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Nishiya K, Takashima R, Shishido I, Yano R. Meaning of hygiene care for patients as perceived by clinical nurses through an interactive care process: A grounded theory approach. Jpn J Nurs Sci 2023; 20:e12538. [PMID: 37122078 DOI: 10.1111/jjns.12538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 03/06/2023] [Accepted: 04/03/2023] [Indexed: 05/02/2023]
Abstract
AIM This study aimed to explore the meaning of hygiene care for patients from the perspective of nurses, who provide them with care through an interactive process. METHODS Sixteen registered nurses working in general wards for over 5 years were selected through purposive and snowball sampling. Individual semi-structured interviews were conducted between May and August 2021. Data were analyzed using a grounded theory approach, and the Consolidated Criteria for Reporting Qualitative Research was used to ensure quality and transparency. RESULTS The participants recognized the core category "realizing oneself alive here," where hygiene care energized patients and promoted their realization of "feeling alive." Hygiene care created "time of relief, temporarily forgetting the illness," and "restoring a sense of oneself." A situation of care also created an "opportunity to treat each other as unique individuals," "opportunity to face self," and "encouraging the recovery and disease-fighting process." CONCLUSIONS This study highlights the value of hygiene care provided by nurses to patients. The meaning of hygiene care conceptualized in this study should help build a conceptual framework for understanding the patient's experience and reaffirming the value of hygiene care.
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Affiliation(s)
- Kotone Nishiya
- Graduate School of Health Sciences, Hokkaido University, Hokkaido, Japan
| | - Risa Takashima
- Faculty of Health Sciences, Hokkaido University, Hokkaido, Japan
| | - Inaho Shishido
- Faculty of Health Sciences, Hokkaido University, Hokkaido, Japan
| | - Rika Yano
- Faculty of Health Sciences, Hokkaido University, Hokkaido, Japan
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Rosendal KA, Lehn S, Overgaard D. Body care of older people in different institutionalized settings: A systematic mapping review of international nursing research from a Scandinavian perspective. Nurs Inq 2023; 30:e12503. [PMID: 35666581 PMCID: PMC10078501 DOI: 10.1111/nin.12503] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 05/12/2022] [Accepted: 05/19/2022] [Indexed: 01/25/2023]
Abstract
Body care is considered a key aspect of nursing and imperative for the health, wellbeing, and dignity of older people. In Scandinavian countries, body care as a professional practice has undergone considerable changes, bringing new understandings, values, and dilemmas into nursing. A systematic mapping review was conducted with the aims of identifying and mapping international nursing research on body care of older people in different institutionalized settings in the healthcare system and to critically discuss the dominant assumptions within the research by adapting a problematization approach. Most identified papers reported on empirical research with a biomedical approach focusing on outcome and effectiveness. Conceptual papers, papers with a focus on the perspectives of the older people, or contextual and material aspects were lacking. The research field is dominated by four dominant assumptions: Body care as an evidence-based practice, body care as a relational ethical practice, the body as a body-object and a body-subject, the objects in the body care practices as nonrelational materialities. Given the complexities of professional body care practices, there is a need for other research designs and theoretical perspectives within nursing that expand our understanding of body care taking into consideration the multiple social and material realities.
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Affiliation(s)
- Kirstine A Rosendal
- Department of People and Technology, Research Centre in Health Promotion, University of Roskilde, Roskilde, Denmark
| | - Sine Lehn
- Department of People and Technology, Research Centre in Health Promotion, University of Roskilde, Roskilde, Denmark
| | - Dorthe Overgaard
- Department of Nursing and Nutrition, Faculty of Health, University College Copenhagen, Copenhagen N, Denmark
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The Impact of the COVID-19 Pandemic on Nursing Care: A Cross-Sectional Survey-Based Study. J Pers Med 2021; 11:jpm11100945. [PMID: 34683086 PMCID: PMC8538569 DOI: 10.3390/jpm11100945] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/14/2021] [Accepted: 09/22/2021] [Indexed: 12/15/2022] Open
Abstract
The COVID-19 pandemic has had a severe impact on nursing care. This cross-sectional survey-based study compared aspects of nursing care and nurses’ satisfaction with care provided before and during the first wave of the COVID-19 pandemic. A total of 936 registered nurses (RNs) rated the frequency with which they performed fundamental care, nursing techniques, patient education, symptom management, and nurse–patient relationships before and during the pandemic. A recursive partitioning for ordered multivariate response in a conditional inference framework approach was applied. More frequent fundamental cares were associated with their frequency before the pandemic (p < 0.001), caring for COVID-19 patients (p < 0.001), and workplace reassignment (p = 0.004). Caring for COVID-19 patients (p < 0.001), workplace reassignment (p = 0.030), and caring for ≤7.4 COVID-19 patients (p = 0.014) increased nursing techniques. RNs in high-intensity COVID-19 units (p = 0.002) who educated patients before the pandemic, stopped this task. RNs caring for COVID-19 patients reported increased symptom management (p < 0.001), as did RNs caring for more non-COVID-19 patients (p = 0.037). Less frequent nurse–patient relationships before the pandemic and working in high-intensity COVID-19 units decreased nurse–patient relationships (p = 0.002). Despite enormous challenges, nurses continued to provide a high level of care. Ensuring the appropriate deployment and education of nurses is crucial to personalize care and to maintain nurses’ satisfaction with the care provided.
