Breaking bad news in complex palliative care situations through role-play simulation

Background: One of the most important components in the repertoire of nursing communication skills is the ability to ‘break bad news’ to patients and families. This article presents a pilot role-play simulation conducted at a Portuguese undergraduate nursing program with senior-level students. Methods: The simulation was designed to aid nursing students to develop communication skills necessary to care for the critically ill patient nearing the EOL. This approach had two main learning outcomes: a) improve students’ ability to break bad news and build their confidence in that ability, and b) assist students to engage in the process of self- and peer reflection. Thirty students were recruited from palliative care nursing course, they had no previous experience with this type of simulation. The simulation took place on three separate theoretical-practical classes with ten students each one. Prior to each role-play, three students were randomly role-played both the nurse, the patient and the relative roles. Students who were not assigned active roles observed the simulation and provided feedback during the debriefing period. Students were encouraged to reflect on issues related to the communication of bad news using the Gibbs´ reflective cycle. Results: Themes of students’ responses during the debriefing included an overall positive feeling about the experience and their performance (n=25), nevertheless, students acknowledged they lacked confidence in their skills to communicate effectively (n=12). They indicated that they felt more prepared to meet the patient‘s physical needs than emotional needs. All students also reported valuing working together as a team as it fostered meaningful sharing of ideas. Conclusions: As a result of this kind of learning, the student develops greater capacity for treating others with the respect and understanding required in palliative care nursing. This may inform his or her understanding and capacity to help the other person.info:eu-repo/semantics/publishedVersio

Addressing spiritual needs, facilities and barriers in portuguese palliative care: a cross-sectional survey

Background: Spiritual care is an essential component of Palliative Care (PC) and a dimension of holistic care that preserves dignity and helps sick people to find meaning in suffering and in life. The knowledge about its implementation is still scarce in the Portuguese context. This study aimed to evaluate the facilities, barriers and needs for spiritual care in PC. Method: We conducted a descriptive cross-sectional survey of 180 health professionals in the period November 2018 to September 2019 at PC units. The data were collected through an online questionnaire published on social networks, after approval by an Ethics Committee. Sociodemographic and professional data, spiritual beliefs and knowledge about the objectives and purposes of PCs were collected. These were evaluated using an instrument consisting of 26 statements of dichotomous response (true/false). Results: The average age of participants was 42.42 years (SD=11.35), most are female (82.2%), nurses (43.9%), and 70% work in the health field. The total sample has worked on average for 15.67 ± 10.28 years and more than half (58.9%) perform functions in palliative care. Most identify with a religious belief (87.8%), attaching great importance to spiritual/religious conviction (45% of participants). The results suggest that empathy and the therapeutic use of silence (82.2%) are facilitators of spiritual care. The key barriers refer to the lack of expert professionals and the organization of care (36.1%). The results also highlight the need for specific training in the area of spirituality, hope and intervention strategies (53.9%). Conclusion: This study has provided insight into spiritual care in PC in Portugal. Future studies are necessary to investigate the effects of spiritual care more fully, and to develop outcome measurements that appropriately capture the effects of the variety of spiritual care practices.info:eu-repo/semantics/publishedVersio

Effect of hope-based program on the hope of people with palliative needs: a RCT pilot study in Portugal

Background: Some studies have demonstrated the effectiveness of interventions in the levels of hope, however the relationship between these interventions and the results is still limited. The aim of the study was to evaluate the efficacy of a hopebased program in nursing on Portuguese adult outpatients with advanced and progressive chronic illness. Methods: A single-blind RCT was conducted to test the hypothesis that outpatients in the intervention group, who participated in the Hope Promotion Program (HPP), have higher levels of hope than those who did not participate in the program. Participants were recruited from Day Hospitals of two medical institutions. Following the individuals’ agreement to participate, they were thoroughly screened for eligibility by the main researcher. Inclusion criteria: (1) adults diagnosed with advanced and progressive chronic disease; (2) accompanied by a health care team; and (3) ability to speak and comprehend Portuguese. Hope is measured by the Portuguese version of Herth Hope Index for chronic conditions. The time frames for assessment were at baseline (T1), follow-up (T2 15 days after) and post-test (T3 30 days after). Results: A total of 56 patients were enrolled in the study. They were randomized assigned to either the intervention group [IG] (n=28) or to control group [CG] (n=28). Over time the hope indexes in the IG compared to the CG, suggest a positive effect of HPP in the increase of hope over time. The most expressive effect was observed in the total hope level and in the gains in positive interior disposition and expectations, with significant differences in each of the data collection points in time. Conclusions: Further research should create training programs for nurses and nursing students within the scope of the promotion of hope, in order to promote the development of personal and professional skills.info:eu-repo/semantics/publishedVersio

