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RESEARCH01-01-2016
Leads for potentializing groups in Primary Health Care
Revista Brasileira de Enfermagem. 2016;69(5):964-971
Abstract
RESEARCHLeads for potentializing groups in Primary Health Care
Revista Brasileira de Enfermagem. 2016;69(5):964-971
DOI 10.1590/0034-7167-2015-0102
Views0ABSTRACT
Objective:
to analyze the aspects that potentialize groups in Primary Health Care according to their coordinators and participants.
Method:
This is a descriptive study with a qualitative approach, conducted with a health promotion group affiliated with a Family Health Unit. The data were collected by means of focus groups with participants and community workers who were submitted to thematic content analysis.
Results:
the analysis gave rise to three thematic categories: The group is our medicine; Healthy living and learning; and Priceless leadership.
Conclusion:
the leads identified during the study were as follows: group organization involves investment in motivation and leadership by the coordinators; production of grouping and cohesion is a result of participants and coordinators meeting together, interspersed with dialog, things said and left unsaid that the subjects expressed in the group dynamic; the sense of belonging guarantees their placement in the group based on the recognition of their knowledge and affective, social and health needs.
Keywords:Group ProcessesGroup StructureHealth PromotionNursing in Community HealthPrimary Health CareSee more -
RESEARCH01-01-2016
Intimate partner violence in adolescence: an analysis of gender and generation
Revista Brasileira de Enfermagem. 2016;69(5):946-955
Abstract
RESEARCHIntimate partner violence in adolescence: an analysis of gender and generation
Revista Brasileira de Enfermagem. 2016;69(5):946-955
DOI 10.1590/0034-7167-2016-0408
Views0ABSTRACT
Objective:
to analyze the intimate partner violence in adolescence from the perspective of gender and generation.
Method:
Quantitative, descriptive, and exploratory research. 111 adolescents participated in this study, with ages from 15 to 19 years old.
Results:
We found that 91% of participants have perpetrated and 90.1% have undergone at least one of the natures of violence. The intimate partner violence in adolescence constitutes a form of gender violence, and gender constructions have determined the suffered and perpetrated aggressions, possibly also determining the naturalization and legitimization of such aggressions. The inequality of power between generations may determine greater vulnerability of youngsters to the phenomenon.
Conclusion:
The historical and social construction of masculinity and femininity and the power inequalities set by these constructions converge with the power inequality between generations. Thus, gender and generation are determinants of intimate partner violence in adolescence, as well as of the vulnerability of adolescents to this phenomenon.
Keywords:AdolescentAdolescent HealthGender and HealthIntimate Partner ViolenceViolence Against WomenSee more -
RESEARCH01-01-2016
Hospitalization anxiety in children: conceptual analysis
Revista Brasileira de Enfermagem. 2016;69(5):940-945
Abstract
RESEARCHHospitalization anxiety in children: conceptual analysis
Revista Brasileira de Enfermagem. 2016;69(5):940-945
DOI 10.1590/0034-7167-2015-0116
Views0See moreABSTRACT
Objective:
to analyze the concept “hospitalization anxiety in children”, identifying its antecedents, attributes, and consequences, with the objective of clarifying its meaning.
Method:
we used a conceptual analysis model, whose objective is to clarify the meaning of terms.
Results:
we identified the concept antecedents and its attributes, classified as biological and psychological needs, which are essential characteristics of “hospitalization anxiety in children”. This process consequences have also been identified. We proceeded to the analysis of the characteristics with emphasis on the impacts of the hospitalization process on the child and on the family.
Conclusion:
based on the conceptual analysis of the phenomenon, it was possible to identify the antecedents, attributes, and consequences of Hospitalization Anxiety in children. We recommend the continuation of the study validating the essential characteristics presently identified as a way to join knowledge gathered and professional practice.
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RESEARCH01-01-2016
Stroke: patient characteristics and quality of life of caregivers
Revista Brasileira de Enfermagem. 2016;69(5):933-939
Abstract
RESEARCHStroke: patient characteristics and quality of life of caregivers
Revista Brasileira de Enfermagem. 2016;69(5):933-939
DOI 10.1590/0034-7167-2015-0064
Views0See moreABSTRACT
Objective:
to investigate the association between the domains of health-related quality of life of family caregivers and sociodemographic characteristics of individuals with stroke sequelae.
