ABSTRACT Introduction: the issue relating to the end of life represents a matter particularly felt by contemporary society, especially if the pediatric population is taken into consideration. Daily reality confirms that even minors with a terminal oncological disease experience all the clinical, psychological, ethical and spiritual problems of the disease and the end of life. Objective: the purpose of this literature review is based on understanding whether the implementation of non-pharmacological techniques for the management of chronic pain can guarantee quality support for the child and his family with a view to not trying to prolong the time of life but to offer dignity and respect to the person, with particular reference to the concept of relationship as a time for care. Furthermore, the question has been asked which is the place of first choice for the patient and the family where the event of death is preferable for them to happen. Materials and methods: a literature review was performed identifying the search term through the PICOM methodology. The reference population was identified: terminally ill pediatric patient aged between 0 and 18 years; the intervention: nursing interventions in a context of pediatric palliative care and the objective: to analyze the best strategies able to offer better support at the end of the child's life. The bibliographic search of articles was carried out through the search engines MEDLINE (Pubmed) and EBSCO (Cinhal). In order to select articles pertinent to the topic, various research questions were elaborated using the following key words: "end of life"; “paediatric palliative care”; “nursing”; “pain”; "pain management"; "hospice"; “palliative care nursing”; "relationship". The Boolean operator of choice was "AND". Finally, limitation criteria were set through the selection of "free full text", "year of publication of the articles from 2012 to 2022" and "age between 0 and 18 years". Results: it can be stated that from the analysis of the results of the articles examined, it emerged that healthcare professionals consider it essential to personalize the clinical-care plan, in a context of pediatric palliative care (PPC). The concept of how important the non-pharmacological management of chronic pain through a favorable therapeutic relationship between nurse and pediatric patient arose. Despite this, many nurses also state that the benefits of non-pharmacological treatments, in some cases, are reduced because it is complex and not obvious that an effective relationship is established between nurse and pediatric patient. The degree of collaboration and knowledge of the disease, personal and family beliefs and values have a profound effect on the establishment of an effective therapeutic relationship. Many nurses have also declared that they do not have enough skills with the PPC care setting, especially from a communication point of view with the pediatric patient and his parents. A final analysis of the studies shows that parents prefer that the event of their child's death take place in their own home. Conclusions: in the light of the results emerging from the study and from the analysis of the articles included in the review, it is stated that a holistic health care approach is needed which allows one to focus on the pursuit of normal daily activities. Furthermore, for all the actors involved in the process of care and assistance to the end of life, the care relationship represents a key factor, which, certainly, under favorable conditions and with qualified and experienced personnel, can improve the quality of life of both the child and of parents.
ABSTRACT Introduzione: la tematica inerente al fine vita rappresenta una questione particolarmente sentita dalla società contemporanea, in particolar modo se si prende in considerazione la popolazione pediatrica. La realtà quotidiana conferma che anche i minori aventi una malattia oncologica terminale, sperimentano tutte le problematiche cliniche, psicologiche, etiche e spirituali della malattia e del fine vita. Obiettivo: lo scopo di questa revisione della letteratura si basa sul comprendere se l’attuazione di tecniche non farmacologiche per la gestione del dolore cronico possano garantire un accompagnamento di qualità del bambino e della sua famiglia con l’ottica di non cercare di prolungare il tempo di vita ma di offrire dignità e rispetto alla persona, con particolare riferimento al concetto di relazione come tempo di cura. Inoltre, ci si è domandato quale sia il luogo di prima scelta per il paziente e la famiglia in cui l’evento della morte sia preferibile per loro che accada. Materiali e metodi: è stata eseguita una revisione della letteratura identificando la stringa di ricerca attraverso la metodologia PICOM. Sono stati identificati la popolazione di riferimento: paziente pediatrico terminale di età compresa fra gli 0 e i 18 anni; l’intervento: interventi infermieristici in un contesto di cure palliative pediatriche e l’obiettivo: analizzare le migliori strategie in grado di offrire un miglior accompagnamento nel fine vita del bambino. La ricerca bibliografica di articoli è stata effettuata attraverso i motori di ricerca MEDLINE (Pubmed) ed EBSCO (Cinhal). Al fine di selezionare articoli pertinenti l’argomento, si sono elaborate vari quesiti di ricerca utilizzando le seguenti key words: “end of life”; “paediatric palliative care”; “nursing”; “pain”; “pain management”; “hospice”; “palliative care nursing”; “relationship”. L’operatore booleano di scelta è stato “AND”. Infine, sono stati impostati dei criteri di limitazione attraverso la selezione “free full text”, “anno di pubblicazione degli