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- Death Unpreparedness Due to the COVID-19 Pandemic: A Concept AnalysisPublication . Costeira, Cristina; Dixe, Maria dos Anjos; Querido, Ana; Rocha, Ana; Vitorino, Joel; Santos, Cátia; Laranjeira, CarlosThe COVID-19 pandemic imposed changes upon the capacity of healthcare systems, with significant repercussions on healthcare provision, particularly at end-of-life. This study aims to analyze the concept map of death unpreparedness due to the COVID-19 pandemic, capturing the relationships among the attributes, antecedents, consequences, and empirical indicators. Walker and Avant’s method was used to guide an analysis of this concept. A literature search was performed systematically, between May 2022 and August 2023, using the following electronic databases on the Elton Bryson Stephens Company (EBSCO) host platform: Medical Literature Analysis and Retrieval System Online (Medline), Psychological Information Database (PsycINFO), Cumulative Index to Nursing and Allied Health Literature (CINAHL) Complete, Cochrane Library, and Nursing and Allied Health Collection. Thirty-four articles were retrieved. The unexpected and unpredictable impositions associated with inexperience and unskillfulness in dealing with COVID-19 configured challenges for healthcare professionals, family/caregivers, and even the dying person. Nine key attributes emerged in three main domains: (1) Individual: (a) disease-related conditions, (b) separation distress, and (c) scarcity of death and grief literacy; (2) Relational: (a) Dying alone, (b) poor communication, and (c) existential issues; and (3) Contextual: (a) disrupted collective mourning and grieving, (b) disrupted compassionate care and, (c) pandemic social stigma. This study contributed a full definition of death unpreparedness in a global pandemic scenario such as COVID-19. In this sense, feeling unprepared or unready for death brought new challenges to the bioecological resources of those affected. It is essential to embrace strategies capable of providing emotional and spiritual support in the dying process and to respect patient wishes. The lessons learned from COVID-19 should be applied to events with a comparable impact to minimize their consequences.
- Compassionate engagement of communities in support of palliative and end-of-life care: challenges in post-pandemic eraPublication . Vitorino, Joel Vieira; Duarte, Beatriz Veiga; Ali, Amira Mohammed; Laranjeira, CarlosOver the years, humanity has faced various global crises of different kinds that have caused great suffering in the community, such as wars, slavery, torture or the Holocaust, but also climate change, economic crises, or sanitary disasters. The recent pandemic posed a barrier to palliative and End-of-Life (EoL) care, as the need for physical distance made it difficult to retain essential human interactions while minimizing the risk of viral transmission. During the COVID-19 pandemic, the robustness of supportive networks (i.e., family, friends, neighbors, and community members) determined whether someone experienced a calm death at home or an unnecessary hospital admission, labeled as an ‘emergency’. In this vein, active establishment and strengthening of such networks are the foundation of compassionate community efforts. Firstly, providing both physical and emotional support to the entire network of caregivers enhances their ability to care for others and improves the overall experience of death, including the process of dying and the ensuing bereavement period. Furthermore, individuals can enhance their own physical and mental health by practicing compassion. The ability of networks to withstand and recover from physical and emotional challenges, while maintaining strong and supportive relationships among its members, depends on the health and overall well-being of those members. Therefore, we argue that active community participation and death education can strengthen a community’s capacity to assist people facing death, dying, and bereavement.
- Legacy in End-of-Life Care: A Concept AnalysisPublication . Timóteo, Carolina; Vitorino, Joel; Ali, Amira Mohammed; Laranjeira, CarlosComprehending the significance of legacy in end-of-life (EoL) situations helps palliative care professionals enhance person-centered outcomes for those with a life-threatening illness and their families. Our purpose was to conduct a concept analysis of legacy in EoL care. By employing Walker and Avant’s approach, we identified the concept’s defining characteristics. Subsequently, we established the antecedents, consequences, and empirical referents. After conducting a thorough review of titles and abstracts, a total of 30 publications were analyzed. These articles were sourced from three databases (CINAHL, Medline via PubMed, and Scopus) from 2002 to 2023. Our analysis identified several core attributes of legacy: (a) leave behind something of value that transcends death; (b) determine how people want to be remembered; (c) build and bestow across generations; (d) integrate advance care planning through EoL conversations and shared decision-making; and (e) develop strategies of dignity-conserving care. The consequences are related to improvements in spiritual and subjective well-being; coping with inevitable EoL existential issues; decreases in EoL suffering; engendering self-awareness, hope, gratitude, and peace; achieving and maintaining dignity; creating good memories; promoting mutually constructive and transformative relationships; and fostering the adjustment of bereaved people. Nevertheless, further effort is required to implement the key attributes of legacy that form the basis for creating legacy-oriented interventions near the EoL.