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Takahata M, Ishizawa M, Uchiumi T, Yamaki M, Sato T. Effects of maneuver of hair-washing motion and gender on oxygen uptake and ventilation in healthy people. Sci Rep 2020; 10:13142. [PMID: 32753680 PMCID: PMC7403424 DOI: 10.1038/s41598-020-69945-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 07/21/2020] [Indexed: 11/23/2022] Open
Abstract
It is known that patients with chronic obstructive pulmonary disease experience dyspnea during unsupported arm exercise (UAE). We examined the respiratory variables in during a hair-washing motion for healthy young people requiring the UAE to find the effects across gender, motion, and speed. In this study, 33 healthy young people were enrolled. Participants performed the following four types of hair-washing motions: both hands with fast speed, both hands with slow speed, one hand with fast speed, and one hand with slow speed. The respiratory variables such as oxygen uptake (\documentclass[12pt]{minimal}
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\begin{document}$${\dot{\text{V}}}$$\end{document}V˙E during a hair-washing motion with both hands were greater than those during hair-washing motion with one hand. \documentclass[12pt]{minimal}
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\begin{document}$${\dot{\text{V}}}$$\end{document}V˙CO2, RR, or \documentclass[12pt]{minimal}
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\begin{document}$${\dot{\text{V}}}$$\end{document}V˙E during a hair-washing motion with both hands fast speed was greater than those during a hair-washing motion with slow speed. In conclusion, this study showed the effects owing to the differences in motion maneuvers and gender during UAE in healthy young people. These suggest a need to consider motion maneuver or gender when teaching motion methods of activities of daily living on the patients.
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Affiliation(s)
- Miki Takahata
- Graduate School of Health Sciences, Yamagata Prefectural University of Health Sciences, Yamagata, Japan.
| | - Masao Ishizawa
- Graduate School of Health Sciences, Yamagata Prefectural University of Health Sciences, Yamagata, Japan.,Department of Occupational Therapy, Yamagata College of Medical Arts and Sciences, Yamagata, Japan
| | - Takuya Uchiumi
- Graduate School of Health Sciences, Yamagata Prefectural University of Health Sciences, Yamagata, Japan.,Department of Occupational Therapy, Yamagata College of Medical Arts and Sciences, Yamagata, Japan
| | - Michiyasu Yamaki
- Graduate School of Health Sciences, Yamagata Prefectural University of Health Sciences, Yamagata, Japan
| | - Toshiaki Sato
- Graduate School of Health Sciences, Yamagata Prefectural University of Health Sciences, Yamagata, Japan
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Kaptain RJ, Helle T, Patomella AH, Weinreich UM, Kottorp A. Association Between Everyday Technology Use, Activities of Daily Living and Health-Related Quality of Life in Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis 2020; 15:89-98. [PMID: 32021147 PMCID: PMC6957009 DOI: 10.2147/copd.s229630] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 12/17/2019] [Indexed: 01/05/2023] Open
Abstract
Purpose A decline in the ability to perform activities of daily living (ADL) and ability to use everyday technology can pose threats to independent living, healthcare management and quality of life (QOL) of patients suffering from chronic obstructive pulmonary disease (COPD). Evidence of the relationship between these variables remains limited. The dual aim of this study was, first, to investigate if health-related QOL (HRQOL) was associated with quality in ADL performance and everyday technology use; second, to examine whether lung function, years with COPD diagnosis, living status or educational level affected physical and mental domains of HRQOL. Methods This cross-sectional study included (N=80) participants aged 46-87 years recruited at healthcare centres in the Northern Region of Denmark using a convenience sampling procedure. Data were gathered through standardized assessments and analysed using multiple regression analysis. Results The regression model explained 50.6% (R2=0.506) of the variation in HRQOL-physical. The following four variables were statistically significantly associated with HRQOL - physical: years since COPD diagnosis (p=0.023), ability to use everyday technology (p=0.006), amount of relevant everyday technologies (p=0.015) and ADL motor ability (p<0.01). The regression model explained 22.80% (R2=0.228) of HRQOL - mental. Only the variable ability to use everyday technology was statistically significantly associated with HRQOL - mental (p=0.009). Conclusion Quality of ADL performance and everyday technology use seem to be associated with HRQOL in people living with COPD. The only demographic variable associated with HRQOL was years with COPD. This indicates that healthcare professionals should enhance their attention also to ADL-performance and everyday technology use when striving to increase the HRQOL of persons living with COPD.
