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Advisor(s)
Abstract(s)
Introdução: O diagnóstico de enfermagem ansiedade perante a morte foi introduzido
na classificação da NANDA Internacional, Inc com o objetivo de descrever os
cuidados específicos, prestados a pessoas em sofrimento decorrente da proximidade
da morte. Tem sido reconhecida a necessidade de clarificação da definição e dos
indicadores clínicos associados a este diagnóstico, de modo a que a sua utilização na
prática clínica seja menos complexa e mais objetiva.
Objetivo: Validar o diagnóstico de enfermagem death anxiety em cuidadores
familiares de doentes paliativos.
Métodos: Estudo transversal, de natureza quantitativa, exploratório e descritivo, com
duas etapas. Na primeira, denominada análise do conteúdo, efetuou-se a tradução do
enunciado diagnóstico death anxiety do inglês para português europeu, revisão
integrativa da literatura para identificação de indicadores clínicos, operacionalização
das características definidoras do diagnóstico e respetiva validação por juízes. Na
segunda etapa, fez-se a validação do diagnóstico em contexto clínico, utilizando como
alicerce o Modelo de Validação Clínica de Fehring (1987,1994), calculou-se a
sensibilidade, especificidade, valores preditivos e curva de ROC das características
definidoras e identificou-se a presença de fatores relacionados com o diagnóstico,
numa amostra de 111 cuidadores familiares de doentes paliativos.
Resultados: O estudo de revisão integrativa incluiu 67 publicações de 21 países.
Foram identificadas 17 características definidoras e 14 fatores relacionados. No estudo
de validação clínica, com uma amostra de cuidadores familiares, estes tinham uma
idade média de 50,8 anos, 82,9% do género feminino, 41,4% eram filhos do doente,
coabitando com o mesmo (67,6%) e prestando cuidados diariamente (91,9%). Foram
identificadas nove características principais do diagnóstico e oito secundárias. A
característica mais sensível foi o “medo da solidão e abandono relacionados com a
morte”. A característica “medo da vida após a morte” foi a mais específica. Nenhuma
destas constava da classificação da NANDA-I. O “medo de perder as capacidades
mentais quando estiver a morrer” foi a que teve maior equilíbrio entre a sensibilidade e especificidade, constituindo também um indicador relevante para a identificação do
diagnóstico. A prevalência do diagnóstico de ansiedade perante a morte foi de 38,7%,
sendo superior nos cuidadores mais jovens, filhos do doente, com sentimento de
sobrecarga, baixa autoestima, pouca qualidade de vida e com a sensação de que
“desperdiçaram” a vida.
Conclusões: A validação clínica de novas características definidoras e identificação
de novos fatores relacionados confirmou a necessidade da revisão deste diagnóstico.
A sua prevalência na amostra estudada confirma que este é um problema que atinge,
não só os doentes paliativos, mas também os seus cuidadores.
Introduction: The death anxiety nursing diagnosis was introduced in the NANDA-I Classification with the purpose of describing the specific care provided to people in distress due to the nearness of death. It has been recognized the need to clarify the definition and the clinical indicators associated with this diagnosis, so that its use in clinical practice could be less complex and more objective. Purpose: To validate the nursing diagnosis death anxiety in family caregivers of palliative patients. Methods: Cross-sectional, quantitative, exploratory and descriptive research with two stages. In the first one, called content analysis, the death anxiety diagnosis was translated from English to European Portuguese. Also, we made an integrative review of the literature to identify clinical indicators and the operationalization of the diagnosis defining characteristics. Then, it was validated by judges. In the second stage, the diagnosis was validated in a clinical context, using the Fehring’s Clinical Diagnostic Validity Model approach. The sensitivity, specificity, predictive values and area under the ROC curve of the defining characteristics were calculated. It was identified the presence of factors related with the diagnosis in a sample of 111 family caregivers of palliative patients. Findings: The integrative review included 67 studies from 21 countries. We identified 17 defining characteristics and 14 related factors. Family caregivers had a mean age of 50,8 years, 82,9% were female, 41,4% were sons of the patient and cohabiting with them (67,6%) providing daily care (91,9%). Nine defining characteristics were labelled as “major” and six as “minor”. The most sensitive characteristic was the "fear of loneliness and the abandonment related to death". The characteristic "fear of the afterlife" was the most specific. None of them were in the NANDA-I classification. The "fear of losing mental abilities when dying" had the best balance between sensitivity and specificity, so it is also a relevant indicator for the presence of the diagnosis. The prevalence of death anxiety in this sample was 38,7%. The diagnosis is more frequent in the younger caregivers, sons of the patient, with a burden, low selfesteem, poor quality of life and with the sensation that they "wasted" life. Conclusions: Clinical validation of new defining characteristics and identification of new related factors confirmed the need to review this diagnosis. Its prevalence in the sample studied confirms that this is a problem that affects not only palliative patients, but also their caregivers.
Introduction: The death anxiety nursing diagnosis was introduced in the NANDA-I Classification with the purpose of describing the specific care provided to people in distress due to the nearness of death. It has been recognized the need to clarify the definition and the clinical indicators associated with this diagnosis, so that its use in clinical practice could be less complex and more objective. Purpose: To validate the nursing diagnosis death anxiety in family caregivers of palliative patients. Methods: Cross-sectional, quantitative, exploratory and descriptive research with two stages. In the first one, called content analysis, the death anxiety diagnosis was translated from English to European Portuguese. Also, we made an integrative review of the literature to identify clinical indicators and the operationalization of the diagnosis defining characteristics. Then, it was validated by judges. In the second stage, the diagnosis was validated in a clinical context, using the Fehring’s Clinical Diagnostic Validity Model approach. The sensitivity, specificity, predictive values and area under the ROC curve of the defining characteristics were calculated. It was identified the presence of factors related with the diagnosis in a sample of 111 family caregivers of palliative patients. Findings: The integrative review included 67 studies from 21 countries. We identified 17 defining characteristics and 14 related factors. Family caregivers had a mean age of 50,8 years, 82,9% were female, 41,4% were sons of the patient and cohabiting with them (67,6%) providing daily care (91,9%). Nine defining characteristics were labelled as “major” and six as “minor”. The most sensitive characteristic was the "fear of loneliness and the abandonment related to death". The characteristic "fear of the afterlife" was the most specific. None of them were in the NANDA-I classification. The "fear of losing mental abilities when dying" had the best balance between sensitivity and specificity, so it is also a relevant indicator for the presence of the diagnosis. The prevalence of death anxiety in this sample was 38,7%. The diagnosis is more frequent in the younger caregivers, sons of the patient, with a burden, low selfesteem, poor quality of life and with the sensation that they "wasted" life. Conclusions: Clinical validation of new defining characteristics and identification of new related factors confirmed the need to review this diagnosis. Its prevalence in the sample studied confirms that this is a problem that affects not only palliative patients, but also their caregivers.
Description
Keywords
Enfermagem Diagnóstico de enfermagem Cuidadores informais Cuidados paliativos Nursing Nursing diagnosis Death anxiety Caregivers Palliative care