Method:
descriptive, cross-sectional, quantitative research, conducted with 136 family caregivers of individuals with stroke sequelae by means of home interviews from April to June 2013.
Results:
we found that caregivers of individuals aged under 65 years, married, with 10 to 12 years of formal education, presented higher scores, respectively, in the domains ‘Social aspects’, ‘Emotional aspects’, and ‘Mental health’. However, caregivers of patients with higher degree of disability obtained lower score in the ‘Mental Health’ domain.
Conclusion:
the results foster reflection on the need of including the family caregivers of individuals with stroke sequelae in the planning of care provided by health professionals.
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RESEARCH01-01-2016
A quasi-experimental nursing study on pain in comatose patients
Revista Brasileira de Enfermagem. 2016;69(5):927-932
Abstract
RESEARCHA quasi-experimental nursing study on pain in comatose patients
Revista Brasileira de Enfermagem. 2016;69(5):927-932
DOI 10.1590/0034-7167-2015-0121
Views0See moreABSTRACT
Objective:
to verify whether comatose patients feel pain during the bed bath nursing procedure.
Method:
nineteen patients aged 61 ± 17.39 years participated in the study. A quantitative analysis was conducted on the P substance (PS) in the saliva collected before and during a bed bath, using the ELISA method. Program Graph Pad Prisma 6 was used to analyze the data. The verification of normality was made through the Shapiro Wilk test, which determined the choice for the Wilcoxon nonparametric test.
Results:
the study showed a statistically significant increase (∆= 5.62%, p<0.001) in the PS level of the patients studied during the nursing procedure.
Conclusion:
when caring for comatose patients during a bed bath, professionals cause or add painful stimuli; therefore, they feel pain.
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RESEARCH01-01-2016
Quality of nursing care: instrument development and validation
Revista Brasileira de Enfermagem. 2016;69(5):920-926
Abstract
RESEARCHQuality of nursing care: instrument development and validation
Revista Brasileira de Enfermagem. 2016;69(5):920-926
DOI 10.1590/0034-7167-2015-0151
Views0See moreABSTRACT
Objectives:
to describe the development and validation process of a scale to measure the nurses’ perception of the activities that contribute to nursing care quality.
Method:
methodological study based on a literature review, the opinion of experts and the experience of study investigators. An instrument was designed containing six dimensions and 25 items, applied as a questionnaire to 775 nurses from a hospital in northern Portugal, from May to July 2014. The instrument validation used an exploratory factor analysis and an internal consistency assessment of each factor/dimension.
Results:
the factor analysis indicated the need to adjust the original composition of the scale, which then received one more dimension, totaling seven dimensions and the same 25 items, and presented a high internal consistency (Cronbach’s alpha of 0.940).
Conclusion:
the final version of the scale presents adequate psychometric properties, with potential use in future studies.
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REVIEW07-15-2024
Risk for imbalanced blood pressure pattern among incarcerated women: Middle-Range Theory
Revista Brasileira de Enfermagem. 2024;77:e20230288
Abstract
REVIEWRisk for imbalanced blood pressure pattern among incarcerated women: Middle-Range Theory
Revista Brasileira de Enfermagem. 2024;77:e20230288
DOI 10.1590/0034-7167-2023-0288
Views0See moreABSTRACT
Objectives:
to develop a Middle-Range Theory for the Risk for imbalanced blood pressure pattern among incarcerated women.
Methods:
theoretical development study to obtain the theoretical-causal validity of the Nursing Diagnosis Risk for unstable blood pressure. The Middle-Range Theory was developed according to six stages: establishment of the approach to developing the theory; definition of the conceptual models to be later analyzed; definition of the main conceptions; a pictorial diagram; propositions; causal relationships and evidence for practice.
Results:
two attributes and 20 antecedents related to imbalanced blood pressure were identified, a pictorial diagram was developed, and nine theoretical propositions were presented.
Conclusions:
the theory developed here favors the diagnostic reasoning of nurses and contributes to planning actions to promote the cardiovascular health of incarcerated women. A new proposition for the diagnosis of Risk for unstable blood pressure was also structured with a new title, definition, and etiological factors.
