Psychosocial care in oncology nursing: a study of social knowledge

Oncology nurses' lived experiences of video communication in follow-up care of home-living patients: A phenomenological study in rural Norway

PURPOSE

To explore the lived experiences of oncology nurses (ONs) during three months of virtual care provided through video conferencing (VC) in the follow-up care for home-living patients with cancer in rural Norway.

METHOD

An exploratory study employing a descriptive phenomenological approach conducted with a purposive sample of four ONs working in primary health care in three municipalities. Individual interviews based on open-ended questions about the ONs' experiences of VC use in follow-up care were analyzed using methodology inspired by Clark Moustakas. The COREQ checklist was utilized in this study.

RESULTS

ONs provided VC as a quality-promoting supplement to traditional follow-up. Their lived experiences of the phenomenon were described by the following themes: 1) Choice of VC based on care need considerations, 2) Use of VC on portable tablets facilitated contact and frequent follow-up, and 3) Adaption of relevant virtual care in person-centered and goal-oriented practice.

CONCLUSION

The use of VC may contribute to accessible and frequent quality care and reduce the ONs' travel time for home visits. This study points to a need to individualize and assess the appropriateness of virtual care in challenging cancer situations. Furthermore, there is a need for larger-scale studies on how VC may influence quality care.

Nurses' Caring Behaviors Toward Patients Undergoing Chemotherapy in Greece: A Mixed-Methods Study

BACKGROUND

Nurses' caring behaviors are central in the quality of care of patients undergoing sophisticated chemotherapy protocols. However, there is a scarcity of research regarding these behaviors in non-Anglo-Saxon countries.

OBJECTIVE

The aim of this study was to explore caring behaviors that nurses perceive as important in caring for patients in Greece receiving chemotherapy.

METHODS

We used a mixed-methods design, including a survey in 7 oncology wards in 3 cancer hospitals in Attica, Greece, and a subsequent qualitative focus group investigation. Caring behaviors were explored through the Caring Behavior Inventory 24 and content analysis of 3 focus group interviews.

RESULTS

A sample of 72 nurses (response rate, 68.5%) were surveyed, and 18 nurses participated in the focus groups. "Knowledge/skills" (5 [SD, 0.7]) was the most important caring behaviors. No significant associations with nurses' characteristics were noted, except for higher scores in caring behaviors in participants who were married (P < .02). Six caring-related categories emerged from the qualitative analysis: "the concept of care," "respect," "nurse-patients' connection," "empathy," "fear of cancer," and "nurses' professional role." Moreover, they stressed barriers they faced in each category.

CONCLUSIONS

Integrated quantitative and qualitative data concur that operational tasks are central in Greek nurses' caring behaviors. In addition, qualitative findings highlighted those skills equipping nurses to provide holistic individualized care in a hectic care environment.

IMPLICATIONS FOR PRACTICE

Supporting nurses in attaining excellence in technical skills and in meaningfully engaging with patients receiving chemotherapy is essential in the realization of their caring role. These should be priorities for continuing education and practice improvement initiatives.

Ward social workers' views of what facilitates or hinders collaboration with specialist palliative care team social workers: A grounded theory

BACKGROUND

Inpatient, generalist social workers in discharge planning roles work alongside specialist palliative care social workers to care for patients, often resulting in two social workers being concurrently involved in the same patient's care. Previous studies identifying components of effective collaboration, which impacts patient outcomes, care efficiency, professional job satisfaction, and healthcare costs, were conducted with nurses and physicians but not social workers. This study explores ward social workers' perceptions of what facilitates or hinders collaboration with palliative care social workers.

METHODS

Grounded theory was used to explore the research aim. In-depth qualitative interviews with masters trained ward social workers (n = 14) working in six hospitals located in the Midwest, United States were conducted between February 2014 and January 2015. A theoretical model of ward social workers' collaboration with palliative care social workers was developed.

RESULTS

The emerging model of collaboration consists of: 1) trust, which is comprised of a) ability, b) benevolence, and c) integrity, 2) information sharing, and 3) role negotiation. Effective collaboration occurs when all elements of the model are present.

CONCLUSION

Collaboration is facilitated when ward social workers' perceptions of trust are high, pertinent information is communicated in a time-sensitive manner, and a flexible approach to roles is taken. The theoretical model of collaboration can inform organisational policy and social work clinical practice guidelines, and may be of use to other healthcare professionals, as improvements in collaboration among healthcare providers may have a positive impact on patient outcomes.

