Clinical applicability of the terminological subset of palliative care for dignified dying / Aplicabilidad clínica del subconjunto terminológico cuidados paliativos para un morir con dignidad / Aplicabilidade clínica do subconjunto terminológico cuidados paliativos para um morrer com dignidade

ABSTRACT Objective: To evaluate the clinical applicability of the terminological subset of the international classification for the nursing practice of palliative care for a dignified dying, in oncology. Method: Prospective study evaluating the clinical applicability of 33 nursing diagnoses/outcomes and 220 nursing interventions. It used case studies of 20 cancer patients undergoing palliation. The nursing process steps were operated by two nurses. Descriptive statistics was used to present, according to the theoretical model, the nursing diagnoses/outcomes and interventions identified in the patients. All statements identified in patients at some point during care were considered applicable in clinical practice. Results: Twenty-nine nursing diagnoses/outcomes and 197 nursing interventions from the subset were identified. Conclusion: In the context of palliative care in patients with cancer, the clinical applicability of 87.8% of the diagnoses/outcomes and 89.5% of the interventions that make up the palliative care terminological subset for dignified dying is affirmed.

RESUMEN Objetivo: Evaluar la aplicabilidad clínica del subconjunto terminológico de la CIPE para la práctica de enfermería cuidados paliativos para un morir con dignidad, en oncología. Método: Estudio prospectivo, para evaluar la aplicabilidad clínica de 33 diagnósticos/resultados y 220 intervenciones de enfermería. Fueron utilizados estudios de caso de 20 pacientes oncológicos sometidos a paliación. Las etapas del proceso de enfermería fueron operacionalizadas por dos enfermeras. Se utilizó la estadística descriptiva para presentar, de acuerdo con el modelo teórico, los diagnósticos/resultados e intervenciones de enfermería identificados en los pacientes. Fueron considerados aplicables en la práctica clínica todos los enunciados identificados en los pacientes en algún momento de la asistencia. Resultados: Se identificaron 29 diagnósticos/resultados de enfermería y 197 intervenciones de enfermería del subconjunto. Conclusión: En el contexto de los cuidados paliativos en pacientes con enfermedad oncológica se puede afirmar la aplicabilidad clínica de 87,8% de los diagnósticos/resultados y 89,5% de las intervenciones que componen el subconjunto terminológico cuidados paliativos para un morir con dignidad.

RESUMO Objetivo: Avaliar a aplicabilidade clínica do subconjunto terminológico da classificação internacional para a prática de enfermagem cuidados paliativos para um morrer com dignidade, em oncologia. Método: Estudo prospectivo, de avaliação de aplicabilidade clínica de 33 diagnósticos/resultados e 220 intervenções de enfermagem. Usou estudos de caso de 20 pacientes oncológicos em paliação. As etapas do processo de enfermagem foram operacionalizadas por duas enfermeiras. Utilizou-se estatística descritiva para apresentar, conforme o modelo teórico, os diagnósticos/resultados e intervenções de enfermagem identificados nos pacientes. Foram considerados aplicáveis na prática clínica todos os enunciados identificados nos pacientes em algum momento da assistência. Resultados: Foram identificados 29 diagnósticos/resultados de enfermagem e 197 intervenções de enfermagem do subconjunto. Conclusão: No contexto dos cuidados paliativos em pacientes com doença oncológica afirma-se a aplicabilidade clínica de 87,8% dos diagnósticos/resultados e 89,5% das intervenções que compõem o subconjunto terminológico cuidados paliativos para um morrer com dignidade.

Reconstruction options for locally advanced breast cancer cases and their impact on the quality of life

Introduction: Radical surgical procedures are indicated for part of the patients with locally advanced breast cancer (LABC). The improvement in the use of myocutaneous flaps allowed surgeons to perform extensive resections, a procedure that can be traumatic for women, leading to several biopsychosocial complications in a shortened survival. Objectives: This study aimed at understanding the effects of surgical treatment on the quality of survival of patients with guarded and unchanging prognosis. Methodology: The project was designed in two stages: review of medical records with a sample of 27 cases and face-to-face interviews with the administration of questionnaires in a sample of five cases among the remaining patients who underwent LABC surgery at Hospital Erasto Gaertner in Curitiba (PR). Results: On average, the answers obtained with the World Health Organization Quality of Life (WHOQOL-BREF) instrument were "regular" for physical, psychological, and environmental domains and "good" for the social relations domain. In the 12-item short-form survey (SF-12), the means were 45,125 points for the mental component and 40,875 points for the physical one. These values show the impact of advanced disease, hygienic surgery, and chest reconstruction on the quality of life of the patients, reflecting the biopsychosocial damage caused by LABC. Conclusion: The data reveal that LABC treatment is aggressive, but in patients with survival, the surgical treatment associated with chest reconstruction had surprisingly positive results in relation to quality of life.