The Sustainability of Public Social Services: A Qualitative Study

[EN] The 2008 global economic crisis heightened social inequality and drastically reduced equal opportunities for many people. It had negative consequences for social regulation in many European countries, which have dismantled their public social policies. The objective of the study was to describe social workers’ perceptions of their lived experiences in di erent areas of the public social services system. A qualitative study was developed, based on a hermeneutic approach. Six in-depth interviews and two focus groups were conducted with 20 social workers employed by community social services and the Andalusian public health service (Spain). The professionals agreed that the public social services system has been eroded, that the lack of resources has consequences for workers and the general public alike, and that the public authorities and the administration are responsible for this situation. Social services have become distributors of scarce resources rather than a social protection system that empowers and accompanies the most vulnerable. The system must provide the necessary resources and structures so that they can escape the situation of poverty, exclusion and social injustice.S

Estudo qualitativo sobre as experiências do cuidador de Alzheimer: adaptação e impacto

Objetivo: Profundizar a través de las vivencias de los cuidadores familiares, cuáles eras las percepciones que tenían los cuidadores con respecto al proceso de adaptación de la enfermedad de Alzheimer y el impacto que tenía en sus vidas. Metodología: Se formaron dos grupos focales de cuidadores de pacientes con demencia tipo Alzheimer, representativos de la población de estudio. Resultados: Del análisis de los discursos emergieron cinco dimensiones o unidades de significado con catorce subdimensiones. Estas cinco dimensiones son: conocimientos sobre la enfermedad, sufrimiento del cuidador, emociones, capacidad de afrontamiento y las consecuencias en la vida del cuidador. Conclusión: Podemos determinar que la adaptación al rol de cuidador de una persona con Alzheimer queda condicionada por las creencias erróneas o pensamientos disfuncionales que surgen en el cuidador, las emociones derivadas de la responsabilidad moral de asumir el rol de cuidador desde la perspectiva de género y, por último, las consecuencias que produce el cuidado en este periodo las repercusiones en su vida personal, familiar y laboral.Objective: To deepen, through the experiences of family caregivers, what were the perceptions that caregivers had regarding the process of adaptation of Alzheimer's disease and the impact it had on their lives. Methodology: Two focus groups of caregivers of patients with Alzheimer-type dementia were formed, representative of the study population. Results: From the analysis of the discourses five dimensions or units of meaning emerged with fourteen subdimensions. These five dimensions are: knowledge about the illness, the caregiver's suffering, emotions, coping skills and the consequences in the life of the caregiver. Conclusion: We can determine that the adaptation to the role of caregiver of a person with Alzheimer's is conditioned by the mistaken beliefs or dysfunctional thoughts that arise in the caregiver, the emotions derived from the moral responsibility to assume the role of caregiver from the perspective of gender and, finally, the consequences of care during this period, the repercussions on their personal, family and work life.Objetivo: Aprofundar, através das vivências dos familiares cuidadores, quais as percepções que os cuidadores possuíam em relação ao processo de adaptação da doença de Alzheimer e o impacto que isso teve em suas vidas. Metodologia: Foram constituídos dois grupos focais de cuidadores de pacientes com demência tipo Alzheimer, representativos da população estudada. Resultados: A partir da análise dos discursos, emergiram cinco dimensões ou unidades de significado com quatorze subdimensões. Essas cinco dimensões são: conhecimento sobre a doença, o sofrimento do cuidador, emoções, habilidades de enfrentamento e as consequências na vida do cuidador. Conclusão: Podemos determinar que a adaptação ao papel de cuidador de uma pessoa com Alzheimer é condicionada pelas crenças equivocadas ou pensamentos disfuncionais que surgem no cuidador, as emoções derivadas da responsabilidade moral de assumir o papel de cuidador a partir da perspectiva de gênero e, por fim, as consequências do cuidado nesse período, as repercussões na sua vida pessoal, familiar e laboral

Attitudes of nursing students towards the legalization of euthanasia, end-of-life planning and the spiritual dimension: A quantitative study

