Suicide attempts in Spain according to prehospital healthcare emergency records.

OBJECTIVE: To analyze the number and characteristics of suicide attempts by reviewing records of the public emergency healthcare service information system. METHOD: A retrospective observational study was conducted of emergency telephone calls received between January 1 2007 and December 31 2013 throughout the Andalusia region (Southern Spain). Cases were selected based on phone operator or healthcare team labeling. Data were analyzed on the characteristics of the individuals, the timing and severity of attempts, their prioritization, and their outcome. RESULTS: Between January 1 2007 and December 31 2013, 20.942 calls related to suicide attempts were recorded, a rate of 34.7 attempts per 100,000 inhabitants. Most cases were classified by the public emergency healthcare service (Empresa Pública de Emergencias Sanitarias, EPES) as code X84 (The International Statistical Classification of Diseases, tenth revision, ICD-10) or 305(The International Statistical Classification of Diseases, ninth revision, ICD-9). Attempts were more frequent in the 35-49-year age group and there were similar proportions of males and females. The lowest number of calls for suicide attempts were in 2007 and the highest in 2013. Calls were more frequent during the summer months, at weekends, and between 16:00 and 23:00 h. The likelihood of evacuation to the hospital emergency department was almost two-fold lower in over 65-yr-olds than in younger individuals. Significant (Æ¿ = 0.001) gender differences were found in call outcome and prioritization. The most influential factor for evacuation to a hospital emergency department was the code assigned by the attending healthcare team. CONCLUSIONS: Information obtained from extra-hospital emergency services provides valuable data on the characteristics and timing of calls related to suicide attempts, complementing information from hospital emergency departments or population surveys. There is a need to standardize the definition and recording of a suicide attempt.

Facing death. Student's thoughts towards the feeling of their own death / La muerte ante uno mismo. Respuestas de jóvenes estudiantes ante el pensamiento de la propia muerte

Narratives produced by thinking and reflecting about death and dying may be themselves a source of new knowledge in the study of anxiety and attitudes toward death. A qualitative descriptive study aimed to explore the features of thoughts, emotions and feelings about young people's own death, (nursing students) was conducted. 85 students voluntarily answered a self-administered questionnaire with open questions based on Mortality Salience, used in the Terror Management Theory. Content analysis using Atlas.ti software was performed. When reflecting upon their own death, participants reported substantive emotions such as fear, pain, distress, sadness or loneliness. The fear of their own death was specified as the inability to achieve goals in life, to leave the family and the dying process itself. When reflecting upon been physically dead, attributes of the decomposition of the body, spiritual attributes, beliefs, denial and preferences were identified. Cultural worldview, values and beliefs of each person were remarkably present when thinking about their own death (AU)

Las narraciones sobre lo que evoca pensar en la propia muerte y describir los pensamientos y sentimientos sobre el morir, pueden ser por sí mismas una fuente de conocimiento nuevo en el estudio de la ansiedad y las actitudes ante la muerte. Se llevó a cabo un estudio cualitativo descriptivo con el objetivo de explorar las características de los pensamientos, las emociones y sentimientos sobre la propia muerte de jóvenes, estudiantes de enfermería. 85 estudiantes respondieron voluntariamente un cuestionario autoadministrado de preguntas abiertas basadas en la Mortality Salience empleada en la Teoría de la Gestión del Terror. El análisis se realizó mediante la estrategia de análisis de contenido con el programa Atlas ti. Ante el pensamiento sobre la propia muerte respondieron con los sustantivos miedo, dolor, angustia, tristeza o soledad. El miedo a la propia muerte se concretó como la imposibilidad de lograr las metas en la vida, dejar a la familia y el proceso de muerte en sí mismo. Ante las creencias sobre estar físicamente muerto señalaron atributos de la descomposición del cuerpo, atributos espirituales, creencias, negación y preferencias. La visión cultural, los valores y creencias de cada persona, se encuentran muy presentes cuando piensan en su propia muerte (AU)

Establecimiento de la situación de enfermedad terminal en enfermedades oncológicas y no oncológicas: estudio retrospectivo con historias clínicas / Indentifying terminal illness situation in cancer and non cancer diseases: A retrospective study using clinical records