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ORIGINAL ARTICLE07-15-2024
Root cause analysis of safety incidents in antineoplastic use in children
Revista Brasileira de Enfermagem. 2024;77:e20230139
Abstract
ORIGINAL ARTICLERoot cause analysis of safety incidents in antineoplastic use in children
Revista Brasileira de Enfermagem. 2024;77:e20230139
DOI 10.1590/0034-7167-2021-0139
Views0See moreABSTRACT
Objectives:
to identify and analyze the factors that contribute to safety incident occurrence in the processes of prescribing, preparing and dispensing antineoplastic medications in pediatric oncology patients.
Methods:
a quality improvement study focused on oncopediatric pharmaceutical care processes that identified and analyzed incidents between 2019-2020. A multidisciplinary group performed root cause analysis (RCA), identifying main contributing factors.
Results:
in 2019, seven incidents were recorded, 57% of which were prescription-related. In 2020, through active search, 34 incidents were identified, 65% relating to prescription, 29% to preparation and 6% to dispensing. The main contributing factors were interruptions, lack of electronic alert, work overload, training and staff shortages.
Conclusions:
the results showed that adequate recording and application of RCA to identified incidents can provide improvements in the quality of pediatric oncology care, mapping contributing factors and enabling managers to develop an effective action plan to mitigate risks associated with the process.
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REVIEW07-15-2024
Leprosy and its impact on the quality of life of people with physical disabilities: a scoping review
Revista Brasileira de Enfermagem. 2024;77:e20230101
Abstract
REVIEWLeprosy and its impact on the quality of life of people with physical disabilities: a scoping review
Revista Brasileira de Enfermagem. 2024;77:e20230101
DOI 10.1590/0034-7167-2023-0101
Views0See moreABSTRACT
Objectives:
to identify and synthesize, from the literature, the impacts of physical disability caused by leprosy on the quality of life of individuals receiving care within the Health Care Network.
Methods:
this is a scoping review conducted following the JBI recommendations. The databases used in the search included the Medical Literature Analysis and Retrieval System Online, Cochrane Library, Web of Science, Lilacs, Cumulative Index to Nursing and Allied Health Literature, Scopus, Embase, Leprosy Information Services, and Google Scholar.
Results:
1690 documents were identified, of which 36 were included in the review. Physical disability caused by leprosy affects the quality of life in the areas of daily activities, socioeconomic aspects, psychological well-being, pain, and overall well-being.
Conclusions:
we identified the impairments caused by physical disability in the quality of life, highlighting the need for prevention, promotion, and rehabilitation actions, such as screening, case management, and health education.
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ORIGINAL ARTICLE07-15-2024
Depressive symptoms and associated factors among travestis and transsexuals: a cross-sectional study
Revista Brasileira de Enfermagem. 2024;77:e20230071
Abstract
ORIGINAL ARTICLEDepressive symptoms and associated factors among travestis and transsexuals: a cross-sectional study
Revista Brasileira de Enfermagem. 2024;77:e20230071
DOI 10.1590/0034-7167-2023-0071
Views0ABSTRACT
Objectives:
to estimate the prevalence of depressive levels and their associated factors among transvestite and transsexual individuals.
Methods:
this cross-sectional study involved 58 participants assisted by non-governmental organizations. The Beck Depression Inventory was utilized to assess levels of depression, complemented by a sociodemographic questionnaire and a questionnaire on experiences of violence. Data were analyzed using descriptive statistics and Poisson regression with robust variance.
Results:
a prevalence of 27.6% (95% CI = 11.50-39.10) for moderate to severe levels of depression was observed. This prevalence was associated with being unmarried (PR = 1.19; 95% CI = 1.10-1.28) and experiencing violence in healthcare services (PR = 2.30; 95% CI = 1.10-4.81).
Conclusions:
the absence of a partner and experiences of violence in healthcare settings negatively impacted mental health, leading to an increased prevalence of depressive symptoms among transvestite and transsexual individuals. Advocating for transgender rights and providing ongoing education in health care for professionals are critical strategies in promoting the mental health of this population.
Keywords:Cross-Sectional StudiesDepressionGender-Based ViolenceSexual and Gender MinoritiesTransgender PersonsSee more -
REVIEW07-15-2024
Factors associated with Burnout Syndrome in police officers: a scoping review
Revista Brasileira de Enfermagem. 2024;77(2):e20230444
Abstract
REVIEWFactors associated with Burnout Syndrome in police officers: a scoping review
Revista Brasileira de Enfermagem. 2024;77(2):e20230444
DOI 10.1590/0034-7167-2023-0444
Views0See moreABSTRACT
Objectives:
to synthesize research on factors associated with Burnout Syndrome (BS) in police officers.
