complex situations was one of the strategies most commonly used by professionals to face the death of a patient. Conclusions The lack of training in the basic care of terminally ill patients, as well as today’s preconceived negative idea about death, both cause health professionals to experience situations of great stress and frustration resulting, on many occasions, in resorting to avoidance of these situations, thus preventing dying with dignity. Clinical Relevance In this article, we explore the consequences of this process for nursing professionals, common coping strategies, and possible areas for improvement, such as the need for the training of nursing professionals in the care of terminally ill patients and their families.

Recibido el 8 de noviembre de 2010; aceptado el 23 de noviembre de 2010 Disponible en Internet el 3 de diciembre de 2011 PALABRAS CLAVECompetencia; Formación; Cuidados paliativos; Afrontamiento ResumenObjetivos: Evaluar el efecto de un programa de formación en cuidados paliativos dirigido a estudiantes de ciencias de la salud, usando la escala de Bugen de afrontamiento de la muerte. Método: Estudio cuasi-experimental. Se desarrolló un programa de formación dirigido a futuros profesionales de la salud (enfermería, medicina, psicología, terapia ocupacional y fisioterapia) que participaron voluntariamente y cuyo único criterio de selección es que no hubiesen tenido formación previa en cuidados paliativos. La duración del curso fue de 45 horas, distribuidas en 15 semanas, desde octubre de 2008 a febrero de 2009. Iniciaron el programa 90 participantes, de los cuales tres abandonaron la formación, finalizando 87. Al inicio y al final del mismo se administró la «escala de Bugen de afrontamiento de la muerte» a los 87 participantes para determinar su grado de afrontamiento de la muerte en cada uno de los momentos. Resultados: De los 87 participantes un 74% son mujeres y el resto hombres. La edad media es de 21,35 años. La mayoría de los participantes son de enfermería (64%), seguidos de terapia ocupacional (23,6%), psicología (5,6%), por último medicina y fisioterapia (2,2%). Se encontraron diferencias significativas respecto al afrontamiento de la muerte tras el programa formativo (p = 0,000). Antes del mismo la media era de 121,46 ± 19,7 y tras el curso la media fue de 158,16 ± 20,6. En dicha escala la puntuación mínima es de 30 y la máxima de 210; valores inferiores a 105 puntos (percentil 50) indican afrontamiento inadecuado y valores superiores a 147 (percentil 70) indican afrontamiento adecuado. Conclusiones: A la vista de los resultados podemos decir que se trata de un programa de formación que mejora considerablemente el afrontamiento ante la muerte de los futuros profesionales de ciencias de la salud. Según la bibliografía consultada, un mejor afrontamiento de la muerte permite a los profesionales sanitarios un incremento de la calidad asistencial en los procesos de fin de vida.

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BackgroundMany ‘routine’ interventions performed in hospital rooms have repercussions for the comfort of the patient, and the decision to perform them should depend on whether the patient is identified as in a terminal phase. The aim of this study is to analyse the health interventions performed and decisions made in the last days of life in patients with advanced oncological and non-oncological illness to ascertain whether identifying the patient’s terminal illness situation has any effect on these decisions.MethodsRetrospective study of the clinical histories of deceased patients in four hospitals in Granada (Spain) in 2010. Clinical histories corresponding to the last three months of the patient’s life were reviewed.ResultsA total of 202 clinical histories were reviewed, 60 % of which were those of non-oncology patients. Opioid prescriptions (58.4 %), palliative sedation (35.1 %) and Do Not Resuscitate (DNR) orders (34.7 %) were the decisions most often reflected in the histories, and differences in these decisions were found between patients registered as terminal and those who were not registered as terminal. The most frequent interventions in the final 14 days and 48 h were parenteral hydration (96–83 %), peripheral venous catheter (90.1–82 %) and oxygen therapy (81.2–70.5 %). There were statistically significant differences between the patients who were registered as terminal and those not registered as terminal in the number of interventions applied in the final 14 days and 48 h (p = 0.01–p = 0.00) and in many of the described treatments.ConclusionThe recognition of a patient’s terminal status in the clinical history conditions the decisions that are made and is generally associated with a lower number of interventions.

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It is necessary to improve communication among nursing homes professionals, families, patients and other health workers.

Introduction: Congruence, understood as the agreement between the patient's preferred place of death and their actual place of death, is emerging as one of the main variables indicating the quality of end-of-life care. The aim of this research was to conduct a systematic literature review on levels and determinants of congruence in palliative patients over the period 2010–2021.Method: A systematic review of the literature in the databases of PubMed, Scopus, Web of Science, PsycINFO, CINAHL, Cuiden, the Cochrane Library, CSIC Indexes, and IBECS. Information was extracted on research characteristics, congruence, and associated factors.Results: A total of 30 studies were identified, mainly of retrospective observational design. The congruence values varied substantially between the various studies, ranging from 21 to 100%. The main predictors of congruence include illness-related factors (functional status, treatments and diagnosis), individual factors (age, gender, marital status, and end of life preferences), and environmental factors (place of residence, availability of health, and palliative care services).Conclusion: This review, in comparison with previous studies, shows that treatment-related factors such as physical pain control, marital status, having a non-working relative, age, discussing preferred place of death with a healthcare professional, and caregiver's preference have been associated with higher levels of congruence. Depending on the study, other factors have been associated with either higher or lower congruence, such as the patient's diagnosis, gender, or place of residence. This information is useful for designing interventions aimed towards greater congruence at the end of life.

The aim of this study was to compare the symptomatology, palliative care outcomes, therapeutic procedures, diagnostic tests, and pharmacological treatments for people with dementia (PWD) and without dementia (PW/OD) admitted to Spanish nursing homes. Design: This was a cross-sectional study which is part of a long-term prospective follow-up of elderly people performed in nursing homes to measure end-of-life care processes. Participants: 107 nursing home patients with advanced or terminal chronic diseases were selected according to the criteria of the Palliative Care Spanish Society. Setting: Two trained nurses from each nursing home were responsible for participant selection and data collection. They must have treated the residents and had a minimum seniority of 6 months in the nursing home. Measurements: Sociodemographic data; Edmonton Symptom Assessment Scale; Palliative Care Outcome Scale; and prevalence of diagnostic tests, pharmacological treatments, and therapeutic procedures were evaluated. Results: Pain, fatigue, and nausea were found to be significantly higher in the nondementia group and insomnia, poor appetite, and drowsiness were significantly higher in the dementia group. Patient anxiety, support, feeling that life was worth living, self-worth, and practical matters management were higher in the nondementia group. Regarding drugs, use of corticoids was higher in the nondementia group, while use of anxiolytics was higher in the dementia group. Diagnostic procedures such as urine analysis and X-ray were higher in the dementia group. Conclusions: Differences in symptom perception, diagnostic tests, and pharmacological procedures were found between patients with and without dementia. Specific diagnostic tools need to be developed for patients with dementia.