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Affiliation(s)
- Rina Juel Kaptain
- Department of Occupational Therapy, University College of Northern Denmark, Aalborg, Denmark
- Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institutet, Stockholm, Sweden
| | - Tina Helle
- Department of Occupational Therapy, University College of Northern Denmark, Aalborg, Denmark
- Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institutet, Stockholm, Sweden
| | - Ann-Helen Patomella
- Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institutet, Stockholm, Sweden
| | - Ulla Møller Weinreich
- Department of Respiratory Diseases, Aalborg University Hospital, Aalborg, Denmark
- The Clinical Institute, Aalborg University, Aalborg, Denmark
| | - Anders Kottorp
- Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institutet, Stockholm, Sweden
- Faculty of Health and Society, Malmö University, Malmö, Sweden
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6
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Pentecost C, Frost J, Sugg HVR, Hilli A, Goodwin VA, Richards DA. Patients' and nurses' experiences of fundamental nursing care: A systematic review and qualitative synthesis. J Clin Nurs 2019; 29:1858-1882. [PMID: 31661591 PMCID: PMC7319357 DOI: 10.1111/jocn.15082] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 08/07/2019] [Accepted: 08/24/2019] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To systematically identify, appraise and synthesise patients', residents' and nurses' experiences of fundamental nursing care for nutrition, elimination, mobility and hygiene. BACKGROUND The evidence base for effective nursing behaviours to assist people with their fundamental care needs is sparse, hampering the development of effective interventions. Synthesising data on patients' and nurses' experiences of fundamentals of nursing care could contribute to the development of such an intervention. METHODS Systematic review and synthesis of qualitative data from qualitative studies on patients' and nurses' experiences of fundamental nursing care behaviours addressing peoples' nutrition, elimination, mobility and hygiene needs. We appraised study quality and relevance and used a narrative approach to data synthesis, fulfilling PRISMA criteria (Appendix S2). RESULTS We identified 22,374 papers, and 47 met our inclusion criteria. Most papers were of low quality. Sixteen papers met our quality and relevance criteria and were included for synthesis. Papers were about nutrition (2) elimination (2), mobility (5), hygiene (5) and multiple care areas (2). We found nurses and patients report that fundamental nursing care practices involve strong leadership, collaborative partnerships with patients and cohesive organisational practices aligned to nursing care objectives and actions. CONCLUSIONS To improve fundamental care and interventions suitable for testing may require attention to leadership, patient-nurse relationships and organisational coherence plus the fundamentals of care nursing interventions themselves. RELEVANCE TO CLINICAL PRACTICE More rigorous mixed methods research about fundamental nursing care is needed to inform nursing practice and improve patient's experience. Nursing interventions should include effective nurse leadership and nurse-patient collaboration and a focus on fundamental care by the host organisation.
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Affiliation(s)
- Claire Pentecost
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Julia Frost
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Holly V R Sugg
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Angelique Hilli
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Victoria A Goodwin
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - David A Richards
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
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7
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Abstract
As a practice, nursing centers on patients' bodies and how they live the experience of illness and disability through their bodies (embodiment). International nursing studies conducted on the topic of body care primarily include theoretical studies, whereas empirical studies remain sparse. The aim of this study was to describe nurses' perceptions of the role of their bodies and the bodies of patients during body care. This study used a descriptive phenomenological study based on Husserl's philosophical perspective. A purposive sample of 11 Italian registered nurses representing the highest level of nursing education, different clinical experience levels, and different clinical specialties were interviewed. Data were collected between July 2015 and September 2015. Open-ended interviews were analyzed using Giorgi's descriptive phenomenological method. Lincoln and Guba's strategies were used to ensure the trustworthiness of the data. In addition to the overarching theme, "Body care is the heart of nursing," 4 major themes with 13 subthemes emerged from the data. The 4 major themes were as follows: (1) "Body care encompasses the essence of person"; (2) "Body care touches the heart of person"; (3) "The body generates opposite strategies of care"; and (4) "In time, the body 'nourishes' the helping relationship." Nurses considered body and embodiment concepts central to nursing. Body care is treated as an experience with extraordinary emotional contents, allowing nurses to discover the essentials of human nature.
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8
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Lindström I, Gaston-Johansson F, Danielson E. Documentation of Patients’ Participation in Care at the End of Life. Nurs Ethics 2016; 13:394-403. [PMID: 16838570 DOI: 10.1191/0969733006ne883oa] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The aim of this study was to describe how patients’ participation in the care they received was documented in their health care records during the last three months of their lives. Two hundred and twenty-nine deceased adult persons were randomly identified from 12 municipalities in a Swedish county and their records were selected from different health care units. Content analysis was used to analyse the text. Four categories of patient participation were described: refusing offered care and treatments; appealing for relief; desire for everyday life; and making personal decisions. The most common way for these patients to be involved in their care at the end of their life was by refusal of the treatment and care offered. Characteristic of the different ways of participation were the diverse activities represented. The description of patients’ involvement in their life situation at this time indicated their dissociation from the health care offered more than consenting to it.
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Affiliation(s)
- Irma Lindström
- The Sahlgrenska Academy at Göteborg University, Institute of Nursing, Box 457, SE 405 30 Göteborg, Sweden.