Background: The Law on Euthanasia was approved in Spain and implemented in the health system. Nursing students must position themselves with respect to euthanasia in their work in the near future. Objectives: To know the attitudes of nursing students towards the legalization of euthanasia, its relationship with end-of-life planning, and the spiritual dimension. Design: A cross-sectional descriptive quantitative study. Settings and participants: Study carried out with students of the Nursing Degree at the Universities of Huelva and Almería in Spain from April to July 2021. Methods: Attitudes towards the final phase of life, Anxiety towards death, and Attitudes towards Euthanasia questionnaires were administered. Descriptive, inferential and logistic regression statistics were calculated to determine the relationship between attitudes towards euthanasia and sociodemographic variables, end-of-life planning, and the spiritual dimension. Results: 285 Nursing students with an average age of 23.58 years (SD = 8.19) participated. The scores on the attitude towards euthanasia were higher than the mean. While 70.5 % of the students were aware about advanced planning, only 2.5 % of them had made advanced plans. In religious practice and the spiritual dimension, the average score was high as they considered these elements to be of great support at the end of life. In terms of anxiety about death, the average score was significantly higher in women. Age, spiritual accompaniment and help, and the frequency with which spiritual beliefs are practiced are predictive factors for the attitude towards euthanasia. Conclusions: Students have a positive vision of euthanasia while admitting anxiety about death. They emphasize advance planning and greater religious practice as supports for euthanasia. The need for curricular training related to moral deliberation and values that support euthanasia is clear.This work was funded by the call for grants to carry out Research Projects (Modality A) of the University of Huelva [ID: 1076]. Funding for open access charge: Universidad de Huelva / CBU

Nursing students' perceptions of euthanasia legislation: A qualitative study

Background: Spain passed a law to legalise euthanasia in March 2021. This law introduces a new right that is incorporated into the portfolio of services provided by the Spanish public health system, meaning that nurses and nursing students will play a key role in its administration. Objectives: To determine and understand nursing students' perceptions of the legalisation of euthanasia and the life experiences involved in their positions. Design: This is a descriptive qualitative study. Settings and participants: Thirteen semi-structured, open-ended, focused interviews were conducted with undergraduate nursing students at two faculties in south-eastern Spain. The Atlas ti.9.0 programme was used to analyse their discourses. Results: There are students who are in favour of euthanasia and those who are against it. Most students viewed the regulation of conscientious objection as positive and necessary. Students reported that they did not have indepth knowledge of the law, and those who were familiar with it expressed some misgivings. Students also felt that there was a lack of information and training on the management of euthanasia. Conclusions: The students described the legalisation of euthanasia as a breakthrough in Spanish public health which will benefit many patients. However, they were aware that they are not capable of facing new legal situation and demanded extra training in ethical conflicts at the end of life to avoid potential psychological sequelae. Nursing faculties should include in their curricula spaces to encourage moral deliberation in complex settings involving the implementation of euthanasia

Emotions, Feelings, and Experiences of Social Workers While Attending to Vulnerable Groups: A Qualitative Approach

[EN] Social workers in the community setting are in constant contact with the suffering experienced by the most vulnerable individual. Social interventions are complex and affect social workers’ emotional well-being. The aim of this study was to identify the emotions, feelings, and experiences social workers have while attending to individuals in situations of vulnerability and hardship. A qualitative methodology based on hermeneutic phenomenology was used. Six interviews and two focus group sessions were conducted with social workers from the community social services and health services of the Andalusian Public Health System in the province of Almería (Spain). Atlas.ti 8.0 software was used for discourse analysis. The professionals highlighted the vulnerability of certain groups, such as the elderly and minors, people with serious mental problems, and people with scarce or no economic resources. Daily contact with situations of suffering generates a variety of feelings and emotions (anger, sadness, fear, concern). Therefore, more attention should be paid to working with the emotions of social workers who are exposed to tense and threatening situations. Peer support, talking, and discussions of experiences are pointed out as relevant by all social workers. Receiving training and support (in formal settings) in order to learn how to deal with vulnerable groups could be positive for their work and their professional and personal quality of life.S

Predictor factors of perceived health in family caregivers of people diagnosed with mild or moderate Alzheimer's disease

