Connectedness in the nurse-patient relationship: a grounded theory study

Spiritual Care[Givers] Competence in Palliative Care: A Scoping Review

To deliver spiritual care, professionals must be skilled in physical, mental, social, and spiritual care. Spiritual care competence includes knowledge, behaviors, attitudes, and skills that enable successful or efficient care. This review aims to identify the scope of competence and the specific skills, knowledge, and attitudes used in providing spiritual care to people needing palliative care, and the main challenges and facilitators. A scoping review was developed using the Joanna Briggs Institute methodology. Six databases (Web of Science; MEDLINE/Pubmed; Scopus; CINAHL; MedicLatina and SciELO) were searched in September 2023, with an update in January 2024. The resulting 30 articles were analyzed using a content analysis approach. Information was categorized into three domains: cognitive, affective, and functional (based on three personal resources: intrapersonal, interpersonal, and transpersonal). Palliative care professionals face a lack of training and insufficient preparation to deliver spiritual care. Spiritual care competence depends on professional spiritual development and experience, spiritual intelligence (cognitive), spiritual humility (affective), and having a critical and reflexive mind (functional). In the future, palliative care should seek to improve competent spiritual care. This review could help clarify the real configuration of competent spiritual care and lead to improvements in a professional's empowerment when delivering effective spiritual care to patients and families.

Taking into account patient preferences in personalised care: Blending types of nursing knowledge in evidence-based practice

AIMS AND OBJECTIVES

To explore how excellent nurses in hospitals take into account patient preferences in nursing decision-making in the evidence-based practice towards personalised care.

BACKGROUND

In evidence-based practice, nursing decision-making is based on scientific evidence, evidence of best practice and individual patient preferences. Little is known about how nurses in hospitals take into account patient preferences in nursing decision-making.

DESIGN

Qualitative grounded theory.

METHODS

Data collection entailed 27 semi-structured interviews with nurses designated by their colleagues as excellent caregivers, followed by 57 hours of participant observation. Data analysis was conducted using three-level coding with constant comparison and theoretical sampling. The COREQ checklist for qualitative research was followed.

RESULTS

A main finding was that participants used three implicit tools to discover patient preferences: establishing a connection, using antennae and asking empathic questions, thus instantly reassuring patients from the very first contact. Their starting point in care was the patient's perception of quality of life wherein they shifted towards their patient's perspective: "Teach me to provide the best care for you in this situation." During the observations, it was confirmed that the excellent nurses behaved as they had described before.

CONCLUSION

Excellent nurses actively turn towards patients' expectations and experienced quality of life by carefully blending individual sensitive and situation specific patient preferences with scientific evidence and evidence of best practice. In doing so, they are able to balancing more equally patient preferences in to the equation called evidence-based practice, thus leading to wise decision-making in personalised nursing care.

RELEVANCE TO CLINICAL PRACTICE

Patient preferences become a fully fledged part of nursing decision-making in EBP when in education and practice, the implicit knowledge of excellent nurses about how to take into account patient preferences to provide personalised care is more valued and taught.

Employee–organisation connectedness and ethical behaviour: the mediating role of moral courage

Purpose

How employees connect with their work organisation and how it may play a role in their moral courage and ethical behaviour remain under-explored. This study, using Psychological Contract Theory, aims to explore how employee–organisation connectedness influences employees' moral courage and ethical behaviour.

Design/methodology/approach

The hypotheses were tested using Partial Least Squares Structural Equation Modelling (PLS-SEM) on data collected through a questionnaire survey from 212 Australian healthcare professionals.

Findings

Employee connectedness with their work organisations showed a significant and direct impact on ethical behaviour. Along with moral courage, connectedness explained over half of the variance in ethical behaviour. Furthermore, moral courage partially mediated the effect of employee connectedness on ethical behaviour.

Research limitations/implications

The overall theoretical implication of this study is that psychological contracts between employees and their organisations operationalised through employee–organisation connectedness can explain the role of moral courage in ethical behaviour.

Practical implications

With increasing borderless management of organisations, organisational connectedness can be a critical factor in developing employees' moral courage and ethical behaviour within organisations. Socialisation interventions can be useful to promote employee–organisation connectedness.

Originality/value

The study developed a higher-order connectedness model and validated it with PLS-SEM. The study provides novel empirical evidence on the relationships between employee–organisation connectedness, moral courage and ethical behaviour.

