Vitor Parola

Prevalence of burnout in health professionals working in palliative care: a systematic review.

BackgroundMore than ever, the current increasing need for palliative care leads to health professionals providing this type of care which further leads to multiple challenges, and stressful and demanding situations. The multiple challenges of working in palliative care put health professionals working in this context at the risk of burnout. ObjectivesTo examine the evidence on the prevalence of burnout among health professionals working in palliative care. Inclusion criteria Types of participantsThe current review included studies that encompass qualified health professionals working in palliative care, caring for patients 18 years of age or older. ConditionThe current review considered studies reporting on the point prevalence of burnout, measured by a burnout scale, such as, but not limited to, the Maslach Burnout Inventory, Burnout Measure and Copenhagen Burnout Inventory. ContextThe current review considered studies conducted in the context of specialist palliative care, more specifically, palliative care units, specialized palliative home care or hospices. Types of studiesThe current review considered observational study designs, including prospective and retrospective cohort, case-control and cross-sectional studies. Search strategyAn initial search of MEDLINE (via PubMed) and CINAHL was undertaken, followed by a second search for published and unpublished studies since 1975 in major healthcare-related electronic databases. Studies written in English, Spanish and Portuguese were included. Methodological qualityTwo independent reviewers assessed the methodological quality of studies using the standardized critical appraisal instrument from the Joanna Briggs Institute. No studies were excluded from the review based on the methodological appraisal. Data extractionData were extracted using a data extraction table, taking into account the review questions. Data synthesisSignificant differences were found between condition measures, thus we were unable to perform a meta-analysis. ResultsEight cross-sectional studies met the inclusion criteria, with a total of 1406 health professionals. The sample was limited to nurses, physicians and social workers. None of the included articles presented data about other health professionals. Seven of the included studies assessed the prevalence of burnout using the same instrument – the Maslach Burnout Inventory. Data revealed a prevalence of burnout of 17.3% among health professionals. Personal Accomplishment was the sub-scale from the Maslach Burnout Inventory that had the highest prevalence (19.5%). Nurses had higher levels of Emotional Exhaustion (19.5%) and Depersonalization (8.2%), and physicians had lower levels of Personal Accomplishment (41.2%). The prevalence of burnout was, however, higher in social workers (27%). The palliative care context with the highest prevalence of burnout was home care (19.6%). ConclusionThe current systematic review contributes to a body of empirical knowledge that can facilitate the professional development of palliative care teams by highlighting the prevalence of burnout in health professionals, which staff category is the most affected (social workers), and which palliative care context has the highest prevalence (home care).

The prevalence of burnout in health professionals working in palliative care: a systematic review protocol.

REVIEW QUESTION/OBJECTIVE The objective of this review is to examine the evidence on the prevalence of burnout among health professionals working in palliative care.More specifically, the review focuses on the following questions: What is the prevalence of burnout among health professionals working in palliative care? Is there a difference in the prevalence of burnout in different subgroups of health professionals working in palliative care (such as, but not limited to, nurses, physicians, social workers, psychologists)? Is there a difference in the prevalence of burnout among health professionals working in different contexts of palliative care (palliative care units, home care, hospices)?

Comfort experience in palliative care: a phenomenological study

BackgroundPalliative care aims to provide maximum comfort to the patient. However it is unknown what factors facilitate or hinder the experience of comfort, from the perspective of inpatients of palliative care units. This lack of knowledge hinders the development of comfort interventions adjusted to these patients. The aim of this research is to describe the comfort and discomfort experienced by inpatients at palliative care units.MethodsA phenomenological descriptive study was undertaken. Ten inpatients were recruited from a Spanish palliative care unit and seven from a Portuguese palliative care unit. Data were collected using individual interviews and analysed following the method of Giorgi.ResultsFour themes reflect the essence of the lived experience: The Palliative Care as a response to the patient’s needs with advanced disease, attempt to naturalize advanced disease, confrontation with their own vulnerability, openness to the spiritual dimension.ConclusionsInformants revealed that they experience comfort through humanized care, differentiated environment, symptomatic control, hope and relationships. The discomfort emerges from the losses and powerlessness against their situation. Even if such findings may seem intuitive, documenting them is essential because it invites us to reflect on our convictions about what it means to be comfortable for these patients, and allows incorporating this information in the design of focused interventions to maximize the comfort experience.