articoli dal 2012 al 2022” ed “età compresa fra gli 0 e i 18 anni”. Risultati: si può affermare che dall’analisi dei risultati degli articoli esaminati è emerso che gli operatori sanitari considerano fondamentale personalizzare il piano clinico-assistenziale, in un contesto di cure palliative pediatriche (PPC). E’ scaturito il concetto di quanto sia importante la gestione non farmacologica del dolore cronico attraverso una relazione terapeutica favorevole tra infermiere e paziente pediatrico. Nonostante ciò, molti infermieri affermano anche che i benefici delle cure non farmacologiche, in alcuni casi, si riducono perché è complesso e non scontato che si instauri una relazione efficace tra infermiere e paziente pediatrico. Il grado di collaborazione e di conoscenza della malattia, le credenze e i valori personali e familiari incidono profondamente sull’istaurarsi di un’efficace relazione terapeutica. Molti infermieri hanno dichiarato, altresì di non avere abbastanza competenze con il setting di cura delle PPC, soprattutto da un punto di vista comunicativo con il paziente pediatrico ed i suoi genitori. Da un’ultima analisi degli studi emerge che i genitori preferiscono che l’evento della morte del proprio figlio accada nella propria casa. Conclusioni: alla luce dei risultati emersi dallo studio e dall’analisi degli articoli inclusi nella revisione, si afferma che è necessario un approccio assistenziale sanitario olistico che consenta di concentrarsi sul perseguimento delle normali attività quotidiane. Inoltre, per tutti gli attori coinvolti nel processo di cura e accompagnamento al fine vita, la relazione di cura rappresenta un fattore cardine, che, sicuramente, in condizioni favorevoli e con personale qualificato e con esperienza può migliorare la qualità di vita sia del bambino sia dei genitori.
Accompagnamento all'end of life: nursing in cure palliative pediatriche. Revisione della letteratura
VINCIGUERRA, NICOLA
2021/2022
Abstract
ABSTRACT Introduction: the issue relating to the end of life represents a matter particularly felt by contemporary society, especially if the pediatric population is taken into consideration. Daily reality confirms that even minors with a terminal oncological disease experience all the clinical, psychological, ethical and spiritual problems of the disease and the end of life. Objective: the purpose of this literature review is based on understanding whether the implementation of non-pharmacological techniques for the management of chronic pain can guarantee quality support for the child and his family with a view to not trying to prolong the time of life but to offer dignity and respect to the person, with particular reference to the concept of relationship as a time for care. Furthermore, the question has been asked which is the place of first choice for the patient and the family where the event of death is preferable for them to happen. Materials and methods: a literature review was performed identifying the search term through the PICOM methodology. The reference population was identified: terminally ill pediatric patient aged between 0 and 18 years; the intervention: nursing interventions in a context of pediatric palliative care and the objective: to analyze the best strategies able to offer better support at the end of the child's life. The bibliographic search of articles was carried out through the search engines MEDLINE (Pubmed) and EBSCO (Cinhal). In order to select articles pertinent to the topic, various research questions were elaborated using the following key words: "end of life"; “paediatric palliative care”; “nursing”; “pain”; "pain management"; "hospice"; “palliative care nursing”; "relationship". The Boolean operator of choice was "AND". Finally, limitation criteria were set through the selection of "free full text", "year of publication of the articles from 2012 to 2022" and "age between 0 and 18 years". Results: it can be stated that from the analysis of the results of the articles examined, it emerged that healthcare professionals consider it essential to personalize the clinical-care plan, in a context of pediatric palliative care (PPC). The concept of how important the non-pharmacological management of chronic pain through a favorable therapeutic relationship between nurse and pediatric patient arose. Despite this, many nurses also state that the benefits of non-pharmacological treatments, in some cases, are reduced because it is complex and not obvious that an effective relationship is established between nurse and pediatric patient. The degree of collaboration and knowledge of the disease, personal and family beliefs and values have a profound effect on the establishment of an effective therapeutic relationship. Many nurses have also declared that they do not have enough skills with the PPC care setting, especially from a communication point of view with the pediatric patient and his parents. A final analysis of the studies shows that parents prefer that the event of their child's death take place in their own home. Conclusions: in the light of the results emerging from the study and from the analysis of the articles included in the review, it is stated that a holistic health care approach is needed which allows one to focus on the pursuit of normal daily activities. Furthermore, for all the actors involved in the process of care and assistance to the end of life, the care relationship represents a key factor, which, certainly, under favorable conditions and with qualified and experienced personnel, can improve the quality of life of both the child and of parents.| File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.12075/12909