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9
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Jellington MO, Overgaard D, Sørensen EE. Manoeuvring along the edge of breathlessness: an ethnographic case study of two nurses. BMC Nurs 2016; 15:27. [PMID: 27127418 PMCID: PMC4848841 DOI: 10.1186/s12912-016-0148-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Accepted: 04/20/2016] [Indexed: 11/10/2022] Open
Abstract
Background There appears to be divergence between nurses’ and patients’ perceptions of dyspnoea onset and on how help should be given. This may affect how nurses understand and assess their patients’ anxiety and the severity of dyspnoea, potentially diminishing their chances of relieving patients’ dyspnoea. The aim of this study was to explore nurse–patient interaction in situations where patients with chronic obstructive pulmonary disease are experiencing acute or worsened dyspnoea in a hospital setting. Methods An ethnographic study using participant observation of two nurses’ interactions with six patients, followed by qualitative in-depth interviews with the nurses. Data were analysed in three steps. First, they were coded for identification of preliminary themes. Second, data were regrouped into preliminary themes for focused analysis which led to formulation of themes and subthemes. Third, hermeneutical principles were used as all data were interpreted from the viewpoint of each theme. Results Three themes were identified: Manoeuvring along the edge; Dyspnoea within the pattern; and Dyspnoea outside the pattern. They were encompassed by the main finding: Manoeuvring along the edge of breathlessness. The nurses attempted to navigate between implicit and explicit care approaches and to create a sphere for relieving or avoiding further worsening of dyspnoea. Depending on the identified pattern for a particular dyspnoeic episode, nurses attributed different significance to the dyspnoea. Conclusions Interacting in dyspnoeic situations places nurses in a dilemma: an implicit approach risk, deriving from exclusion of patients and performing hesitantly; or an explicit negotiation risk, where patients are exhausted and removed from focusing and breathing. The dilemma weakens nurses’ opportunities to relieve or avoid a worsening of the dyspnoea. Likewise, the divergence between nurses’ and patients’ assessment of dyspnoea as within or outside the pattern appears to jeopardize the efficiency of care. Our findings contribute to a deeper understanding of the challenges of respiratory nursing care in general, and the challenges of relieving in-patients’ dyspnoea in particular.
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Affiliation(s)
- Maria Omel Jellington
- Department of Pulmonary and Infectious Diseases, North Zealand Hospital, Hilleroed, Denmark
| | - Dorthe Overgaard
- Department of Nursing, Metropolitan University College, Copenhagen, Denmark
| | - Erik Elgaard Sørensen
- Department of Clinical Medicine, Aalborg University, Sdr. Skovvej 15, 9000 Aalborg, Denmark ; Clinical Nursing Research Unit, Aalborg University Hospital, Sdr. Skovvej 15, 9000 Aalborg, Denmark
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10
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Piredda M, Bartiromo C, Capuzzo MT, Matarese M, De Marinis MG. Nursing care dependence in the experiences of advanced cancer inpatients. Eur J Oncol Nurs 2016; 20:125-32. [DOI: 10.1016/j.ejon.2015.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 06/15/2015] [Accepted: 07/01/2015] [Indexed: 10/23/2022]
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12
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Piredda M, Matarese M, Mastroianni C, D'Angelo D, Hammer MJ, De Marinis MG. Adult Patients’ Experiences of Nursing Care Dependence. J Nurs Scholarsh 2015; 47:397-406. [DOI: 10.1111/jnu.12154] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Michela Piredda
- Research Fellow, Tor Vergata University Rome, and Research Unit Nursing Science; Campus Bio-Medico di Roma University; Rome Italy
| | - Maria Matarese
- Associate Professor, Research Unit Nursing Science; Campus Bio-Medico di Roma University; Rome Italy
| | | | | | - Marilyn J. Hammer
- Assistant Professor; New York University College of Nursing; New York NY USA
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13
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Lykkegaard K, Delmar C. Between violation and competent care--lived experiences of dependency on care in the ICU. Int J Qual Stud Health Well-being 2015; 10:26603. [PMID: 25765881 PMCID: PMC4357638 DOI: 10.3402/qhw.v10.26603] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/19/2015] [Indexed: 11/15/2022] Open
Abstract
This study explores the perceived meaning of dependency on care as experienced by intensive care patients. Research from non-intensive settings shows that dependency is often experienced negatively, but literature on the subject experienced by patients in the ICU is sparse. The study is based on in-depth qualitative semi-structured interviews of lived experience with three former patients admitted to an intensive care unit at a Danish university hospital. The in-depth interviews have been characterized as narratives. The main inspiration for the analysis method is Ricoeur's phenomenological hermeneutical interpretation theory. The study has found that dependency is experienced as difficult, and the relationship with the nurses seems to be ambivalent. The good relationship is experienced to make dependency easier, whereas negative experiences make it harder to cope with dependency. The participants deal with dependency by accepting negative experiences in gratitude for having recovered from critical illness. The findings might be influenced by studies being conducted in a western country setting where independence is valued. They can be used as means of reflection on nursing practice and matters such as communication and patient participation.
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Affiliation(s)
| | - Charlotte Delmar
- Section for Nursing, Department of Public Health, Faculty of Health Sciences, Aarhus University, Aarhus, Denmark.,University College Diakonova, Oslo, Norway;
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Luz EL, Basto ML. The opinion of patients with COPD: the process of becoming chronically sick. CIENCIA & SAUDE COLETIVA 2014; 18:2221-8. [PMID: 23896904 DOI: 10.1590/s1413-81232013000800006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Accepted: 11/14/2012] [Indexed: 01/09/2023] Open
Abstract
Many earlier studies have contributed to a general understanding of the symptoms and signs of chronic obstructive pulmonary disease (COPD), yet very little is known about the transition from a healthy to a chronically sick individual. The scope of this study was to understand how people live with their chronic illness, using Grounded Theory. Twenty-two participants with COPD were interviewed. Findings revealed "the basic social process" of becoming sick with COPD: The significance of living with COPD; Stages of becoming a sick individual; Strategies for management of the process used by participants. The conclusion reached is that understanding the process of "becoming sick" from the person's perspective assists nurses to develop personalized interventions with individuals suffering from COPD, focussing on the subject of care.
