Barriers to empathy-based care: oncology nurses' perceptions

Human Caring Perspectives of Care Meanings and Expressions in a Nigerian Cancer Care Setting

BACKGROUND

Caring in Africa is often viewed from sociopolitical and humanity perspectives.

OBJECTIVE

The aim of this study was to investigate the meanings and expressions of caring from the narratives of persons living with cancer and their nurses.

METHODS

This study adopted a qualitative ethnonursing methodology. A purposive sampling technique was used to select the key participants, who were grouped into 7 nurses and 6 patients. General participants included 4 physicians, 3 ward assistants, and 6 patients' relatives. Interviews of participants were digitally audio-taped and then transcribed verbatim. Data analysis in this study followed the phases of ethnonursing data analysis enabler and was conducted using NVivo 14 software. Data categories were reviewed and sorted to discover recurrent patterns within the data.

RESULTS

Caring was seen as a social practice that is both transactional and transformational. Six thematic patterns emerged: restoring hope, reaching out to the inner lifeworlds of the patients, mutual empathy, going the extra mile, compassionate presence, and being human/having a sense of human connection. The study revealed that there are discernible patterns in care needs and expectations, even though each cancer patient is unique in his or her specific care needs and expectations.

CONCLUSION

Caring in this study constituted a variety of meanings, and human caring was demonstrated and practiced interpersonally. Hence, there is evidence of living caring in everyday life, in observable ways.

IMPLICATIONS FOR PRACTICE

Nurses should enhance both their own and the patient's sense of personal meaning in the caring partnership to enable them to be present in concrete unique nursing situations with the suffering human being.

Empathy in Nursing Students: A Scoping Review

Purpose: Empathy is essential for nursing students as they progress through their education. To date, few review studies explored empathy in nursing students. This review examined empathy in nursing students, including how to promote empathy, factors contributing to empathy, and the evaluation of empathy. Design: The eligible population included undergraduate nursing students. The concept of interest was empathy related to nursing students. The context was undergraduate nursing programs. Eligible studies included quantitative, qualitative, and mixed-method studies. The protocol was registered in Open Science Framework (OSF). Review Methods: Joanna Briggs Institute Reviewers' Manual guided this scoping review protocol. MEDLINE with Full text (EBSCO), Scopus, ScienceDirect (Elsevier), and PubMed were used for the electronic database search. The findings were analyzed with descriptive statistics and thematic analysis. Findings: A total of 94 articles were included for analysis. Three main themes emerged: (1) approaches to promoting empathy, (2) contributing factors to empathy, and (3) evaluation of empathy. Conclusions: Empathy is cultivated in nursing in numerous ways, highlighting the need to incorporate it into the nursing curriculum. There is also controversy regarding the relationship between empathy and individual characteristics. This finding highlights the need for more effective empathy-promoting educational training that considers these personal characteristics.

Addressing the communication needs of cancer patients for Magnetic Resonance Imaging (MRI) investigations-A phenomenological study on the experiences of MRI radiographers

INTRODUCTION

A higher demand in MRI services could increase the pressure on MRI departments to increase scanning efficiency. This presents the risk of downplaying person-centred care especially for cancer patients with increased communication needs that result from anxiety associated with the nature of their disease. This study explored the experiences of MRI radiographers in addressing the communication needs of cancer patients attending for MRI examinations.

METHODS

The study adopted a descriptive phenomenological methodology. Single contact interviews were conducted on eight MRI specialist radiographers, and these were recorded and transcribed using Microsoft Teams conferencing platform. Thematic analysis of the transcribed data was done through an inductive approach, breaking down the data into meaningful codes and thereafter, into themes and sub-themes.

