Morrer com dignidade no contexto da prática de enfermagem

Abstract

The concept of dignified dying has been identified as a focus of attention of nurses in the context of nursing care to dying patients. However, it is not known how nurses describe the phenomenon of dignified dying, which interventions they implement and what importance these assume in their daily practice while caring for dying patients. This study focuses on the concept of the phenomenon “Dignified dying” and on the nursing interventions to promote dignified dying while caring for terminal ill patients. It aims to describe how nurses define the concept of dignified dying, as well as to characterize nursing interventions, which promote it. This study attempts to contribute to the improvement of nursing care in the context of end of life care by making the care model culturally congruent. This is a exploratory, cross-sectional descriptive study with a quantitative approach. Data was collected between the beginning of 2010 and the end of 2011. The sample included 267 nurses in a total of 18 health care institutions, including the majority of palliative care wards and teams working in Portugal. The instrument for data collection was translated and adapted from the International Classification for Nursing Practice (ICNP®) catalogue “Palliative Care for Dignified Dying Survey”. Following this step, nurses who in their daily practice care for dying patients were invited to participate in the study, including nurses working in palliative care teams and in hospital wards for acute care. Authorization for this study was obtained from the participating institutions, and questionnaires were delivered in person or by postal mail. The questionnaire comprised three sections: demographic variables (section I), qualification of the 14 defining features of the concept of dignified dying according to their representation in their personal practice (section II), and a third section in which nurses were requested to rate the importance of 105 nursing interventions for the promotion of dignified dying (section III). In section III, nurses were given the possibility of freely adding other interventions, considered by them, to promote dignified dying. A descriptive and inferential analysis of the data was performed. Relationships were established between the data obtained and descriptive variables of nurses: education, context of care, and length of professional experience. The results allow the confirmation of the 14 defining items as being representative of the phenomenon dignified dying, in the opinion of nurses. Major items were “verbalizes relief of pain”, “verbalizes physical comfort”, “expresses control of symptoms”, and “resolves personal and family concerns”. Verification of the construct validity through factorial analysis lead to a three factor solution, this explained 66,38% of the total variance. The grouping of defining features of the phenomenon dignified dying seem to match the dimensions of the Dignity-Conserving Model of Care: “Social Dignity Inventory” (Fa1); “Dignity Conserving Repertoire” (Factor 2) and “Illness-Related Concerns” (Factor 3). The results of our investigation showed that the level of representativeness of the defining items of the phenomenon, in the context of clinical practice, relate to nurse’s professional experience in palliative care, years of experience in this field and to specific education in palliative care. It was shown that these correlate positively with a greater representativeness attributed by nurses to certain defining features of the concept of dignified dying in their nursing practice. This provides nurses with additional clinical competences allowing them to identify these features in their clinical practice, and to add value to them, making them representative of the phenomenon dignified dying. As to the level of importance awarded by nurses to the nursing interventions integrated in the data collection instrument “Palliative Care for dignified dying”, from the ICNP® catalogue, in the promotion of dignified dying, more than half of the interventions were considered “very important”. The remaining interventions were considered mostly “moderately important” or at least “slightly important”. The interventions considered by nurses as most important are mainly related to the symptom management (“administer pain medication”, “manage pain” or “manage dyspnoea”). Interventions related to the preservation of dignity and privacy of the patient, the support to the family, the communication and emotional support, and the spiritual comfort were also considered important. The three most important interventions were considered to be “maintain dignity and privacy”, “administer pain medication” and “manage pain”. We could observe that the interventions considered most important belong to the types of action “managing” and “attending”, this is related to the specificity of nursing interventions associated to the model of care for dying patients in end of life care. The importance attributed by nurses to the interventions described in this study varies with the level of nursing education, the context of nursing care, palliative care experience and palliative care education. In addition to the interventions mentioned in the data collection instrument, participants suggested other nursing interventions important in the promotion of dignified dying indicating the importance of presence, availability, listening, and support to the family.

Date of Award	Sept 2012
Original language	Portuguese
Awarding Institution	Universidade Católica Portuguesa
Supervisor	Paulino Sousa (Supervisor)