Assertiveness Training of Novice Psychiatric Nurses: A Necessary Approach

Funding The authors declared no support that facilitated conduct of the work described in the article.The statement “assertiveness is both a skill and a choice” is a popular expression in nursing. Being assertive is a core communication skill, which can be learned like many other skills. Appropriate communication skills are critical for novice psychiatric nurses, helping them develop competency for acute care and recovery. The notion of assertiveness has been extensively used in the nursing literature and has been established as a key approach for avoiding adverse occurrences in health care, boosting patient safety (Omura, Levett-Jones & Stone, 2019). Lazarus (1973, cited in Pipas & Jaradat, 2010) identified specific classes of assertive responses, namely the ability to deny a client’s requests, to make requests of the client, to express positive and negative feelings, and to initiate and hold a conversation.info:eu-repo/semantics/publishedVersio

El modelo multidimensional de la esperanza mientras práctica dirigida por el recovery en enfermería de salud mental

Funding: This work is funded by national funds through FCT – Fundação para a Ciência e a Tecnologia, I.P (UIDB/05704/2020 and UIDP/05704/2020) and under the Scientific Employment Stimulus - Institutional Call – [CEECINST/00051/2018].Objective: To analyze the theoretical dimensions of hope as a recovery-oriented practice in mental health nursing. Method: This is a reflective and discursive study based on theoretical and experiential aspects of hope in the recovery process of people facing mental health disorders. Results: Maintaining hope in adverse situations, especially while facing mental suffering, requires skills to manage the factors that promote and inhibit hope. This balance can be tricky to reach without the presence of high-skilled professionals. The study presents the concept of hope-inspiring competence and its main dimensions. The nurse’s hope-inspiring competence is recognized as a crucial advanced practice that optimizes mental health by providing motivational resources. Final Considerations: Hope-inspiring competence should be a core principle for recovery-oriented mental health professionals. Despite this recognition, the promotion of hope in mental health nursing specialized practice lacks evidence and visibilityinfo:eu-repo/semantics/publishedVersio

A esperança em cuidados paliativos

Dissertação de Mestrado apresentada à Faculdade de Medicina da Universidade de Lisboa para obtenção do grau de Mestre em Cuidados Paliativos.A esperança tem sido considerada como um dos elementos essenciais na vivência das pessoas com doença oncológica. Em contexto de doença terminal, quando a cura não é possível, o “focus” da esperança assume uma importância fundamental na forma como as pessoas doentes vivem o período de fim da vida. O objectivo deste estudo foi: Explorar o processo de manutenção da esperança para o doente oncológico de um Hospital da região centro, tendo sido formulada a seguinte questão orientadora: Como é que os doentes oncológicos submetidos a quimioterapia paliativa mantém a esperança? O estudo baseou-se numa metodologia qualitativa, segundo a abordagem da “Grounded Theory” apresentada e desenvolvida por Glaser & Strauss (1967), na qual o princípio fundador é a indução, orientando-se assim de uma forma exploratória como um meio de descoberta. Para a obtenção dos dados utilizámos entrevistas semi-estruturadas, realizadas a onze participantes do estudo, adultos, seleccionados de acordo com critérios de intencionalidade previamente definidos. As entrevistas foram posteriormente transcritas e analisadas. A estrutura do fenómeno é composta por quatro temas: A percepção da esperança enquanto força interior, fé, resistindo no sentido de atingir os objectos de esperança; A percepção da dimensão temporal, perspectivando o futuro, o tempo e o ciclo de vida; Vivências da esperança, caracterizadas por comportamentos, emoções, pensamentos e relações vivenciadas durante o processo de manutenção da esperança; e Mantendo a esperança representando o viver um dia de cada vez, tendo a morte como limite presente, em que foram identificados factores que influenciam a esperança, promotores e inibidores. Os resultados obtidos pretendem contribuir para a melhor compreensão da esperança, não sendo generalizáveis, mas uma base para novas pesquisas neste âmbito

A promoção da esperança em fim de vida : avaliação da efetividade de um programa de intervenção em pessoas com doença crónica avançada e progressiva

