Training Proposal in Palliative Care for Primary Care Nurses in a Health Area in Spain.

BACKGROUND: Primary Health Care nurses express deficits in their training in Palliative Care. The purpose of this study is to design a Palliative Care training plan and a bereavement care protocol for Primary Health Care nurses of the Dr. Peset Health Department according to their needs. METHODS: Assessment of theoretical and practical training needs and literature review for the design of the training plan. RESULTS: A training plan was elaborated that included a protocol of care for the bereaved. The plan was adjusted to the needs detected in Primary Health Care nurses of the Dr. Peset Health Department. Important training deficits were detected in clinical practice; Conclusions: Improving the care of people with palliative needs in Primary Health Care requires adequate training of the nurses who care for them so their knowledge is the basis of their interventions. This study was not registered.

Valoración de necesidades formativas de nivel básico en cuidados paliativos en enfermeras de atención primaria en España / Assessment of basic training needs in palliative care in primary healthcare nurses in Spain

Objetivo: Valorar la formación, la percepción de preparación y las necesidades formativas en cuidados paliativos (CP) teóricas y prácticas de las enfermeras de atención primaria en España. Diseño: Estudio descriptivo transversal. Emplazamiento: Centros de atención primaria en España con acceso online. Participantes: Enfermeras de atención primaria en España durante enero y febrero de 2021. De las 344 respuestas, 339 cumplían criterios de inclusión. Mediciones principales: Se analizaron variables sociodemográficas, formación en CP, necesidades de formación mediante cuestionario online de Google Forms e Instrumento INCUE. Se realizaron análisis descriptivos y se compararon los resultados mediante test de simetría exacto y test de Mann-Whitney. Resultados: Mayoritariamente mujeres (82,6%) con una media de edad de 45,5años. El 86,1% de las enfermeras encuestadas tenían formación en CP, siendo básica en el 45,4%. Solo el 40,5% se sienten bastante o muy preparadas para cuidar de pacientes paliativos. Demandaban mayor formación en psicoemocional y duelo y afrontamiento de pérdidas. Superaron el bloque teórico el 83,76%, frente el 43,36% del práctico, detectándose mayores necesidades formativas en este último (p<0,001). Las proporciones de capacitados variaban en función del nivel formativo. Conclusiones: La formación enfermera en CP en atención primaria continúa siendo deficitaria sobre todo en su aplicación práctica, siendo necesaria formación dirigida para que repercuta en el cuidado de las personas con necesidades paliativas y sus familias.(AU)

Aim: Asses training, perception of readiness and training needs in palliative care (PC) theoretical and practical of primary care nurses in Spain, through descriptive cross-sectional study. Design: Descriptive cross-sectional study. Setting: Primary care nurses in Spain with online access. Participants: Primary care nurses in Spain, January and February 2021. 344 responses, 339 met the inclusion criteria. Main neasurements: Sociodemographic variables, PC training, training needs were analyzed. Through Google Forms online questionnaire and INCUE Instrument. Descriptive analyses were performed and the results were compared using the exact symmetry test and the Mann-Whitney test. Results: 82,6% women, with an average age of 45.5years. 86.1% of the nurses had training in PC, been basic in the 45.4%. Only 40.5% feel quite or very prepared to take care for palliative patients. Nurses demanded more training in psycho-emotional and grief and coping with losses. 83.76% passed the theoretical block compared to 43.36% of the practical, detecting higher training needs in the last (P<.001). The passed rates varied depending on the educational level. Conclusions: Nursing training in PC in primary care continues to be deficient, especially in practical application. Targeted training is necessary to have an impact on the care of people with palliative needs and their families.(AU)

[Assessment of basic training needs in palliative care in primary healthcare nurses in Spain]. / Valoración de necesidades formativas de nivel básico en cuidados paliativos en enfermeras de atención primaria en España.