Methods:
a scoping review was conducted without temporal or language restrictions. Data were exported to EndNote to remove duplicates and then imported into the Rayyan app for organization, article selection, and data extraction.
Results:
a total of 4559 publications were identified, with 50 studies included in the review. Research conducted in Brazil and the United States predominated. Certain occupational factors were found to be more closely linked to police officers compared to other professions, including law enforcement, frequency of interaction with suspects and criminals, rank, dissatisfaction with the organization, and civilian confrontations.
Conclusions:
certain aspects of the police profession contribute to BS, even in countries with better working conditions in public security. It is recommended to prioritize health promotion initiatives for these professionals.
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EDITORIAL07-08-2024
¿Puede la enfermería contribuir a reducir la mortalidad por accidentes de transporte terrestre?
Revista Brasileira de Enfermagem. 2024;77(4):e770401
Abstract
EDITORIAL¿Puede la enfermería contribuir a reducir la mortalidad por accidentes de transporte terrestre?
Revista Brasileira de Enfermagem. 2024;77(4):e770401
DOI 10.1590/0034-7167.2024770401es
Views0La morbilidad y la mortalidad por causas externas, especialmente las resultantes de accidentes de transporte terrestre (ATT), persisten como un desafío global, dado que es responsable de alrededor de 2 millones de vidas perdidas anualmente, impactando a diversos segmentos de la sociedad, especialmente en los servicios y sistemas de salud().La evidencia indica que los ATT […]See more -
EDITORIAL07-08-2024
Can nursing contribute to reducing mortality from land transport accidents?
Revista Brasileira de Enfermagem. 2024;77(4):e770401
Abstract
EDITORIALCan nursing contribute to reducing mortality from land transport accidents?
Revista Brasileira de Enfermagem. 2024;77(4):e770401
DOI 10.1590/0034-7167.2024770401
Views0Morbidity and mortality from external causes, especially those resulting from land transport accidents (LTA), persist as a global challenge, given that they account for around 2 million lives lost annually, impacting various segments of society, especially in health services and systems().Evidence indicates that LTA are preventable, although historically they have been considered inevitable. However, isolated […]See more -
ORIGINAL ARTICLE06-28-2024
Quality of life at work for health professionals during the COVID-19 pandemic
Revista Brasileira de Enfermagem. 2024;77:e20230461
Abstract
ORIGINAL ARTICLEQuality of life at work for health professionals during the COVID-19 pandemic
Revista Brasileira de Enfermagem. 2024;77:e20230461
DOI 10.1590/0034-7167-2023-0461
Views0ABSTRACT
Objective:
to evaluate the quality of life at work of health professionals in direct and indirect care of COVID-19 cases.
Methods:
this was a cross-sectional study with 156 health professionals from a referral hospital. The relationship between sociodemographic and work-related variables and perceived stress and domains of the Quality of Life at Work Scale was investigated using inferential statistics and regression.
Results:
Satisfaction with Compassion was moderate (mean: 38.2), with low perception of stress, Burnout and Secondary Traumatic Stress (means: 18.8, 21.6 and 19.1). There were associations between: education, salary, multiple jobs and direct care with Compassion Satisfaction; low income, being a nurse and working overtime with Burnout; and working more than 12 hours, underlying disease and hospitalization for COVID-19 with Secondary Traumatic Stress.
Conclusion:
quality of life at work was satisfactory, despite the presence of Burnout and Secondary Traumatic Stress.
Keywords:Occupational HealthOccupational StressPsychological BurnoutQuality of LifeWorking ConditionsSee more
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RESEARCH01-01-2016
Factors associated with inconsistent condom use among people living with HIV/Aids
Revista Brasileira de Enfermagem. 2016;69(1):47-53
Abstract
RESEARCHFactors associated with inconsistent condom use among people living with HIV/Aids
Revista Brasileira de Enfermagem. 2016;69(1):47-53
DOI 10.1590/0034-7167.2016690106i
Views0See moreABSTRACT
Objective:
to analyze the prevalence and factors associated with inconsistent use of condoms among people living with HIV/ Aids (PLWHA).
