Motricidade

Advance directives of willingness: an exploratory study

Sun, 31 Mar 2024 00:00:00 +0000

Technological progress and the advancement of scientific knowledge in health provide a longer life. Still, on their own, they do not guarantee the desired quality of life, as they can lead to therapeutic obstinacy or dysthanasia, undermining the autonomy of the person. The main aim of this research was to analyse the knowledge, attitudes and practices of nurses at a hospital centre in the north of Portugal regarding advance directives. This is a descriptive and correlational study with a quantitative approach carried out among 270 nurses. The majority of participants were female (87%), with an average age of 39 and an average time in professional practice of 15 years. 52.9% of the nurses revealed that they had a "Good" level of knowledge, although there were gaps in some points of the law and in the operationalisation of the consultation of Advance Directives of willingness. The results of this study seem to suggest that nurses have adequate knowledge and show a positive attitude towards people with valid Advance Directives. However, it is important to expand research in this area and invest in the knowledge and training of nurses.

Hello! How can I help you? The role of telephone consultation in palliative care for patients at home

Sun, 31 Mar 2024 00:00:00 +0000

This work aims to describe and analyse the telephone consultation (TC) for palliative care (PC) patients at home and their caregivers provided by a PC team in Portugal in 2020. This study is observational, retrospective, cross-sectional and correlational, conforming to the STROBE checklist. Records of calls between 01/01/20 and 31/12/20 and clinical process consultations were analysed for trend clearance, including cross-tabulations to look for associations between call characteristics. Call data included information on the caller, patient, problem, utility and choice of service. The data were analysed using the statistical program SPSS software (V.26). During 2020, 494 calls were answered. The majority of the contacts were made by relatives and answered by nurses. The main reason for the contact was symptom management. The TC solved 92.91% of the problems, allowing the patient to remain at home, which is associated with a decrease in the number of hospitalisation days and admissions to the emergency department. The identification of the causes that motivated the calls and who solved them allows us to anticipate some needs that may be less controlled at home. Call distribution time may help allocate human resources better. TC is a viable alternative to traditional hospital follow-ups.

UP, Nutritional Status and Frailty

Sun, 31 Mar 2024 00:00:00 +0000

The predisposition to pressure ulcers (PU) is related to a prolonged process of disability that indicates frailty, functional decline and dependence, with malnutrition being a preponderant factor in its evolution. The present study aimed to relate the risk of developing PU with the nutritional status and frailty of elderly people institutionalised in residential structures for the elderly (ERPIs). It was a Quantitative, descriptive and cross-sectional study. A questionnaire was used, which included questions to characterise the participants, the Braden scale, the Mini Nutrition Assessment, and the Groningen Frailty Index. One hundred and thirty-four institutionalised users participated in the study: 86 (64.2%) were female, with an average age of 85.0 (SD=7.9) years, 94 (70.1%) widowed, and 78 (58.2%) had not completed elementary school. The results indicated that 48 (35.8%) of the elderly were at high risk of developing PU, 77 (57.4%) were classified as malnourished or at risk of malnutrition and 110 (82.1%) were frail. Assessing the risk of PU, frailty and malnutrition in institutionalised elderly people makes it possible to institute preventive measures to improve their quality of life. The prevention of PU is an indicator of the quality of care provided. Therefore, clinical practice must be based on current evidence.

Dignity at the End of Life: the nursing student's perspective

Carlos Almeida, João Francisco de Castro, Vitor Manuel Costa Pereira Rodrigues — Sun, 31 Mar 2024 00:00:00 +0000

According to official statistics, more and more people are dying from chronic and oncological diseases, dragging the last days of life into health institutions. In this sense, the discussion about the defence of the dignity of the patient at the end of life has often gone hand in hand with the discussion of euthanasia. We carried out an exploratory study of a qualitative nature, with the aim of identifying the situations that, in the opinion of nursing students, can lead to the loss of dignity of the terminally ill patient and the reasons that can lead them to request euthanasia. The sample consisted of 55 undergraduate nursing students, and the data was collected using a questionnaire consisting mainly of open questions. The data was processed using content analysis following the procedures described by Bardin. The main results indicate that the situations that can lead patients to feel a loss of dignity are loss of autonomy, abandonment, suffering, lack of respect, pity and loss of self. The reasons for evoking euthanasia are suffering, loss of autonomy, loss of hope, being a burden on the family and loss of meaning.