AIM: Asses training, perception of readiness and training needs in palliative care (PC) theoretical and practical of primary care nurses in Spain, through descriptive cross-sectional study. DESIGN: Descriptive cross-sectional study. SETTING: Primary care nurses in Spain with online access. PARTICIPANTS: Primary care nurses in Spain, January and February 2021. 344 responses, 339 met the inclusion criteria. MAIN NEASUREMENTS: Sociodemographic variables, PC training, training needs were analyzed. Through Google Forms online questionnaire and INCUE Instrument. Descriptive analyses were performed and the results were compared using the exact symmetry test and the Mann-Whitney test. RESULTS: 82,6% women, with an average age of 45.5years. 86.1% of the nurses had training in PC, been basic in the 45.4%. Only 40.5% feel quite or very prepared to take care for palliative patients. Nurses demanded more training in psycho-emotional and grief and coping with losses. 83.76% passed the theoretical block compared to 43.36% of the practical, detecting higher training needs in the last (P<.001). The passed rates varied depending on the educational level. CONCLUSIONS: Nursing training in PC in primary care continues to be deficient, especially in practical application. Targeted training is necessary to have an impact on the care of people with palliative needs and their families.

Influence of Palliative Care Training on Nurses' Attitudes towards End-of-Life Care during the COVID-19 Pandemic in Spain.

AIM: This study aims to assess the influence of training on nurses' attitudes toward end-of-life care during the COVID-19 pandemic alarm state in Spain. DESIGN: Cross-sectional descriptive study. Data collection was carried out by means of an ad hoc questionnaire using Google Forms in April and May 2020. The score of attitudes toward end-of-life care was used, to which sociodemographic variables and training in palliative care were added. METHODS: Data were collected from 238 nursing professionals who had cared for COVID-19 and non-COVID-19 adult patients at the end-of-life stage in a hospital or nursing home. RESULTS: Results showed that 51% of the nurses in the sample had training in palliative care. However, the percentage decreased to 38.5% among those who cared for COVID-19 patients and to 44.5% in those who cared for non-COVID-19 patients. In relation to attitudes about end-of-life care, more positive attitudes and a higher mean score were found in the trained group. CONCLUSIONS: Palliative care training is a key element in end-of-life care and is even more important in times of COVID-19. IMPACT: Although end-of-life accompaniment has been studied, few studies have included the influence of training on this during the pandemic. This study identifies key elements of accompaniment and training in a comparison of COVID-19 and non-COVID-19 patients during the pandemic. In relation to attitudes toward end-of-life care, the results showed a more positive attitude and a higher mean score in the trained group (3.43 ± 0.37 versus 3.21 ± 0.32), the difference being statistically significant (p < 0.001).

Design and Validation of the INCUE Questionnaire: Assessment of Primary Healthcare Nurses' Basic Training Needs in Palliative Care.

Many instruments have been created to measure knowledge and attitudes in palliative care. However, not only is it important to acquire knowledge, but also that this knowledge should reach patients and their relatives through application in clinical practice. This study aimed to develop and psychometrically test the INCUE questionnaire (Investigación Cuidados Enfermeros/Investigation into Nurses' Care Understanding of End-of-Life) to assess the basic training needs of primary or home healthcare nurses in palliative care. A questionnaire was developed based on the classical theory of tests and factor analysis models. Initially, 18 experts developed 67 items in two blocks and determined content validity by two rounds of expert panels. Exploratory factor analysis and reliability testing were conducted with a non-probabilistic sample of 370 nurses. Some items were observed to have very low homogeneity indices or presented convergence problems and were eliminated. Questionnaire reliability was 0.700 in the theoretical block (KR20 Index) and 0.941 in the practical block (Cronbach's alpha). The model converges and shows an adequate fit, specifically CFI = 0.977, TLI = 0.977 and RMSEA = 0.05. The correlation between the two factors in the model is ρ = 0.63. The questionnaire objectively evaluates primary or home healthcare nurses' knowledge of palliative care and its practical application, thereby facilitating more efficient training plans.