Method:
it is a cross-sectional study with 228, with individual interviews conducted in 2011. A multivariate analysis was performed with a logistic regression model.
Results:
143 participants met the inclusion criteria, and the prevalence of inconsistent condom use was 28.7%. However, there was greater adherence among men (79.3%). In the multivariate analysis, the independent variable daily use of alcohol (OR=11.02; 95% CI 1.84, 65.92; p = 0.021) was associated with inconsistent condom use. The chance of men making consistent condom use was higher than women (OR = 0.36, 95% CI 0.15, 0.81; p = 0.015).
Conclusion:
the prevalence of inconsistent condom male use among PLWHA was low, however, evidenced greater compliance among men over women with a statistically significant difference and the daily use of alcohol was associated with inconsistent condom use.
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RESEARCH01-01-2016
Influence of sociodemographic and clinical characteristics at the impact of valvular heart disease
Revista Brasileira de Enfermagem. 2016;69(1):40-46
Abstract
RESEARCHInfluence of sociodemographic and clinical characteristics at the impact of valvular heart disease
Revista Brasileira de Enfermagem. 2016;69(1):40-46
DOI 10.1590/0034-7167.2016690105i
Views0See moreABSTRACT
Objective:
to analyze the sociodemographic and clinical characteristics of patients with valvular heart disease and to verify the influence of these variables on the impact of valve disease in daily life.
Method:
the study involved 86 outpatients. Data collection was performed in two stages – face-to-face interview for sociodemographic and clinical characterization and through telephone contact for the application of the Instrument to Measure the Impact of Valvular Heart Disease on Patient’s Everyday Life (IDCV). Data were analyzed through descriptive statistics and multiple regression analysis.
Results:
it was noticed that the total score of IDCV and its domains were influenced by age, schooling, presence or absence of symptoms, use or not of diuretic.
Conclusion:
The impact of the disease was influenced by sociodemographic and clinical variables. The results provide subsidies for the design of nursing interventions aimed at reducing the impact of the disease on the patient’s daily life with valve disease.
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RESEARCH01-01-2016
Health indicators of workers of the hospital area
Revista Brasileira de Enfermagem. 2016;69(1):30-39
Abstract
RESEARCHHealth indicators of workers of the hospital area
Revista Brasileira de Enfermagem. 2016;69(1):30-39
DOI 10.1590/0034-7167.2016690104i
Views0ABSTRACT
Objective:
to analyze the health indicators of workers of hospital area for exposure to workloads, wear processes and its consequences.
Method:
a retrospective, descriptive and exploratory study performed in a hospital in southern Brazil. The population consisted of 1,050 workers notifications of registered in the Monitoring System of Nursing Workers Health, in 2011.
Results:
80.8% of the records were female workers, with 34.2% aged between 31 to 40 years old, corresponding to 2478 working lost days. The results subsidized the implementation of nine indicators that showed the prevalence of respiratory and osteoarticular problems.
Conclusion:
the results allow the reflection and redirection of actions for workers’ health, as the processes of becoming ill are compounded by exposure to psychic burdens. These indicators, when monitored, can contribute to the transformation of the profile of morbidity of these workers.
Keywords:Epidemiological SurveillanceHealth Basics IndicatorsHospital Human ResourcesNursingOccupational HealthSee more -
RESEARCH01-01-2016
Evaluation of environmentally sustainable actions in the medication process
Revista Brasileira de Enfermagem. 2016;69(1):23-29
Abstract
RESEARCHEvaluation of environmentally sustainable actions in the medication process
Revista Brasileira de Enfermagem. 2016;69(1):23-29
DOI 10.1590/0034-7167.2016690103i
Views0See moreABSTRACT
Objective:
to analyze sustainable actions from an environmental point of view in the medication process, from the reception of the prescription of the pharmacy to waste discard by nursing.
Method:
study before and after performed through Lean Six Sigma methodology. The sample consisted of the amount and type of waste resulting from the pharmacy and nursing services of a medical-surgical clinical unit.
Results:
after the intervention was obtained at the pharmacy a reduction of 74.8% of chemical, infectious and sharps waste, an increase of 33.3% of common recyclable and 20% of common non-recyclable. In nursing, there was a reduction of 22.5% of chemical, infectious and sharps waste, an increase of 22.9% of common recyclable and an increase of 20% of common non-recyclable.
