The concept of caring: Perceptions of radiation therapists

But what does it mean to us? Radiographic patients and carer perceptions of compassion

INTRODUCTION

An increased focus on compassion was one of the recommendations in the Francis Report following an inquiry into failures of care at the Mid Staffordshire NHS Trust in 2010. Responses to the Francis report did not take up the question of what compassion meant and how its recommendations might be meaningfully implemented in radiography practice. As part of two wider doctoral research studies, the findings presented in this paper reveal patients and carers perspectives of how compassionate care is experienced, based on an exploration of their experiences, views and attitudes in order to better understand its meaning and application in radiographic practice.

METHODS

A constructivist approach was taken with appropriate ethical approval. Using a combination of interviews, focus groups, co-production workshops and online discussion forums the authors explored the experiences and opinions of patients and carers about compassion in radiotherapy and diagnostic imaging. Data were transcribed and analysed thematically.

RESULTS

The thematically mapped findings are presented under four sub-themes: The values of caring vs the 'business' values of the NHS, Person-centred care, Characteristics of the radiographer and Compassion in the radiographer-patient interaction.

CONCLUSION

Looking at compassion through a patient's lens has highlighted how person-centred care consists of components not attributable to radiographers alone. The personal values of a radiographer must not only align with those of the profession they seek to join, but the value placed on compassion must also be reflected in the environment in which they practice. Alignment signifies patients are part of a compassionate culture.

IMPLICATIONS FOR PRACTICE

Equal emphasis should be placed on both technical and caring practices in order to stop the profession being perceived as target-driven, rather than one which ensures patients are at the heart of practice.

Radiographers’ perception on the provision of psychosocial support for cancer patients

Introduction:

Therapeutic radiographers are the first point of contact for cancer patients undergoing radiotherapy treatment and therefore have an important role in providing both physical and psychosocial support to these patients. This study aimed to evaluate therapeutic radiographers’ perception about their role in identifying and providing psychosocial support for patients receiving RT treatment.

Method:

The study used a cross-sectional, prospective research design. A self-designed questionnaire was distributed to all therapeutic radiographers (n = 26) working at a radiotherapy department in Malta.

Results:

A total of 21 therapeutic radiographers completed the questionnaire. All participants felt that the provision of psychological care was an important part of their role as therapeutic radiographers. The majority of the participants reported having the most confidence in giving treatment-related symptoms advice rather than psychological support. The most common barrier to providing psychological support was lack of training (95·2%), followed by the lack of an appropriate screening tool (85·7%), availability of private space to talk to patients (76·2%) and a lack of knowledge (61·9%).

Conclusion:

While most therapeutic radiographers believed that providing psychosocial support was an important aspect of their role, several barriers prevented them from fulfilling this role. Training, the introduction of a psychosocial screening tool and clear referral processes are recommended to improve radiotherapy service.

Operating room nurses' experience about patient cares for laparotomy surgeries: A phenomenological study

Introduction:

The primary purpose of the present study was to explain the lived experiences of operating room nurses in the field of patient care undergoing laparotomy surgeries.

Methods:

The analytical phenomenological method was used. Ten operating room nurses employed in the operating rooms were selected using purposeful sampling. In-depth and semi-structured interviews were used for data collection. Data analysis was also applied using van Manen’s six-step test.

Results:

In this study, 749 initial codes were extracted, classified into three main themes and six sub-themes following the elimination of similar codes. The main themes included a positive view of patient care, preservation of the physical safety of patients, and consideration of patient vulnerability in the operating room. Moreover, responsibility, holistic care, readiness standards of the surgical environment, physical care provision, medical team malpractice, and lack of care context were considered as sub-themes.

Conclusion:

The operating room nurses’ experiences of patient care in operating rooms included a positive view of patient care, preservation of the patient’s physical safety, and consideration of patient vulnerability in the operating room.

How do radiation therapists detect and manage patients experiencing anxiety in the radiation oncology setting? A vignette study

PURPOSE

Anxiety is commonly observed in oncology patients but infrequently screened, assessed or addressed. According to psychosocial guidelines, all healthcare professionals, including radiation therapists, are responsible for the psychosocial care of patients. Radiation therapists (RTs) interact with patients daily throughout treatment; however, little research exists to evaluate RTs' ability to identify and manage patients' psychosocial needs. This study aimed to determine if RTs can detect and manage patient anxiety.