RESULTS

Common themes generated from the interview data included: identified communication needs, approach to communication needs, support for radiographers and factors affecting communication. Experiences of MRI radiographers indicated increased communication needs in anxious cancer patients and approaches adopted in addressing these were mainly through listening and use of empathetic gestures. Some radiographers admitted to using "blocking" strategies to avoid being drawn into emotionally exhausting conversations. Both intrinsic factors such as radiographers' personality and experience; and extrinsic factors such as time constraints, demanding workload, inadequate staffing, and skill mix were noted to influenced MRI radiographers in addressing these communication needs.

CONCLUSION

Cancer patients can present with communication needs due to anxieties related to their disease. For the radiographer to deal with these needs, adequate support is needed, and necessary steps taken to address the identified influencing factors.

IMPLICATIONS FOR PRACTICE

MRI departments should encourage enabling environment and services that address communication needs of patients with cancer.

Silent Mourning: Infant Death and Caring for Iranian Parents Under the Influence of Religious and Socio-cultural Factors

Despite all the advances in healthcare technology and all the care services in the field of neonates, many infants die in neonatal intensive care units (NICUs). This qualitative study investigated socio-cultural factors influencing the care for bereaved parents in three main NICUs of northwest Iran between March 2018 and April 2019. The purposeful sampling method with the maximum variation was used, and data collection was continued until obtaining rich data to answer the research question. Twenty-eight interviews were conducted with 26 healthcare providers. The thematic analysis method was applied to analyze the data, and two main themes, including "Religious context as a restriction on the parental involvement in the infant's end-of-life care" and the "Socio-cultural challenges of the grieving process among parents", were generated accordingly. The religious and socio-cultural contexts in the NICUs of Iran are a restriction to the presence of parents at their infants' end-of-life phase, and health care providers are less inclined to have parents in the NICU at the time of infant death.

Nursing in oncology ward with intertwined roles: a focused ethnography

BACKGROUND

Characteristics of nursing care in the oncology ward depend on this ward's specific context. This study aimed to investigate the nursing care in the oncology ward regarding the culture of this ward.

METHODS

This qualitative study was conducted in an oncology ward using a focused ethnographic approach. The whole nursing team of the selected ward (N = 16) participated in the study through purposeful sampling. Three methods of observation, interview, and field documents were used for data collection. Data were analyzed by Spradley's (1980) ethnographic method.

RESULTS

'Nursing in the oncology ward with intertwined roles' emerged as the main theme. This theme included the following subthemes: 'Robin Hood nurse,' 'a secretive nurse,' 'a negligent nurse,' 'a snitching nurse,' 'a complaining nurse,' 'an apathetic senior nurse,' 'a stigmatized training nurse,' 'a brazen-bodied nurse,' 'a compassionate nurse,' 'a moonlighting nurse,' and 'a drug bartender.'

CONCLUSION

This study provided a deep cultural insight into nursing care in the oncology ward, considering the particular culture of this ward and emphasizing the nurses' intertwined roles. These roles are on a spectrum, with positive roles, such as compassion, on one side and negative roles, such as negligence, on the other. The results of this study can be provided to nursing managers; therefore, by being aware of nurses' roles considering the specific subculture of the oncology ward, they can provide psychological interventions to improve the mental health of reluctant and complaining nurses and ethics-based training for secretive, negligent, and snitching nurses to provide quality care to the patient.

Understanding the essence of care in nurses' lived stories: A phenomenological study

BACKGROUND

Caring contains understanding and connecting with the individual and the process of providing the healing effect. Nurses' awareness of the science of care can be improved by analyzing and sharing their care experiences, including their healing power, with members of the profession.

AIM

The aim of this study was to understand the meaning of care from nurses' experiences and the real-life stories told by nurses.

METHOD

A descriptive phenomenological design was used. A total of 124 stories told by 23 nurses participating in the training of Human Caring Theory constituted the sample of the study. The content analysis of the stories was carried out in four stages with Giorgi's phenomenological method analysis.