The influence of engaging authentically on nurse-patient relationships: A scoping review

The current international healthcare focus on ensuring the perspectives and needs of individual persons, families or communities are met has led to the core tenet of person-centred care for all. The nurse-patient relationship is central to the provision of care, and enhancing this relationship to ensure trust and respect supports optimal care outcomes for those accessing healthcare services. Engaging authentically is one of the recognised key approaches in person-centred practice, and this scoping review of the literature aims to gain an understanding of the role this process plays in developing effective relationships between nurses and the people they care for. A systematic search of databases and grey literature was undertaken, and twenty-one research papers met the inclusion criteria. A thematic analysis revealed four themes: 'getting to know the patient as a person', 'the complexity of relationship building-it takes time', 'the nurse: characteristics and behaviours that support the nurse-patient relationship' and 'the patient voice'. Nurses and patients both benefit from effective relationships, feeling valued and experiencing greater satisfaction with care. Key elements of engaging authentically were revealed as a nurse-patient relational process through this literature review; however, further research is needed to gain a greater understanding of this concept.

Neurophysiology of human touch and eye gaze in therapeutic relationships and healing: a scoping review

Objective:

The primary objective of this scoping review was to examine and map the range of neurophysiological impacts of human touch and eye gaze, and consider their potential relevance to the therapeutic relationship and to healing.

Introduction:

Clinicians, and many patients and their relatives, have no doubt as to the efficacy of a positive therapeutic relationship; however, much evidence is based on self-reporting by the patient or observation by the researcher. There has been little formal exploration into what is happening in the body to elicit efficacious reactions in patients. There is, however, a growing body of work on the neurophysiological impact of human interaction. Physical touch and face-to-face interaction are two central elements of this interaction that produce neurophysiological effects on the body.

Inclusion criteria:

This scoping review considered studies that included cognitively intact human subjects in any setting. This review investigated the neurophysiology of human interaction including touch and eye gaze. It considered studies that have examined, in a variety of settings, the neurophysiological impacts of touch and eye gaze. Quantitative studies were included as the aim was to examine objective measures of neurophysiological changes as a result of human touch and gaze.

Methods:

An extensive search of multiple databases was undertaken to identify published research in the English language with no date restriction. Data extraction was undertaken using an extraction tool developed specifically for the scoping review objectives.

Results:

The results of the review are presented in narrative form supported by tables and concept maps. Sixty-four studies were included and the majority were related to touch with various types of massage predominating. Only seven studies investigated gaze with three of these utilizing both touch and gaze. Interventions were delivered by a variety of providers including nurses, significant others and masseuses. The main neurophysiological measures were cortisol, oxytocin and noradrenaline.

Conclusions:

The aim of this review was to map the neurophysiological impact of human touch and gaze. Although our interest was in studies that might have implications for the therapeutic relationship, we accepted studies that explored phenomena outside of the context of a nurse-patient relationship. This allowed exploration of the boundary of what might be relevant in any therapeutic relationship. Indeed, only a small number of studies included in the review involved clinicians (all nurses) and patients. There was sufficient consistency in trends evident across many studies in regard to the beneficial impact of touch and eye gaze to warrant further investigation in the clinical setting. There is a balance between tightly controlled studies conducted in an artificial (laboratory) setting and/or using artificial stimuli and those of a more pragmatic nature that are contextually closer to the reality of providing nursing care. The latter should be encouraged.

Sharing our story individualized and triadic nurse meetings support couples adjustment to living with deep brain stimulation for Parkinson's disease

Treatment with deep brain stimulation for Parkinson’s disease, leads to a rapid improvement in mobility, which may challenge patients and spouses when adjusting to everyday life. An intervention, developed to support the adjustment to everyday life with DBS, demonstrated that individualized meetings with a specialized nurse was experienced as important and fruitful by both patient and spouses. Purpose: The aim was to gain a deeper understanding of how the meetings contributed to the adjustment process. Method: 38 audio-recorded meetings and six written summaries from eight couples participating in the intervention, were analyzed in a hermeneutic process. Results: The analysis revealed four themes: A relational triad of co-creating personal knowing. Sharing and listening in an atmosphere of trust and openness. Unveiling the couple’s everyday life, coping strategies and expectations. Supporting adjustment through knowing their personal story. Conclusion: The triadic dynamics in the meetings were quite particular. The main focus was the patients’ and spouses’ stories, individually and as a couple. The DBS nurse pursues solutions based on professional and specialized knowledge of Parkinson’s disease and the couple’s everyday life. Thus, the intervention meetings offered tailored, individualized and specialized care in supporting adjustment to DBS for PD both individually and as couples.