A Esperança é essencial na experiência de viver com a doença crónica avançada e progressiva. Manter a esperança em situações de sofrimento físico, psicológico, espiritual e social requer uma gestão das condições facilitadoras e inibidoras da esperança, num equilíbrio que pode ser muito difícil conseguir sem a ajuda de profissionais competentes. A promoção da esperança enquanto foco da área de atenção de Enfermagem é imperativa na prática dos enfermeiros que cuidam de doentes em situação de fim de vida, capaz de produzir resultados no aumento do conforto e da qualidade de vida. No entanto as intervenções dirigidas à promoção da esperança são frequentemente inespecíficas na sua natureza, pouco adaptadas às reais necessidades dos doentes e de efeito difícil de avaliar. Com o objetivo de desenvolver e testar um programa de promoção de esperança para as pessoas com doença crónica avançada e progressiva, realizou-se este trabalho composto por quatro estudos: - O primeiro permitiu adaptar à realidade portuguesa e validar os instrumentos de medida de esperança (HHI) conforto (HCQ) e qualidade de vida (MQOL) numa amostra de 205 doentes em fase paliativa em diferentes contextos. Os resultados permitiram obter instrumentos válidos, com boas capacidades psicométricas, capazes de medir a eficácia de intervenções nestas variáveis; - O segundo visou o estudo das características da esperança, conforto e qualidade de vida (QV) na mesma amostra, para identificar a relação entre estas variáveis e os fatores mediadores. Os resultados permitiram identificar as necessidades de esperança dos doentes e as condições sociodemográficas e clínicas influentes na sua esperança, que foram tidos em consideração na criação do programa de intervenção. O objetivo do terceiro estudo foi construir um programa de intervenção de Enfermagem para promover a esperança a partir da revisão da literatura e dos resultados do estudo anterior. O Programa de Promoção de Esperança (PPE) cumpre as premissas das intervenções de enfermagem efetivas. No quarto estudo testou-se a efetividade do PPE nas variáveis esperança, conforto e QV, num desenho experimental longitudinal do tipo préteste – pós teste ao longo de um mês. A amostra de 26 doentes em fase paliativa foi randomizada em dois grupos equivalentes e a aplicação do programa foi realizada no domicílio a um dos grupos. Os resultados são favoráveis à efetividade do PPE na promoção da esperança, com efeitos positivos no conforto e na QV. Os resultados contribuem para uma prática mais efetiva, um ensino mais dirigido às intervenções autónomas e para uma investigação mais produtiva.Hope is essential in the experience of living with advanced chronic disease. Maintaining hope in situations of physical, psychological, spiritual and social suffering requires expertise in managing hope enabling and inhibiting factors’. Its’ balance can be very difficult to achieve without the help of professionals, nurses in particular. The focus on hope promotion is imperative in caring for patients at end of life. Fostering hope in patients can result in comfort and quality of life. However interventions designed to promote hope are often nonspecific in its nature, and often don’t address the real needs of patients. On the other hand, as they are nonspecific, their effectiveness is hard to measure. Aiming to develop and test a program to promote hope for people with advanced disease, we conducted four studies The first was a cross cultural validation into Portuguese of HHI to measure hope; HCQ to measure comfort, and MQOL to measure quality of life in a sample of 205 palliative patients in different contexts. The results confirm that the all Portuguese versions are valid good psychometric properties. They fit the culture and are suitable for measuring the effectiveness of nursing interventions. The second study aimed to characterize hope, comfort and quality of life (QOL) in the same sample, to identify the relationship between these variables and their mediators. The results allowed us to identify the needs of patients regarding hope promotion and identify socio demographic and clinical variables that impact in their hope. These factors were taken into consideration and incorporated in the design of the intervention program. The objective of the third study was to construct a program of nursing intervention to promote hope from the literature review and the results of the previous study. The Hope Promotion Program (EPP) satisfies the assumptions of nursing interventions effective. In the fourth study we tested the effectiveness of PPE variables in hope, comfort and QOL, in a longitudinal experimental design (pretest-post test) over a month. A sample of 26 palliative patients was randomized into two equivalent groups. The intervention took place at patients home. The results indicate that PPE is effective in promoting hope, improving comfort and QoL. The results contribute to a more effective practice, nursing education using autonomous intervention and to a better research