RESULTS

Three themes and six subthemes were derived from the 124 stories. Three main themes: (1) care holds mysteries, (2) care as praxis and (3) obstacles to caring relationship. The first main theme consisted of three subthemes; "Hearing the call for help", "Metaphysical presence" and "Discovery of the healing effect". The second main theme consisted of three subthemes; "Criticism of the objective approach", "Unforgettable experiences of carecaring experiences" and "Awareness of expertise".

CONCLUSION

The use of stories in the training of Human Caring Theory that centers care, besides facilitating learning, has created awareness among nurses about the 'Concept of Care' and has been an important step towards developing awareness of care among nurses.

Communication culture in cancer nursing care: an ethnographic study

PURPOSE

This study aimed to explore the communication culture in nursing care of patients with cancer.

METHODS

This ethnographic study was conducted in 2018-2019. Data were collected through participatory observation (318 h of observing nurses, patients, and family behaviors), semi-structured interviews (8 interviews with nurses), and informal interactions. Data were analyzed using Spradley's framework.

RESULTS

The study results in five cultural components of "communication determinants," "experimental acquisition of communication skills," "gradual empathetic communication," "avoidant communication with patient," and "communication with family as caregiver." "Communication between nurse, patient and family is an experimental, gradual and avoidant relationship" was the study's cultural statement.

CONCLUSION

In this study, the nurse-patient communication was influenced by factors related to the patient, the nurse and the care environment, and nurses acquired communication skills experimentally. There were two patterns of empathetic and avoidant communication between the nurse and the patient. For having high-quality care, nurses' behavioral patterns must be improved and changed in some cases. Nursing professors, managers, and nurses can use these results in training, hiring, orienting novice nurses, and empowering oncology nurses. Training communication skills to nurses and changing managers and nurses' approach to move from task-oriented care to holistic care help improve nurses' communication patterns.

Storytelling: One arts-based learning strategy to reflect on clinical placement. An integrative review

Storytelling is one method of arts-based learning. The pedagogy of arts-based learning integrates the arts into another topic to enhance learning. Nursing students' experiences of clinical placement are often complex. Students may benefit not only from cognitive thinking, but also creative reflection. This integrative literature review explores storytelling as an arts-based approach to learning during clinical placements. A search of electronic databases focused on articles published in English during 2010-2020. The search identified thirteen international papers. The diversity of clinical environments included community mental health, overseas placement, community aged care, and acute care hospitals. The synthesis revealed four main themes: arts-based learning in nurse education, student-patient communication, student-Registered Nurse communication, and student-educator communication. Engaging in stories as a means of reflection improved students' self-knowledge, identified their preconceptions and stereotyping of patients and so improving their patient interactions. Positive relationships between students and patients were not only necessary for caring practice, but also intrinsic to learning. Positive relationships between Registered Nurses and students reduced anxiety and encouraged students to focus on quality patient care. Storytelling provided a creative approach to reflect on practice. Reflection using the affective domain assisted students to reflect more broadly about their placement experience.

Motives for Empathy among Clinical Nurses in China: A Qualitative Study

PURPOSE

This study aimed to explore the motives of clinical nurses for experiencing empathy with patients and their families based on a self-determination theory framework.

METHODS

Semi-structured face-to-face interviews with twenty-one nurses at four tertiary hospitals in Anhui, China, were conducted, recorded and transcribed. A content analysis with a directed approach was performed.

RESULTS

An analysis of the interview transcripts revealed three categories of empathy motivation: autonomous motivation, controlled motivation and a lack of empathy motivation. Autonomous motivation included personal interests, enjoyment and a sense of value, pure altruism, assimilation, and recognition of the importance of empathy. Controlled motivation highlighted pressures from oneself and others, the possibility of tangible or intangible rewards, and avoidance of adverse effects. Finally, a lack of empathy motivation referred to a lack of intention for empathy and denial of the value of empathy.

CONCLUSION

This study provides a deep understanding of the motives underlying empathy in nurses. The results reveal the reasons for empathy and may support the development of effective strategies to foster and promote empathy in nurses.

