Análisis de las actitudes, aptitudes y creencias en la profesión enfermera, sobre el final de la vida y su cuidado

Introducción: Enfermería asiste a los pacientes en todas las etapas de la vida, desde el diagnóstico de una enfermedad hasta su curación o muerte. El entorno de los cuidados en fin de vida representa un reto para los profesionales de enfermería, que constantemente deben adaptarse tanto social, como culturalmente, a las diferentes necesidades que puedan surgir en los pacientes y en sus familiares. Objetivo: Analizar las actitudes, aptitudes y creencias sobre el final de la vida y su cuidado, en un grupo de profesionales de enfermería de Navarra (España) y de Valdivia (Chile), a través de los diferentes periodos y escenarios de su actividad laboral (atención especializada y atención primaria), y en función de las diferentes variables socio demográficas porque son descritos (edad, género, estado civil, religión y percepción de competencias técnicas y emocionales). Metodología: Estudio descriptivo trasversal, que ha empleado un muestreo no probabilístico accidental en dos muestras de profesionales de enfermería. Se han empleado diversos cuestionarios previamente estandarizados y validados, como son la escala del Perfil revisado de actitudes hacia la muerte (PRAM), la escala de Afrontamiento hacia la muerte (AM) de Bugen, la escala de Actitudes hacia el cuidado de la muerte de Frommelt (FATCOD-B) y la escala reducida de Creencias Post Críticas de Duriez B, Soenens B y Hutsebaut D (S-PCB). Resultados: Los profesionales de enfermería de Navarra mostraron mayores niveles de actitud de miedo hacia la muerte con respecto a los de Valdivia (p<0,021), los cuales se diferenciaron por mayores actitudes de reacercamiento (p<0,000) y de escape (p<0,008). Del mismo modo, los participantes de Navarra obtuvieron una puntuación menos favorecedora en el afrontamiento de la muerte en términos generales (p<0,019), así como menores aptitudes para el cuidado del paciente moribundo y su familia de acuerdo con la escala FATCOD-B (p<0,020). Además, los profesionales de enfermería de Valdivia muestran significativamente posturas religiosas más trascendentales que los profesionales de enfermería de Navarra (S-PCB) (p<0.000), resultando ser más ortodoxos (p<0,000) y con posturas más cercanas a la segunda 5 ingenuidad (0,000), frente a otras posturas como el relativismo (0,011) y la crítica externa (0,000). En todas las dimensiones de las escalas, se encontraron diferencias significativas de los elementos de análisis en torno a la muerte según la edad, el contexto cultural y religioso y las experiencias previas de muerte, así como en la percepción emocional y técnica para el cuidado de pacientes en fin de vida y el afrontamiento de su muerte. De este modo, a mayor edad, mayor experiencia previa en ceremonias fúnebres en la infancia, el hecho de profesar una religión, o poseer una autopercepción alta sobre el manejo técnico en los cuidados de enfermería al final de la vida, son aspectos que favorecen en el profesional de enfermería, una construcción adecuada sobre el concepto de muerte, así como una provisión asistencial coherente y flexible de cuidados paliativos durante el proceso de fin de vida. Conclusiones: El personal de enfermería del presente estudio, en base diversos factores sociodemográficos y a sus experiencias, tanto personales como culturales, elabora de manera diversa una serie de actitudes, aptitudes y creencias en torno a la muerte y su proceso. Dichos factores intervienen en la conformación de unos cuidados de enfermería al final de la vida, tanto comunitarios como a nivel hospitalario. Las habilidades que son aprendidas al respecto bien sean tanto emocionales como prácticas, facilitan la atención a personas terminales y a sus familiares, y por ello, su abordaje es necesario entre el colectivo sanitario. De este modo, el presente estudio, recomienda intervenir en aquellas actitudes evitativas de entre los profesionales de la enfermería ante la muerte y su afrontamiento, y considerar la adquisición de actitudes positivas, así como de competencias propias del contexto de los cuidados de fin de vida, que faciliten su calidad y desarrollo. En ese sentido, se sugiere de algún modo fomentar el número de programas de formación de enfermería en cuidados paliativos y en fin de vida, dirigidos bien a nivel de pregrado como de posgrado.Introduction: Nursing assists patients in all stages of life, from the diagnosis of a disease to its cure or death. The end-of-life care environment represents a challenge for nursing professionals, who must constantly adapt both socially and culturally to the different needs that may arise in patients and their families. Objective: To analyse the attitudes, aptitudes and beliefs about the end of life and its care, in a group of nursing professionals from Navarra (Spain) and Valdivia (Chile), through the different periods and scenarios of their work activity (specialized care and primary care), and according to the different socio-demographic variables because they are described (age, gender, marital status, religion and perception of technical and emotional competences). Methodology: Cross-sectional descriptive study, which has used an accidental non-probabilistic sampling in two samples of nursing professionals. Various previously standardized and validated questionnaires have been used, such as the Death Attitude Revised Profile scale (DAP-R), Bugen's Coping with Death scale, Frommelt's Attitudes Towards Care of dying patients scale (FATCOD-B) and reduced Post-Critical Beliefs scale (S-PCB) by Duriez, Soenens and Hutsebaut. Results: Nursing professionals from Navarra showed higher levels of attitude of fear towards death compared to those from Valdivia (p<0.021), which were differentiated by higher attitudes of rapprochement (p<0.000) and escape (p<0.008). Similarly, the participants from Navarra obtained a less favourable score in coping with death in general terms (p<0.019), as well as less aptitude for caring for the dying patient and their family according to the FATCOD-B scale (p<0.020). In addition, nursing professionals from Valdivia show significantly more transcendental religious positions than nursing professionals from Navarra (S-PCB) (p<0.000), turning out to be more orthodox (p<0.000) and with a position closer to the second naivete (0.000), compared to other positions such as relativism (0.011) and external criticism (0.000). In all the dimensions of the scales, significant differences were found in items of analysis around death according to age, cultural and religious context, and previous experiences of death, as well as in the emotional perception and technique of caring for end-of-life patients and coping with their death. In this way, older age, greater previous experience in funeral ceremonies in childhood, the fact of professing a religion, or having a high self-perception about technical management in nursing care at the end of life, are aspects that encourage the nursing professional, an adequate construction on the concept of death, as well as a coherent and flexible provision of palliative care during the end-of-life process. Conclusions: Nursing personnel, based on sociodemographic factors and their experiences, both personal and cultural, elaborate in a diverse way a series of attitudes, aptitudes and beliefs about death and its process, which intervene in the conformation of nursing care at the end of life, whether at community and hospital level. The skills that are developed in this regard, both emotional and practical, facilitate the care of terminally ill persons and their families, and therefore, their approach is necessary among the health collective. Consequently, the present study recommends intervening in the avoidant attitudes of nursing professionals towards death and coping with it, and considering the acquisition of positive attitudes, as well as specific skills to the context of end-of-life care, which facilitate their development. In this sense, it is suggested to encourage the number of nursing training programs in palliative and end-of-life care, both at the undergraduate and postgraduate levels.La estancia de investigación realizada en Chile fue financiada parcialmente por la Asociación de Universidades Iberoamericana de Posgrado (AUIP), y por el Instituto de Medicina y Enfermería de la Universidad Austral de Chile.Programa de Doctorado en Ciencias de la Salud (RD 99/2011)Osasun Zientzietako Doktoretza Programa (ED 99/2011