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Affiliation(s)
- Elisabete Lamy Luz
- Departamento de Ciências da Saúde, Universidade Católica Portuguesa, Lisboa, Portugal.
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Meanings and experiential outcomes of bodily care in a specialist palliative context. Palliat Support Care 2014; 13:625-33. [PMID: 24762673 DOI: 10.1017/s147895151400025x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The objective of this study was to enhance the depth of existing knowledge about meanings and experiential outcomes of bodily care in the context of an inpatient specialist palliative setting. METHOD Interpretative phenomenology was chosen as the study sought to explore individuals' lived experiences related to bodily care. Nine participants (five women, four men) of various ages and with various metastasized cancers and bodily-care needs, all from one specialist palliative care ward, participated. Data were collected with repeated narrative interviews and supplementary participating observations. Analysis was informed by van Manen's approach. RESULTS The following meanings and experiential outcomes of bodily care were revealed by our study: maintaining and losing body capability, breaching borders of bodily integrity, being comforted and relieved in bodily-care situations, and being left in distress with unmet needs. These meanings overlap and shape the nature of each other and involve comforting and distressing experiences related to what can be described as conditional dimensions: the particular situation, one's own experiences of the body, and healthcare professionals' approaches. SIGNIFICANCE OF RESULTS The results, based on specialist palliative care patients' experiences, outline the meanings and outcomes that relate to the quintessence and complexity of palliative care, deriving from dying persons' blend of both basic and symptom-oriented bodily-care needs. Moreover, the results outline how these two dimensions of care equally influence whether comfort and well-being are facilitated or not. Considering this, specialist palliative care may consider how to best integrate and acknowledge the value of skilled basic nursing care as part of and complementary to expertise in symptom relief during the trajectories of illness and dying.
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Delmar C. The interplay between autonomy and dignity: summarizing patients voices. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2013; 16:975-981. [PMID: 22623342 DOI: 10.1007/s11019-012-9416-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Patients have to be respected with dignity as the masters of their own lives. The problem, however, is that autonomy may become so dominant and the fundamental value of caring in professional nursing that the patient's dignity is affected. The aim of this article is to point out some of the issues with the interplay between autonomy, also called self-management and dignity. Given voice to the patient perspective the background is provided by cases from research conducted through qualitative interviews with patients and expanded by summarizing empirical research concerning the interplay between autonomy and dignity. The search strategy and the research question gave five empirical research papers and three theoretical studies and concept analyses. A concise overview of the relevant research contains information about all the major elements of the studies. The background research and an interpretative summary address new issues to be taken into account in dignity conserving care.
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Affiliation(s)
- Charlotte Delmar
- Department of Nursing Science, School of Public Health and Institute of Clinical Medicine, Aarhus University, Høgh Guldbergsgade 6 A, 8000, Aarhus C, Denmark,
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Jørgensen LB, Lomborg K, Dahl R, Pedersen PU. Coping with breathlessness among people with COPD: distinct physiological and behavioural indicators. J Res Nurs 2013. [DOI: 10.1177/1744987113504410] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Identifying indicators on predominant types of coping with breathlessness may facilitate the possibility for qualified individualised advice on how to live with breathing difficulties. This paper reports the statistical findings on several parameters constituting possible coping-type-specific indicators with the ability to discriminate between four previously identified types of coping with breathlessness. Data were collected from 12 patients with moderate to very severe chronic obstructive pulmonary disease (COPD) in relation to body care during hospital stay and at home. Data consisted of: (a) Bedside forced expiratory volume in 1 s of predicted; (b) scores on the Modified Borg Scale; (c) respiratory rate; (d) peripheral oxygen saturation and (e) use of breaks from activity and break time duration. We found that the following parameters were able to discriminate between the four coping types: COPD severity, intensity of breathlessness, respiratory rate, level of oxygen saturation and the patients’ use of breaks. These findings should be further tested.
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Affiliation(s)
- Lene Bastrup Jørgensen
- Head of Interdisciplinary Research Unit, Head of Nursing Research, Centre for Planned Surgery, Regional Hospital Central Jutland, Denmark
| | - Kirsten Lomborg
- Professor, Faculty of Health, Aarhus University, Denmark, and Bergen University College, Norway
| | - Ronald Dahl
- Professor, Institute for Clinical Medicine, Aarhus University, Denmark
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Lykkegaard K, Delmar C. A threat to the understanding of oneself: intensive care patients' experiences of dependency. Int J Qual Stud Health Well-being 2013; 8:20934. [PMID: 23809023 PMCID: PMC3697396 DOI: 10.3402/qhw.v8i0.20934] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/15/2013] [Indexed: 11/29/2022] Open
Abstract
This study examines the meaning of dependency on care as experienced by intensive care patients. Literature on the subject is sparse, but research from nonintensive settings shows that dependency is often experienced negatively. The study is based on in-depth qualitative semistructured interviews with three former patients characterized as narratives. The analysis is inspired by a phenomenological hermeneutical method. The study has found that dependency is experienced as difficult and that the experience seems to be attached to the relationship to oneself. Patients feel powerless and experience shame, their understanding of self is threatened, and they fight for independence in the course after intensive care. The findings might be influenced by the study being conducted in a Western country setting, where independence is valued. They can be used as means of reflection on nursing practice and matters such as communication and patient participation.
