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Purpose of review Qualitative research in the field of palliative care allows for a crucial study of the final stage of life from a social point of view and cultural perspective. This review evaluates the advantages and challenges of applying an ethnographic approach to palliative care research. Recent findings Thirteen ethnographic articles on organization or quality of care, decision-making, delirium, death, and the process of dying, were reviewed. Most studies use interviews, participant observation, and field notes as their primary data collection techniques. In ethnographic research, cultural issues, relationships and interactions of a group, the meanings and perceptions of the participants, the communication process, and the use of language in a particular and natural context were analyzed. Data collection and information analysis took an average of 14 months in the included studies. Summary The ethnographic method, applied with rigor, is valuable in the analysis of a real phenomenon if the particular context in which the study developed is well defined. With an ethnographic approach, researchers can uncover cultural nuances that evidence different realities.

Background: Coping is essential to manage palliative care professionals’ challenges. The focus has been on the effects of coping mechanism; however, little is known about coping itself in palliative care. Aim: To synthesise evidence of coping strategies in palliative care professionals, and how different strategies play roles over time. Design: Systematically conducted integrative review. Data sources: PubMed; CINAHL; Medline; PsycINFO and B-ON were searched (1996–2021) combining ‘coping’ AND ‘palliative care’. A predefined data extraction sheet was developed to report data. Two researchers performed constant comparative analysis using Nvivo®. Results: Thirty-one studies were included. Four main strategies with recurrent reference to time were found: (a) proactive coping, involving activities to achieve self-confidence and control situations and emotions; (b) self-care based coping, including self-protection and self-awareness activities, with behavioural disconnection; (c) self-transformation coping, involving activities to accept limits; and (d) encountering deep professional meaning, is a coping mechanism based on meaning, frequently considering the deepest meaning of work. The dynamic and influencing factors were training, team interaction, professional motivation and family. They were usually protective factors, though sometimes they represented risk factors. The emotional burden associated with healthcare and systemic stressors were always risk factors. An explanatory model describes a complex and dynamic process, in which everyday strategies and more introspective strategies are combined. Conclusions: The model showed a process of adaptation and learning to persevere in palliative care. It changes over time under factors and strategies, and evolves in a personal and professional transformation, parallel to the working life. It would be worth assessing coping in healthcare professionals who chose to leave palliative care and to investigate the reasons they did so and their coping mechanisms.

Background: Emotional exhaustion is a problem many palliative care (PC) professionals face during their activity. Art therapy is emotionally beneficial for palliative patients who experience suffering, but its impact on professionals' experience of suffering has not been researched. Objective: To examine the immediate reactions of professionals after an art therapy workshop focused on personal self-care, also considering previously used coping strategies. Design: A four-hour art therapy workshop was designed including a generic qualitative study of participants. Participants were PC professionals and their reactions were examined using an ad hoc questionnaire with open-ended questions. Descriptive analysis of quantitative variables and thematic analysis of open-ended questions were conducted. Results: Seventeen professionals participated voluntarily. They rated the workshop positively, using words such as "calm" and "relaxation" to express the effects of the workshop, which they considered therapeutic and a source of self-awareness. For some, it allowed them to release emotions; for others, it enabled introspection and opened up a more elaborated emotional response. They thought artistic expression would be useful for their colleagues, or even for their own personal development. In the workshop, professionals opened up and explained how they face intense moments on a day-to-day basis: how they approach the situation, or how they try to control their surroundings; how they disconnect/distance themselves; and how they consider circumstances as a learning process and source of self-nurturing. Participants described art therapy as calming, healing the most intense feelings, and feeding the soul. Conclusion: Professionals reacted immediately with enthusiasm to art therapy, positively assessing its effects. Some attributed effects are in line with daily strategies of connecting with one's inner self. Others are about promoting self-awareness and inner peace, while providing healing opportunities. Art therapy may play a role in self-care for the PC professional, and should be researched further. Research Ethics Committee of the Universidad de Navarra approved the study (Number: 2019.167).

Objectives: This article intends to present some of the results obtained during the research on the Promotion and Preservation of Dignity in the context of care in nursing homes, carried out in the context of the PhD in Nursing of the University of Lisbon. Methodology: Within the interpretative paradigm, Grounded Theory (GT) was adopted as methodology. Data were collected through participant observation and interviews at an Nursing Home (IPSS) with about 350 residents distributed through three residential structures in the county of Castelo Branco for 21 months, with residents, nurses and direct acting helpers as participants. The constant comparative analysis of the data occurred simultaneously, using the software NVivo 10® and NVivo 11®. From the data analysis it was possible to construct a middle-range theory - Promotion and Preservation of Dignity in Nursing Homes: Self Conservation. Results: A complex, unforeseen phenomenon, exposed to variability and multiple, constructed, deconstructed and reconstructed in the daily rhythms, in a continuous, systematic and dynamic manner. It follows a two-dimensional route that was called the Self Conservation Trajectory. On the one hand a personal, individual, although accompanied and promoted. On the other hand a profoundly social path. Is the first dimension of this route that will be presented in this article.

