Caring for and about cancer patients: identifying the meaning of the phenomenon "caring" through narratives

Professional Development: Iranian and Swedish Nurses’ experiences of Caring for Dying People

Our world is rapidly becoming a global community. This creates a need for us to further understand the universal phenomena of death and professional care for dying persons. A transcultural study was undertaken using a phenomenological approach to illuminate the meaning of nurses’ experiences of professional development in the contexts of Iran and Sweden. Eight registered nurses working in oncology units in Tehran, Iran, and eight working in the context of a hospital and private homes in northern Sweden were interviewed. The interviews were analyzed using the principles of phenomenological hermeneutics inspired by Paul Ricoeur. A naive reading guided a structural analysis, which yielded four main themes: coping with existential, organizational, and cultural contexts; sharing knowledge, experiences, and responsibilities; using embodied knowledge; and developing personal competence. The interpreted comprehensive understanding revealed that the meaning of professional development is that it actualizes other-oriented values and self- oriented values. Caring professionally for dying people was a learning process that could help nurses to develop their personal and professional lives when they were supported by teamwork, reflective practice, and counselling.

Taking the responsibility in dementia care: A concept analysis about facticity

AIM

The aim of this study is to develop a comprehensive definition of facticity, applicable to dementia nursing.

METHODS

Walker and Avant's Concept Analysis was used to analyse facticity. Published literature found in PubMed, CINAHL, PsycInfo, and Scopus using the search term facticity and nursing, as well as books and dictionaries and empirical data was used to clarify the concept.

RESULTS

Facticity in nursing dementia care is being in reality taking on responsibility to truth. Antecedents of facticity include persons occupied with caring a demented older person including full-time duties, often accompanied by resistive behaviours. They are overloaded both physically and psychologically. Being present and feeling compassion and nurturing the relationship with the demented older persons and in that way strengthen the caregiving process.

CONCLUSION

Nurses need to be aware that all human beings are living with facticity.

A concept analysis about temporality and its applicability in nursing care

TOPIC

Concept analysis of temporality.

PURPOSE

To develop a comprehensive definition of temporality applicable to nursing care.

SOURCE

Published literature.

CONCLUSIONS

Temporality is a central component of our experience of the world. Phenomena such as the passage of time, time cycles, the trajectory of aging, transitions toward something, something being, and life as a limited time are integral to human experience. Temporality could be seen as lived time, and as such it is subjective time as opposed to clock time or objective time. The temporal dimensions of past, present, and future constitute the perspective of a person's temporal world.

Corroborating indicates nurses' ethical values in a geriatric ward

The aim of the study was to identify nurses' ethical values, which become apparent through their behaviour in the interactions with older patients in caring encounters at a geriatric clinic.Descriptions of ethics in a caring practice are a problem since they are vague compared with the four principles of autonomy, beneficence, non-maleficence, and justice.A Grounded Theory methodology was used. In total, 65 observations and follow-up interviews with 20 nurses were conducted, and data were analysed by constant comparative analysis.THREE CATEGORIES WERE IDENTIFIED: showing consideration, connecting, and caring for. These categories formed the basis of the core category: "Corroborating." In corroborating, the focus is on the person in need of integrity and self-determination; that is, the autonomy principle. A similar concept was earlier described in regard to confirming. Corroborating deals more with support and interaction. It is not enough to be kind and show consideration (i.e., to benefit someone); nurses must also connect and care for the older person (i.e., demonstrate non-maleficence) in order to corroborate that person.The findings of this study can improve the ethics of nursing care. There is a need for research on development of a high standard of nursing care to corroborate the older patients in order to maintain their autonomy, beneficence, and non-maleficence. The principal of justice was not specifically identified as a visible nursing action. However, all older patients received treatment, care, and reception in an equivalent manner.

Creating a new profession in cancer nursing? Experiences of working as a psychosocial nurse in cancer care

AIMS

To describe the nature of being a psychosocial nurse in cancer care.

BACKGROUND

Psychosocial nurses in cancer care are a new profession in cancer nursing in Sweden, with potential to offer unique support to patients regarding somatic and psychological needs. This new profession is hitherto unexplored.

DESIGN

A qualitative inductive interview approach was used.

METHODS

A strategic sample of five nurses working as psychosocial nurses in cancer care in Sweden was interviewed. A thematic stepwise analysis was performed.