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Simon ST, Bausewein C, Schildmann E, Higginson IJ, Magnussen H, Scheve C, Ramsenthaler C. Episodic breathlessness in patients with advanced disease: a systematic review. J Pain Symptom Manage 2013; 45:561-78. [PMID: 22921180 DOI: 10.1016/j.jpainsymman.2012.02.022] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Revised: 02/20/2012] [Accepted: 02/20/2012] [Indexed: 01/04/2023]
Abstract
CONTEXT Although episodic breathlessness (EB) is reported to be highly prevalent in advanced disease, our understanding about it is limited. OBJECTIVES The aim of this study was to systematically review and synthesize the evidence on EB regarding definition, characteristics, and patients' experiences. METHODS Systematic review using searches in six databases, hand search, and personal contacts with authors in the field. Search terms included the combination of "episodic" and "breathlessness" (and synonyms) with five different diseases. Selection criteria included patients with advanced disease and information about EB based on original research. All retrieved studies were reviewed by two independent investigators. RESULTS Twenty-seven studies (of 7584) were included in this review. Only eight studies explored EB as a primary outcome. EB is poorly defined. It is characterized by high prevalence (81%-85%), high frequency (daily), short duration (often less than 10 minutes), and severe peak intensity. EB either develops without any known trigger or is triggered by physical exertion, emotions, or environmental influences. CONCLUSION EB is a common symptom in patients with advanced disease, but information about characteristics and experiences is limited. As there is no common terminology, an agreed definition is needed to foster research to develop effective treatments for EB.
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Jensen AL, Vedelø TW, Lomborg K. A patient-centred approach to assisted personal body care for patients hospitalised with chronic obstructive pulmonary disease. J Clin Nurs 2013; 22:1005-15. [PMID: 23331341 DOI: 10.1111/jocn.12050] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2012] [Indexed: 12/01/2022]
Abstract
AIMS AND OBJECTIVES To explore the patients' experiences of receiving patient-centred personal body care and to document changes compared to the patients' experiences in previous hospital stays. BACKGROUND Patients with severe chronic obstructive pulmonary disease suffer from breathlessness. Personal body care is therefore often a major challenge, and during exacerbation these patients may need comprehensive assistance. The quality of assisted personal body care depends largely on the patients' and the nurses' symptom recognition, disease management and ability to achieve therapeutic clarity in the nurse-patient interaction. We developed, implemented and evaluated a patient-centred approach to assisted personal body care in which these characteristics were sought. DESIGN The study is a qualitative outcome analysis with an interpretive description methodology. METHODS Nine female and two male hospitalised patients with severe chronic obstructive pulmonary disease were selected for patient-centred care. Specially trained nurses and nursing assistants performed the patient-centred personal body care. Data material was obtained through participant observation of body care sessions with the patients, followed by individual in-depth interviews. The transcribed interviews were analysed and an interpretive description of the patients' experiences was established. RESULTS All patients experienced the patient-centred care to be different from what they had previously experienced. The most fundamental change was the experience of being an active part of a shared project. This experience encompassed three dimensions: clear signs of acknowledgement, attentive time and security. CONCLUSION Patient-centred assistance enables patients to take an active part in their personal body care activity. The intervention may be a method for nursing staff to secure patients-centred care. RELEVANCE TO CLINICAL PRACTICE Effective communication, tools for the assessment of breathlessness, clear and straight forward organisation of body care sessions, awareness of pauses and personal acknowledgment are important for the patients' ability to take part in personal body care activities.
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Affiliation(s)
- Annesofie L Jensen
- Department of Public Health, Section for Nursing Science, Faculty of Health Science, Aarhus University, Aarhus, Denmark.
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Jørgensen LB, Dahl R, Pedersen PU, Lomborg K. Four types of coping with COPD-induced breathlessness in daily living: a grounded theory study. J Res Nurs 2012. [DOI: 10.1177/1744987112468443] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Coping with breathlessness is a complex and multidimensional challenge for people with chronic obstructive pulmonary disease (COPD) and involves interacting physiological, cognitive, affective, and psychosocial dimensions. The aim of this study was to explore how people with moderate to most severe COPD predominantly cope with breathlessness during daily living. We chose a multi-modal grounded theory design that holds the opportunity to combine qualitative and quantitative data to capture and explain the multidimensional coping behaviour among people with COPD. The participants’ main concern in coping with breathlessness appeared to be an endless striving to economise on resources in an effort to preserve their integrity. In this integrity-preserving process, four predominant coping types emerged and were labelled: ‘Overrater’, ‘Challenger’, ‘Underrater’, and ‘Leveller’. Each coping type comprised distinctive physiological, cognitive, affective and psychosocial features constituting coping-type-specific indicators. In theory, four predominant coping types with distinct physiological, cognitive, affective and psychosocial properties are observed among people with COPD. The four coping types seem to constitute a coping trajectory. This hypothesis should be further tested in a longitudinal study.