METHOD

A cross-sectional, mixed-methods survey containing two clinically relevant vignettes was developed. Two fictitious patients were presented to elicit responses reflective of RTs' experiences and judgements in the recognition and management of anxiety. Surveys were distributed via email in Australia, New Zealand and Canada. Ethical approval was obtained from the University of Sydney (2016/227) and informed consent was obtained from participants.

RESULTS

Eligible and complete surveys were received from 582 respondents (240 (41.2%) from Australia; 78 (13.4%) New Zealand; 264 (45.4%) Canada). Almost all respondents endorsed a relevant descriptor of anxiety (vignette 1, 577 (99.1%); vignette 2, 579 (99.5%)). For both vignettes, the most frequently endorsed management strategy was to acknowledge the patients' feelings and encourage them to express their concerns (vignette 1, 548 (94.2%); vignette 2, 455 (78.2%)).

CONCLUSION

RTs in Australia, New Zealand and Canada are able to detect anxiety and endorse a strategy to manage patients experiencing anxiety depicted in written vignettes. Exploring RTs' abilities to detect and manage patient anxiety whilst in the high-pressure clinical environment is an important next step.

The Behavioural Display of Compassion in Radiation Therapy: Purpose, Meaning and Interpretation

INTRODUCTION

Providing high quality patient care is a worldwide standard of proficiency across the radiographic workforce. As compassion and compassionate behaviours are considered synonymous with patient-centred care, the focus of professional practice throughout healthcare should be on a system that places compassion at its heart. Inadequate care and dispassionate practice have been blamed for failings within the National Health Service. United Kingdom healthcare legislation has been criticised for its failure to provide meaning or clarity to practical compassionate care. Consequently, it has hindered the ability of National Health Service Trusts, service delivery managers and Medical Radiation Technologists to interpret and implement policy recommendations regarding compassionate practice at a local level.

AIMS

To support the implementation of compassionate legislation, the study sought to understand the perspectives of those in receipt and those delivering compassionate practice. The research aimed to develop a context specific definition of compassion and identify commonly recognised compassionate behaviours. This article reports on the display of compassion through the behaviours of Medical Radiation Technologists.

METHODS/MATERIALS

Co-production underpinned the qualitative methodological inquiry and design of the research. Eleven focus groups were conducted, five with Medical Radiation Technologists three with cancer patients and care-givers and three with student Medical Radiation Technologists. On completion of thematic analysis from those groups, three co-production workshops were conducted, integrating the data to ensure the co-produced findings were equally representative of the perspectives of the three participant groups.

RESULTS

An understanding of compassionate display is illustrated through the construction of a conceptual framework. The findings established observable behaviours which a Medical Radiation Technologist must engage in to undertake compassionate display. Three compassionate behavioural classifications were established through the analysis; 'embodied connection', 'characteristic expression' and 'indicative communication'. A Medical Radiation Technologist must engage in all the three core behaviours to gain comprehension of the patient and person. Comprehension enables the Medical Radiation Technologist to establish practices that aim to address the compassionate needs of the patient.

DISCUSSION/CONCLUSION

Adoption of the behaviours by Medical Radiation Technologists should enhance compassionate care received by patients within clinical practice. The conceptual framework provides both a theoretical and practical understanding of compassionate display, making it a valuable tool for training and assessment.

A Qualitative Approach to Understanding the Effects of a Caring Relationship Between the Sonographer and Patient

BACKGROUND

The concept of caring is rapidly becoming an area of interest in healthcare research, especially in medical imaging. While patients, academic institutions, hospitals and policy makers have an expectation for healthcare professionals to be caring, the effects of such a relationship between patient and professional is equally important to understand. Within sonography, a discipline of radiography, there is limited literature on this concept.

PURPOSE

The purpose of the main study was to explore and describe the sonographers' experiences of being caring professionals within private practices in the province of Gauteng, South Africa. This paper focuses on one essential theme that emerged from the study: the effects of a caring relationship between sonographer and patient. Guidelines to enhance caring relationships are also provided.

MATERIALS AND METHODS

A qualitative, exploratory, descriptive, contextual, phenomenology research design was utilised. Four focus group interviews (n = 14) were conducted with qualified sonographers working in the private sector, in Gauteng. Data collection took place until data saturation was reached.

RESULTS

Sonographers described caring for their patients as having both positive and negative effects on themselves. Sonographers explained having developed protective mechanisms to help them when caring for tenacious patients. There was also a sense of emotional and psychological strain identified. Despite this, sonographers displayed a sense of professional pride for their careers.

CONCLUSION

Guidelines were developed to alleviate the emotional and psychological strains sonographers are burdened with. These guidelines included; the facilitation of a supportive and healing environment through reflective practice, availability of a psychologist, and having a tea garden at work.