RESULTS

The analysis revealed the twofold experience of being a psychosocial nurse in cancer care. The nurses felt as if they had two professions: nurse and therapist. They used skills from both professions to help the person, who had cancer and a psychosocial problem. It was stimulating to be able to combine the knowledge and practices of two professions. It was also difficult because they felt an uncertainty about what their roles and responsibilities really were.

CONCLUSIONS

This new profession seems to need role descriptions and formal education so that psychosocial nurses receive respect and appreciation in their new and relatively unknown work in cancer care. RELEVANCE TO CLINICAL PRACTICES: The adjustment to the cancer disease and treatment side effects can be difficult for the patients and their families, which has highlighted the need for psychosocial support. To meet this need the health care system has to provide such support. Nurses are available and can be successfully educated to handle psychosocial problems among cancer patients. A new profession among nurses is emerging, which the present study aimed at describing. The present findings have potential to make healthcare professionals grasp what the core of psychosocial cancer nursing is, as well as its potential and pitfalls.

What does it mean to be an oncology nurse? Reexamining the life cycle concepts

PURPOSE/OBJECTIVES

To summarize the current research pertaining to the concepts initially examined by the Oncology Nursing Society Life Cycle of the Oncology Nurse Task Force and related projects completed in 1994.

DATA SOURCES

Published articles on the 21 concepts from the Oncology Nursing Society Life Cycle of the Oncology Nurse Task Force work. Research published in English from 1995-2009 was obtained from PubMed, CINAHL(R), PsycINFO, ISI Science, and EBSCO Health Source(R): Nursing/Academic Edition databases.

DATA SYNTHESIS

Most of the concepts identified from the Oncology Nursing Society Life Cycle of the Oncology Nurse Task Force have been examined in the literature. Relationships and witnessing suffering were common concepts among studies of the meaning of oncology nursing. Nurses provide holistic care, and not surprisingly, holistic interventions have been found useful to support nurses. Interventions included storytelling, clinical support of nurses, workshops to find balance in lives, and dream work. Additional support comes from mentoring.

CONCLUSIONS

The research identified was primarily descriptive, with very few interventions reported. Findings have been consistent over time in diverse countries.

IMPLICATIONS FOR NURSING

This review indicates that although the healthcare system has changed significantly in 15 years, nurses' experiences of providing care to patients with cancer have remained consistent. The need for interventions to support nurses remains.

The effectiveness of a caring protocol: An evaluation study

Abstract

Caring has long been affirmed as the essence in nursing. A caring protocol was developed to enhance professional caring and served as a tool to establish a caring culture within a cluster of hospitals. The protocol encompasses three essential elements of professional caring: image, attitude and behaviour. It aims to assess the effectiveness of the protocol in two convalescent hospitals with the objectives to: (1) gain the responses from patients and relatives and (2) explore the feedback from nursing and supporting staff. A mixed method was adopted: a pre- and post-test design and focus group interviews. Nursing and supporting staff from 18 wards were recruited for the study using the caring protocol in two convalescent hospitals. A positive response was obtained from patients and relatives after the implementation of the protocol. Nursing and supporting staff appreciated the implementation process, which could enhance caring. Valuable suggestions were also gathered to maintain the caring culture in wards. The caring protocol is an effective way in enhancing professional caring in hospitals shown by the positive responses from patients and relatives. The protocol was also well accepted by nursing and supporting staff and had a significant impact demonstrated on supporting staff.

Caring for people at the end of life: Iranian oncology nurses' experiences

AIM

To explore the meaning of Iranian oncology nurses' experiences of caring for people at the end of life.

MATERIALS AND METHODS

A phenomenological hermeneutic approach was applied. Fifteen nurses working in oncology units were interviewed in 2007 regarding their experiences of caring for people at the end of life.

RESULTS

Participants experienced caring for people at the end of life as sharing space and time to be lost within an organizational context. This main theme was divided into three subthemes including being attentive to the dying persons and their families, being cared for by the dying persons and their families, and being faced with barriers.

CONCLUSION

The study suggests that the nurses' success in caring for people at the end of life is reliant on their interpersonal caring relationship. Facilitating such relationship requires the establishment of palliative care unit, incorporation of palliative care into undergraduate nursing studies, and cultural preparation through public education.

