Percepciones de los profesionales sobre la atención prestada, obstáculos y dilemas éticos relacionados con el final de la vida en hospitales, centros de Atención Primaria y residencias de ancianos

  1. P. Guardia Mancilla 1
  2. R. Montoya-Juarez 2
  3. C. Marti-Garcia 3
  4. R. Herrero Hahn 2
  5. M.P. García Caro 2
  6. F. Cruz Quintana 4
  1. 1 Hospital Clínico San Cecilio
  2. 2 Departamento de Enfermería. Universidad de Granada
  3. 3 Departamento de Enfermería. Universidad de Málaga
  4. 4 Departamento de Personalidad, Evaluación y Tratamiento Psicológico. Universidad de Granada
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Journal:
Anales del sistema sanitario de Navarra

ISSN: 1137-6627

Year of publication: 2018

Volume: 41

Issue: 1

Pages: 35-46

Type: Article

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Abstract

Background. This study compares the perceptions of physicians and nurses regarding professional practice, perceived obstacles and ethical dilemmas in end-of-life care in primary care (PC), hospitals and nursing homes (NH). Methods. Descriptive, cross-sectional and multicentre study. Intentional sampling of physicians and nurses with more than four months professional practice from four hospitals, five PC centres and twenty-nine NH in Granada was carried out. An ad hoc questionnaire was developed to assess perception of professional practice in eight dimensions (structure and processes of care, physical, psychological, social, spiritual, cultural, ethical aspects and care for the dying), frequency of ethical dilemmas, and obstacles to optimum care. Scores of different settings were compared using the ANOVA test and post hoc analysis. Results. A total of 378 professionals participated, 215 (56.9%) from hospitals, 97 (25.7%) from PC and 66 (17.5%) from NH. NH professionals were older and had more professional experience than those from PC and hospitals, and they also rated both the institution and their own professional practice significantly better (p<0.01) than other professionals with respect to the dimensions of structure and processes of care, physical, psychological, social, spiritual, cultural aspects and care for the dying. Psychological and ethical aspects were the worst valued in all settings, with no differences regarding ethical aspects. Fewer ethical dilemmas were identified by PC professionals, while NH professionals perceived greater obstacles to end-of-life care in relation to other settings. Conclusion. Primary care and hospitalization presented similar results on the perception of end-of-life care, and lower results than those of nursing homes, although in these centres more ethical dilemmas and more obstacles were identified.

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Finalmente, se ha constatado que los dilemas éticos que menos se presentan a los profesionales en cualquiera de los ám-bitos estudiados han sido el uso del DVA y causar la muerte al dar medicamentos para el dolor. Ambos son poco frecuentes por motivos contrarios, de acuerdo a la situa-ción actual de lo que puede entenderse como mentalidad paliativa, esto es, se ha asimilado rápidamente el control del dolor utilizando la medicación que sea necesaria, pero siguen existiendo grandes dificultades para incorporar la toma de decisiones del paciente mediante el uso de las voluntades anticipadas, de ahí que sea un dilema poco frecuente, lo que es acorde con numerosos estudios publicados28-31.

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