Rol de la enfermera e influencia de los elementos culturales en la atención al paciente y familia en el proceso final de vida

Résumé

Introduction: The doctoral thesis presented here is subject to presentation by the compendium of scientific publications. It was developed according to four phases which are interlinked in a complimentary way, contemplating nursing work in the home setting and deepening knowledge about elements that facilitate or obstruct care. It also considers educational interventions targeting carers who attend to individuals during their final days. The present research also takes a cultural perspective of care, evidencing the need for its inclusion in the academic curriculum of Nursing Degrees due to its transversality in the role of carer, with this being a growing demand in an ever more globalized world. Further, we have been able to connect this component with end-of-life care, which is another highly demanded process given the extraordinary health crisis brought about by Covid- 19. Aims: The main aim is to describe the role of nurses in the care of patients and their family during end-of-life processes. It specifically considers the skills possessed by nurses in the home setting, in addition to the cultural component of end-of-life care and its influence on the attitudes of care providers. Methodology: The research was conducted in four stages, using mixed methodology combining qualitative methods with phenomenology and qualitative techniques, with the aim of responding to the proposed aims. This methodological strategy allowed us to, not only meet the proposed objectives but, also, adapt to the different contexts in which the research was conducted: Primary care, family setting and university training of preprofessionals. The first phase considered the role of nursing in educational home interventions directed towards the care of dependent individuals and end-of-life. The second phase was carried out during an international research visit to Dakar, Senegal, during which we analysed the end-of-life cultural competencies of students in different cultural contexts. The third and fourth phases were framed within the global pandemic lived over the last year and considered the role played by nursing professionals and the care given to relatives through strategies put in place to deal with grief. Results: Phase 1 described nursing interventions and their relation with professional attitudes. Interventions included the promotion of communication and teaching support, communication interventions in education for health and counselling, and technical interventions designed to improve access to health information and support for informal carers. The lack of individual will, advanced age of carers, charged emotional state and work overload are all factors that make care more difficult. Reverting these factors turns them into facilitators of learning. The context determines, to a large extent, these actions. The second phase described the influence of culture on end-of-life coping. It established that cultures in which religion has a large influence on social functioning take on a special importance which must be taken into consideration. The Covid-19 pandemic has produced evidence in relation to nursing work and the high levels of self-concept that sustain it. Nonetheless, at the same time, it has reflected the need to count on institutional support and support from the health system to facilitate adaptive measures in the face of exceptional circumstances that may arise. Conclusions: The present research has uncovered three patterns which should be addressed in nursing. Cultural conceptions of death and the way in which this largely directs the standpoints of professionals, patients and families; the power of religion and spirituality during these vital developmental moments, especially when we consider cultures in which religion does not only direct the spiritual dimension of individuals but, also, impacts on the economic, educational and family ambit; and, finally, specialised training in coping with death. Health professionals must be prepared to provide culturally competent care and must possess enough security in their work to be driven to provide quality care, despite the circumstances of the environment around them. It is the responsibility of nurses to continue their specialised training in consideration of the new needs shown by society. In addition, we must continue to strengthen the role of nursing, turning towards a type of nursing that creates science and is science. In short, evidence-based nursing. Developing the role of nursing requires professional, personal, social and cultural commitment in order to ensure that, despite the circumstances surrounding our work, we will continue to provide culturally competent care which is adjusted to the needs of individuals and their families throughout the entire lifecycle.