Nurse-Patient Connectedness and Nurses' Professional Quality of Life: Experiences of Volunteering at a Pediatric Oncology Camp

Objective: Pediatric oncology nurses can experience burnout, vicarious traumatization, and compassion fatigue related to the unique stressors of their profession. Opportunities to enhance nurses' professional commitment and nurse-patient connectedness may mitigate these stressors. This study explored the impact of volunteering at a local oncology camp on pediatric oncology nurses' professional quality of life and connectedness with their oncology patients. Method and Sample: Pediatric oncology nurses from a single institution were invited to participate in this mixed methods study. Participants completed a survey assessing professional quality of life, professional commitment, and patient connectedness. Nurses who had oncology camp volunteer experience were invited to participate in a qualitative interview. Results: Compared with noncamp nurses (n = 23), camp nurses (n = 25) had increased odds of a low burnout score (odds ratio = 6.74, 95% confidence interval [1.10, 41.43], p = .039) and increased odds of a high compassion satisfaction score (odds ratio = 4.69, 95% confidence interval [1.14, 19.32], p = .033). Qualitative interviews supported the impact of volunteering at camp on nurses' personal and professional perspective, nursing practice, and delivery of person-centered care. Conclusion: Volunteering at a pediatric oncology camp provided nurses the opportunity to engage with patients, share experiences, and view patients as individuals while still maintaining professional boundaries. Nurses who volunteer at camp described a perspective moving beyond patient-centered to person-centered care, and for some pediatric oncology nurses, camp volunteering may be a novel way to mitigate burnout and an important tool to enhance resiliency.

Validation of Chinese version of the 4-item Trust in Nurses Scale in patients with cancer

OBJECTIVE

This study was designed to examine the internal consistency, test-retest reliability, construct, and concurrent validity of the Trust in Nurses Scale (TNS) in hospitalized patients with cancer in China.

METHODS

Between October and December 2016, the Chinese version of TNS and Nurse-Patient Trust Scale were applied to assess 190 patients with cancer in a general hospital. A subsample of 70 patients completed the TNS again 1 week later.

RESULTS

The Chinese version of the TNS had good internal consistency (α=0.817), fair test-retest reliability (r=0.866), and confirmatory factor analysis demonstrated good fit for a four-item version of the TNS.

CONCLUSION

The Chinese TNS exhibited sufficient validity and reliability in hospitalized patients with cancer.

The neurophysiology of human touch and eye gaze and its effects on therapeutic relationships and healing: a scoping review protocol

REVIEW QUESTION/OBJECTIVE

The objective of this scoping review is to examine and map the range of neurophysiological impacts of human touch and eye gaze, and better understand their possible links to the therapeutic relationship and the process of healing. The specific question is "what neurophysiological impacts of human touch and eye gaze have been reported in relation to therapeutic relationships and healing?"

Spirituality of staff nurses: application of modeling and role modeling theory

This qualitative study examines the spiritual needs of staff nurses. Focus group participants discussed "care of the patient" and "care of self." We use theory to argue that self-care is essential for the care of both nurses and patients, and spirituality is the foundation of nurses' work.

Getting in and getting out whole: nurse-patient connections in the psychiatric setting

As a strong component in patient healing, interpersonal connection in the psychiatric/mental health setting can threaten nurses' health. Participant observation on four behavioral health and addiction units revealed a process of connecting with patients' emotional pain, delineating strategies applicable to nurses' multiple world views and practice styles. Findings from 12 nurses highlighted connectedness as a process and personal decision that, with self-awareness and individualized self-protective/self-separating strategies, can enhance patient healing as well as nurse satisfaction and growth. The evolved model may help nurses ease emotional labor, combat compassion fatigue, enhance performance, and preserve their self in today's complex acute care setting.

The Care Relationship Required by Seniors in Nursing Homes: A Qualitative Meta-study

Objetivo: describir que tipo de cuidados y de interacción humana demandan de sus enfermeras las personas mayores que viven en un hogar para ancianos, a partir de la síntesis y el reanálisis de los datos proporcionados por una serie de estudios primarios que han abordado la experiencia de vivir en un hogar para ancianos. Antecedentes: los estudios de tipo cualitativo que han tratado el tema de las experiencias vitales en un hogar para ancianos se han centrado en aspectos como la vida diaria, la calidad de vida, las experiencias de sufrimiento, los cuidados recibidos, la proximidad de la muerte y las relaciones personales. Materiales y métodos: metaestudio cualitativo de tipo análisis de metadatos. Las bases de datos empleadas han sido: ISI Web of Knowledge, CINAHL, EMBASE, LILACS y CUIDEN PLUS. Se han seleccionado 29 estudios. Resultados: las categorías centrales emergentes de los datos han sido: las cualidades personales demandadas al personal cuidador, las intervenciones cuidadoras, la relación personal con los cuidadores y la influencia de la relación persona mayor-cuidador en otros aspectos. Conclusión: con este trabajo hemos pretendido sintetizar las evidencias proporcionadas por una serie de investigaciones primarias tratando de proporcionar un nivel de conocimientos mayor sobre las necesidades de atención de las personas residentes en un hogar para ancianos, siempre a partir de los testimonios, las experiencias y las vivencias de los protagonistas.