OBJETIVO: Conocer cómo y en qué momento del proceso de enfermedad se identifica la situación terminal en las historias clínicas de pacientes con enfermedades avanzadas oncológicas y no oncológicas; las expresiones y argumentos registrados para definirla y la presencia de factores pronósticos. MÉTODO: Estudio observacional y retrospectivo de las historias clínicas de los pacientes que fallecieron en 4 hospitales de Granada (España) en el año 2010, por enfermedad oncológica, enfermedad pulmonar crónica/EPOC, insuficiencia cardiaca crónica, enfermedad hepática avanzada e insuficiencia renal crónica. Se revisaron los informes clínicos de ingreso, el informe de alta y la evolución médica y enfermera correspondientes a los últimos 3 meses de vida del paciente. Se registraron los datos sociodemográficos, clínicos y específicos relacionadas con el pronóstico de enfermedad terminal. RESULTADOS: Se revisaron 202 historias clínicas. En un 51,5% de los casos consta el establecimiento de la situación de enfermedad terminal. Un 33,6% han sido registrados como paciente en situación terminal entre los 7 días y las últimas 48h antes del fallecimiento. Se produce una mayor identificación de situación terminal en pacientes oncológicos (p = 0,004). Las expresiones que más se emplean en las historias son «enfermedad terminal» (32,7%) en el caso de pacientes de cáncer y «mal pronóstico» (41,3%) en pacientes no oncológicos. Los argumentos que más se emplean son cuestiones relativas a un mal pronóstico (42,2%) y al estadio de la enfermedad (39,8%), especialmente en los pacientes de cáncer. No existen diferencias entre los pacientes identificados como en situación terminal y aquellos que no, en relación con la edad, el sexo, la comorbilidad y el tiempo de evolución de la enfermedad. CONCLUSIONES: Este trabajo muestra la dificultad de los clínicos en identificar la fase terminal de forma temprana y una actitud poco favorable a registrarla en las historias clínicas. Esta conducta puede constatarse por la frecuente utilización de expresiones ambiguas y por la falta de criterios y argumentos para señalar la situación terminal

AIM: To know how and when terminal illness situation is identified in advanced cancer and non-cancer patients in medical records, and which expressions and arguments are used when this situation is established, as well as the presence of prognosis factors. METHOD: Observational, retrospective study of medical records of patients who died of oncological disease, COPD disease, chronic heart failure, advanced liver disease, and chronic renal failure in 4 hospitals in Granada (Spain). Medical records including hospitalisation reports, discharge documents, and medical and nurse evaluations of the last 3 months of life were reviewed. Sociodemographic, clinical, and specific data related to the prognosis of terminal illness were recorded. RESULTS: From the 202 medical records reviewed, 51.5% patients were identified as in terminal illness situation. One third (33.6%) of them were identified between 7 days and the last 48h before death. Doctors tend to identify more cancer-patients than non-cancer patients as in terminal illness situation (P=.004). The most used expressions in medical records are 'terminal disease' in cancer patients (32.7%) and 'poor prognosis' in non-cancer patients (41.3%). The arguments most used are related to poor prognosis (42.2%), and related to the stage of the disease (39.8%), especially in cancer PATIENTS: There are no statistical differences between patients identified as terminally ill, and patients not identified, related to age, gender, comorbidity and time of evolution. CONCLUSIONS: This paper shows how difficult it is for clinicians to identify terminal illness at an early stage, and an unfavourable attitude towards reporting it in medical records. This attitude could be confirmed by the frequent use of ambiguous expressions regarding terminally ill, the lack of criteria and arguments to identify this situation

Formación en cuidados paliativos y efecto en la evaluación emocional de imágenes de muerte / Palliative care training and its effects on emotional evaluation of death related images