Acompañamiento a los pacientes al final de la vida durante la pandemia por COVID-19 / Accompaniment of patients at the end of life during the COVID-19 pandemic

OBJETIVOS: Describir el acompañamiento y la despedida de los pacientes en situación de últimos días a nivel hospitalario y residencial y conocer las actitudes profesionales hacia el cuidado de los pacientes al final de su vida durante la pandemia por COVID-19. MÉTODO: Estudio descriptivo transversal dirigido a profesionales de enfermería. La recogida de datos se realizó a través de un cuestionario ad hoc a través de Google Forms, durante abril y mayo de 2020. Se recogieron variables sociodemográficas, laborales, de formación, variables de satisfacción, motivación y estrés laboral y la escala de actitudes hacia el cuidado de pacientes al final de la vida. Se realizó un análisis descriptivo univariante de los sujetos de la muestra y de cada una de las variables estudiadas mediante proporciones, frecuencias, medidas de tendencia central y de dispersión mediante SPSS 22.0. RESULTADOS: Según los profesionales, un porcentaje importante de pacientes con diagnóstico de COVID-19 (38,8 %, n = 110) no han estado acompañados en las últimas 48 horas de vida; este se ha limitado a horas (56,4 %, n = 154). La despedida se ha producido mayoritariamente antes del fallecimiento (44,1 %, n = 143). Gran parte de los profesionales han notado cambios en el acompañamiento y despedida (77,3 %, n = 211), al igual que en su forma de cuidar. Un 52,4 % (n = 143) refieren haber encontrado algún paciente fallecido al entrar en la habitación. CONCLUSIONES: A pesar de la existencia de protocolos de acompañamiento y el esfuerzo de los sanitarios, la soledad ha estado presente en los pacientes durante la pandemia. Los profesionales han modificado el cuidado proporcionado a los pacientes al final de la vida, generando conflictos y actitudes emocionales negativas hacia el cuidado de estos pacientes durante la pandemia. La situación de aislamiento supone un coste emocional para profesionales y familias en duelo, que será importante valorar y estudiar a medio plazo

OBJECTIVES: This study describes how patients were accompanied and bidden farewell in their last few days of life at hospitals and nursing homes. It also describes the attitudes of health professionals towards the care of patients in the last days of life during the COVID-19 pandemic. METHOD: A cross-sectional descriptive study was conducted in nurses. Data collection was done by an ad-hoc questionnaire in April and May 2020 through Google Forms. Collected variables included social demographics, work environment, training, satisfaction variables, motivation, work-related stress, and an attitude towards patients at the end of life scale. A descriptive univariate analysis of the subjects in the sample was carried out using the SPSS 22.0 software including proportions, frequencies, measurements of central tendency, and distribution. RESULTS: According to professionals, an important number of patients diagnosed with Covid-19 (38.8%, n = 110) were not accompanied in their last 48 hours of life. This was limited to a few hours (56.4%, n = 154), and saying goodbye was done in a majority of cases before death (44.1%, n = 143). A great number of professionals have noticed changes in accompanying and saying goodbye (77.3%, n = 211), including their way of caring. A total of 52.4%, n = 143, said that they had found patients dead on entering the room; 53.1%, n = 178 were aware of accompanying protocols. CONCLUSIONS: It is obviously clear that many patients were alone during their last hours in spite of accompaniment protocols and the efforts of the staff looking after them. Professionals have modified the care given to patients at the end of life during the pandemic, generating conflicts and negative emotional attitudes. Isolation has a great emotional cost for the staff and for families during bereavement, which is important to study and evaluate in the mid-term

La alimentación como fuente de conflicto entre paciente y familia en cuidados paliativos / Feeding as a source of conflict between patient and family in palliative care

Introducción: los conflictos forman parte de las relaciones humanas. Pocos estudios han contemplado los conflictos que la alimentación puede producir en la fase final de la vida, los factores que inciden en su aparición y la forma de gestionarlos. Su conocimiento ayudaría al equipo asistencial a mejorar el cuidado de estos pacientes y sus familias. Objetivo: analizar la existencia del conflicto intrafamiliar vinculado con la alimentación en la enfermedad oncológica en cuidados paliativos, la gestión del mismo y la influencia en su aparición de los cambios en la alimentación, el control sobre la misma, la necesidad de comer, el acompañamiento, la adaptación a la enfermedad y la vinculación de la alimentación con la supervivencia, la calidad de vida y el cuidado. Métodos: el diseño del estudio fue transversal. Se recogieron datos de 57 parejas formadas por un paciente oncológico en cuidados paliativos y su cuidador principal por medio de una entrevista ad hoc validada y de la escala Perceived Adjustement to Chronic Illness Scale (PACIS). Los datos se analizaron mediante análisis de contenidos y análisis descriptivos e inferenciales. Resultados: pacientes y cuidadores reconocieron la existencia de un conflicto relacionado con la alimentación del paciente (49,1% y 54,4%), gestionándolo cerca del 30% de forma inadecuada. Ninguna de las variables analizadas resultó estadísticamente significativa en relación a la aparición del conflicto (considerando p < 0,05), excepto la necesidad de comer del paciente (?² = 9,163; p = 0,027). Conclusiones: el conflicto intrafamiliar debido a la alimentación se presenta como un problema que requiere reflexión, análisis e intervención por parte del equipo asistencial, dado que no se han podido establecer todos los factores que inciden en su aparición