- Promoção do Autocuidado: ferramentas que cuidam de mim para cuidar de ti!Publication . Vitorino, Joel Vieira; Laranjeira, Carlos António Sampaio de JesusEste relatório é realizado no âmbito do mestrado com especialização em enfermagem de saúde mental e psiquiátrica, e com ele pretende-se evidenciar o desenvolvimento e consolidação de competências comuns e da prática especializada do enfermeiro especialista em enfermagem de saúde mental e psiquiátrica. Foi realizada uma breve contextualização dos contextos da prática clínica onde foram desenvolvidos os diferentes ensinos clínicos – ensino clínico em unidade de internamento de agudos, numa unidade de cuidados na comunidade e numa unidade de cuidados diferenciados – seguindo-se a análise crítico-reflexiva acerca dos processos de aprendizagem e desenvolvimento profissional. Na segunda parte apresenta-se um projeto de melhoria dos cuidados de enfermagem que surge a partir da identificação de um problema experienciado na prática clínica em ensino clínico. A promoção do autocuidado foi encarada como intervenção protetora do desenvolvimento de fenómenos laborais como o absentismo, presentismo, fadiga por compaixão e Burnout, que resultam em elevados custos sociais e para a saúde individual, em especial para a saúde mental. Foram por isso dirigidas intervenções cientificamente validadas a um conjunto de focos de saúde mental (autoeficácia, resiliência, relacionamentos, autocuidado, autoconhecimento e esperança) que podem constituir-se como mediadores do surgimento dos fenómenos apresentados. A experiência decorrente do exercício nas diferentes realidades de ensino clínico, face à multiplicidade de oportunidades de aprendizagem em ambiente supervisado, permitiu a mobilização de vastas competências numa atitude de constante desenvolvimento, científico, técnico e humano. Terminado este percurso, concluo que se revelou enriquecedor pela oportunidade de desenvolvimento profissional de acordo com as orientações científicas capazes de sustentar uma prática de segurança, qualidade e prossecutora da excelência.
- Coaching as a model for facilitating the performance, learning, and development of palliative care nursesPublication . Costeira, Cristina; Dixe, Maria A.; Querido, Ana; Vitorino, Joel; Laranjeira, CarlosPalliative care nurses experience huge pressures, which only increased with coronavirus disease 2019 (COVID-19). A reflection on the new demands for nursing care should include an evaluation of which evidence-based practices should be implemented in clinical settings. This paper discusses the impacts and challenges of incorporating coaching strategies into palliative care nursing. Evidence suggests that coaching strategies can foster emotional self-management and self-adjustment to daily life among nurses. The current challenge is incorporating this expanded knowledge into nurses’ coping strategies. Coaching strategies can contribute to nurses’ well-being, empower them, and consequently bring clinical benefits to patients, through humanized care focused on the particularities of end-of-life patients and their families.
- Seeking Something Beyond Themselves: A Concept Analysis of Spiritual Awakening Experiences at the End of LifePublication . Monteiro, Manuela; Vitorino, Joel; Marina G. Salvetti; Laranjeira, CarlosBackground/Objectives: End-of-life (EoL) experiences are critically important for everyone involved, giving rise to a set of needs that extend far beyond bio-physiological aspects, to encompass the spiritual dimension as the core of human beings. Understanding the processes of spiritual awakening (SA) assists palliative care professionals in enhancing the quality of care provided to individuals with life-threatening illnesses, as well as to their families. SA is a fundamental occurrence linked to the fulfilment of our spiritual needs when facing an existential crisis, such as the proximity of death. However, its conceptual boundaries need to be clarified to provide qualified and humanized palliative care. Therefore, this study aims to identify the key attributes, antecedents, consequents, and empirical referents of SA at EoL, as well as to clarify the concept’s existing ambiguities. Methods: Walker and Avant’s eight-step concept analysis was used. A literature search was conducted in May 2025 across three databases (PubMed, CINAHL and Scopus). Results: Following the review, 21 articles were included for analysis. The concept analysis revealed four main attribute domains: (1) sensory–perceptual domain; (2) affective/cognitive domain; (3) relational domain; and (4) transcendental domain. Moreover, spiritual consciousness and the existential matrix were antecedents to this concept; revaluation of beliefs, finding spiritual serenity and inner freedom, fostering spiritual growth, and the desire to leave a legacy were its consequences. Conclusions: The concept of SA at the EoL reveals itself to be a complex and multifactorial phenomenon, with a profound impact on a person’s confrontation with finitude. Recognizing and integrating SA into palliative care allows for a more comprehensive understanding of human consciousness. To deal with SA experiences in healthcare settings, a multifaceted approach is needed. This encompasses acknowledging spirituality as a determinant of health, including spiritual care in standard practice, and offering education and training on spiritual care competence for healthcare practitioners. Further transdisciplinary research should be undertaken to explore SA phenomenological variations, guide clinical interventions, and evaluate SA impacts on spiritual well-being and spiritual growth.
- Promote Dignity in Palliative Care Nursing Education using a narrative pedagogical approachPublication . Vitorino, Joel; Querido, Ana; Semeão, Isabel; Laranjeira, CarlosThe education of nursing students encompasses the transmission of knowledge and clinical skills, as well as values, attitudes, and behaviors. In palliative care, it is imperative to uphold and safeguard individuals' dignity. We aimed to explore senior nursing students’ perceptions of dignity in care using a narrative approach. Reflection prompts were designed using the ABCDs dignity in care model. Audio recording reflection entries from 18 students were collected and analysed using qualitative content analysis. Three themes were identified: 1) being transformed; 2) the power of narrative to expose personal vulnerability; and 3) connection and detachment in EoL. Our findings indicated that reflection on personal dignity enhances comprehension, fosters the humanization of care, and facilitates acts that can uphold the dignity of patients.