Determinants of emotional exhaustion among nursing workforce in urban Ghana: a cross-sectional study

BACKGROUND

The subject of emotional exhaustion organisations has become important because of the emerging trends in employment and its associated challenges. Unhealthy practice environment is a major threat in the incidence of emotional exhaustion among nurses; and any organisational culture that do not support its personnel has huge burnout costs. The study aimed at assessing rate of emotional exhaustion; determining factors that accounts for it and also ascertaining the coping strategies used by nurses to overcome it in the Ghanaian health care setting.

METHODS

A cross-sectional study with a proportionate stratified sampling was used to draw a sample from five health facilities. A standardized questionnaire of Professional Practice Environment Scale of Nursing Work Index, Maslach Burnout Inventory and Coping Scale were used to assess variables under study. The STROBE guidelines were followed in reporting this study.

RESULTS

Out of the 232 registered nurses studied, 91.1% of them reported experiencing moderate to high rate of emotional exhaustion. The practice environment of the nurses explained 39.6% of the variance in emotional exhaustion. Emotion-focused and problem-focused approaches were identified to be used by registered nurses to cope with emotional exhaustion.

CONCLUSION

When appropriate and effective intervention are employed, emotional exhaustion will be reduce and this will enrich the effectiveness of quality care delivery to patients.

Final-year student nurses' experiences of caring for patients

BACKGROUND

Shortage of nurses in South African hospitals has affected the nurse-patient ratio, thus prompting nurses to be focussed on completing nursing-related duties with less or no caring for the patient. Caring involves having a therapeutic relationship with the patients, and it can be challenging and demanding for final-year student nurses who are still novices in the nursing profession.

OBJECTIVES

To explore and describe the experiences of caring for patients amongst final-year student nurses in order to develop and provide recommendations to facilitate caring.

METHOD

A qualitative, descriptive and contextual design was used. Data collection was done through eight in-depth individual interviews. Giorgi's five-step method of data analysis was used, along with an independent coder. Measures to ensure trustworthiness and ethical principles were applied throughout the research.

RESULTS

Four themes with 12 subthemes emerged from the data: therapeutic relationship with patients as an integral part of caring, teamwork - team spirit makes caring easy, continuous caring that promotes quality and safe nursing, as well as satisfaction amongst staff and patients, and various barriers that contributed to lack of caring in the unit.

CONCLUSION

The majority of student nurses had positive experiences of caring, which included therapeutic relationships between nurses and the patients, teamwork and team spirit that fostered safe and quality nursing care, rendered effortlessly. Barriers to caring were also highlighted as negative experiences.

Exploring oncology nurses' perception of the consequences of clinical empathy in patients and nurses: a qualitative study

Purpose

Clinical empathy is the ability to understand the patient's situation, perspective, feelings, and actions, based on the patient’s perception, in a helping or therapeutic way. This study was conducted with the aim of exploring oncology nurses’ perception of the consequences of clinical empathy in patients and nurses and the factors influencing it.

Methods

A qualitative study was conducted by semi-structured face-to-face interviews. The participants were 6 male and 9 female oncology nurses who were selected by purposive sampling. Data were analyzed using conventional content analysis.

Results

The theme of “empathy as a double-sided mirror” was created, based on oncology nurses’ perception of the effects of clinical empathy in patients and nurses. Two themes of “organizational factors” and “contextual factors” were generated in response to influencing factors on clinical empathy.

Conclusions

By awareness of the effects of clinical empathy, controlling the barriers and strengthening the facilitators, there is a possibility to design interventional programs to develop empathy as a clinical competency in oncology nurses.

The hidden curriculum: Undergraduate nursing students' perspectives of socialization and professionalism

BACKGROUND AND AIM

Nursing students form a professional identity from their core values, role models, and past experiences, and these factors contribute to the development of their professional identity. The hidden curriculum, a set of ethics and values learned within a clinical setting, may be part of developing a professional identity. Nursing students will develop a professional identity throughout school; however, their identity might be challenged as they attempt to balance their core values with behaviors learned through the hidden curriculum. The purpose of this project was to educate students on the hidden curriculum in the development of their professional identity.