Introduction: conflicts are part of human relationships. Few studies have looked at the conflicts that food can produce at the end of life, the factors that affect its appearance, and the way to manage them. This knowledge would help healthcare teams to improve the care of these patients and their families. Aim: to analyze the existence of a family conflict linked to food in palliative-care oncological patients, its management, and the influence on their appearance of changes in diet, diet control, need to eat, support, adaptation to disease, and the association of feeding with survival, quality of life, and care. Methods: the design of the study was cross-sectional. Data from 57 palliative-care oncological patient-family caregiver pairs were collected through a validated ad hoc interview and the PACIS scale. The data was analyzed through content analyses and descriptive and inferential analyses. Results: patients and caregivers recognized the existence of conflict related to the patient's diet (49.1 % and 54.4 %), with approximately 30 % managing it in an inappropriate way. None of the analyzed variables was statistically significant in relation to conflict appearance (considering p < 0.05), except patient need to eat (?² = 9.163, p = 0,027). Conclusions: family conflict due to patient feeding is reported as a problem that requires reflection, analysis, and intervention by the healthcare team, given that all factors involved in its appearance could not be established

[Feeding as a source of conflict between patient and family in palliative care]. / La alimentación como fuente de conflicto entre paciente y familia en cuidados paliativos.

INTRODUCTION: Introduction: conflicts are part of human relationships. Few studies have looked at the conflicts that food can produce at the end of life, the factors that affect its appearance, and the way to manage them. This knowledge would help healthcare teams to improve the care of these patients and their families. Aim: to analyze the existence of a family conflict linked to food in palliative-care oncological patients, its management, and the influence on their appearance of changes in diet, diet control, need to eat, support, adaptation to disease, and the association of feeding with survival, quality of life, and care. Methods: the design of the study was cross-sectional. Data from 57 palliative-care oncological patient-family caregiver pairs were collected through a validated ad hoc interview and the PACIS scale. The data was analyzed through content analyses and descriptive and inferential analyses. Results: patients and caregivers recognized the existence of conflict related to the patient's diet (49.1% and 54.4%), with approximately 30% managing it in an inappropriate way. None of the analyzed variables was statistically significant in relation to conflict appearance (considering p < 0.05), except patient need to eat (χ² = 9.163, p = 0,027). Conclusions: family conflict due to patient feeding is reported as a problem that requires reflection, analysis, and intervention by the healthcare team, given that all factors involved in its appearance could not be established.

INTRODUCCIÓN: Introducción: los conflictos forman parte de las relaciones humanas. Pocos estudios han contemplado los conflictos que la alimentación puede producir en la fase final de la vida, los factores que inciden en su aparición y la forma de gestionarlos. Su conocimiento ayudaría al equipo asistencial a mejorar el cuidado de estos pacientes y sus familias. Objetivo: analizar la existencia del conflicto intrafamiliar vinculado con la alimentación en la enfermedad oncológica en cuidados paliativos, la gestión del mismo y la influencia en su aparición de los cambios en la alimentación, el control sobre la misma, la necesidad de comer, el acompañamiento, la adaptación a la enfermedad y la vinculación de la alimentación con la supervivencia, la calidad de vida y el cuidado. Métodos: el diseño del estudio fue transversal. Se recogieron datos de 57 parejas formadas por un paciente oncológico en cuidados paliativos y su cuidador principal por medio de una entrevista ad hoc validada y de la escala Perceived Adjustement to Chronic Illness Scale (PACIS). Los datos se analizaron mediante análisis de contenidos y análisis descriptivos e inferenciales. Resultados: pacientes y cuidadores reconocieron la existencia de un conflicto relacionado con la alimentación del paciente (49,1% y 54,4%), gestionándolo cerca del 30% de forma inadecuada. Ninguna de las variables analizadas resultó estadísticamente significativa en relación a la aparición del conflicto (considerando p < 0,05), excepto la necesidad de comer del paciente (χ² = 9,163; p = 0,027). Conclusiones: el conflicto intrafamiliar debido a la alimentación se presenta como un problema que requiere reflexión, análisis e intervención por parte del equipo asistencial, dado que no se han podido establecer todos los factores que inciden en su aparición.