Lamentation and loss: expressions of caring by contemporary surgical nurses

AIM

This paper is a report of a phenomenological study of caring from the perspective of nurses working on surgical wards.

BACKGROUND

While care and caring are complex foundational nursing concepts which have received considerable and ongoing attention from theorists, researchers and clinicians, there has been little research into caring on surgical units.

METHOD

A convenience sample of ten nurses working on surgical units in a public teaching hospital in Canada was interviewed using van Manen's phenomenological approach. Data were collected during 2001 using semi-structured interviews.

FINDINGS

The major theme of lamentation and loss was identified from the data. Participants revealed a dichotomous tension between what caring should be and what actually occurs. This tension was pervasive and generated lament - an expression of grief and mourning for the loss of caring. The essential structures supporting this theme included lack of time, lack of caring support, tasking, increased acuity, lack of continuity of care, emotional divestment and not caring for each other. Loss and sadness were articulated and participants lamented and grieved about the loss of care in contemporary practice.

CONCLUSION

The forces and influences described by participants undermined caring in the new practice milieu. If this is a glimpse of the future, then the values of the nursing profession may be under siege. Caring as the central core, the essence or unifying concept of nursing may be subject to marginalization in contemporary practice.

Being asked not to tell: nurses' experiences of caring for cancer patients not told their diagnosis

AIMS AND OBJECTIVES

The aim of the primary research was to investigate the impact of the nurse-patient relationship on clinical learning and subsequently clinical practice. Coincidently, 32 participants, all Registered Nurses in Hong Kong, provided details of nurse-patient encounters involving withholding of a cancer diagnosis.

BACKGROUND

The changing face of clinical practice and cancer care has fuelled discussion and debate around disclosure or non-disclosure of the diagnosis of cancer, global consensus on this issue still does not exist. In different countries there is marked variation in how and what a patient may be told about their diagnosis and prognosis. There is considerable variability in the reported rate of cancer diagnosis disclosure across studies and countries. Being asked not to tell a patient their diagnosis of cancer presents many problems for nurses caring for those patients. The issue of non-disclosure directly affects nurses and their clinical practice.

METHODS

This paper reports one of the findings of a large international qualitative study informed by phenomenology into the perceptions of nurses about caring for a patient with a diagnosis of cancer.

RESULTS

Responses from participants revealed considerable difficulties for nurses when caring for patients who were not informed of their diagnosis. They recounted having learned from the encounters but remarked on the negativity of the experience. They discussed their inability to act decisively in the past situations but expressed hope that they had found a resolve to act in future.

RELEVANCE TO CLINICAL PRACTICE

Although, overwhelmingly, participants doubted they would actually be able to change the reality of practice. The identified care episode and the nurse-patient relationship, according to participants, did change their clinical practice but often not for the better.

Admiring courage: Nurses' perceptions of caring for patients with cancer

This paper details one of the findings of a large phenomenological study into the effects of nurse-patient encounters on clinical learning and practice. Every nurse faces the challenge of caring for a patient with cancer at some point in his or her nursing career. The participants, 392 nurses, were asked to provide an account of a care episode from their practice. These narrative/clinical exemplars were for a patient with a diagnosis of cancer and participants were asked to discuss the impact this encounter had on clinical learning and clinical practice. Each day nurses work through the daily grind of the job and occasionally encounter a person, who inspires them, someone they admire because of their courage. Responses from the participants identified a number of such people. Nurses used powerful language, brave, strong, courageous, to describe these patients. The diagnosis of cancer is a daunting prospect and is seen as a challenge physically and emotionally. Participants spoke of their admiration, affection and their sadness when describing the nurse-patient encounters. The life-threatening potential of cancer for the patient and the perception of potential and actual suffering does impact on nurses, their learning and their clinical practice. The struggle against such a daunting adversary places patients diagnosed with cancer in a position to be seen by nurses as people with immense courage. Participants clearly felt the influence of patients' courage, personally and professionally. Many spoke of the inspirational qualities of their patients. Participants detailed learning from the encounters and reflected with great insight on themselves and their practice. The identified nurse-patient encounters were seen to have changed their clinical practice forever.