Two Individuals of Pseudobiceros bedfordi About to Have a Sperm Battle

<p>Species of the flatworm genus Pseudobiceros are hermaphroditic and have two penises that are used to inject sperm into the partner. P. bedfordi is exceptional in that it applies sperm onto the partner's skin rather than injecting it. Photo courtesy of Nico Michiels.</p

Figure 3

<div><p>Apple Snail Eggs</p> <p>The hatching times for egg-laying animals, including birds, fish, amphibians, insects, and plankton—or even these Apple Snail eggs—turn out to follow the same relationship. (Photo: Gary M. Stolz, U. S. Fish and Wildlife Service)</p></div

If processes underlying life are explained as a tendency towards maximum entropy production, systems such as galaxies and hurricanes might be described as alive.

<p>(A) Three dimensional cloud-top image of Hurricane Diana as it was strengthening from a Category III storm to a Category IV storm. Publication of the National Oceanic and Atmospheric Administration (NOAA), NOAA Central Library (Image ID: spac0289, NOAA in Space Collection) (B). The colorful demise of a sun-like star. [Photo credit: NASA, ESA, and K. Noll (STScI); acknowledgment: The Hubble Heritage Team (STScI/AURA)]</p

Adult Male Raggiana Bird of Paradise (Paradisaea raggiana)

<div><p>Body size, altitude, and diet account for 99.0% of the variation in the metabolic rates of birds of paradise.</p> <p>(Photo: Brian McNab)</p></div

After Correcting for Body Size and Temperature, the Metabolic Rates of a Shark, a Tomato Plant, and a Tree Are Remarkably Similar

<p>(Illustration: Sapna Khandwala)</p

An Ant with Three Sexes?

<div><p>(A) Two males from the harvester ant genus Pogonomyrmex, one from each genetic strain. In a recently discovered hybrid system, queens must mate with both types of males to produce reproductives and workers. Photo courtesy of Charles Hedgcock, Charles Hedgcock Photography, Tucson, Arizona, United States.</p> <p>(B) Hybrid workers emerging from a nest. Photo courtesy of Veronica Volny, University of California, Berkeley, California, United States.</p></div

Entropy and biodiversity are mathematically equivalent, making tropical forests the most entropic environments on Earth.

<p>(Photograph: John Whitfield)</p

Language and Darwin

<p>The idea that modern languages had descended from a common ancestor, as proposed by Sir John Herschel, inspired the young Charles Darwin to think about the notion of descent with modification in relation to biological evolution. (Water-color portrait of Charles Darwin painted by George Richmond in the late 1830s.)</p

Four Different Species of Volvocales Algae

<p>(A) Gonium pectorale, (B) Eudorina elegans, (C) Pleodorina californica, and (D) Volvox carteri. These are unicellular organisms that live in colonies and have both large and small gametes. Photo courtesy of Aurora M. Nedelcu, from the Volvocales Information Project (<a href="http://http:%5C%5Cwww.unbf.ca%5Cvip%5Cindex.htm)" target="_blank">http:\\www.unbf.ca\vip\index.htm)</a>.</p