Dificultades de reclutamiento en investigación en cuidados paliativos / Sampling difficulties in palliative care research

OBJETIVO: Analizar la mortandad de la muestra en investigaciones con pacientes paliativos oncológicos en domicilio. MÉTODO: Estudio descriptivo y transversal. Se planteó un estudio multicéntrico con muestreo intencional entre enero 2011 y junio 2012. CRITERIOS DE INCLUSIÓN: Pacientes oncológicos subsidiarios de cuidados paliativos, ECOG 2-3, mayores de 18 años, con cuidador familiar en domicilio y consentimiento informado. Se analizaron variables sociodemográficas, mortandad de la muestra y otros factores relacionados con las dificultades en el reclutamiento, la participación y los tiempos de dilación entre las etapas de la investigación. Se realizaron análisis descriptivos e inferenciales. RESULTADOS: Ciento treinta y cuatro pacientes cumplían criterios de inclusión, con una edad media de 69,97 años. El 50% eran hombres, estando casados el 58,2% y viudos el 29,9%. Tan solo 57 pacientes concluyeron el estudio. El 53% de los pacientes no fueron incluidos en el estudio, un 4,5% de las entrevistas no se concluyeron, por lo que la mortandad de la muestra fue del 57,5%. Declinaron participar el 35,2% de los pacientes (57,7% hombres) y el 42,3% de los cuidadores (80,3% mujeres). El equipo excluyó al 22,5%de los pacientes por causas clínicas. Las causas de la no participación fueron: sin especificar el 29,6%; reagudización de los síntomas el 25,4%; deterioro del estado general el 23,9%; exitus el 8,5%; no problemas alimenticios el 5,6%; falta de tiempo el 4,2%; no firmar el consentimiento el 1,4%; y no implicar a la cuidadora el 1,4%. Todas las entrevistas no concluidas fueron causadas por reagudización sintomática. El tiempo transcurrido entre el reclutamiento y el sondeo sobre la participación no fue estadísticamente significativo entre los participantes y los no participantes. Tampoco lo fue entre las entrevistas concluidas y las no concluidas. CONCLUSIONES: El diseño de cualquier investigación en paliativos debería tener en cuenta la alta mortandad de la muestra en este tipo de investigaciones, no habiéndose encontrado factores fácilmente modificables por el investigador que puedan disminuirla

AIMS: To analyze the sample attrition in research with cancer patients at home. METHODS: Descriptive and transversal study. Multicentre study with purposive sampling. Inclusion criteria: palliative oncological, ECOG 2-3, older than 18 years, with family caregiver at home, informed consent. Variables: sociodemographic, sample attrition and other factors related to recruiting difficulties, participation and time delay between stages of research. Descriptive and inferential analysis. RESULTS: One hundred and thirty four patients met the inclusion criteria, 69.97 years old on average.50% men, 58.2% were married and 29.9% widowed. Only 57 patients completed the study. Fifty-three percent of patients were not included in the study. The sample attrition was 57.5%, 4.5% surveys were not completed.35.2% patients declined to participate (57.7% men) and 42.3% caregivers (80.3% women). The team excluded 22.5% patients for clinical reasons. The causes of nonparticipation were: 29.6% unspecified, 25.4% symptomatic exacerbation, 23.9% patient worsening, 8.5% died, 5.6% had no food problems, 4.2% lack of time, 1.4% did not sign consent and 1.4% patients did not want to involve their caregiver. All of the uncompleted surveys were due to symptomatic exacerbation. The time between recruitment and surveying on participation was not statistically significant between participants and nonparticipants, or between the completed and uncompleted surveys. CONCLUSIONS: The design of any investigation in palliative care should consider the high sample attrition in this type of research, factors that could be easily modifiable by the researcher to reduce it were not found