Patients' experiences and perceptions of dignity in end‐of‐life care in emergency departments: A qualitative study.

Aims: To explore and understand the experiences of patients with advanced illness inrelation to dignity during end-of-life care in emergency departments.Design: Qualitative study based on Gadamer's hermeneutics.Methods: Between September 2019 and February 2020, 16 in-depth interviews werecarried out with advanced illness patients who attended emergency departments.The participants were informed priorly and signed informed consent. The data wereanalysed using an inductive strategy for finding emerging themes. The ConsolidatedCriteria for Reporting Qualitative Research was used for writing the study's report.Results: In the data analysis process, two main themes emerged that glean the ex-periences of patients in relation to dignity during end-of-life care in emergency de-partments. ‘Dignity as an individual's attribute’ and ‘Acting with dignity: Dignity as abehavioural attribute’.Conclusion: Patient dignity in end-of-life care is centred around the principle of con-trol (of oneself, one's death and one's emotions). The strategies required for patientsto preserve their dignity can be somewhat incompatible with the dynamics and objec-tives of healthcare professionals who work in emergency departments.Impact statement: The dignity of patients with advanced illness who attend emer-gency departments is a relevant issue that merits being addressed from the patients'perspective. Participants have identified that dignity is a way of being and behavingin the face of illness. Emergency departments need to respect end-of-life patients'desires by supporting and accompanying them, avoiding therapeutic obstinacy. Werecommend care to be centred on patients' well-being, to respect their autonomy anddecision-making processes, and to allow prompt referrals to palliative care services.Ministerio de Asuntos Económicos yTransformación Digital, Gobierno deEspaña, Grant/Award Number: FFI2016-76927-

Sexuality and affectivity after a grieving process for an antenatal death: a qualitative study of fathers’ experiences

The loss of an infant at the prenatal stage is one of the most traumatic events parents can experience. Prenatal losses have several negative implications for parents’ physical, psychological, and social well-being, including intimacy and sexuality. Fathers who suffer from this experience have to cope not only with their grief, but also with the physical and emotional suffering of their partners. The social context gives the father a masculine role of strength, insensitivity, and protection of the mother, with the result that his pain and grief become invisible. The objective of this study is to understand fathers’ experience of affective-sexual relationships after a grieving process for an antenatal death; A qualitative study based on interviews with 11 fathers in Spain who have experienced an antenatal death was conducted. Data were analyzed with the help of ATLAS.ti software to discover emerging themes. 6 sub-themes were developed from the analysis, grouped into two main themes: the invisibility of grieving fathers and the relationships between the grieving parents are influenced by the death of their infants. The sexuality of fathers who suffer an antenatal death is altered. Gender stereotypes and the lack of social and professional awareness make their grief invisible. Fathers need to express their emotions to cope with their own grief and break the stereotypical gendered bereavement. In most cases, the couple’s relationship is altered, from a close union to a more distant relationship, in addition to a decrease in sexual desire and arousal. However, other fathers experienced greater closeness and intimacy in the couple. A communication based on sincerity, exposing their own grief, feelings, emotions and needs could help the couple’s relationship

Nursing Interventions to Facilitate the Grieving Process after Perinatal Death: A Systematic Review

Perinatal death is the death of a baby that occurs between the 22nd week of pregnancy (or when the baby weighs more than 500 g) and 7 days after birth. After perinatal death, parents experience the process of perinatal grief. Midwives and nurses can develop interventions to improve the perinatal grief process. The aim of this review was to determine the efficacy of nursing interventions to facilitate the process of grief as a result of perinatal death. A systematic review of the literature was carried out. Studies that met the selection criteria underwent a quality assessment using the Joanna Briggs Institute critical appraisal tool. Four articles were selected out of the 640 found. Two are quasi-experimental studies, and two are randomized controlled clinical studies. The interventions that were analyzed positively improve psychological self-concept and role functions, as well as mutual commitment, depression, post-traumatic stress and symptoms of grief. These interventions are effective if they are carried out both before perinatal loss and after it has occurred. The support of health professionals for affected parents, their participation in the loss, expressing feelings and emotions, using distraction methods, group sessions, social support, physical activity, and family education are some of the effective interventions

Society facing death and its implications for end-of-life care: a qualitative study with healthcare professionals (Research Project FFI2016-76927-P-AEI/FEDER, UE)