A esperança na prática especializada de enfermagem de saúde mental e psiquiatria

A Esperança é essencial na experiência da vida, assumindo especial relevância na saúde mental das pessoas. Manter a esperança em situações de adversidade e na presença de sofrimento mental, requer uma gestão das condições facilitadoras e inibidoras da esperança, num equilíbrio que pode ser muito difícil conseguir sem a ajuda de profissionais competentes. A promoção da esperança enquanto foco de enfermagem é imperativa na prática do enfermeiro especialista em enfermagem de saúde mental, no sentido de assistir e apoiar os clientes no uso de estratégias de esperança na capacitação para a gestão da complexidade dos problemas mentais. Não obstante este reconhecimento do papel do enfermeiro especialista em saúde mental na capacitação para a esperança, a forma como ela se desenvolve nos contextos da prática especializada carece de evidência e visibilidade. O presente relatório versa sobre a prática especializada em enfermagem de saúde mental, realizada em dois contextos da prática clínica que favoreceram o desenvolvimento das competências de enfermeiro especialista e enfermeiro especialista de saúde mental, tendo a esperança como foco de atenção. Nele pretende-se descrever a relevância da esperança nos contextos de saúde mental, analisar o processo de desenvolvimento de competências à luz dos referenciais da enfermagem especializada e identificar o papel na esperança na saúde mental com base na evidência científica. As competências desenvolvidas foram suportadas pela metodologia científica, alicerçadas em modelos teóricos de enfermagem avançada, assente na identificação das necessidades /elaboração de diagnósticos, planeamento das intervenções, implementação de intervenções com vista à obtenção de ganhos em saúde nos clientes / grupos, e avaliação das mesmas face aos resultados esperados. A análise dos resultados obtidos face à especificidade das intervenções dirigidas à esperança foram considerados sensíveis à prática de enfermagem, e evidenciaram ganhos em saúde e esperança, suportados pela revisão integrativa da literatura e pelo estudo de caso

Alfaiataria Feminina na Atualidade: A Desconstrução do Clássico

Ao longo dos séculos, a alfaiataria vai ganhando evidência, o que demarca a sua transformação em cada década com diferentes assinaturas. A sua produção advém do artesanal para a vertente de ser produzida em massa, o que interseta com o estudo desta dissertação, destacar a forma como a alfaiataria está a adaptar-se aos diferentes contextos de modelagem e silhuetas desconstruídas de modo a permanecer nas bases da alfaiataria tradicional. Neste sentido, em termos metodológicos, a investigação teve como propósito de efetivar o vínculo entre a dimensão teórica e reflexiva e a dimensão prática e criativa, a elaboração de uma timeline do processo de transformação da alfaiataria até aos dias de hoje; com um caso prático que consiste na desconstrução de um blazer clássico, que compreenderá os conteúdos anteriormente estudados. Entre os principais resultados do trabalho, destaca-se na alfaiataria, a personalização como um processo de transformação por meio de promover a sustentabilidade, e a desconstrução enquanto uma tendência. Porém, apesar da sua silhueta diferir, as linhas clássicas estão presentes por determinados detalhes. Numa sociedade ainda muito pautada pelo consumo, a qual cada vez mais anseia pela personalização de peças, parece-nos importante estudar a forma como podemos promover a sua consciência, a fim de distinguir as diferenças que possui na alfaiataria para continuar a sofrer mutações no futuro.In our contemporary society, tailoring is one of the garments that brings the most power to our wardrobe. In any situation that marks a meeting or a business deal, both men and women opt for this symbolism that the piece conveys. Although it is a contempor ary piece, over time it has undergone some mutations in its modeling and materials, either to make, in this case, the blazer more comfortable or to be worn in a more informal way. The demand for tailoring, which now also holds the aspects of being mass pro duced not only in ateliers, intersects with the relationship of the study of this dissertation, to highlight how tailoring is adapting to different contexts of deconstructed modeling in order to remain the bases of the traditional. In this sense, in meth odological terms, the purpose of research was to establish a link between the theoretical and reflective dimension and the practical and creative dimension, the creation of a timeline of the tailoring transformation process until today and a practical case consisting of the deconstruction of a classic blazer, which will comprise the contents previously scrutinized. Among the main results of the work, tailoring stands out as a process of transformation through the promotion of sustainability, and deconst ruction as a trend. However, despite their different silhouettes, the classic lines are present in certain details. In a society still very much guided by consumption, which increasingly craves the customization of pieces, it seems important to us to study how we can promote its awareness, in order to distinguish the differences, it has in tailoring to continue to mutate in the future

Esperanza en un grupo terapéutico de pacientes deprimidos: Un estudio de caso cualitativo

To understand the perceptions of hope for people with depression in the context of a therapy group. Methods: using a qualitative case study approach, a semi-structured in-depth interview and a self-report questionnaire were conducted with seven women with depression integrated in a therapy group at a Portuguese day-care psychiatric unit. Data collection and analysis used triangulation of sources. Results: the participants evidenced hope founded on the positive experiences of the past with a strong affiliation component. Hope management is done fundamentally through the interpersonal relationships established between the members of the group, based on communicational patterns that are established on a regular basis, mediated by the group therapist. Conclusion: the therapy group functioned towards the reinforcement of hope in people who experience depression, and it works as a motivation to manage the implications of illness in the participants’ life and health project. Descriptors: Case Study; Depression; Hope; Interpersonal Relations; Self-Help Groups.info:eu-repo/semantics/publishedVersio