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Affiliation(s)
| | - Ronald Dahl
- Professor, Department of Pulmonary Diseases, Aarhus University Hospital, Denmark
| | | | - Kirsten Lomborg
- Associate Professor, Section for Nursing Science, Aarhus University, Denmark
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Eriksen KÅ, Sundfør B, Karlsson B, Råholm MB, Arman M. Recognition as a valued human being: Perspectives of mental health service users. Nurs Ethics 2012; 19:357-68. [DOI: 10.1177/0969733011423293] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The acknowledgement of basic human vulnerability in relationships between mental health service users and professionals working in community-based mental health services (in Norway) was a starting point. The purpose was to explore how users of these services describe and make sense of their meetings with other people. The research is collaborative, with researcher and person with experienced-based knowledge cooperating through the research process. Data is derived from 19 interviews with 11 people who depend on mental health services for assistance at least three times a week. Data is analysed according to the Interpretative Phenomenological Analysis (IPA). Results confirm that reciprocity is fundamental for relationships, and that recognizing the individual entails personal involvement. The participants describe a struggle, and recognizing this struggle may help the professional to achieve a deeper understanding of the individual.
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Jørgensen LB, Dahl R, Pedersen PU, Lomborg K. Evaluation of a multi-modal grounded theory approach to explore patients’ daily coping with breathlessness due to chronic obstructive pulmonary disease. J Res Nurs 2012. [DOI: 10.1177/1744987111427418] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Conventional methods have not yet succeeded in capturing the complexity of how people with chronic obstructive pulmonary disease (COPD) cope with breathlessness during daily living. We used a multi-modal grounded theory (GT) approach to investigate coping. In this paper, we describe and evaluate the multi-modal GT approach, which encompasses videos of daily life activity, interviews, medical history, demographics, self-rated sensation of breathlessness, and physiological measurements. A formative evaluation was conducted according to the criteria that the data collection should strengthen the participants’ ability to remember and narrate how they cope with breathlessness; capture the multidimensional aspects involved in coping with breathlessness; encompass tools for collecting both qualitative and quantitative data, providing the opportunity to generate, synchronize, and combine data; and be ethically justifiable. The approach should also be consistent with the GT methodology of generating a theory. Striving to develop and perfect the multi-modal GT approach was time-consuming. Apart from this practical challenge, the multimodal GT approach met all evaluation criteria. This approach has the potential to generate new knowledge and may become an important methodological contribution towards understanding the multidimensionality of coping with breathlessness.
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Affiliation(s)
| | - Ronald Dahl
- Professor, Department of Pulmonary Diseases, Aarhus University Hospital, Denmark
| | - Preben Ulrich Pedersen
- Associate Professor, School of Public Health, Department of Nursing Science, Aarhus University, Denmark
| | - Kirsten Lomborg
- Associate Professor, School of Public Health, Department of Nursing Science, Aarhus University, Denmark
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Delmar C, Alenius-Karlsson N, Mikkelsen AH. The implications of autonomy: Viewed in the light of efforts to uphold patients dignity and integrity. Int J Qual Stud Health Well-being 2011; 6:QHW-6-6045. [PMID: 21695070 PMCID: PMC3118775 DOI: 10.3402/qhw.v6i2.6045] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/19/2011] [Indexed: 11/14/2022] Open
Abstract
This article focuses on Danish patients’ experience of autonomy and its interplay with dignity and integrity in their meeting with health professionals. The aim is to chart the meanings and implications of autonomy for persons whose illness places them in a vulnerable life situation. The interplay between autonomy and personal dignity in the meeting with health care staff are central concepts in the framework. Data collection and findings are based on eight qualitative semi-structured interviews with patients. Patients with acute, chronic, and life threatening diseases were represented including surgical as well as medical patients. The values associated with autonomy are in many ways vitalising, but may become so dominant, autonomy seeking, and pervasive that the patient's dignity is affected. Three types of patient behaviour were identified. (1) The proactive patient: Patients feel that they assume responsibility for their own situation, but it may be a responsibility that they find hard to bear. (2) The rejected patient: proactive patients take responsibility on many occasions but very active patients are at risk of being rejected with consequences for their dignity. (3) The knowledgeable patient: when patients are health care professionals, the patient's right of self-determination was managed in a variety of ways, sometimes the patient's right of autonomy was treated in a dignified way but the opposite was also evident. In one way, patients are active and willing to take responsibility for themselves, and at the same time they are “forced” to do so by health care staff. Patients would like health professionals to be more attentive and proactive.
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Affiliation(s)
- Charlotte Delmar
- Aalborg Hospital Science and Innovation Center, Aarhus University Hospital, Denmark
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Ek K, Sahlberg-Blom E, Andershed B, Ternestedt BM. Struggling to retain living space: patients' stories about living with advanced chronic obstructive pulmonary disease. J Adv Nurs 2011; 67:1480-90. [PMID: 21375574 DOI: 10.1111/j.1365-2648.2010.05604.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM This paper is a report of a study of the experience of living with advanced chronic obstructive pulmonary disease and long-term oxygen therapy when living alone. BACKGROUND Chronic obstructive pulmonary disease affects an increasing number of people. Breathlessness, fatigue and dejection are common symptoms during the last years of life. METHOD Repeated qualitative interviews with four participants were conducted over an 8-month period in 2008. The data comprised 17 interviews, 15 telephone conversations and various field notes. A phenomenological hermeneutical method was used to interpret the text. FINDINGS The analysis resulted in two main themes and five sub-themes. The first main theme, Being subordinated to the sick body, implies that the body, assistive devices and entrusting oneself to the hands of others can both extend and restrict the living space. The second main theme, Protecting significant values of identity, encompasses both the struggle to maintain self-image and the awareness of one's own death. CONCLUSION Living alone with advanced chronic obstructive pulmonary disease is a challenging and complex phenomenon. The everyday life was characterized by a struggle to keep autonomy during a time of increasing dependency and need for help. A person-centred nursing care, built upon peoples' own experiences, may be one way to promote identity and dignity in patients even when they are close to death.