Use of non-pharmacological interventions for comforting patients in palliative care: a scoping review.

BackgroundPalliative care aims to provide the maximum possible comfort to people with advanced and incurable diseases. The use of non-pharmacological interventions to promote comfort in palliative care settings has been increasing.However, information on implemented and evaluated interventions, their characteristics, contexts of application, and population is scattered in the literature, hampering the formulation of accurate questions on the effectiveness of those interventions and, consequently, the development of a systematic review. ObjectiveThe objective of this scoping review is to examine and map the non-pharmacological interventions implemented and evaluated to provide comfort in palliative care. Inclusion criteria Types of participantsThis scoping review considered all studies that focused on patients with advanced and incurable diseases, aged 18 years or older, assisted by palliative care teams. ConceptThis scoping review considered all studies that addressed non-pharmacological interventions implemented and evaluated to provide comfort for patients with advanced and incurable diseases.It considered non-pharmacological interventions implemented to provide not only comfort but also well-being, and relief of pain, suffering, anxiety, depression, stress and fatigue which are comfort-related concepts. ContextThis scoping review considered all non-pharmacological interventions implemented and evaluated in the context of palliative care. This included home care, hospices or palliative care units (PCUs). Types of sourcesThis scoping review considered quantitative and qualitative studies, and systematic reviews. Search strategyA three-step search strategy was undertaken: 1) an initial limited search of CINAHL and MEDLINE; 2) an extensive search using all identified keywords and index terms across all included databases; and 3) a hand search of the reference lists of included articles.This review was limited to studies published in English, Spanish and Portuguese in any year. Extraction of resultsA data extraction instrument was developed. Two reviewers extracted data independently. Any disagreements that arose between the reviewers were resolved through discussion, or with a third reviewer. When necessary, primary authors were contacted for further information/clarification of data. Presentation of resultsEighteen studies were included covering 10 non-pharmacological interventions implemented and evaluated to provide comfort. The interventions included one to 14 sessions. The interventions lasted between five and 60 minutes. Most of the interventions were implemented in PCUs and hospice settings. Ten of the 18 interventions were implemented and evaluated exclusively in cancer patients. ConclusionsTen non-pharmacological interventions were identified, of which the most common were music therapy and massage therapy. Their characteristics differed significantly across interventions and even in the same intervention. They were mostly implemented in palliative care units and hospices, and in patients with a cancer diagnosis. These data raise questions for future primary studies and systematic reviews. Implications for researchFuture research should focus on the implementation of interventions not only with cancer patients but also with non-cancer patients and patients receiving palliative care at home. Systematic reviews on the effect of massage therapy and music therapy should be conducted.

The use of non-pharmacological interventions for the comfort of patients in palliative care: a scoping review protocol.

REVIEW QUESTION / OBJECTIVE The objective of this scoping review is to examine and map the non-pharmacological interventions implemented and evaluated to provide comfort in palliative care. More specifically, the review will focus on the following questions: What non-pharmacological interventions have been implemented and evaluated to provide comfort in patients with incurable and advanced diseases? What are the characteristics (duration, dose and frequency) of these interventions? In what contexts (home care, palliative care unit or hospice) are the non-pharmacological interventions implemented and evaluated? In which populations (cancer and non-cancer patients) are the non-pharmacological interventions implemented and evaluated? INCLUSION CRITERIA Types of participants This scoping review will consider all studies that focus on patients with incurable and advanced disease, 18 years or over, assisted by palliative care teams. Context This scoping review will consider all non-pharmacological interventions implemented and evaluated in the context of palliative care. This will include specifically home care, hospices or palliative care units. Types of sources This scoping review will consider quantitative, qualitative studies and systematic reviews. Quantitative designs include any experimental study designs (including randomized controlled trials, non-randomized controlled trials, or other quasi-experimental studies, including before and after studies), and observational designs (descriptive studies, cohort studies, cross sectional studies, case studies and case series studies). Qualitative designs include any studies that focus on qualitative data such as, but not limited to, phenomenology, grounded theory and ethnography designs. Systematic reviews include meta-analysis and meta-syntheses.