The Meaning of a Positive Client-Nurse Relationship for Senior Home Care Clients with Chronic Disease

Cette étude a exploré la signification d’une relation positive client-infirmière pour les personnes âgées atteintes de maladies chroniques qui reçoivent les soins à domicile. Pour les besoins de cette étude phénoménologique, huit participants âgés de 65 à 86 ont été sélectionnés à partir du Sud-Ouest Centre communautaire d’accès aux soins [or retain as Southwest Community Care Access Centre (SW-CCAC)]? à London, Ontario. Des données narratives ont été recueillies par des entrevues en profondeur capturé sur cassette audio, tout en utilisant un guide d’entretien semi-structuré. L’analyse et l’interprétation des entrevues ont révélé que le sens d’une relation client-infirmière positive de ces personnes âgées englobait deux tendances de sens: avoir de confort, et étant relié au sein de cette relation. Ces deux modèles ont été contextualisés par être une personne âgée avec une maladie chronique et ont été socialement construits à travers l’expérience d’avoir créé un rapport positif. Bien que des recherches supplémentaires sont nécessaires, les connaissances acquises ajouter à ce que l’on sait déjà au sujet de la théorie et la pratique de la promotion de la santé relationnelle pour les personnes âgées vivant avec des maladies chroniques et recevant les soins à domicile.

Connectedness in the context of patient-provider relationships: a concept analysis

AIM

This paper is a report of an analysis of the concept of connectedness.

BACKGROUND

Previous attempts to conceptualize patient-provider relationships were limited in explaining how such relationships are fostered and maintained, and how they influence patient outcomes. Connectedness is a concept that may provide insights into the advantages of patient-provider relationships; however, the usefulness of this concept in health care is limited by its conceptual ambiguity. Although connectedness is widely used to describe other social relationships, little consistency exists among its definitions and measures.

DATA SOURCES

Sources identified through CINAHL, OVID, PubMed and PsychINFO databases and references lists of selected articles between 1983 and 2010.

REVIEW METHODS

A hybrid concept analysis approach was used, involving a combination of traditional concept analysis strategies that included: describing historical conceptualizations, identifying attributes, critiquing existing definitions, examining boundaries and identifying antecedents and consequences.

RESULTS

Using five distinct historical perspectives, seven attributes of connectedness were identified: intimacy, sense of belonging, caring, empathy, respect, trust and reciprocity. A broad definition of connectedness, which can be used in the context of patient-provider relationships, was developed. A preliminary theoretical framework of connectedness was derived from the identified antecedents, attributes and consequences.

CONCLUSION

Research efforts to advance the concept of connectedness in patient-provider relationships have been hampered by a lack of conceptual clarity. This concept analysis offers a clearer understanding of connectedness, provides recommendations for future research and suggests practice implications.

Quality of life revisited: the concept of connectedness in older adults

Viewing quality of life from a generative context gave rise to a new perspective and the old term quality of life failed to capture the essence of the new idea. Creation of a new term required a series of deliberate studies to develop the concept of connectedness. This article traces the conceptual progression and presents the concept synthesis of connectedness using literary synthesis, qualitative synthesis, and quantitative synthesis. Based on the concept synthesis, connectedness in community-dwelling older adults can be defined as engaging life by self-regulating, facing aging, being part of a family, having friends, and being spiritual.

Relationship between job stress level and coping strategies used by Hong Kong nurses working in an acute surgical unit

OBJECTIVE

The aim of this study is to explore the relationship between job stress and coping strategies of Hong Kong nurses working in an acute surgical unit.

METHOD

This is a descriptive correlational study. Data were collected from 98 Hong Kong surgical nurses using the Nursing Stress Scale and the Jalowiec Coping Scale.

RESULTS

Results showed that workload (M = 15.36), lack of support (M = 13.32), and inadequate preparation (M = 12.33) are the most common stressors for Hong Kong surgical nurses. The most frequent strategies used by nurses to cope with stress can be characterized as evasive (M = 19.23), confrontive (M = 17.46), and optimistic (M = 15.81), all of which are also rated as the most effective strategies in reducing stress levels. Only the confrontive, optimistic, supportant, and emotive coping strategies reveal significant correlations (p < .05) with the stress levels of nurses, whereas the evasive, fatalistic, palliative, and self-reliant strategies showed no significant correlation with stress levels (p > .05).

CONCLUSION

Recognizing the impacts of job-related stress and making use of effective coping methods play a vital role in reducing nurse's stress. A change in leadership styles from the managerial level and reallocation of manpower may help reduce job stress. The use of confrontive and optimistic coping strategies in reducing job-related stress for surgical nurses should be advocated and promoted in their daily work.