Objective: This systematic literature review aims to clarify indications for the use of enteral feeding in patients with dementia. Difficulties in feeding patients with dementia may arise at any stage of the disease and may include malnutrition, weight loss, decreased quality of life, among others. Enteral tube feeding by tube may be a way of mitigating the effects, but its benefits are under discussion. Methods: Eight qualitative studies were included: 5 primary sources, 3 systematic literature reviews, published in the 2008-2013 period. Results: Enteral tube feeding in patients with dementia may affect survival/mortality rate (no evidence of benefit), nutritional status (no improvement), functional status and cognitive development (no improvement), aspiration (does not reduce the risk of aspiration), pressure ulcers (no evidence of benefit in ulcers incidence and progression), and quality of life (without hard data in most studies). Conclusion: Evidence on benefits of enteral tube feeding in patients with dementia was not conclusive and may even have the opposite effect. We lack data on the adverse effects of these interventions. Keywords: Palliative care; Dementia; Enteral feeding; Therapeutic use.

In an ideal situation, the elderly live in their natural environment, such as their own home or that of their relatives and is free to decide on the various aspects of their daily life in a safe environment. The decline or loss of the independence level, autonomy, social support, adverse economic conditions, loss of the dominant role within the family and loneliness are some of the causal factors that may modify this ideal situation. If action on these causal factors is insufficient or not possible, admission to a nursing home may occur as a temporary or permanent solution. After the establishment of the exchange situation, the elderly start a path of acceptance of the circumstances of living as a user of a nursing home, which becomes their home.

Our world is very noisy. It’s the shrill sound of deafening music, the unbearable screams of hysterical people, is the constant aggression to our ears coming from mobile commercial advertising, and finally, there is a foreign conspiracy, under various forms of protest, against the need for peace and stillness . The world must think. We need, everyone, to hear more. Life calls for silence and reflection. Respect the patient’s silence implicit a deep respect for his personality, a sublime professional act that demonstrate the ethic of the health professional. It is, probably, in the moment of serene acceptance of death, that haunt the quiet periods of silence. The patient no longer wants explanations, is mind grasps the great truth. At such moments the health professionals should not abandon the patient. They must maintain this silence, a understanding glance, the gentle touch of hands. They must establish a better dialogue, never a empty set of words. Caring is also carefully listening, being present, sharing the silence, complicity; be challenged by the lack of words. It’s welcoming. This article is based on a narrative review of the literature related with the therapeutic use of silence in end-of-life care. info:eu-repo/semantics/publishedVersion

Segundo a WHO (2002), as sociedades estão a envelhecer, sendo possível observar uma transformação demográfica sem precedentes na história da humanidade. O sucesso das transformações sociais, ao acolherem o envelhecimento saudável, é proporcional à precariedade dos mecanismos que dispomos para lidar com a velhice frágil e dependente. É um facto que se acrescentou mais anos de vida à população em geral; contudo, a inexorabilidade da velhice só poderá ser evitada se houver uma morte prematura. Para muitos idosos, os últimos anos de vida são devastados pela doença crónica, deficiência ou demência, e dependência maior. Do ponto de vista histórico da humanidade, somos uma sucessão de gerações, cada vez mais velhas, amparadas pela ilusão da renovação. O passado foi mais jovem que o presente, e o futuro terá ainda mais idade. Este artigo pretende apresentar a reflexão acerca do envelhecimento individual, realizada durante a investigação acerca da Promoção e Preservação da Dignidade no contexto de cuidados em lares de idosos, realizada no contexto do Doutoramento em Enfermagem da Universidade de Lisboa, Portugal. info:eu-repo/semantics/publishedVersion

