Exploring perceptions of inpatient hospital attire in children with cancer

BACKGROUND

Attire bolsters identity, self-expression, and comfort. Hospital gowns are known to be distressing in adults. Attitudes of children with cancer toward hospital attire remain uninvestigated and may be a modifiable factor in overall well-being.

METHODS

A 39-item mixed methods survey evaluated perceptions of patient attire in children with cancer. Children aged 7-18 years were recruited at an academic medical center. Data analysis included simple statistics and thematic analysis.

RESULTS

Forty children with cancer receiving oncologic care participated. Participants' mean age was 12.4 (SD = 3.0, range = 7-17) years, and 25 (62%) were male. Quantitative data revealed 81% of participants preferred their own attire when admitted to the hospital, feeling more comfortable in such when well (91%) or sick (75%). They did not feel like they "must" wear a gown when admitted (60%) and did not want to be asked about preferred inpatient attire (63%). Thematic analysis revealed that children had strong negative views of gowns and preferred to wear their own attire in the hospital, which provided physical and emotional comfort. Children worried wearing their own clothing could impede their care.

CONCLUSION

Children with cancer prefer wearing their own clothes in the hospital for physical and emotional comfort. They are willing to wear gowns for ease of care; however, they do not want to arbitrate when they need to make that choice. Providers may ease distress by considering a child's own clothes as default hospital attire with instructions for when a gown is necessary for good clinical care.

Should oral care be about more than a gut feeling? A qualitative study investigating patients' and healthcare professionals' experiences

AIM

To explore patients' and healthcare professionals' (HCPs) experiences of oral care during hospitalisation to identify needs and challenges.

BACKGROUND

Daily oral care is important to patients' health and well-being, to prevent diseases in the oral cavity, systemic infections and increased morbidity, which subsequently can lead to prolonged hospitalisation and, at worst, increased mortality. Despite this knowledge, oral care is a neglected part of nursing practice. Studies do not clearly identify barriers regarding oral care, as the existing knowledge is inadequate.

DESIGN

A qualitative study exploring participants' experiences to gain new in-depth knowledge of oral care among hospitalised patients.

METHODS

A phenomenological-hermeneutic approach was applied. Participant observations were conducted on five hospital wards, combined with individual semi-structured interviews with 16 patients and 15 HCP. Data analysis was based on Ricoeur's theory of narrative and interpretation.

RESULTS

Four themes describing the challenges regarding oral care emerged: Oral care as a gut feeling; oral care fades into the background; even self-reliant patients need help with oral care; and the mouth reflects the life lived.

CONCLUSIONS

The identified challenges show there is a need for improvement in the health professional approach to oral care in nursing practice. Focus on increasing HCPs' knowledge, skills and competences can increase their nursing agency and support patients' self-care capacity.

IMPACT

Investigation of oral care during hospitalisation revealed four main challenges concerning both patients' and HCPs' lack of knowledge and awareness of oral care. Thus, patients and HCPs should be included in developing solutions to improve oral care in nursing practice.

REPORTING METHODS

The COREQ criteria for reporting qualitative research were adhered to.

PATIENT CONTRIBUTION

A patient representative was involved in the discussion of the proposal, conduct and results of the study.

Sexual Health and Well-Being in Adults With Congenital Heart Disease: A International Society of Adult Congenital Heart Disease Statement

As health care outcomes improve the priority for those living with adult congenital heart disease have changed to a more holistic focus on quality of life and well-being. Although health care has embraced this, there are still areas where there is a deficit in advice, allyship, and advocacy. One of these deficits is in the area of sexual health and well-being. A healthy sexual life has a myriad of physical and psychosocial benefits. However, individuals with adult congenital heart disease may have significant barriers to achieving well-being in this aspect of their lives. These barriers and their potential solutions are outlined in this paper.

Developing rights-based standards for children having tests, treatments, examinations and interventions: using a collaborative, multi-phased, multi-method and multi-stakeholder approach to build consensus

Children continue to experience harm when undergoing clinical procedures despite increased evidence of the need to improve the provision of child-centred care. The international ISupport collaboration aimed to develop standards to outline and explain good procedural practice and the rights of children within the context of a clinical procedure. The rights-based standards for children undergoing tests, treatments, investigations, examinations and interventions were developed using an iterative, multi-phased, multi-method and multi-stakeholder consensus building approach. This consensus approach used a range of online and face to face methods across three phases to ensure ongoing engagement with multiple stakeholders. The views and perspectives of 203 children and young people, 78 parents and 418 multi-disciplinary professionals gathered over a two year period (2020-2022) informed the development of international rights-based standards for the care of children having tests, treatments, examinations and interventions. The standards are the first to reach international multi-stakeholder consensus on definitions of supportive and restraining holds.    Conclusion: This is the first study of its kind which outlines international rights-based procedural care standards from multi-stakeholder perspectives. The standards offer health professionals and educators clear evidence-based tools to support discussions and practice changes to challenge prevailing assumptions about holding or restraining children and instead encourage a focus on the interests and rights of the child. What is Known: • Children continue to experience short and long-term harm when undergoing clinical procedures despite increased evidence of the need to improve the provision of child-centred care. • Professionals report uncertainty and tensions in applying evidence-based practice to children's procedural care. What is New: • This is the first study of its kind which has developed international rights-based procedural care standards from multi-stakeholder perspectives. • The standards are the first to reach international multi-stakeholder consensus on definitions of supportive and restraining holds.