Striving for emotional survival in palliative cancer nursing

In this grounded theory study, the authors analyze interviews and participant observation data related to palliative cancer nursing in hospitals. Striving for Emotional Survival emerged as the pattern of behavior through which nurses deal with their main concern, the risk of being emotionally overloaded by their work. It involved three main strategies: Emotional Shielding through Professional Shielding or Cold Shielding; Emotional Processing through Chatting, Confirmation Seeking, Self-Reflecting, or Ruminating; and Emotional Postponing through Storing or Stashing. Emotional Competence is a property of Striving for Emotional Survival that explains more or less adequate ways of dealing with emotional overload. The theory Striving for Emotional Survival can be useful in the nurses' daily work and provides a comprehensive framework for understanding how nurses deal with emotional difficulties. The authors suggest that health care organizations encourage self-care, prioritize time to talk, and offer counseling to nursing staff with emotionally difficult working conditions.

Informational and emotional support received by relatives before and after the cancer patient's death

The purpose of this study is to find out what cancer patients' relatives think about the informational and emotional support they receive from health care professionals before and after the patient's death. The data were collected with a structured questionnaire administered to relatives of cancer patients who had died in one of seven health care centres and in one hospice in south-western Finland during a 2-year period before data collection. The questionnaires were sent out by staff to one family member of each adult patient (n=910). The final sample comprised 376 family members, most of whom were the deceased patient's spouses or children. Relatives felt that they had received fairly much support from health care professionals, both before and after the patient's death. Before the patient's death most of the information received by relatives concerned the patient's illness and treatment. They received less information about forms of financial support available. Communication had been honest and the information provided was easy to understand and based upon the relatives' needs. Emotional support before the patient's death consisted mainly of acceptance of the relative and listening to what relatives had to say. However, relatives had only limited opportunity to talk about their difficulties in everyday life. After the death of the patient, staff had mostly supported relatives by showing their acceptance of them and by giving them the time they wanted. Some background variables for both patients and relatives correlated with the support received by relatives before and after the patient's death.

Caring Behaviors As Perceived by Nurse Practitioners

PURPOSE

To investigate nurse pratctitioners' (NPs') perceptions of their own caring behaviors and to examine NPs' demographics as a function of their caring behaviors.

DATA SOURCES

Responses to the Caring Behaviors Inventory(CBI) and a demographic inquiry from 348 NPs in Louisiana.

CONCLUSIONS

CBI mean scores and subscale scores were high for all 348 NPs. No statistically significant difference was found between male NPs' and female NPs' total mean CBI scores or between urban or rural total mean CBI scores. The interaction between nurse gender and area o practice was not statistically significant.

IMPLICATIONS FOR PRACTICE

NPs often work in clinic situations where productivity is the most valued characteristic and where little time is afforded for identifying caring behaviors of the NP and/or establishing a caring relationship with the patient. NPs must be extremely conscious of the need not to "throw out the baby with the bathwater" and sacrifice characteristics that are inherent in nursing for those emphasized in primary care practice. As their responsibilities in the health care setting continue to expand, NPs must continually evaluate and validate their roles to ensure quality care that satisfies patients.

The phenomenon of caring from the novice student nurse's perspective: a qualitative content analysis

BACKGROUND

Caring has been seen as a nursing term/concept, including all the aspects that are used to deliver nursing care to patients. Sometimes caring has been conceptualized as a relational expression of human concern and as a collection of human activities that assists others.

AIM

This study is to identify and describe the nature of the concept "caring" from the novice student nurse's perspective.

METHODS

A total of 127 Swedish novice student nurses wrote comments in essay form to the question: "what is your image of the concept caring?" Data were analysed using qualitative content analysis, with the use of the theoretical framework: "doing" and "being".

FINDINGS

Three categories of caring were identified as "doing", "being" and "professionalism". The phenomena of caring and the caring process could be illustrated as including hand (doing), heart (being) and brain (professionalism).

CONCLUSIONS

It is now time to make care more visible as a principle of practice and of moral action. This could be explicit in a clear professional framework and incorporated more fully into nursing education programmes. Caring is to take care of the entire human being physically, emotionally and intellectually. Nurses need to use hand, heart and brain in order to fulfil their commitments.