MATERIALS AND METHODS

A sample of 112 senior nursing students was recruited from a northeastern university in the United States for this study. Pre-post survey design was used, and an educational session was administered prior to the post-survey. Descriptive statistics and a valid percentage were used to describe the data within the surveys.

ETHICAL CONSIDERATION

Study was approved by the author's University Institutional Review Board.

FINDINGS

A significant finding was for advocacy as students would speak up if witnessing inappropriate behavior toward patients or families with a mean score increase from 2.50 (pre-survey) to 1.45 (post-survey). Also, over 95% (n = 106) found the educational session beneficial as they learned they had the ability to advocate and speak up for their patients.

CONCLUSION

Students were able to use their core values and advocate for their patients and families which allows for safer patient care.

Evaluation of emotional skills in nursing using regression and QCA models: A transversal study

BACKGROUND

Emotional skills are fundamental for quality service by nursing professionals, providing more personalized attention and a close relationship between the professional and patient.

OBJECTIVES

To compare linear relationship models (linear regressions) and models based on comparative qualitative analysis (QCA) in the analysis of the possible influence of socio-demographic variables (age and sex), working conditions (type of contract and seniority) and academic training (type of degree and specific training) on emotional abilities (emotional intelligence and empathy) in nursing.

DESIGN

It is a transversal design in a single temporary moment.

PARTICIPANTS

The sample of this study consisted of 217 direct patient care nursing professionals from 7 public hospitals in Valencia, Spain.

METHODS

The Jefferson Scale for Nursing Empathy was used to measure empathy and the Trait of Meta-Mood Scale 24 to measure emotional intelligence. Two different statistical methodologies were used: traditional regression models and qualitative comparative analysis models of fuzzy sets (fsQCA).

RESULTS

The results of the regression model suggest that only sex (negatively in the case of perspective taking) and positively (in compassionate care and thinking like the patient) is a predictive variable in the case of empathy, but not in emotional intelligence. Thus, the results of the fsQCA models provide a greater amount of predictive value for both emotional intelligence and empathy, although when varying the variables that best explained the dimensions, the type of contract and age were the main conditions that were sufficient but not necessary.

CONCLUSIONS

Given the differences in linear relationship models and fsQCA, far from prioritizing one technique over another, both are complementary and should be used simultaneously in other studies.

Development and Validity of the Nursing Care Scale and Nurse's Difficulty Scale in Caring for Dying Patients With Cancer and Their Families in General Hospitals in Japan

This study develops and examines the validity and reliability of 2 scales, respectively, for evaluating nursing care and the experience of difficulties providing nursing care for dying patients with cancer and their families. A cross-sectional anonymous questionnaire was administered to nursing staff caring for dying patients with cancer and their families in 4 general hospitals and a university hospital in Japan. The instruments assessed were the Nursing Care Scale for Dying Patients and Their Families (NCD) and the Nurse’s Difficulty Scale for Dying Patients and Their Families (NDD). Of the 497 questionnaires sent to nurses, 401 responses (80%) were analyzed. Factor analyses revealed that the NCD and NDD consisted of 12 items with 4 subscales: “symptom management,” “reassessment of current treatment and nursing care,” “explanation to family,” and “respect for the patient and family’s dignity before and after death.” These scales had sufficient convergent and discriminative validity, sufficient internal consistency (α of subscales: NCD, 0.71-0.87; NDD, 0.74-0.93), and sufficient test-retest reliability (intraclass correlation coefficient of subscales: NCD, 0.59-0.81; NDD, 0.67-0.82) to be used as self-assessments and evaluation tools in education programs to improve the quality of nursing care for the dying patients and their families.