Conclusion:
the practice of sustainable actions in the hospital is possible, contributing to the optimization of resources and waste production with benefits to the institution, environment, and health.
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RESEARCH01-01-2016
Nursing education: training evaluation by graduates, employers and teachers
Revista Brasileira de Enfermagem. 2016;69(1):16-22
Abstract
RESEARCHNursing education: training evaluation by graduates, employers and teachers
Revista Brasileira de Enfermagem. 2016;69(1):16-22
DOI 10.1590/0034-7167.2016690102i
Views0ABSTRACT
Objective:
to support the assessment and the necessary changes in the curriculum of an undergraduate degree in Nursing.
Methods:
it is a descriptive study developed in two stages as an action research. In the first stage, the speeches of 19 graduates and 15 employers were interviewed and analyzed; in the second stage, five teachers participated in the focus group. For processing the data, the content analysis was adopted.
Results:
based on the assessment of the actors, an action plan was created with suggestions regarding the curriculum flexibility, content resizing, continuing education, practice enhancement, active methodologies and autonomy of the student.
Conclusion:
the participation of actors participants of the training process and performance of professional nurses in the evaluation of a curriculum pointed aspects to realignment and provided concrete benefits to improving the quality of undergraduate course curriculum, scenario of this study.
Keywords:CurriculumGraduate Programs in NursingNursing EducationNursing StudentsResearch in Nursing EducationSee more -
EDITORIAL01-01-2016
The challenge of the 67th Brazilian Conference of Nursing: In what direction is the Brazilian Nursing going?
Revista Brasileira de Enfermagem. 2016;69(1):7-9
Abstract
EDITORIALThe challenge of the 67th Brazilian Conference of Nursing: In what direction is the Brazilian Nursing going?
Revista Brasileira de Enfermagem. 2016;69(1):7-9
DOI 10.1590/0034-7167.2016690101i
Views0Bringing together about 3,700 participants among conference participants, speakers, support staff, organizers and exhibitors, the 67th Brazilian Conference of Nursing extraordinary presented São Paulo with deep and meaningful reflections in an attempt to answer the question “In what direction is the Brazilian Nursing going?”.From the submission of the proposal to host the event until its […]See more -
EDITORIAL01-01-2016
O desafio do 67º Congresso Brasileiro de Enfermagem: para onde caminha a Enfermagem brasileira?
Revista Brasileira de Enfermagem. 2016;69(1):7-9
Abstract
EDITORIALO desafio do 67º Congresso Brasileiro de Enfermagem: para onde caminha a Enfermagem brasileira?
Revista Brasileira de Enfermagem. 2016;69(1):7-9
DOI 10.1590/0034-7167.2016690101i
Views0Reunindo cerca de 3.700 participantes entre congressistas, palestrantes, equipe de apoio, organizadores e expositores, o 67º Congresso Brasileiro de Enfermagem agraciou São Paulo com reflexões profundas e significativas, na tentativa de dar sua resposta à questão “Para onde caminha a enfermagem brasileira?”.Desde a apresentação da proposta de sediar o evento até sua realização, o que […]See more -
REVIEW06-01-2015
Anticipated directives and living will for terminal patients: an integrative review
Revista Brasileira de Enfermagem. 2015;68(3):524-534
Abstract
REVIEWAnticipated directives and living will for terminal patients: an integrative review
Revista Brasileira de Enfermagem. 2015;68(3):524-534
DOI 10.1590/0034-7167.2015680321i
Views0See moreABSTRACT
Objective:
characterizing the national and international scientifi c literature about the advanced directives of living will as applied to the terminally ill patient.
Method:
integrative review considering the articles published in Portal Capes, SciELO, LILACS, MEDLINE, Journal of Bioethics and Bioethikos, with the descriptors: Advanced directives, Wills regarding life and Advance Directives, Living Will and Terminally Ill, totaling 44 articles submitted to content analysis.
Results:
three categories emerged: Students and professionals facing the advance directives of living will: Perceptions, opinions and practices; Patient’s receptivity to the Advance Directives of Living Will; The family facing the advance directives of living will.
Conclusion:
the relevance of the topic became evident as a guarantee of respect for the dignity and autonomy of the patient, as well as to reduce ethical confl icts faced by families and health professionals facing care at the end of life.
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