Balance and Cognition: Psychomotor Intervention in the Elderly

Vanessa Oliveira, Ana Rita Bodas, Diogo Nóbrega , Cristina Antunes — Sun, 31 Mar 2024 00:00:00 +0000

Ageing is a progressive process, and decreased balance and changes in cognitive functions are risk factors for falls and dependence in the elderly. Studies indicate that psychomotor intervention can improve balance and cognition in older adults. The study aimed to evaluate balance and cognitive functions in institutionalised elderly people and verify whether a psychomotor intervention has effects on static and dynamic balance. Held in a senior residence in the northeast of the country, 15 elderly people (average age 86.27 years, 67% women) were evaluated with the Geronto-Psychomotor Examination, Mini-Mental State Examination and Barthel Index before and after four months of intervention. In the first assessment, 60% presented a psychomotor profile below the cut-off level for the age group, 67% had cognitive impairment, and 53.3% had mild dependence. After the intervention, there were no significant changes in static balance, but there was a significant decrease (p=0.015) in dynamic balance. The results indicate maintenance of static balance, and considering the advanced age of the sample, the absence of changes is a satisfactory indicator. The decrease in dynamic balance can be attributed to advanced age. Psychomotor intervention in institutionalised elderly people can help maintain balance, contributing to the prevention of falls.

Social Representations of Death: from research to intervention in health humanisation

Cristina Duarte, Deolinda Leão, Graça Duarte — Sun, 31 Mar 2024 00:00:00 +0000

In palliative care, the topic of death and dying is transversal to life, also constituting a taboo topic. The relationship that each civilisation and each culture establishes with death reflects how it relates to life. Social representations are a form of practical knowledge that contributes to a common reality in a community. The present study was developed within the scope of a Community of Practice in Palliative Care at the Higher Institute of Social and Political Sciences of the University of Lisbon, with the aim of understanding the social representations of death in the Portuguese population, starting from the translation and adaptation of the revised version of the Scale for Assessment of the Profile of Attitudes about Death (EAPAM), for the population residing in Portugal, using a quantitative and qualitative methodology. Of the 736 responses received, it is important to highlight that it is essential to reflect and share on this topic, either to give a voice to everyone who cares at the end of life and to ensure that all felt needs are heard at a humanisation of end-of-life care. We conclude that the topic of death and dying requires more in-depth studies and literacy programs on this topic.

Being an Informal Caregiver in Palliative Care

Maria da Graça Duarte, Telma Alves, Carla Ribeirinho, Sónia Alves — Sun, 31 Mar 2024 00:00:00 +0000

This study aimed to understand the perceptions (difficulties, needs, positive and negative repercussions, strategies used and significant moments) of informal caregivers of people undergoing palliative and end-of-life care. An online questionnaire survey was administered, obtaining 70 responses. The data collected were subject to quantitative and qualitative analysis. Data revealed that the majority of respondents are Portuguese, female, with an average age equal to or greater than 54 years, with high education and educational qualifications, having become caregivers in the face of a family member's severe illness or dependence. The results show that caring has common conditions but reveals a unique process influenced by multiple variables, including perceived support. In the case of end-of-life care, they represent a greater burden on caregivers, although care is a dynamic process in which facilitating, protective and other hindering factors interact, adaptive strategies, depending on individual resources, whether of the person being cared for, or of the caregiver, as well as other determinants of health and social support, as well as the sense of purpose, selflessness and usefulness experienced by the caregiver.

Impact of spirituality, emotional intelligence and self-efficacy on the perception of the ability to provide care at the end of life

Maria de Lurdes da Costa Martins — Sun, 31 Mar 2024 00:00:00 +0000

Palliative care (PC) is a differentiated healthcare area focused on promoting comfort, and preventing and alleviating suffering. End-of-life (EOL) care is integrated into this branch of medicine and will have great relevance in the near future as a result of increased life expectancy and highly disabling chronic diseases. It is imperative that healthcare professionals have the capacity and preparation to guarantee this care. The objective of this work is to propose a model that relates spirituality, emotional intelligence, PC knowledge, self-efficacy, and the ability of doctors and nurses to provide EOL care. A questionnaire was applied to collect data. The relationships between these latent variables were evaluated using structural equation models. The results indicate that self-efficacy, spirituality and knowledge positively influence the ability to provide EOL care. Emotional intelligence and spirituality directly and positively affect self-efficacy. Emotional intelligence has an indirect effect, mediated by self-efficacy, on the ability to provide EOL care.

Health Literacy in Primary Care

Sun, 31 Mar 2024 00:00:00 +0000

The World Health Organization defines Health Literacy as a person's ability to obtain and understand basic health information and to use available health services responsibly. The present study aimed to assess the level of health literacy of patients attending a nursing consultation at a health centre in northern Portugal. It was an observational, cross-sectional, descriptive, and correlational study with a quantitative approach. One hundred subjects enrolled in the nursing consultation participated in the study, and data was collected using the health literacy questionnaire HLS-EU-PT. The majority of participants (63%) were female, aged between 18 and 94; most (34%) were 65 years and older, and 35% had completed their elementary school. As for health literacy, 32% of participants had an inadequate level, 56% a problematic level and 12% a sufficient level. The low levels of health literacy of the users of a nursing consultation who participated in the study indicate the need to implement intervention projects to empower participants and their families in health literacy and self-care.