Crowdsourcing: A novel tool to elicit the student voice in the curriculum design process for an undergraduate diagnostic radiography degree programme

INTRODUCTION

Stakeholder participation in healthcare curriculum design is an important aspect of higher education with stakeholders including students, staff members, clinical partners, healthcare organisations, patients and members of the public. Significantly, student co-creation, of the curriculum, has become increasingly important. Yet there is limited research which addresses how to engage this group in design processes.

METHODS

This paper represents the first phase of a three stage action research spiral whereby the authors evaluated the use of a novel tool for curriculum design processes, anonymised crowdsourcing. This initial phase was open to all students enrolled on an undergraduate diagnostic radiography programme in the UK. To confirm the reliability of the crowdsource design an established eight point crowdsourcing verification tool was applied.

RESULTS

Twenty-three unique ideas were generated by participants, 40 comments made and 173 votes cast. Inductive analysis of the comments generated five themes. These included: the role of technology enhanced learning; simulation activities; patient focused curriculum; mental wealth (resilience) authentic assessment approaches. An evaluation of those who had and had not engaged highlighted areas of improvement for the administration of the second and third iterations which will include a wider pool of participants.

CONCLUSION

This study from a single programme offers lessons for others wishing to adopt and develop this approach elsewhere.

IMPLICATIONS FOR PRACTICE

Several ideas elicited by the crowdsource have been considered by the curriculum design team and will be implemented in the 2020 curriculum thus demonstrating the impact on local education practice of this research approach.

A model to facilitate the teaching of caring to diagnostic radiography students: Original research

BACKGROUND

Healthcare has moved towards a patient-centred caring environment. Radiography students have described feeling unprepared for daily patient interactions therefore, it is essential for educators to facilitate the development of caring attributes in students.

OBJECTIVE

The objective of this article is to describe the process that was followed in order to develop a model to facilitate the teaching of caring to diagnostic radiography students.

METHOD

A qualitative, theory-generating, exploratory and descriptive research design was used. Phase one was a descriptive, exploratory study that utilized focus group interviews to explore and describe the concept of caring from the perspective of first year diagnostic radiography students. Phase two, the focus of this article, was the theory generation phase of the study which began with identifying a central concept from the focus group interview results. The central concepts were then defined according to dictionary and literature sources and relationships between the identified concepts were created. Thereafter, the model was developed.

RESULTS

The central concept was identified as the "facilitation of a culture of caring". This concept was then defined, classified and described.

CONCLUSION

This model as a framework of reference could assist diagnostic radiography educators in facilitating the teaching of caring among student radiographers.

The journey to radiographer advanced practice: a methodological reflection on the use of interpretative phenomenological analysis to explore perceptions and experiences

Introduction:

This paper is a methodological reflection on the use of interpretative phenomenological analysis (IPA) utilised in the context of a qualitative research project that explored perceptions and experiences of the journey to radiographer advanced practice.

Methods and materials:

A two-phase qualitative research explored the perceptions and experiences. Phase 1 reviewed reflective diaries (n = 12) kept during the educational phase of the practitioner journeys. Phase 2 included one-to-one, semi-structured interviews (n = 6) which were recorded, transcribed verbatim and reviewed using the IPA six-stage thematic analysis for practitioners embedded in the advanced practice role.

Findings:

Key themes arising from reflective diary analysis informed the interview content; and following interview transcription, data immersion and IPA, 12 emergent sub-themes generated 3 superordinate themes.

Discussion:

Theoretical perspectives and application of the methodology are discussed. The phenomenological and interpretative qualities of IPA have the potential to provide unique and valuable insights into lived experiences of individuals. It is hoped that this researchers’ reflections are transferrable for those interested in employing a qualitative methodology for radiotherapy and oncology research.

Conclusion:

Therapeutic radiographers work within rapidly changing environments from technological, treatment and care perspectives. With continued development and change, the impact of research utilising an IPA methodology may allow exploration of perceptions and experiences from a range of key stakeholders with the potential to increase the research base.

Sexual Health Issues in Patients with Cancer-An Exploratory Mixed Methods Study of the Awareness Levels of Radiation Therapists

INTRODUCTION

Patients with cancer report dissatisfaction with care they receive in relation to changes affecting intimacy and relationships. Health care professionals describe barriers in providing support in these areas due to lack of time, training, education, and privacy. Radiation therapists (RTs) play a key role in cancer care, but there is little evidence in the literature of their role in sexual health care. This project investigated awareness levels of RTs in sexual health issues related to patients with cancer receiving radiation therapy.