Development and testing of the Role-related Meaning Scale for Staff in Pediatric Oncology

The purpose of this study was to develop and test the Role-Related Meaning Scale for Staff in Pediatric Oncology (RRMS) to determine the internal consistency and the content and construct validity of this two-phase instrument. During phase 1 (item generation, content validation, and initial field testing), 23 nurses from two cancer centers participated, and during phase 2 (instrument testing), 89 nurses from one pediatric research center participated. The nurses completed either the RRMS only (phase 1) or six instruments including the RRMS (phase 2) to assess the following research variables: role-related meaning, group cohesion, organizational commitment, work satisfaction, and intent to leave. The RRMS was revised after phase 1 because the results yielded a ceiling effect and three overlapping items. The Cronbach alpha for the phase 2 total RRMS was.83, and four of the five hypothesized relations were confirmed (P =.04). Therefore, the RRMS was concluded to be an internally consistent instrument that has content validity and beginning construct validity. Future studies will examine whether the RRMS adequately measures the change in meaning brought about by interventions designed to increase role-related meaning among nurses.

Health care implications and space allocation of research published in nursing journals

PURPOSE

To examine how research is disseminated through nursing journals and to examine characteristics of published research.

DESIGN

A cross-sectional descriptive survey was conducted with manuscripts from 78 nursing journals that publish research.

METHOD

The final issue for 1999 was examined. Pairs of independent raters content-analyzed all research manuscripts.

DISCUSSION

Research studies comprised 241 (42.9%) of the manuscripts and 51.4% of the journal space. Many empirical studies omitted validity and reliability. Few manuscripts reported the date for completion of data collection, and fewer than one third contained the length of time from acceptance to publication.

CONCLUSIONS

Enhanced instrumentation reporting, shorter time from data collection to publication, and an increase in journal space devoted to research might enable nurses to make more cutting-edge clinical decisions.

Caring behaviors of advanced practice nursing students

The purpose of this project was to provide advanced practice nursing (APN) students with the opportunity to enrich their aesthetic knowing and acquire the meaning of caring in their practice by reflecting on their caring narratives. Students were asked to write about a caring encounter they experienced in their practice. The instructor analyzed and organized that data from each narrative. The instructor shared the data with the students for reflection and discussion. This report focuses on the caring practices of the APN students. Nine themes that embraced physical care, communication, comfort, presence, knowing, acceptance, touch, collaboration, and encouragement were identified. The APN students demonstrated aesthetic knowing as well as other ways of knowing in their caring narratives. Through reflection on the caring experiences and discussion in class, students were able to identify the meaning of caring in their practice.

District nurses' perceptions of palliative care in the home

Palliative care describes a caring philosophy. Originally, palliative care referred exclusively to the care of dying cancer patients, but over time has expanded to include mitigating care of all dying people whatever the diagnosis. The purpose of this paper is to explore the meaning of palliative care according to the experience of district nurses in Sweden. Six district nurses were interviewed, and the transcripts were analyzed using Giorgi's phenomenology. The essence of the caring philosophy for the nurses in the study was identified as commitment, underscored by four themes: challenge, control, frustration, and relationships. These findings indicate that district nurses must be offered resources and education in order to be able to fulfill their commitment, i.e., to supply good palliative care.

Care of women with breast cancer on a surgical ward: nurses' opinions of the need for support for women, relatives and themselves

BACKGROUND

In Sweden women with newly diagnosed breast cancer are admitted to surgical wards in order to undergo surgery and receive postoperative care. On these wards, nursing staff take care of women both with newly diagnosed breast cancer and those with cancer in advanced stages. Nurses have to meet the varying needs of patients and their relatives.

AIM

To describe nurses' opinions of the need for care and support for women and their relatives in connection with surgery for breast cancer, as well as their own need for support on a surgical ward.

METHODS

Thirty-one nurses from a surgical ward participated in semi-structured interviews. The interviews were tape-recorded and transcribed verbatim. Thereafter a step-by-step, qualitative content analysis was carried out.

RESULTS

The nurses described the need to talk and receive information as being the most important among women and their relatives, as well as among themselves. Only a few nurses mentioned the need for physical care among the women. Contact with relatives was described as being almost nonexistent. There was a discrepancy between what nurses described as important needs and how these needs were provided for.

CONCLUSION

This study shows that what the nurses described as being the most important needs, and the way how these needs were provided for, was more often seen from a theoretical point of view with few examples of self-experienced situations in the daily care. Needs among women and their relatives seemed to be not fully known to nurses and therefore, possibly, were not met. Nurses themselves had a pronounced need for support, which was sometimes unsatisfactorily met.