Instituto de Bioética
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Browsing Instituto de Bioética by Sustainable Development Goals (SDG) "10:Reduzir as Desigualdades"
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- The association between infant development and mother-infant quality of interaction in free play activitiesPublication . Soares, Hélia; Fuertes, Marina; Barbieri, Maria do Céu; Pereira, SandraIntroduction: The mother-infant quality of interaction may influence the infant development in different levels. Objectives: To assess mother-infant quality of interaction, infant development and family resources and their interactions. Methods: Descriptive, correlational study including a random sample of 42 Portuguese healthy infants and their parents. At 11 months, mothers described their infants’ temperament using the Temperament Scale (Lopes dos Santos, Fuertes & Sanches-Ferreira) and identified their family resources with Family Support Scale Family Inventory (Dunst, Jenkins & Trivette); Family Needs Survey (Bailey & Simeonsson) and Parent Responsability Scale (McBride & Mills). Child development was assessed using The Schedule of Growing Skills II (Bellman, Lingam & Aukett). At 12 months, mothers were observed and taped playing with their infants; videos were scored with Care-Index (Crittenden) to assess mothers’s sensitivity. Results: The quality of mother-child interaction was strongly related with infant development outcomes. The infants with better development indicators (e.g., manipulation, vision, speech-language, hearing, language, social interaction and cognition) tended to be more cooperative and had more sensitive mothers. Autonomy was negatively correlated with maternal control and social interaction. Speech-language was negatively associated with maternal passivity. Mothers with higher education levels received more help from fathers and exhibited higher scores on maternal sensitivity. Conclusions: Maternal sensitivity is associated with infant development. In turn, infants with better developmental outcomes were more cooperative, engaged and reciprocal when playing. Infant development and mother-infant quality interaction are mutual affected.
- Burnout in palliative and intensive care units: does it make a difference?Publication . Pereira, Sandra Martins; Hernández-Marrero, P.; Teixeira, C. M.; Carvalho, A. S.Background: Repeated contact with dying and death is a major burnout risk factor. Hence, professionals working in palliative and intensive care are at special risk. Aims: To identify and compare burnout levels and its related factors among professionals working in palliative and intensive care units in Portugal. Methods: Multicenter quantitative, comparative study. The Maslach Burnout Inventory was used for data collection together with a questionnaire of socio-demographic and profession-related variables, and a questionnaire of work-related experiences in the week and day prior to completion. 392 professionals participated in this study; 92 worked in palliative care units (PCUs) and 300 in intensive care units (ICUs). Univariate and multivariate logistic regression analyses were performed; OR sidelong with 95% of CI were calculated. Results: While 25% of the professionals working in ICUs exhibited burnout, only 3% of those working in PCUs exhibited this syndrome. Univariate logistic regression analysis showed that burnout was inversely associated with working in PCUs (OR= .419; .224–.785 95%CI). When controlling for other variables (e.g., professionals’ socio-demographic characteristics, post- graduated education in intensive/palliative care, work-related experiences), differences remained significant (OR= .396; .161–.976 95%CI). Higher levels of burnout in ICUs were related to being a nurse (OR=1.849, 95%CI 1.029–3,321) and experiencing conflicts (OR=2.170 95%CI 1.218–3,866). Conclusions: Burnout is inversily associated to working in PCUs. Work-related experiences (e.g., conflicts in the work context) increase the risk of developing burnout among professionals providing end-of-life care. These findings suggest the need to further implement conflict-management strategies in these settings, helping professionals to cope with high-demanding situations associated to providing end-of-life care.
- Empowering leader behaviours: impact on health professionals’ empowerment and commitmentPublication . Hernández-Marrero, P.; Pereira, S. Martins; Lopes, T.; Flint, D. H.Background: The importance of leaders’ behaviours in empowering staff in the workplace is advocated in healthcare management literature. However, there is a lack of empirical evidence linking empowering leadership behaviours with professionals’ sense of workplace empowerment and commitment. Facilitative leadership styles are considered important to redesigning work in palliative care provided in primary care services. Aims: To test a model linking leader-empowering behaviours to health professionals’ perceptions of workplace empowerment and commitment in primary care. Methods: As part of a larger multicenter survey study, a random sample of 209 professionals (nurses and physicians) providing palliative care in primary care settings in two Spanish regions was drawn. Three pre-validated scales were used to measure leader-empowering behaviours, empowerment and commitment. Multiple regression analyses were conducted to test the mediation model. Results: Overall, perceptions of workplace empowerment were significantly related to all dimensions of leader-empowering behaviours. These dimensions were correlated with empowerment and commitment (rs= .31 to .63). Empowerment at least partially mediated the relationship between leader-empowering behaviours and commitment. Empowerment had a significant impact on commitment (β = .64, p < .05). Conclusions: The results of this study highlight the importance of facilitative leaders in creating empowering work environments. Hence, recommendations can be made to ensure that healthcare managers leading primary care teams facilitate the implementation and delivery of palliative care in these settings by promoting professionals’ empowerment and commitment. This study provides encouraging empirical support and guidance for healthcare leaders interested in creating highly-effective work environments that benefit both patients and professionals who care for them within current turbulent healthcare organisations.
- Implementation of an education program in palliative care among nursing students: an action-research project in the outermost region of the AzoresPublication . Lima, T.; Pereira, S. Martins; Hernández-Marrero, P.Background: Most courses leading to a nursing degree do not meet the recommendations of the European Association for Palliative Care in palliative care. This may led to difficulties when caring for patients with palliative care needs. In outermost regions, investing in education is a keystone to ensure palliative care provision for all citizens. Objectives: To study the impact of an optional education program in palliative care among nursing students in their (i) knowledge, (ii) attitudes towards patients and families, and (iii) emotional coping. Methods: Research-action. Data was collected using the following instruments: pre and post-education program questionnaire; field-notes of the participant students and course leaders; written reflections provided by the participant students during the practicum that followed the course completion; focus groups with students after the same practicum. Questionnaires were analysed comparatively; content analyses were done inductively to the transcripts of field-notes, written reflections and focus groups. 24 nursing students participated in this study. Results: After the course completion, the students exhibited a more accurate and broader concept of palliative care. The major impact of the course on the students’ attitudes towards patients and families referred to an improvement in the students’ ability to identify palliative care needs and to better communicate. The course had a major impact on the awareness of students concerning their emotions. Also, the students became more able to cope with difficult situations(e.g., end-of-life care and decisions). Conclusions: The education program in palliative care contributed significantly to students’ clinical practice, namely in terms of an increase of self-confidence while caring for terminally ill patients. By participating in this course, students expanded their knowledge on palliative care, which had an impact also in the development of their competences.