METHODS

A prospective mixed methods approach was used for this investigation. Quantitative data was collected via an online questionnaire developed from the literature. Two hundred eighty-four RTs from two large cancer centers were eligible to participate; 84 responded (29%). Two focus groups were conducted with 15 volunteer RTs to validate questionnaire data and further explore the topic. Content analysis was used to identify key themes from the qualitative data.

RESULTS

RT respondents acknowledged the complexity of sexual health issues in patients with cancer. Eighty-five percent (n = 56) strongly agreed/agreed that all patients with cancer, regardless of cancer site, can experience issues which may affect sexual health. Ninety-two percent (n = 61) strongly agreed/agreed that sexual health is important for a persons' quality of life. As part of the radiation therapy treatment planning process, 54.5% of RTs (n = 31) strongly agreed/agreed that they consider the impact of physical side effects of radiation therapy on the sexual health of patients; during treatment delivery, 56% (n = 36) agreed/strongly agreed that they consider the physical side effects on their patients' sexual health.

CONCLUSIONS

Data indicated that RTs are aware that a cancer diagnosis and the subsequent treatments may lead to issues that affect sexual health. They are aware of the complex nature of sexual health and understand its importance in a persons' quality of life and that all patients with cancer regardless of site may experience issues which can impact their sexual health. Their responses suggest that they can relate their training and clinical practice to sexual health issues experienced by patients in their care. Current RT involvement in sexual health care is limited due to various process and environmental factors similar to those found in other health care professionals practice. By eliminating these barriers and supporting the inclusion of sexual health into the clinical practice of RTs, health care resources can be maximized to support the resolution of unmet needs of patients and their partners. In that way the quality of patient care services can be improved.

Development and pilot of an international survey: 'Radiation Therapists and Psychosocial Support'

INTRODUCTION

Up to one third of radiation therapy patients are reported to have unmet psychosocial needs. Radiation therapists (RTs) have daily contact with patients and can provide daily psychosocial support to reduce patient anxiety, fear and loneliness. However, RTs vary in their values, skills, training, knowledge and involvement in providing psychosocial support. The aims of this study were to: (1) develop an online survey instrument to explore RT values, skills, training and knowledge regarding patient anxiety and psychosocial support, and (2) pilot the instrument with RT professionals to assess content validity, functionality and length.

METHOD

An online cross-sectional survey, titled 'Radiation therapists and psychosocial support' was developed. Items included patient vignettes, embedded items from RT research, and the Professional Quality of Life Scale (ProQOL5). Four radiation oncology departments volunteered to pilot the survey; each nominated four RT staff to participate. Survey data were analysed descriptively and qualitative feedback grouped and coded to determine whether the survey needed to be refined.

RESULTS

Thirteen of sixteen RTs completed the pilot survey and feedback form. Median time to completion was 35 mins, with 54% of respondents stating this was too long. Respondents reported content, questions and response options were relevant and appropriate. Feedback was used to: refine the survey instrument, minimise responder burden and drop out and improve functionality and quality of data collection.

CONCLUSION

This pilot of the 'Radiation therapists and psychosocial support' survey instrument demonstrated content validity and usability. The main survey will be circulated to a representative sample of RTs for completion.

The Second Victim Phenomenon: Perspective of Canadian Radiation Therapists

INTRODUCTION

Clinical incidents are an unfortunate reality in the health care system. Patients and their families are the first victims of these incidents. The health care providers involved in the error are considered the second victims. This research aimed to evaluate the level of awareness of the second victim phenomenon (SVP) in Canadian radiation therapists, determine the post-incident emotional and physical reactions experienced, and determine the existing and/or recommended systems for support.

METHODS

Mixed method design comprised two phases. In phase I, Canadian radiation therapists were invited to view an informational presentation about the SVP and complete an online survey. In phase II, participants partook in an online discussion forum.

RESULTS

Survey results indicate that 31% of respondents were previously aware of the SVP and 86% of respondents report having been involved in a clinical incident. In addition, the results confirm that Canadian radiation therapists who have been involved in health care-related incidents do experience emotional and physical reactions. Most respondents indicated they lacked appropriate organizational support to help them recover from the clinical incident. Support from a colleague is the preferred method of support immediately after the incident. Finally, survey respondents indicated a clear desire for implementation of defined processes for postclinical incident supports.