INTRODUCCIÓN: La literatura informa, ampliamente, que la formación repercute de manera positiva tanto en alumnos a la hora de afrontar sus prácticas clínicas como en el trabajo de los profesionales cuando atienden a personas en proceso de fin de vida, pero es escasa respecto a explicar el modo en que la formación repercute en la modificación del propio procesamiento emocional. El objetivo de este estudio es evaluar el efecto en la respuesta emocional, el grado de sufrimiento y la competencia ante la muerte de estudiantes de Enfermería tras cursar la asignatura de Cuidados Paliativos, incorporando como instrumento de evaluación una batería de imágenes afectivas (IAPS). MÉTODO: Estudio cuasi experimental con una muestra de 143 estudiantes distribuidos en 2 grupos, antes y después de cursar la asignatura, evaluando la respuesta emocional con el IAPS y el afrontamiento ante la muerte con la escala de Bugen. El instrumento de estímulos visuales utilizado consta de 36 imágenes y 4 condiciones como categorías emocionales: agradable, neutra, desagradable y muerte. RESULTADOS: La respuesta emocional ante imágenes desagradables se mantiene igual en ambos grupos en cuanto a valencia, activación y dominancia, sin embargo los alumnos que han cursado la asignatura de Cuidados Paliativos se activan significativamente menos ante imágenes de muerte que aquellos que no han recibido la formación. CONCLUSIÓN: La formación en cuidados paliativos repercute de manera positiva en el procesamiento emocional, la gestión del sufrimiento y el afrontamiento relacionado con el fin de vida

INTRODUCTION: It is widely reported in the literature that training has a positive impact on students, and has an effect in their clinical practice and professional work when facing and caring for people at the end of life process, but how that formation affects and modifies the emotional processing itself is scarcely described. The aim of this study is to evaluate the effect on the emotional response, the scale of suffering and being competent with death, in Nursing students after completing a Palliative Care course, incorporating a battery of affective pictures using the International affective picture system (IAPS) as an evaluation tool. Method: A quasi-experimental study was conducted on a sample of 143 students divided into 2 groups, one before and the other after completing the course, assessing the emotional response to the IAPS, and how they would face death using the Bugen's Coping with Death Scale. The visual stimuli tool used consists of 36 images and 4 conditions as emotional categories: pleasant, neutral, unpleasant, and death. RESULTS: The emotional response to unpleasant images was similar in both groups, in terms of valence, arousal and dominance. However, the students who had taken the Palliative Care course reacted significantly less to death images than those who had not received any training. CONCLUSIONS: Training in palliative care positively affects the emotional processing of suffering management and confrontation related to the end of life

Feelings of loss and grief in parents of children diagnosed with autism spectrum disorder (ASD).

BACKGROUND: Various authors have reported feelings of loss and grief in parents of children with autism spectrum disorder. However, no previous studies have investigated the structure of these feelings. AIMS: To analyze in depth the feelings of loss in parents of children diagnosed with autism spectrum disorder. METHOD: A qualitative study was conducted based on grounded theory. Twenty parents participated through purposive sampling. PROCEDURE: Semi-structured interviews were conducted, asking about different emotional aspects of the upbringing of a child with autism spectrum disorder. Atlas.ti 6.2 program was used for open, axial, and selective coding. RESULTS: The core category that explained the feelings of these parents was unexpected child loss, associated with shock, negation, fear, guilt, anger, and/or sadness. Two processes were identified, one associated with the resolution of grief and the other with obstacles to overcoming it. IMPLICATIONS: Feelings of loss play an important role in explaining the complex emotions experienced by these parents. Different intervention strategies are proposed.

Feelings of loss in parents of children with infantile cerebral palsy.

BACKGROUND: Raising a child diagnosed with infantile cerebral palsy is a challenge for families and causes many changes in their lifestyle. When the diagnosis is unexpected, feelings related to loss and hard-to-manage emotions such as uncertainty and bewilderment can arise. OBJECTIVE: To identify how feelings of loss are structured in fathers and mothers of children diagnosed with infantile cerebral palsy. METHODS: A qualitative design with based on a grounded theory approach was used. Twenty-four participants were selected to participate in the research from San Cecilio Clinical Hospital in the city of Granada (Spain). The sampling procedure was purposive based on inclusion and exclusion criteria and ended when data saturation was acquired. The participants were interviewed according to a script developed ad hoc. Data were collected during 2012. The interviews were analyzed with Atlas.ti 6.2 software, using the sequence suggested by Straus and Corbin including open, axial and selective codification. RESULTS: The analysis led to the identification of the main category, "Experiences of loss." The codes contributing to explain these experiences were "Shock," "Hope," "Traumatic Experience," "Feelings related to loss," "Ideal Child" and "Acceptance of the Child." CONCLUSIONS: These parents experience feelings of loss of the ideal child, which are more complex in the first stage of the diagnosis and when the severity of the cerebral palsy is greater. Emotional intervention on the part of health care providers is needed to aid parents in facing the various obstacles encountered throughout their child's up-bringing.