Background/aims: End-of-life care is conditioned by the social opinion towards disease, suffering, death, and life. In Western countries, the process of dying is often considered a taboo; however, the debate around the topic has led to attempts to dignify end-of-life care (regulation of the right to palliative care, advanced directives). The objective of this study was to understand how social patterns about death influence end-of-life palliative care from the perspective of healthcare professionals. Methods: A qualitative study based on grounded theory was designed and carried out between 2017 and 2019. Forty-six professionals (6 doctors, 5 clinical psychologists and 35 nurses) took part in the study, selected through theoretical and convenience sampling. Four focus groups, with a total of 20 participants, and 17 in-depth interviews were conducted. The data were analysed following Grounded Theory procedure with the assistance of ATLAS.ti software (constant comparative analysis, open, axial and selective coding). Results: Data analysis suggests that there may be two opposing social patterns of coping with death. One represents a “Positive way” that includes effort and internal work to make death a part of existence. The other is a “Negative way” that is dominated by a culture of concealment and stubbornness towards death. Participants also conceptualised “Endof-life and death as a care process”, which encompasses “The facilitating role of health professionals” and “Conflicts in decision-making.” Conclusions: Health professionals have identified that socio-cultural patterns towards death influence aspects of the process of end-of-life care such as emergency departments attendance, demand for hospitalisation or management of clinical information. Healthcare professionals take action to facilitate acceptance within the social and family circle, but are faced with conflicts in decision-making when the patient’s closest social and family network put pressure on the professionals or influence the patient’s own free will

Patients' experiences and perceptions of dignity in end-of- life care in emergency departments: A qualitative study

Aims: To explore and understand the experiences of patients with advanced illness in relation to dignity during end-of- life care in emergency departments. Design: Qualitative study based on Gadamer's hermeneutics. Methods: Between September 2019 and February 2020, 16 in-depth interviews were carried out with advanced illness patients who attended emergency departments. The participants were informed priorly and signed informed consent. The data were analysed using an inductive strategy for finding emerging themes. The Consolidated Criteria for Reporting Qualitative Research was used for writing the study's report. Results: In the data analysis process, two main themes emerged that glean the experiences of patients in relation to dignity during end-of- life care in emergency departments. ‘Dignity as an individual's attribute’ and ‘Acting with dignity: Dignity as a behavioural attribute’. Conclusion: Patient dignity in end-of- life care is centred around the principle of control (of oneself, one's death and one's emotions). The strategies required for patients to preserve their dignity can be somewhat incompatible with the dynamics and objectives of healthcare professionals who work in emergency departments. Impact statement: The dignity of patients with advanced illness who attend emergency departments is a relevant issue that merits being addressed from the patients' perspective. Participants have identified that dignity is a way of being and behaving in the face of illness. Emergency departments need to respect end-of- life patients' desires by supporting and accompanying them, avoiding therapeutic obstinacy. We recommend care to be centred on patients' well-being, to respect their autonomy and decision-making processes, and to allow prompt referrals to palliative care services. Patient or Public Contribution: Managers from the Emergency Departments participated in the study design and patients' recruitment. Patients' relatives were informed about the study's aim, and they contributed to the development of the interview protocol

Psychometric development and evaluation of the Machista Invisible Violence Attitude Questionnaire