Engaging with patients who desire death: Interpretation, presence, and constraint

Canadian end-of-life care is changing. Given recent legislative changes concerning assisted death (euthanasia and assisted suicide), it is vital to examine the perspectives of nurses regarding their care of patients who want to die. This qualitative descriptive study reports findings from interviews with 11 oncology nurses about their experiences of engaging with patients who desire death. Findings provide important insights about how oncology nurses interpret patients' desire-for-death and enact therapeutic presence with these patients. Findings further speak to contextual forces that constrain therapeutic engagement. Interviews were conducted before laws changed in Canada, generating insights that are relevant now more than ever, as increasing numbers of patients will contemplate and receive assisted death in the new landscape of Canadian end-of-life care.

Observations of professional-patient relationships: a mixed-methods study exploring whether familiarity is a condition for nurses' provision of psychosocial support

BACKGROUND

There is a popular belief that the professional-patient relationship is a prerequisite in the provision of psychosocial support. Studies suggest that professionals must know, or be familiar with, a patient in order to effectively provide psychosocial support.

AIM

To examine the association between familiarity and the provision of psychosocial care by professionals.

DESIGN

A mixed-methods study involving participant observation, interviews and organisational and documentary analysis was conducted over 8 months in an inpatient hospice setting.

PARTICIPANTS

In total, 38 nurses (registered and auxiliary) and 47 patients were included in a maximum variation sampling strategy. Data were analysed using both qualitative and quantitative techniques.

RESULTS

The data disconfirm the belief that familiarity is either a necessary or sufficient condition for the provision of psychosocial support. Nurses familiar with patients did not necessarily respond to patients' psychosocial needs, and nurses with no prior contact with the patient immediately dealt with psychosocial needs.

CONCLUSION

Psychosocial support can be provided on a patient's first contact with a clinician and does not rely on building a professional-patient relationship. This suggests that high-quality psychosocial care can be provided in the short time frame available to palliative care clinicians.

A risk to himself: attitudes toward psychiatric patients and choice of psychosocial strategies among nurses in medical-surgical units

Psychiatric patients are liable to stereotyping by healthcare providers. We explored attitudes toward caring for psychiatric patients among 13 nurses working in general hospitals in Ireland. Participants thought aloud in response to a simulated patient case and described a critical incident of a patient for whom they had cared. Two attitudinal orientations were identified that correspond to stereotypical depictions of risk and vulnerability. The nurses described psychosocial care strategies that were pragmatic rather than authentically person-centered, with particular associations between risk-oriented attitudes and directive nursing care. Nurses had expectations likely to impede relationship building and collaborative care. Implications arising include the need for improved knowledge about psychiatric conditions and for access to professional development in targeted therapeutic communication skills.

Climbing Everest: oncology work as an expedition in caring

This study reports findings from 21 in-depth interviews with oncology clinicians (social workers, physicians, and nurses). Interviews addressed clinicians' overall experiences of their work, including professional roles, teamwork, challenges and rewards of the work, and thoughts about whether oncology work changed their world-view. Researchers used an expedition metaphor to understand oncology clinicians' experiences. An expedition and oncology work have in common a clear division of labor, the necessity of collaboration, intense work, significant obstacles, great rewards, and work that the world at large cannot tolerate undertaking. Understanding the experiences of oncology health professionals is essential in attracting and retaining dedicated clinicians and in helping them mitigate the potential deleterious effects of their work, such as compassion fatigue. Additionally, the expedition metaphor itself is compelling; it highlights the breadth of experiences of oncology clinicians, particularly that successful multidisciplinary teamwork in itself can ameliorate compassion fatigue.

Oncology nurses' perceptions of their supportive care for parents with advanced cancer: challenges and educational needs

Despite the emotional impact for children with a parent with advanced cancer, most families receive limited information and support to assist them. A project is underway to determine the acceptability and effectiveness of a supportive and educational intervention for parents with advanced cancer to be delivered by specially trained oncology nurses. To assess the perceptions of oncology nurses about this role, explore potential challenges, and understand their educational needs, oncology nurses were recruited from three metropolitan hospitals to participate in focus groups. This data was supplemented with data from individual interviews conducted with rurally based nurses unable to participate in focus groups held in a metropolitan location. Four focus groups were held, with 24 participants. Individual telephone interviews were conducted with five nurses. Nurses identified the emotional burden of the supportive care role as a key challenge, along with health care systems which were not attuned to the needs of families. Attention to self-care and professional confidence, and access to role-models emerged as key elements required in education, along with information about the impact of parental cancer on children and their developmental stages, and ways to promote more open parental communicate with children.