Funciones y situación actual de la intervención de los psicólogos en cuidados paliativos / No disponible

Los psicólogos tienen un papel crucial en los procesos de fin de vida. Dentro de éstos, los cuidados paliativos son una de las áreas con más desarrollo en los últimos años, proponiendo un cuidado holístico e integral. Sin embargo, las funciones y roles de los psicólogos no están del todo claros. Por ello, se ha realizado una revisión teórica, buscando los estudios que ponen de relevancia su papel, funciones, así como la formación específica que deberían tener los psicólogos que trabajen en esta área. La mayoría subrayan la triple intervención con el paciente, la familia y el equipo sanitario. Funciones de evaluación e intervención psicológica, así como de prevención del burnout y del duelo aparecen como destacadas. La formación no está reglada aunque se está intentando buscar un currículum común

Psychologists have a crucial role in end-of-life processes. Within them, palliative care is one of the most developed areas and it is based on an holistic approach. However, the role of psychologists in this area is not clear. In order to clarify their function, a theoretical review has been carried out. The objective was to identify and integrate into a narrative the roles and functions of psychologist working in palliative care, as well as topics related to specific formation. Most of the articles reviewed outlined an intervention based on three axis: the patient, the family and the health care team. Functions such as psychological assessment, prevention of burnout and intervention on bereaved people appears as central. Specialized training and formation is not regulated, although recent proposals are trying to elaborate a common curriculum

Experiencias y obstáculos de los psicólogos en el acompañamiento de los procesos de fin de vida / Experiences and obstacles of psychologists in the accompaniment of end-of-life processes

Los psicólogos están encargados de realizar la atención emocional a los pacientes que se encuentran en procesos de fin de vida. No se conocen cuáles son las experiencias, los obstáculos y problemas con que se encuentran al intervenir en estos casos, siendo éste el principal objetivo de la investigación. Para ello se realizó un estudio cualitativo de tipo fenomenológico utilizando entrevistas en profundidad, que se analizaron con el software Atlas.ti siguiendo una codificación abierta. La muestra estuvo compuesta por 15 psicólogos que desempeñaban su labor en cuidados paliativos, otras unidades hospitalarias (oncología, salud mental, urgencias y atención temprana) o intervenían de manera privada en la provincia de Granada (España). Los resultados muestran la variedad de experiencias en esta intervención, así como la existencia de diferentes obstáculos que dependen del momento de intervención, de las características propias del paciente o la familia, las emociones del psicólogo, o la organización sanitaria. Se ponen de relevancia cómo los propios sentimientos de los psicólogos pueden influir en su intervención, y se propone la necesidad de una formación para superar los diferentes obstáculos que plantea la intervención en el final de vida (AU)

Psychologists are responsible for the emotional care to patients who are in end-of-life processes. Little is known about the experiences, the obstacles and problems they face when addressing such complex situations, so the main objective of this research is to understand and explore what they are. A qualitative phenomenological design was performed, using semi structured interviews, which were analyzed with the software Atlas.ti following an open coding. The sample consisted of 15 psychologists who perform their work in palliative care, other hospital units (oncology, mental health, emergency and early intervention) or privately involved in the province of Granada (Spain). The results show how psychologists contact with patients in end-of-life processes, as well as the variety of both positive and negative experiences in their speech. It is shown the existence of various obstacles that have to do with the timing of intervention, characteristics of the patient or family, with the emotions of the psychologist, as well as the health organization. This study shows how the feelings of the psychologists can influence their intervention, which raises the need for a specific training where they can learn different strategies to overcome the obstacles posed by intervention at the end-of-life (AU)

Efectos de un programa de formacion en cuidados paliativos sobre el afrontamiento de la muerte / The effects of a training program on coping with death in palliative care