Caring for a person diagnosed with Alzheimer’s disease has a negative impact on family caregivers’ psychological health. This study examined the factors related to ‘perceived health’ and ‘presence of new-onset mental health problems’ in family caregivers of people diagnosed with mild and moderate Alzheimer’s disease. A cross-sectional observational study carried out in Almeria’s Healthcare District (Spain). A total of 255 family caregivers (42.4% cared for people with mild Alzheimer’s disease and 57.6% cared for people with moderate Alzheimer’s disease) participated in the study from January to December 2015. Mainly, caregivers were women (81.5% in the mild Alzheimer’s disease group and 88.4% in the moderate Alzheimer’s disease group), and their average age was 56.54 years (standard deviation (SD) = 13.13) and 54.47 years (SD = 11.71), respectively. Around 47% of the caregivers had been caring for the person with Alzheimer’s between two and five years. The Goldberg General Health Questionnaire was used to measure perceived health and the presence of new-onset mental health problems. An exploratory descriptive analysis and a multivariate logistic regression analysis were conducted. For caregivers of people with mild Alzheimer’s disease, ‘perceived health’ was related to ‘perceived social support’ (r = −0.21; p = 0.028), ‘person’s level of dependency’ (r = −0.24, p = 0.05), ‘severity of the person’s neuropsychiatric symptoms’ (r = 0.22; p = 0.05), and ‘caregiver’s emotional distress in response to the person’s neuropsychiatric symptoms’ (r = 0.22; p = 0.05). For caregivers of people with moderate Alzheimer’s disease, ‘perceived health’ was related to ‘perceived social support’ (r = −0.31; p ˂ 0.01), ‘presence of neuropsychiatric symptoms’ (r = 0.27, p = 0.01), ‘severity of the person’s neuropsychiatric symptoms’ (r = 0.32, p = 0.01) and ‘caregiver’s emotional distress in response to the person’s neuropsychiatric symptoms’ (r = 0.029; p = 0.01). The presence of new-onset mental health problems was detected in 46.3% (n = 50) of caregivers of people with mild Alzheimer’s and 61.9% (n = 91) of caregivers of people with moderate Alzheimer’s. When people are diagnosed with mild Alzheimer’s disease, intervention programs for caregivers should aim to regulate emotions and promote positive coping strategies. When people are diagnosed with moderate Alzheimer’s disease, intervention programs for caregivers must allow them to adapt to caregiving demands that arise with the progression of Alzheimer’s disease

The Sustainability of Public Social Services: A Qualitative Study

The 2008 global economic crisis heightened social inequality and drastically reduced equal opportunities for many people. It had negative consequences for social regulation in many European countries, which have dismantled their public social policies. The objective of the study was to describe social workers’ perceptions of their lived experiences in different areas of the public social services system. A qualitative study was developed, based on a hermeneutic approach. Six in-depth interviews and two focus groups were conducted with 20 social workers employed by community social services and the Andalusian public health service (Spain). The professionals agreed that the public social services system has been eroded, that the lack of resources has consequences for workers and the general public alike, and that the public authorities and the administration are responsible for this situation. Social services have become distributors of scarce resources rather than a social protection system that empowers and accompanies the most vulnerable. The system must provide the necessary resources and structures so that they can escape the situation of poverty, exclusion and social injustice

Communicating Health Information at the End of Life: The Caregivers’ Perspectives

Health information and communication are key elements that allow patients and family members to make decisions about end-of-life care and guarantee a death with dignity. Objective: To understand caregivers’ experiences regarding health information and communication during the illness and death of family members. Methods: This qualitative study was conducted in Andalusia based on the paradigm of hermeneutic phenomenology. Participants were caregivers who had accompanied a family member at the end of life for over 2 months and less than 2 years. Five nominal groups and five discussion groups were established, and 41 in-depth interviews with 123 participants were conducted. Atlas.ti 7.0 software was used to analyze the discourses. A comprehensive reading was carried out along with a second reading. The most relevant units of meaning were identified, and the categories were extracted. The categories were then grouped in dimensions and, finally, the contents of each dimension were interpreted and described given the appropriate clarifications. Results: Four dimensions of the dying process emerged: di erences in caregivers’ perceptions of information and communication, a conspiracy of silence, consequences of the absence or presence of information, and the need for a culture change. Conclusions: Poor management of health information and communication at the end of life increased the su ering and discomfort of patients and their families. The culture of denying and avoiding death is still present today. A change in education about death would better enable health professionals to care for patients at the end of life.Project PI-0643/2012, "The dying process in Andalusia. Qualitative analysis from the perspective of informal caregivers", was funded by the Department of Health and Social Welfare, Junta of Andalusia, Spain. In addition, the Andalusian Association of Community Nursing (ASANEC, its acronym in Spanish) has contributed to the project. The present study was conducted by the working group on Care Bioethics and Humanization of this scientific society