Objetivo. Diseñar y evaluar psicométricamente el “Cuestionario de Actitudes de Violencia Invisible Machista” (CAVIM). Antecedentes. La violencia invisible machista se define como aquellas actitudes y creencias discriminativas hacia la mujer que suelen estar culturalmente aceptadas, naturalizadas e incorporadas en la sociedad y que es precursora de formas más explícitas y graves de violencia. Metodología. Estudio observacional descriptivo transversal. Se llevó a cabo un desarrollo de la versión inicial del cuestionario, estudio piloto (N=63) y estudio de validación final (N=1264). Se analizó psicométricamente la fiabilidad, la validez (de criterio, de contenido y de constructo) y la legibilidad. Resultados. El análisis factorial exploratorio reveló que el CAVIM se compone finalmente de 15 ítems distribuidos en 3 factores. El análisis de grupos conocidos detectó diferencias significativas en dos grupos con distintas características (edad y tiempo en pareja). La validez de criterio indicó la existencia de una correlación moderada y significativa (r= 0,469; p<0,001) entre la puntuación media del CAVIM y la escala de actitudes frente a violencia de género. La validez de contenido se calculó mediante el índice de validez de contenido, que resultó ser excelente, así como la consistencia interna del CAVIM. Conclusión. El CAVIM mostró unos resultados excelentes para la fiabilidad, validez y legibilidad, lo que sugiere que puede tratarse de una buena herramienta para medir las actitudes frente a la violencia invisible machista. Objective. To design and psychometrically evaluate the "Questionnaire of Attitudes of Invisible Machista Violence" (CAVIM). Background. Invisible sexist violence is defined as those discriminatory attitudes and beliefs towards women that are usually culturally accepted, naturalized and incorporated into society and that is a precursor to more explicit and serious ways of violence. Methodology. Cross-sectional descriptive observational study. A development of the initial version of the questionnaire, a pilot study (N=63) and a final validation study (N=1264) were carried out. Reliability, validity (criterion, content, and construct) and readability were psychometrically analyzed. Results. The exploratory factorial analysis revealed that the CAVIM is finally made up of 15 items distributed in 3 factors. The analysis of known groups detected significant differences in two groups with different characteristics (age and time in a relationship). Criterion validity indicated the existence of a moderate and significant correlation (r= 0.469; p<0.001) between the mean score of the CAVIM and the scale of attitudes towards gender violence. Content validity was calculated using the content validity index, which turned out to be excellent, as well as the internal consistency of the CAVIM. Conclusion. The CAVIM demonstrated excellent results for reliability, validity and readability, which suggests that it may be a good tool for measuring attitudes towards invisible gender violence

Development and psychometric assessment of a questionnaire for the detection of invisible violence against women.

Background. Invisible violence against women (IVAW) can be understood as the set of attitudes, behaviors, and subtle beliefs that men use to subordinate women and that are culturally accepted. These behaviors can be a risk factor for intimate partner violence (IPV), so it is important to design tools that allow us to detect it early. The aim of this study was to design and psychometrically assess a questionnaire for the detection of invisible violence against women (Q-IVAW). Methodology. A descriptive cross-sectional methodological study carried out in three phases: (1) development of the initial version; (2) pilot study (N = 51); and (3) final validation study (N = 990). The tool’s reliability, validity, and legibility were assessed. To assess reliability, the internal consistency (Cronbach’s α) was analyzed. The validity assessment included an analysis of content, criterion, and construct validity. Results. The EFA revealed that the Q-IVAW was comprised of five factors that explained 55.85% of the total variance found. The Q-IVAW showed very high reliability (α = 0.937), excellent content validity, and good construct validity. The criterion validity analysis showed a moderate correlation between A-IPVAW and Q-IVAW (r = 0.30; p < 0.001). Conclusion. The psychometric assessment of the Q-IVAW yielded good results, which could support the tool’s ability to assess how often women are subjected to inviable violent behaviors by their partners

Development and psychometric assessment of a questionnaire for the detection of Invisible violence against women

Background. Invisible violence against women (IVAW) can be understood as the set of attitudes, behaviors, and subtle beliefs that men use to subordinate women and that are culturally accepted. These behaviors can be a risk factor for intimate partner violence (IPV), so it is important to design tools that allow us to detect it early. The aim of this study was to design and psychometrically assess a questionnaire for the detection of invisible violence against women (Q-IVAW). Methodology. A descriptive cross-sectional methodological study carried out in three phases: (1) development of the initial version; (2) pilot study (N = 51); and (3) final validation study (N = 990). The tool’s reliability, validity, and legibility were assessed. To assess reliability, the internal consistency (Cronbach’s α) was analyzed. The validity assessment included an analysis of content, criterion, and construct validity. Results. The EFA revealed that the Q-IVAW was comprised of five factors that explained 55.85% of the total variance found. The Q-IVAW showed very high reliability (α = 0.937), excellent content validity, and good construct validity. The criterion validity analysis showed a moderate correlation between A-IPVAW and Q-IVAW (r = 0.30; p < 0.001). Conclusion. The psychometric assessment of the Q-IVAW yielded good results, which could support the tool’s ability to assess how often women are subjected to inviable violent behaviors by their partners