Residential aged care: the last frontier for palliative care

AIM

This paper is a report of an explorative study describing the perceptions and beliefs about palliative care among nurses and care assistants working in residential aged care facilities in Australia.

BACKGROUND

Internationally, the number of people dying in residential aged care facilities is growing. In Australia, aged care providers are being encouraged and supported by a positive policy platform to deliver a palliative approach to care, which has generated significant interest from clinicians, academics and researchers. However, a little is known about the ability and capacity of residential aged care services to adopt and provide a palliative approach to care.

METHODS

Focus groups were used to investigate the collective perceptions and beliefs about palliative care in a convenience sample of nurses and care assistants working in residential aged care facilities in Australia. Thematic content analysis was used to analyse the data, which were collected during 2004.

RESULTS

Four major themes emerged: (1) being like family; (2) advocacy as a key role; (3) challenges in communicating with other healthcare providers; (4) battling and striving to succeed against the odds. Although participants described involvement and commitment to quality palliative care, they also expressed a need for additional education and support about symptom control, language and access to specialist services and resources.

CONCLUSION

The residential aged care sector is in need of support for providing palliative care, yet there are significant professional and system barriers to care delivery. The provision of enhanced palliative care educational and networking opportunities for nurses and care assistants in residential aged care, augmented by a supportive organizational culture, would assist in the adoption of a palliative approach to service delivery and requires systematic investigation.

Exploring the relationship between caring, love and intimacy in nursing

This article uses the five distinct perspectives on caring proposed by Morse et al (1990) to illustrate the relationship between love, intimacy and caring. Two distinct types of love, namely Agape (altruism/charity) and filia (brother love) are utilized in nursing. Only some caring relationships with patients reach an intimate level, and this is determined by patient characteristics to which the nurse responds. It is concluded that caring as a moral imperative is the most relevant to discussions on caring in nursing and the perspective on which the other four viewpoints hinge.

Cardiorespiratory Nurses’ Perceptions of Palliative Care in Nonmalignant Disease: Data for the Development of Clinical Practice

Nurses lack a comprehensive body of scientific knowledge to guide the palliative care of patients with nonmalignant conditions. Current knowledge and practice reveal that nurses in many instances are not well prepared to deal with death and dying. Focus groups were used in an exploratory study to examine the perceptions of palliative care among cardiorespiratory nurses (n = 35). Content analysis was used to reveal themes in the data. Four major themes were found: (1) searching for structure and meaning in the dying experience of patients with chronic disease, (2) lack of a treatment plan and a lack of planning and negotiation, (3) discomfort in dealing with death and dying, and (4) lack of awareness of palliative care philosophies and resources. The information derived from this sample of cardiorespiratory nurses represents a complex interplay between personal, professional, and organizational perspectives on the role of palliative care in cardiorespiratory disease. The results of the study suggest a need for nurses to be equipped on both an intellectual and a practical level about the concept of palliative care in nonmalignant disease.

Nurses' attitudes to palliative care in nursing homes in Western Australia

Nursing homes are one of the care settings in Western Australia where older people may spend their final years. Residents should be able to receive palliative care where appropriate, but this type of care is not always available at some nursing homes in the state. This study investigated nurses' attitudes to palliative care in nursing homes by examining their cognitive, affective and behavioural information. A sample of 228 nurses working in nursing homes completed a questionnaire, using a free response methodology. Results showed that participants had either a positive or negative attitude to palliative care. Cognitive and affective information significantly and independently predicted the attitudes of nurse, whereas knowledge of palliative care did not contribute significantly to these attitudes. Nurses currently working in palliative care were more positively disposed towards such care, but this disappeared when they ceased working in the area. There is an emphasis on education in the literature which does not take into account the beliefs and emotions of the nurse. Therefore, there is a need to consider these in undergraduate and postgraduate training for nurses. Current experience is also important in palliative care education. The results obtained from nurses in this study should be incorporated into policy for introducing palliative care into nursing homes and used to provide support and assistance to nurses working in this field.