The construction of the health professional in palliative care contexts: a scoping review on caring for the person at the end of life

Aim: The aim of the study was to map of the literature on the elements contributing to the construction of the health care professional in the context of palliative care. Methods: Scoping review based on Arksey and O’Malley framework. PubMed, Embase, CINAHL, Scopus databases, and gray literature were the sources searched (2005–2015), completed by reference searching, hand searching, and expert consultations. Primary studies focusing on different professionals working in palliative care units or hospice centers were eligible for inclusion. Results: From a total of 3632 articles, 22 met the inclusion criteria. The content of the studies was described and classified in 5 elements: (i) construction and application of the concept of care; (ii) psychosocial effects that the daily care produces; (iii) working conditions that influence the caregiving provided; (iv) knowledge mobilized in the provision of care; and (v) strategies adopted by health care professionals to build relationships. Data about nurses, physicians, and psychologists were found, but no data were found about social workers. Gaps identified in the publications were as follows: relationship competencies and strategies adopted; the real needs from educational programs; and the view of other professionals. Conclusions: Key elements identified in the concept of the construction of the health care professional should be addressed in future interventions: prevention of emotional exhaustion, depersonalization, and achievement of a greater personal accomplishment. In addition, none of the articles retrieved offered the different perspectives of all the disciplines in a multidisciplinary team.

The use of the aged simulation suit in nursing students:a scoping review

Background: The use of simulation in nurses’ training has increased over the past decades and provided the acquisition and development of several skills. However, data on the specific use of the aged simulation suit are scattered in the literature. Objective: To map interventions implemented in nursing students using the aged simulation suit. Review Method: Scoping review following the Joanna Briggs Institute methodology. Two independent reviewers analyzed the relevance of the studies and extracted and synthesized data. Presentation and interpretation of results: Two studies were included in the review. Each intervention consisted of using the complete simulation suit and only some restrictors and lasted 1 to 3 hours. Instruments were used to measure empathy and learning efficacy. Both studies were implemented in 2nd-year students of the bachelor of science in nursing. Conclusion: The characteristics and the duration of each intervention, as well as the assessment instruments differed between studies. Further studies should be carried out to determine the effect/experiences of using the aged simulation suit in the acquisition and development of skills.

Burnout in Palliative Care Settings Compared With Other Settings: A Systematic Review

A systematic review, using the guideline of the Joanna Briggs Institute, was conducted to explore the effect of working in palliative care settings, compared with other settings, on burnout among health care professionals. Multiple databases were searched—CINAHL, PubMed, Scopus, and SciELO—as well as gray literature for studies published since 1975 that compared health professionals caring for patients older than 18 years in specialized palliative care settings (palliative care units, home care, or hospices) with health professionals working in other settings. Of the 539 studies retrieved, 7 cross-sectional studies were included in this review. Of these, six were conducted with nurses, and six used the Maslach Burnout Inventory. Working in palliative care (palliative care unit or hospices) was associated with lower levels of emotional exhaustion and depersonalization, as well as higher levels of personal accomplishment, compared with working in other settings. Evidence indicates that burnout levels seem to be lower among professionals working in palliative care compared with professionals working in other settings. Further research is needed to explore the strategies used by nurses working in palliative care that help them deal with burnout and to apply these same strategies to professionals working in other settings.