Resumo: A Grounded Theory (GT) e uma metodologia que, a partir das experiencias vivenciadas por atores sociais, e atraves de processos de codificacao e comparacao constante, permite o desenvolvimento de teoria. Este ensaio teorico, de natureza descritivo-reflexiva, elaborada durante a investigacao acerca da Promocao e Preservacao da Dignidade no Contexto de Cuidados em Lares de Idosos, realizada no contexto do Doutoramento em Enfermagem da Universidade de Lisboa, tem o objetivo de apresentar a revisao narrativa e metodologica sobre as origens e evolucao da GT, desde a influencia fundamental do interacionismo simbolico, do pragmatismo e da Escola de Chicago salientando o momento diacritico na trajetoria dos seus autores originais, Barney Glaser e Anselm Strauss, pautado por ideias distintas sobre o processo de recolha e analise de dados e sobre a postura do pesquisador perante o contexto e a propria investigacao, que marcara a evolucao da metodologia ate a atualidade. Palavras-chave : Investigacao qualitativa; Grounded Theory; Interacionismo Simbolico. Socio-philosophical roots and evolution of Grounded Theory Abstract: The Grounded Theory (GT) is a methodology that, from the experiences lived by social actors, and through processes of codification and constant comparison, allows the development of theory. This theoretical essay, of a descriptive-reflexive nature, elaborated during the investigation about the Promotion and Preservation of Dignity in the context of Care in Nursing Homes, carried out in the context of the PhD in Nursing of the University of Lisbon, has the purpose of presenting the narrative and methodological revision on the origins and evolution of the GT, from the fundamental influence of symbolic interactionism, pragmatism and the Chicago School emphasizing the diacritical moment in the trajectory of its original authors, Barney Glaser and Anselm Strauss, based on distinct ideas about the process of data collection and analysis and on the researcher's posture before the context and the research, that will mark the evolution of the methodology to date. Keywords: Qualitative research; Grounded Theory; Symbolic Interactionism.

Objectives: This article intends to present some of the results obtained during the research on the Promotion and Preservation of Dignity in the context of care in nursing homes, carried out in the context of the PhD in Nursing of the University of Lisbon. Methodology: Within the interpretative paradigm, Grounded Theory (GT) was adopted as methodology. Data were collected through participant observation and interviews at an Nursing Home (IPSS) with about 350 residents distributed through three residential structures in the county of Castelo Branco for 21 months, with residents, nurses and direct acting helpers as participants. The constant comparative analysis of the data occurred simultaneously, using the software NVivo 10® and NVivo 11®. From the data analysis it was possible to construct a middle-range theory - Promotion and Preservation of Dignity in Nursing Homes: Self Conservation. Results: A complex, unforeseen phenomenon, exposed to variability and multiple, constructed, deconstructed and reconstructed in the daily rhythms, in a continuous, systematic and dynamic manner. It follows a two-dimensional route that was called the Self Conservation Trajectory. On the one hand a personal, individual, although accompanied and promoted. On the other hand a profoundly social path. Is the first dimension of this route that will be presented in this article. Descriptors: Dignity; self; nursing homes; nursing; grounded theory.

Xerostomia is the subjective feeling of mouth dryness, caused or not by function lowering of salivary glands, with decrease of saliva quality or quantity. It's a frequent symptom in palliative care patients and its prevalence is referred to be 60% to 88% in advanced and progressive oncological disease patients. Xerostomia has physical, social and psychological consequences. Saliva plays an important role in maintaining the best physiological conditions of mouth. Besides humidifying the oral cavity tissues, its lubricating properties help swallowing, talking and prevents other damages caused by mechanical and noxious microbiological agents. Xerostomia is caused by three basic mechanisms: factors that compromise the salivary centre, factors related to the autonomic stimulation or factors related to salivary glands themselves. The diagnosis is mainly clinical. Mouth condition must be thoroughly evaluated. If justified, a quantitative evaluation of saliva secretion, in rest and under stimulation, might be done. The treatment must be oriented by aetiology and directed towards the disease effects in patient comfort and quality of life. During treatment, the use of xerogenic drugs should be controlled, hydration should be promoted and other symptom control measures improved. The symptomatic treatment has three pathways: the increasing of saliva production by mechanical, gustatory or pharmacological stimulation; the using of saliva substitutes and the improving of active mouth care. Mechanical stimulation is obtained by chewing gum and gustatory stimulation may be reached by sucking Vitamin C tablets. Pilocarpine is the available drug to improve salivation. A soft diet must be advised, hard and dry food, tobacco and alcoholic beverages should be avoided. It's important that health workers teach patients with xerostomia the best way to get relief and the measures to prevent its complications that could, even more, compromise their quality of life.

Resumo Atualmente sabe-se que resultados positivos em saúde derivam de fatores como valorização e respeito, participação nas decisões, autoestima positiva e capacidade de exercer controle sobre a própria vida, indicando que a percepção do paciente sobre a própria dignidade é elemento central do cuidado. Trata-se de conceito complexo, difícil de definir por falta de clareza quanto ao que implica, mas fundamental na enfermagem. Este artigo apresenta revisão de literatura com o objetivo de discutir aspectos da dignidade no contexto da ética do cuidado.