Health Literacy of Caregivers for Caring in a Family Context

Cristina Sousa — Sun, 31 Mar 2024 00:00:00 +0000

Healthcare must provide an appropriate response to individual and family needs, engaging the community, promoting shared responsibility, and aligning existing resources with citizen requirements. Individuals in situations of dependency often rely on family caregivers, necessitating family adjustments and specific training to fulfil the caregiver role. The present study aimed to analyse the relationship between satisfaction with social support and the burden on informal caregivers. This observational study employed a cross-sectional, quantitative, and descriptive-correlational approach. Data collection was conducted through a questionnaire. A total of 51 informal caregivers participated in the study. Of these caregivers, 78.4% were women, 29.4% had a medium/low level of education, and 52.9% assumed the role of informal caregiver for five or more years. We observed some level of burden in 80.4% of informal caregivers, with a more significant impact on those who had assumed the caregiver role for approximately 1-2 years. The most sought-after support involved social support for economic assistance (76.5%) and caring for the family member (49%). The study highlights the importance of nurses implementing interventions to enhance caregivers' knowledge, promote health literacy regarding social support, and facilitate group dynamics, allowing informal caregivers to share experiences and navigate situational transitions.

The Intervention of the Social Worker in Palliative Care

Liliana Alves, Maria da Conceição Azevedo, Vera Mendonça — Sun, 31 Mar 2024 00:00:00 +0000

Palliative care involves not only specialised care that allows for the control of physical symptoms but also psychological, spiritual, and social support. In this study, palliative care was analysed from the perspective of social workers, with the aim of understanding their intervention in this context with patients and their families. A qualitative methodology was followed, using nine semi-structured interviews with social workers practising in palliative care. The analysis of these interviews reveals the recognition of the functional dimension and ethical appreciation of social workers. As part of the multidisciplinary team, the social worker assesses the adaptation process to the illness and the socio-familial concerns, promotes the social well-being of the patient and family, and integrates the community network to address needs for the continuity and stability of care. The intervention principles of this professional in palliative care correspond to respecting the patients’ and their family's dignity, involving adherence to the principle of confidentiality, and establishing an empathetic relationship reinforced by communication, with a focus on the humanistic dimension.

Psychological well-being in nursing students: relationship with gender and age

Sun, 31 Mar 2024 00:00:00 +0000

Psychological well-being is a multidimensional concept that includes social, subjective, and psychological dimensions and emphasises people's potential and ability to achieve well-being. The aim of this research was to assess the level of psychological well-being in students attending the Nursing Degree Course at a university in the north of the country, as well as its relationship with gender and age. The present research is a quantitative, cross-sectional and correlational study, with a non-probabilistic sample for convenience, consisting of 203 students attending the Nursing Degree Course in 2022. Data was collected through a questionnaire consisting of questions to characterise the students and the General Psychological Well-Being Questionnaire, adapted and validated for Portuguese students. It consists of six items, answered on a Likert-type scale, with five alternative answers. The score ranges from zero to thirty, and the higher the score, the higher the level of psychological well-being. It was found that 77.8% of the students were female, and 59.1% were over 20 years old. The students showed psychological well-being, with an average score of 16.8. A statistically significant relationship was only found between item 2, "How much energy or vitality did you feel?", with a higher score for males. This study made it possible to design a community intervention project aiming to enable students to adopt coping strategies that promote psychological well-being, which are essential for ensuring the developmental processes inherent in the life cycle they are going through.

Compassionate Communities: a response to Palliative Care challenges

Deolinda Leão, Eduardo Carqueja — Sun, 31 Mar 2024 00:00:00 +0000

Compassionate communities are an increasingly visible strategy in training and in the palliative care support network. In Portugal, since 2019, they have developed their mission in support that goes beyond the treatment of symptoms to include psychological, spiritual and social well-being through the fundamental values of compassion in supporting people with chronic illness and the end of life. The objective of this research was to understand how compassionate palliative care communities develop their action and what projects have emerged in our country. The study allowed semi-structured interviews to be carried out with those responsible for pioneering compassionate communities and content analysis was carried out. It was found that the main activities include awareness raising and training, sharing meetings and collaborative actions, being a response to many challenges felt in empowering society. There was a need to create psycho-social-educational training programs, to create collaborative care networks, to train community mobilizers and to record the impact of projects on communities. The study concluded that there is an urgent need to raise awareness of care based on compassion, emphasizing social strengthening, the helping relationship and the ability of citizens to actively participate in the development of palliative care in their communities.

