Towards a theory of quality nursing care for patients with cancer through hermeneutic phenomenology

Cross-Cultural Validation of the Portuguese Version of the Quality of Oncology Nursing Care Scale

BACKGROUND

Quality assessment in oncology nursing care has been a growing topic in the literature, gaining relevance as oncological nursing care becomes more complex as the science progresses. However, there are no instruments that assess the perception of the quality of oncology nursing care from the point of view of patients for the Portuguese population. Thus, the cross-cultural translation and validation of the Quality of Oncology Nursing Care Scale (QONCS) was performed for the Portuguese context. This instrument allows nurses to assess patients' self-perception of the quality of nursing care provided in an oncological setting. It also allows researchers to compare the results obtained internationally with the application of this scale.

METHODS

This is a methodological study, with two distinct phases: the first corresponded to the translation and cultural adaptation of the scale to the Portuguese context, and the second consisted of the psychometric validation of the QONCS, which included factor analysis and the evaluation of the psychometric properties of the instrument. We obtained responses from 402 patients from a Portuguese oncology hospital.

RESULTS

The Portuguese version of the Quality of Oncology Nursing Care Scale (QONCS_PT) consists of 34 items inserted into a tetra-factorial model, which explains a total variance of the instrument of 69.8%. A Cronbach's alpha of 0.93 was obtained for the complete instrument.

CONCLUSIONS

QONCS_PT has a competent and reliable structure. The scale's validity was assured and can be used in the Portuguese population, as it is useful for direct care provision but also for researchers and managers.

Adult Gastroenterology Trainees’ Experience of Receiving Feedback on Their Performance of Endoscopy in the Workplace

Background

Competency-based gastrointestinal endoscopy training is concerned with outcomes of the learning experience. Feedback allows for trainees to achieve the expected outcomes. However, little is known about trainees’ experience of receiving feedback. Gaining understanding of their experience could help improve feedback practices. The study was conducted to explore what it means for adult gastroenterology trainees to receive feedback on their performance of endoscopy in the workplace.

Methods

An interpretative phenomenological approach was used. Individual semi-structured interviews were conducted with six trainees from three Canadian adult gastroenterology residency programs. Interviews were audio-recorded and transcribed verbatim for analysis. Analysis was conducted to identify the phenomenological themes across participants’ accounts of lived experience to provide an insight into the meaning of experiencing the studied phenomenon.

Findings

Three phenomenological themes of experience were identified: taking pauses, negotiating understandings and accepting asymmetry. Taking pauses allowed for participants to receive feedback on their performance of endoscopy. Participants needed to negotiate attending gastroenterologists’ different understandings of gastrointestinal endoscopy while carrying their own whenever feedback was provided. They had to accept the asymmetry between the roles of care provider and learner as well.

Discussion

The study has captured the uniqueness and the complexity of the lived experience of receiving feedback on the performance of endoscopy in the workplace from the perspective of study participants. The gained understanding of this experience has enabled the authors to suggest how attending gastroenterologists’ feedback practices may be improved.

Translation and validation of the Arabic version of the quality of oncology nursing care scale (QONCS): Psychometric testing in three Arabic countries

BACKGROUND

In the Arab world, little is known about cancer patient's satisfaction with the care provided by the oncology nurses. The only explanation for this dearth of knowledge is lack of a specified, valid and reliable tool that can be utilized with all types of cancer. This regional study was conducted to translate and validate the Arabic version of quality of oncology nursing care scale (QONCS).

METHODS

Brislin's model of translation was used with a cross-sectional, cross-cultural and psychometric design. A convenience sample of 517 from three countries (Jordan, Oman and Egypt) completed the study's surveys.

RESULTS

The results indicated that the total QONCS-Ar was reliable with Cronbach's alpha 0.88 and 0.84, 0.87, 0.83, 0.89 and 0.86 for being supported and confirmed, with the religious and spiritual care, belonging, being valued and being respected domains respectively. Exploratory factor analysis supported the dimensional structure of the 34-item scale with five domains with Kaiser-Meyer-Oklin (KMO) measuring 0.872 and Bartlett's Test of Sphericity being significant (significant p<0.001) CONCLUSION: QONCS-Ar is a relatively short, valid, reliable and easy to use instrument that can be applied with all types of cancer, research and educational institutions in the Arabic region.

Construction and validation of the quality of oncology nursing care scale (QONCS)

Background

There is scarcity of questionnaires specifically on the quality of the nursing care provided to patients diagnosed with cancer. The available questionnaires have been developed without attributing a holistic approach to the care provided with important patient’s needs remaining without assessment. The main aim was to develop a self-administered cancer specific questionnaire exploring patients’ views on quality nursing care provided in oncology settings.