Comprehensive design considerations for a new hospital gown: a patient-oriented qualitative study

BACKGROUND

The standard hospital gown has remained relatively unchanged despite reports that it is uncomfortable, embarrassing to wear and compromises patients' dignity. The objective of this qualitative study was to explore the experiences and perspectives of stakeholders involved in the gown life cycle.

METHODS

We conducted a constructivist, qualitative interview study with a patient-oriented lens. A patient partner was fully integrated into our research team and directly involved in interview guide development, recruitment, data collection, analysis and writing. We audio-recorded telephone interviews with adult (i.e., aged 18 yr or older) patients and family members, interdisciplinary clinicians and key system stakeholders (e.g., designers, manufacturers, textile experts) in North America. We used a hybrid deductive-inductive approach to coding and theme development. This study took place from May 2018 to March 2020.

RESULTS

Analysis of 40 stakeholder interviews (8 patients and family members, 12 clinicians, 20 system stakeholders) generated 4 themes: utility, economics, comfort and dignity, and aesthetics. Patients and clinicians emphasized that current gowns have many functional limitations. By contrast, system stakeholders emphasized that gowns need to be cost-effective and aligned with established health care processes and procedures. Across the stakeholder groups, hospital gowns were reported to not fulfill patients' needs and to negatively affect patients' and families' health care experiences.

INTERPRETATION

Our findings suggest that the standard hospital gown fails to meet the needs of those involved in providing and receiving high-quality health care. Redesigning the gown would be a step toward increased person-centred care and requires partnership across the stakeholder groups involved in the gown life cycle to minimize implementation barriers while placing patients' needs at the forefront.

Psychological Outcomes and Interventions for Individuals With Congenital Heart Disease: A Scientific Statement From the American Heart Association

Although resilience and high quality of life are demonstrated by many individuals with congenital heart disease, a range of significant psychological challenges exists across the life span for this growing patient population. Psychiatric disorders represent the most common comorbidity among people with congenital heart disease. Clinicians are becoming increasingly aware of the magnitude of this problem and its interplay with patients’ physical health, and many seek guidance and resources to improve emotional, behavioral‚ and social outcomes. This American Heart Association scientific statement summarizes the psychological outcomes of patients with congenital heart disease across the life span and reviews age-appropriate mental health interventions, including psychotherapy and pharmacotherapy. Data from studies on psychotherapeutic, educational‚ and pharmacological interventions for this population are scarce but promising. Models for the integration of mental health professionals within both pediatric and adult congenital heart disease care teams exist and have shown benefit. Despite strong advocacy by patients, families‚ and health care professionals, however, initiatives have been slow to move forward in the clinical setting. It is the goal of this scientific statement to serve as a catalyst to spur efforts for large-scale research studies examining psychological experiences, outcomes, and interventions tailored to this population and for integrating mental health professionals within congenital heart disease interdisciplinary teams to implement a care model that offers patients the best possible quality of life.

Healing by Leaps and Gowns: A Novel Patient Gowning System to the Rescue

Patient attire is paramount to a patient's dignity and hospital experience. The traditional hospital gown is dehumanizing, anachronistic, and was designed for providers' convenience. In this descriptive, prospective follow-up to our previous pilot study, we evaluated male and female medical and surgical patients and provider preference and experience with a novel patient gowning system, the Patient Access Linen System (PALS). This study was conducted in 2 hospitals within our health system. Our objective was to assess patient and provider satisfaction, experience, and preference using the PALS. A multiple-choice, free response survey was administered to patients and providers following the use of an item. A total of 315 patients and 249 staff in 2 hospitals completed surveys regarding their experience using or providing care to patients using the PALS. Patients and providers had consistently positive experiences with the PALS, including questions about comfort and function. The data demonstrate a clear preference for the PALS compared to the traditional hospital gown and give additional supporting evidence that the comfort of hospital clothing is of paramount importance to patients.

Health anxiety among adults with congenital heart disease

PURPOSE OF REVIEW

Adults with congenital heart disease (CHD) may experience anxiety specifically related to their medical condition. This review introduces the concepts of health anxiety and heart-focused anxiety, summarizes what is currently known about heart-focused anxiety among adults with CHD and offers suggestions to help adult CHD providers address heart-focused anxiety in their patients.

RECENT FINDINGS

Although minimal research has been conducted specific to this outcome, health anxiety may occur at any point across the lifespan of individuals with CHD. A recent study found that children and adolescents with CHD reported greater health anxiety than community peers. Health anxiety was commonly reported among adults with CHD presenting for psychological assessment. It was linked with older age, trait anxiety, perceived parental overprotection and greater CHD complexity in one study.

SUMMARY

Adults with CHD face many potential health-related stressors, including cardiac symptoms, treatments and interventions throughout the lifespan (including surgeries and other invasive procedures), the impact of CHD on daily lives and longer-term health expectations. Providers should be aware that heart-focused anxiety among patients is understandable and perhaps common. Patient-centred education and psychological intervention should be integrated within a comprehensive approach to long-term disease management.