Preliminary study of the end-of-life process through data triangulation in a regional Hospital
Abstract
Objective: To know the characteristics of the end-of-life process in a Regional Hospital, according to the actors involved, establishing convergence/divergence elements in care process, decision-making, information and knowledge.
Method: Observational, cross-sectional, descriptive, convergent of mixed methods and data triangulation study. Carried out on a sample of 63 subjects, of which 25 were health professionals, 19 family caregivers and 19 medical records of patients who died in the course of a year.
Results: Data triangulation shows discrepancies between family members and health professionals regarding care quality and the information provided. The lack of documentation in medical records of care aspects related to decision-making or terminal sedation stands out.
Conclusion: This study provides an integrated view of end-of-life care provided in a Regional Hospital, identifying priority areas of intervention in order to improve quality of life in this process, such as patient involvement in decision-making, appropriate completion of medical records and health professional training.
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References
Esteban M, Grau, IC, Castells G, Bullicg I, Busquet X, Aranzana A; et al. Complejidad asistencial en la atención al final de la vida: criterios y niveles de intervención en atención comunitaria de salud. Med. paliat. 2015; 22(2): 69-80.
Florêncio MM, Lopes de Almeida M C. The illness experience: Palliative care given the impossibility of healing. Rev. Esc. Enferm. USP. 2016; 50:7-53.
Donato CT, Matuoka Y, Yamashita C, Salvetti MG. Effects of dignity therapy on terminally ill patients: a systematic review. Rev. Esc. Enferm. USP. 2016;50(6):1011-1021.
Fascioli A. Los cuidados paliativos al final de la vida: Expresión del reconocimiento del otro. Enfermería (Montev.) . 2016; 5(2):46-53.
Sepúlveda JM, Morales JM, Morales IM, Canca JC, Crespillo E, Timonet E. El derecho a morir con dignidad en un hospital de agudos: un estudio cualitativo. Enferm. clín. (Ed. Impr.). 2014; 24(4): 211-218.
Lima JS, Asensio MR, Palomo JC Ramírez EB, Lima M. Razones para decidir morir en el hospital o en el domicilio. Visión de los/las profesionales. Gac. Sanit. (Barc., Ed. Impr.). 2018; 32(4): 362-368.
Lozano B, Huertas MM. Cuidados paliativos, cuidados compartidos. Cult. cuid. 2018; 49: 100-107.
Esteban M, Fernández J, Boira RM, Martínez T, Nadal S, Castell G. Concordancia entre la complejidad observada desde diferentes niveles asistenciales en pacientes crónicos complejos, con enfermedad avanzada o al final de la vida mediante un modelo de abordaje de la complejidad. Med. paliat. 2018; 4: 236-244.
García MT, Gil E, Fernández MC, Sanz EM, Dones M, Domínguez A, et al. Programa centralizado de formación en Cuidados Paliativos. Coordinación Regional de la Comunidad de Madrid 2010-2015. Educ. med. (Ed. Impr.). 2017; 18(2): 103-113.
Rodríguez I, Villamor A, Lahosa MT, Dorca M, Mas M, Salvador MI. Conocimientos y actitudes de enfermeras de onco-hematología ante el documento de voluntades anticipadas. Rev. cuba. enferm. 2018; 34(2): 1-15
Pascual MC. Información a familiares de pacientes en proceso final de vida en unidades de cuidados intensivos. Evaluación por parte de las enfermeras. Enferm. clín. (Ed. Impr.). 2014; 24(3):168-174.
Sánchez MR, Moreno M, Hueso C, Campos C, Varella A, Montoya R. Dificultades y factores favorables para la atención al final de la vida en residencias de ancianos: un estudio con grupos focales. Aten. prim. (Barc., Ed. Impr.). 2017; 49(5): 278-285.
Velarde JF, Luengo R, González R, González S, Álvarez B, Palacios D. Dificultades para ofrecer cuidados al final de la vida en las unidades de cuidados intensivos. La perspectiva de enfermería. Gac. Sanit. (Barc., Ed. Impr.). 2017; 31(4):299-304
Puerto HM. Calidad de vida en cuidadores familiares de personas en tratamiento contra el cáncer. Rev. cuid. (Bucaramenga. 2010). 2015; 6(2): 1029-1040.
Instituto Nacional de Estadística. Cifras oficiales de población resultantes de la revisión del Padrón municipal a 1 de enero [Internet]. INE; 2017 [citado 2018 mar. 1]. Disponible en: https://www.ine.es/jaxiT3/Datos.htm?t=2915
Guerrero RF, Prado M, Ojeda MG. Reflexión crítica epistemológica sobre métodos mixtos en investigación de enfermería. Enferm. univ. 2016; 13(4): 246-252.
Alzás T, García LM. La evolución del concepto de triangulación en la investigación social. Rev Pesqui Qualit. 2017; 5(8): 395-418.
Sepúlveda JM, Morales JM, Morales IM, Sánchez JC, Timonet EM, Rivas F. Análisis de la toma de decisiones compartidas al final de la vida en las historias clínicas. Med. paliat. 2017; 24(1):14-20.
Kreetapirom P, Jaruratanasirikul S, Pruphetkaew N. Audit of paediatric residents' medical records. Clin Teach. 2017; 14(3): 189-194.
López JJ, Moreno MG, Saavedra CH, Espinosa AL, Camacho JU. La importancia del registro clínico de enfermería: un acercamiento cualitativo. Nure Investigación. 2018; 15(93): 1-9.
Dy SM. Patient safety and end-of-life care: common issues, perspectives, and strategies for improving care. Am Hosp Care. 2016;33(8): 791-796.
Burge F, Lawson B, Asada Y, Mclntyre PF, Grufeld E, Flowerdew G. Bereaved family member perceptions of patient-focused family-centred care during the last 30 days of life using a mortality follow-back survey: does location matter?. BMC Palliat Care. 2014; 13:25
Manalo MF. End-of-Life Decisions about Withholding or Withdrawing Therapy: Medical, ethical, and Religio-cultural considerations. Palliat Care. 2013; 7: 1-5
Van Der Eerden M, Csikos A, Busa A, Hughes S, Radbruch L, Menten J, et al. Experiences of patients, family and professional caregivers with Integrated Palliative Care in Europe: protocol for an international, multicenter, prospective, mixed method study. BMC Palliat Care. 2014; 13:52. DOI: https://doi.org/10.1186/1472-684X-13-52
Singer AE, Goebel JR, Kim YS, Dy SM, Ahluwalia SC, Clifford M, et al. Populations and interventions for palliative and end-of-life care: a systematic review. J Palliat Med. 2016; 9(9): 995-1008.
Otte IC, Jung C. Bally K, Elger BS, Schildmann J. Interprofessional Silence at the End of Life: Do Swiss General Practitioners and Hospital Physicians Sufficiently Share Information About Their Patients?. J Palliat Med. 2016; 19(9): 983-986.
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