Methods

The development of the scale proceeded through three phases. As part of the first development phase areas of concern and items of interest were identified through a literature review. The second phase included a pilot study of the QONCS and a subsequent validation phase through a multicentre study in 3 hospitals, 4 departments and 418 patients diagnosed with cancer and receiving care as inpatients. The study was designed to select items, identify dimensions, measure reliability, content and construct validity.

Results

The QONCS consisted of 34 items. A factorial analysis grouped the items into five categories that define quality nursing care: a) Being supported and confirmed, b) Spiritual caring c) Sense of belonging, d) Being valued and e) Being respected. Cronbach’s alpha was 0.95 for the entire questionnaire. The factor solution explained 68.53% of the variance.

Conclusions

QONCS appears to measure with adequate reliability and validity the attributes of quality nursing care within the oncological settings and to patients with a variety of cancer diagnoses and at different phases of the cancer trajectory. The instrument is quick to disseminate and easy to complete, making it a suitable instrument for nursing professionals to evaluate patients’ self-perceived quality of nursing care as a mean to promote the quality of the care provided in oncological settings.

Undergraduate nursing students caring for cancer patients: hermeneutic phenomenological insights of their experiences

BACKGROUND

The care of patients suffering from cancer and especially those facing the death trajectory appears to be complex and demanding not only for student nurses but for professional nurses as well. The educational models often used in nursing require students to face challenging care scenarios, sometimes with minimal or no supervision and guidance. These "worst case scenarios" can be traumatic experiences that can leave the student hopeless and disappointed of themselves and in many cases can "scar" their subsequent professional career. The literature demonstrates that this can be the result of the students' ill-preparation to care for cancer patients and deal with death and dying. The purpose of this study was to interpret the students' experiences of coming face-to-face with cancer care during their clinical placements.

METHODS

This is a hermeneutic phenomenological study influenced by the ideas of the French Philosopher Paul Ricoeur. Based on this philosophical enquiry the interpretation process included three stages: 1) naïve reading, 2) structural analysis and 3) comprehensive understanding. Data were collected through reflective/narrative diaries from the 4th grade undergraduate (pre-registration) nursing students practicing at oncology, hematology, pediatric oncology departments and hospices. Diaries of twelve students met the inclusion criteria and were included in the interpretation process. The study took place during January and May 2011.

RESULTS

The interpretation yielded the following themes: a) Being part of the center's life, b) Being sympathetic, c) Being confronted by others, d) Being self-reflective, e) Being trapped in the system, f) Being caring towards the family and g) Being better in clinical practice.

CONCLUSIONS

The students emphasized the need for appropriate preparation both at a theoretical and at a clinical level, as to better confront situations involving death and dying as well as learning techniques for crisis management. The students perceived the importance of adopting a policy that is both patient and family-centered in order to provide better care.

Comparative review of family-professional communication: what mental health care can learn from oncology and nursing home care

Because family members take on caring tasks and also suffer as a consequence of the illness of the patient, communication between health-care professionals and family members of the patient is important. This review compares communication practices between these two parties in three different parts of health care: oncology, nursing home care, and mental health care. It shows that there are important differences between sectors. Mental health stands out because contacts between family members and professionals are considered problematic due to the autonomy and confidentiality of the patient. The article explores several explanations for this, and, by comparing the three health sectors, distils lessons to improve the relationship between family members and health-care professionals.

Cultural definitions of quality of care: Perspectives of Jordanian patients

A descriptive qualitative approach was used to develop a cultural definition of quality of care in clinical settings, and understand the phenomena of quality of care from Jordanian patients’ perspectives. The study was conducted in two major teaching hospitals located in the north of Jordan during the period of May–August 2008. The sample consisted of 26 patients who agreed to participate in the study. Understanding the phenomena of quality of care from a cultural perspective will help health care providers, locally and internationally, provide care to Jordanian and Arab immigrants in Western countries. Four main themes emerged from the data to reflect on patients’ perspectives of the quality of care. These themes were: (a) quality as excellence; (b) being caring and concerned; (c) the demonstration of ethical and professional conduct by health care providers; and (d) reflecting on negative experiences during hospitalisation. Findings from this study reflect what is important for Jordanian patients regarding quality of care, and added new dimensions to the definitions of quality of care, including the role of religion in shaping the ethical and professional aspects of quality of care.

These new dimensions open the door for further research that focuses on incorporating social, cultural and spiritual aspects in the measurement of quality of care for the purpose of improving quality of care as determined by patients.