1. Investigación

Actualmente, la mitad de la población muere en los hospitales, lejos del hogar, en ocasiones, también lejos de familiares y amigos; rodeado de personas con culturas, religiones y valores diferentes. Por otro lado, vivimos en una sociedad que niega y oculta la muerte; no se detiene a reflexionar sobre ella; y cuando llega ese momento, se convierte en un proceso doloroso e insoportable, atenazado por el miedo; lleno de interrogantes sin respuestas. Esta situación conlleva que, frecuentemente en el final de la vida, se generen conflictos éticos cuyas soluciones son difíciles de determinar y provocan dolor en aquellos que intervienen en la toma de decisiones. Garantizar el derecho de autonomía cuando aparece la incapacidad y la muerte es uno de los desafíos de las sociedades modernas. Partiendo del Documento de Voluntades Anticipadas y queriendo avanzar un paso más, surge en los Estados Unidos el proceso de Planificación Anticipada de la Asistencia Sanitaria como medio para preservar el derecho de autodeterminación de toda persona en cualquier circunstancia. El éxito de este proceso se encuentra en que proporciona al paciente, la familia y allegados un tiempo único para aceptar la finitud de la vida y afrontar la muerte en paz.

If healthcare professionals wish to provide healthcare that protects patients' values and preferences, it is necessary to find a way to systematically implement the Advance-Care Planning process. The purpose of this article is to review the literature and present a theoretical model of Advance-Care Planning implementation through the Nursing Process.

Aims and Objectives: To determine the effect of immersive virtual reality (VR) on perceived pain and fear in children during vaccination and parental satisfaction with the procedure. Background: Virtual reality can reduce the perception of pain by children but only three studies have analysed its use during vaccination to date; these had small sample sizes and imperfect methodological designs. Design: A randomised controlled clinical trial. Methods: One hundred and sixty participants from the Tres Forques Health Center were randomly assigned to the intervention group (IG) (n = 82) in which distraction with immersive VR was used during the vaccination, while standard distraction techniques were used for the control group (n = 80). The primary outcome was pain (Wong–Baker FACES). Secondary outcomes included (Children's Fear Scale) and parental satisfaction with the vaccination procedure. Chi-squared tests were used for qualitative variables, relationships between quantitative variables were tested with Spearman correlations, and Mann–Whitney U- or Student t-tests were employed to assess the relationship between quantitative and qualitative variables. Results: Compared to the controls, the children in the IG reported significantly less pain and fear, while parental satisfaction was significantly higher. Reported pain and fear did not differ according to the sex of the patient. Child age was not linked to fear but was related to pain: the younger the patient, the greater the pain they described. Conclusions: Immersive VR effectively controlled pain and fear in children during vaccination and increased parent satisfaction with the vaccination process. Patient sex did not influence the level of pain and fear but age did. Relevance to clinical practice: Improving vaccination experiences can reduce perceived pain and fear in children and increase parent satisfaction, thereby enhancing vaccination schedule adherence and improving group immunity. Reporting Method: The CONSORT Statement for non-pharmacological randomised clinical trials were followed.