Objetivos: Evaluar el efecto de un programa de formación en cuidados paliativos dirigido a estudiantes de ciencias de la salud, usando la escala de Bugen de afrontamiento de la muerte. Método: Estudio cuasi-experimental. Se desarrolló un programa de formación dirigido a futuros profesionales de la salud (enfermería, medicina, psicología, terapia ocupacional y fisioterapia)que participaron voluntariamente y cuyo único criterio de selección es que no hubiesen tenido formación previa en cuidados paliativos. La duración del curso fue de 45 horas, distribuidas en15 semanas, desde octubre de 2008 a febrero de 2009. Iniciaron el programa 90 participantes, de los cuales tres abandonaron la formación, finalizando 87. Al inicio y al final del mismo se administró la «escala de Bugen de afrontamiento de la muerte» a los 87 participantes para determinar su grado de afrontamiento de la muerte en cada uno de los momentos. Resultados: De los 87 participantes un 74% son mujeres y el resto hombres. La edad media es de 21,35 años. La mayoría de los participantes son de enfermería (64%), seguidos de terapia ocupacional (23,6%), psicología (5,6%), por último medicina y fisioterapia (2,2%). Se encontraron diferencias significativas respecto al afrontamiento de la muerte tras el programa formativo(p = 0,000). Antes del mismo la media era de 121,46 ± 19,7 y tras el curso la media fue de (..) (AU)

Objective: To evaluate a training program in palliative care for Health Science students using Bugen’s Coping with Death Scale. Method: Quasi-experimental research. A training program was designed for future health professionals (nursing, medicine, psychology, occupational therapy and physiotherapy). Students’ participation was voluntary. The sole selection criterion was not having previous training in palliative care. The course duration was 45 hours over 15 weeks from October 2008 to February2009. A total of 90 participants started the program, and 87 completed it (three stopped attending). Bugen’s Coping with Death Scale was filled in by all participants both at the beginning and at the end of the program in order to establish their coping skills before and after the program. Results: Of the 87 participants, 74% were female, with the rest being male. The mean age was21.35 years. Most participants were nurses (64%), followed by occupational therapy (23.6%),psychology (5.6%), and finally medicine and physiotherapy (2.2%). A clear difference could be observed in coping skills before and after the program (p=.000). Before the training program the average score was 121.46 ± 19.7, while after the course it was 158.16 ± 20.6. The Scale’s minimum score is 30, the maximum being 210. Values below 105 (percentile 50) indicate inadequate (..) (AU)

Actitudes y afrontamiento ante la muerte en padres de niños de primaria / Coping and attitudes towards death in parents of children in elementary school

La muerte es uno de los acontecimientos que causan más miedo en la infancia y adolescencia y, el modo de tratarlo repercute en el desarrollo cognitivo y emocional. Los objetivos de este estudio han sido conocer cuáles son las actitudes y el miedo hacia la muerte de padres con niños en edad escolar, e identificar variables relacionadas con actitudes y modos de afrontamiento adaptativos. Participaron 224 padres de familia con una edad media de 40,76 (DT= 5,11). Se emplearon una entrevista ad hoc, la “Escala multidimensional de miedo a la muerte”, el “Perfil revisado de actitudes hacia la muerte” y la “Escala de Bugen de afrontamiento de la muerte”. Los resultados ponen de manifiesto que los padres de familia con mayor nivel educativo son aquellos que presentan actitudes más adaptativas y niveles de miedo menores ante la muerte y que las mujeres manifiestan tener mayor miedo a la muerte que los hombres. Los programas de educación para la muerte pueden beneficiar a todas las personas, desde la niñez hasta edades avanzadas (AU)

Death is one of the events that causes more fear during childhood and adolescence, and the way it is treated affects cognitive and emotional development significantly. The aims of this study are: (i) to examine the attitudes and fears towards death in families who have schoolchildren; and (ii) to identify variables related to adaptive attitudes and coping styles regarding death. 224 parents participated in the study, with a mean age of 40.76 years old (SD=5.11). The following instruments were used in the study: a semi-structured interview designed ad hoc, the Multidimensional Scale of Fear to Death, the Revised Profile of Attitudes towards Death, and the Bugen Scale of Coping with Death. Results show that parents with a higher education degree have more adaptive attitudes and lower levels of fear towards death and that women show more fear towards death than men. Education about death can be beneficial for people in all age groups

Enfermería, familia y paciente terminal / Nurses, the family and a terminal patient

Se presentan datos referidos a un estudio realizado con una muestra de 350 profesionales de enfermería de la red hospitalaria de Granada, subdivididos en dos grupos: grupo de riesgo (GR) y grupo de no riesgo (NR). Se analizan los resultados obtenidos relativos a la presencia de estrés en situaciones de agonía y muerte, y el lugar de la familia como objeto de intervención profesional en ambos grupos (AU)