DISCUSSION

The reported level of awareness of the SVP surprised the authors as it was anticipated to be lower; however, there is an obvious need for greater knowledge of the subject. Reported frequency of involvement in a clinical incident as well as the post-clinical reactions experienced are comparable for other health care providers as indicated in the literature. Survey results revealed that emotional and physical reactions were experienced to a greater degree in those unfamiliar with the SVP, indicating potential value to adding an educational component to radiation therapist's training programs as well as on the job training for staff in the workforce. Most respondents requested specific methods of support for recovery after a clinical incident. In addition, an unexpected number of radiation therapists indicated the need for a "no-blame" work environment, which was an unanticipated finding.

CONCLUSION

This study highlights the lack of awareness of the SVP in Canadian radiation therapists. It identifies the gap between the needs of the second victims and the perceived lack of supports offered by their facilities. This issue is important for organizations wanting to positively manage clinical incidents and create a culture of safety for the patients and employees.

Staff's Experiences of Preparing and Caring for Children With Cancer and Their Families During the Child's Radiotherapy

BACKGROUND

Approximately one-third of children diagnosed with cancer are treated with radiotherapy (RT). Staff experiences of preparing and distracting the children and their families during a child's RT are sparsely described.

OBJECTIVE

The aim of this study was to describe staff experiences of preparing and caring for children with cancer and their families during the child's RT.

INTERVENTION/METHODS

Semistructured interviews with staff were performed at 3 Swedish RT centers. The interviews were analyzed using inductive qualitative content analysis.

RESULTS

The analysis revealed 5 categories summarizing the staff members' experiences. These include the following: experiences of various emotions; care for the child and the child's family; commitments before, during, and after RT; organizational issues; and experiences of the intervention and suggestions for improvement.

CONCLUSIONS

The preparatory intervention facilitated the ability of staff members to conduct their work, although the intervention should be specifically tailored to each child. Meeting children and their families and providing care to both during RT were challenging. The staff strived to provide optimal care for each child and family. Interdisciplinary teamwork and organizational acceptance for the importance of preparation and distraction were essential.

IMPLICATIONS FOR PRACTICE

A future challenge will be to provide opportunities for all staff involved in the treatment of children with cancer to develop their skills continuously in order to provide high-quality preparation and distraction to all children undergoing RT, regardless of the geographical location of the RT center.

Compassion in healthcare: a concept analysis

Background

Compassion and compassionate care are central to radiographers’ professional policy and practice and are congruent with the core values of the National Health Service Constitution. The term compassion however is over-used, ambiguous and vague. This work sought to explore and provide contextual understanding to the term compassion in healthcare.

Method

Walker and Avant’s eight-step model was used as the framework for the concept analysis. Data collection utilised a number of resources including online databases: Medline, CINAHL complete, Scopus, PubMed, PsycINFO, ScienceDirect, Cochrane and DARE; dictionaries, social media, Internet sources, books and doctoral theses. In all, 296 resources were included in the review.

Results

The concept analysis distinguishes the defining characteristics of compassion within a healthcare context, allowing for associated meanings and behaviours to be outlined aiding understanding of compassion. Compassion in healthcare requires five defining attributes to be present: recognition, connection, altruistic desire, humanistic response and action.

Conclusion

The findings identify the complexity of the term and subjective nature in which it is displayed and in turn perceived. The concept analysis forms the basis of further research aiming to develop a healthcare explicit definition of compassion within healthcare, specifically cancer care and radiography practices. Lucidity will enhance understanding, facilitating active engagement and implementation into practice.

Nurses' Perceptions of Futile Care: A Qualitative Study

Health care professionals believe that futile care must not be provided; however, there is no clear agreement over the definition and the manifestations of futile care. The aim of this study was to explore Iranian nurses' perceptions of futile care. In this qualitative exploratory study, the conventional content analysis approach was used for collecting and analyzing the study data. Three main themes were extracted from the data: nonfutility of care: care tantamount with outcome; sense of burnout; and subjectivity and relativity of medical futility concept.

Using focus groups in radiation therapy research: Ethical and practical considerations

Focus groups are a means of gathering qualitative data from a group of participants who discuss a given topic. This method has been used in health care research for the past 30 years, but has seen limited use in radiation therapy research. Focus group discussions are a useful tool for investigating a variety of educational, training and clinical issues from the perspective of practitioners, students and patients. This paper reviews the issues associated with using focus groups as a means of data collection. In particular, it addresses some of the decisions which have to be made about group composition and conduct of the discussions. The literature review is contextualised using a recent example of how the authors used focus groups to investigate fitness to practise in radiation therapy. Other challenges such as familiarity between participants and researchers, power relationships and anonymity are addressed. The paper concludes with a consideration of data analysis.