Psychological well-being in informal caregivers

Sun, 31 Mar 2024 00:00:00 +0000

The psychological well-being of the Informal Caregiver is influenced by positive or negative factors, which determine the quality and well-being, or on the contrary, the burden of the caregiver. The aim of this study was to assess the level of psychological well-being of Informal Caregivers in a Community Care Unit in the north of Portugal. This was a cross-sectional, descriptive study whose population was informal caregivers of dependent people. A questionnaire was used to characterise sociodemographics and the psychological well-being scale, whose score ranges from zero to thirty, with the higher the score, the higher the level of psychological well-being. The majority of Informal Caregivers were female and belonged to the 60 and over age groups. In terms of marital status, most were married and retired. They lived with the dependent person and were children/spouses/partners. The income of 55.5% of the households was less than 900 euros. It should be noted that only 17% of Informal Caregivers scored highly on the psychological well-being scale, 61.1% said they felt quite uncomfortable, annoyed or nervous and 66.7% tired, exhausted or worn out. It should be emphasised that the intervention of health professionals facilitates the process of adapting to the role of caregiver and promotes the psychological well-being of Informal Caregivers.

Palliative Care in the patient with dementia – the caregiver’s perspective

Beatriz Andrade, Carolina Damas Pereira, Ana Temes — Sun, 31 Mar 2024 00:00:00 +0000

Palliative care focuses on preventing and easing suffering, supporting people facing serious or terminal illnesses and their family members, and providing them with the best possible quality of life. Dementia is characterised by a gradual decline in cognition and functional status. Its’ progression requires increasing levels of care, with caregivers playing a pivotal role. This study aimed to assess the role of palliative care in caring for patients with dementia. The bibliographic review relied on research within reference databases, including meta-analyses, systematic reviews, bibliographic reviews, clinical trials, clinical guidance standards, and guidelines published in the last 10 years in Portuguese and English. The following MeSH terms were used: caregiver, palliative care and dementia. The results showed that interventions such as stress management, educational programs, coping strategies, as well as psychosocial, spiritual and grief support might mitigate caregiver exhaustion. The family doctor must adopt a holistic approach to late-stage dementia that includes caregivers as a receiving party of care. A multidisciplinary approach alongside the palliative care team facilitates the implementation of strategies to prevent caregiver exhaustion.

Palliative Care and Patient Reluctance. How to overcome? – Case Report

Marta Valentim Cardoso, Cátia Branco, Sandra Mimoso Guedes, Diana Gonçalves — Sun, 31 Mar 2024 00:00:00 +0000

Palliative care is a holistic and multidisciplinary care that focuses on the patient and their family/caregivers, prioritising comfort and quality of life. Primary healthcare involvement is crucial to making palliative care practices accessible, early, and effective. This article reports the case of a woman diagnosed with metastatic gastric adenocarcinoma (pT4bN3M1), with rapid progression, whose follow-up and palliative guidance were carried out by her family doctor, given the patient's and her family's reluctance to be referred to palliative care. This case report reinforces the role and impact of the family doctor in timely and correct coordination with palliative care, as well as the need to dispel misconceptions associated with palliative care, particularly the idea that it is exclusive to end-of-life situations and an alternative to curative treatments.

Case report: Faecal Incontinence

Sun, 31 Mar 2024 00:00:00 +0000

The aim of the study was to assess the effectiveness of a pelvic floor muscle (PFM) rehabilitation programme in overcoming faecal incontinence (FI). This was a case study of a 64-year-old, self-employed teacher diagnosed with FI because of rectal prolapse surgery. A Pelvic Floor Muscle Training (PFMT) programme was carried out, one session/week for 16 weeks, supervised by anorectal biofeedback. Each session took 45 minutes, of which 20 minutes was for PFMT and the rest for physical examination, manual therapy, massage and patient teaching/recording: symptom diary, supervision of diet management, bowel training, defecation techniques/postures and emotional support. In the first session (T0) and the last (T1), an anamnesis, Wexner Index, Bristol Stool Form Scale (BSFS) and Fecal Incontinence Quality of Life (FIQL) were also taken. The results showed gains in PFM strength, which went from grade 2 to 4 on the modified Oxford scale; in quality of life (QoL), absence of faecal losses, stools went from consistency type 2 to 4 on the BSFS. The uropelvic rehabilitation programme proved to be effective in re-educating the PFM and significantly improved the participant's QoL.