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Affiliation(s)
- Kristina Ek
- School of Health and Medical Sciences, Örebro University, Sweden.
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26
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Lindahl B. Patients’ suggestions about how to make life at home easier when dependent on ventilator treatment - a secondary analysis. Scand J Caring Sci 2010; 24:684-92. [DOI: 10.1111/j.1471-6712.2009.00763.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sereika SM, Tate JA, DiVirgilio-Thomas D, Hoffman LA, Swigart VA, Broyles L, Roesch T, Happ MB. The association between bathing and weaning trial duration. Heart Lung 2010; 40:41-8. [PMID: 20561879 PMCID: PMC2997168 DOI: 10.1016/j.hrtlng.2010.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2007] [Revised: 02/11/2010] [Accepted: 03/09/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To describe patterns of bath care for patients who are weaning from prolonged mechanical ventilation (PMV) and to explore the association between bathing and weaning trial duration. METHODS Descriptive correlational study. Clinical records from 439 weaning trial days for 30 patients who required PMV were abstracted for bathing occurrences during weaning trials, within 1 hour before a trial, and nocturnally. RESULTS Most baths occurred during weaning trials (30.8%) or at night (35.3%), and less frequently (16%) within 1 hour before a trial. No significant effects were found on trial duration for nocturnal bathing or bathing within 1 hour before a trial. By using random coefficient modeling, weaning duration was shown to be longer when bathing occurred during a weaning trial (P < .05), even when controlling for age, severity of illness, and days on bedrest. CONCLUSION Bathing occurred during approximately one third of PMV weaning trials. Baths during PMV weaning trials were associated with longer weaning trial duration.
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Affiliation(s)
- Susan M Sereika
- University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania 15261, USA
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Wash and wean: bathing patients undergoing weaning trials during prolonged mechanical ventilation. Heart Lung 2010; 39:S47-56. [PMID: 20561877 PMCID: PMC2994970 DOI: 10.1016/j.hrtlng.2010.03.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2007] [Revised: 02/11/2010] [Accepted: 03/09/2010] [Indexed: 11/20/2022]
Abstract
BACKGROUND Bathing is a fundamental nursing care activity performed for or with the self-assistance of critically ill patients. Few studies address caregiver or patient-family perspectives about bathing activity during weaning from prolonged mechanical ventilation (PMV). OBJECTIVE To describe practices and beliefs about bathing patients during weaning from PMV. METHODS Secondary analysis of qualitative data (observational field notes, interviews, and clinical record review) from a larger ethnographic study involving 30 patients weaning from PMV and the clinicians who cared for them using basic qualitative description. RESULTS Bathing, hygiene, and personal care were highly valued and equated with "good" nursing care by families and nurses. Nurses and respiratory therapists reported "working around" bath time and promoted conducting weaning trials before or after bathing. Patients were nevertheless bathed during weaning trials despite clinicians' expressed concerns for energy conservation. Clinicians recognized individual patient response to bathing during PMV weaning trials. CONCLUSION Bathing is a central care activity for patients on PMV and a component of daily work processes in the intensive care unit. Bathing requires assessment of patient condition and activity tolerance and nurse-respiratory therapist negotiation and accommodation with respect to the initiation or continuation of PMV weaning trials during bathing. Further study is needed to validate the impact (or lack of impact) of various timing strategies for bathing patients who are on PMV.
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Gullick J, Stainton MC. Living with chronic obstructive pulmonary disease: developing conscious body management in a shrinking life-world. J Adv Nurs 2009; 64:605-14. [PMID: 19120575 DOI: 10.1111/j.1365-2648.2008.04823.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM This paper is a report of a study to explore the changes experienced by the person living in a body with chronic obstructive pulmonary disease. BACKGROUND Chronic obstructive pulmonary disease is the world's fourth leading cause of death, and the World Health Organisation predicts further increases in prevalence and mortality. Despite a growing body of associated knowledge, there remains much to learn about patient and family-driven goals for medical and surgical treatment to guide nursing practice, to support self-management strategies, and to provide a context for therapeutic outcomes. METHODS Merleau-Ponty's philosophy of the body provided a framework for this Heideggerian phenomenological inquiry with 15 people with emphysema and 14 of their family members. The participants were drawn from three Australian teaching hospitals. Hermeneutic analysis was used to interpret 58 in-depth interviews conducted between 2003 and 2005. FINDINGS People with severe emphysema experience a shrinking life-world shaped by breathlessness. This diminishes the predictability and automatic nature of their bodies and their perceived effectiveness as a person. They develop a number of strategies of conscious body management to facilitate breathing, mobility and task completion. CONCLUSION Understanding of the person's changed body and the resulting expertise that those living with chronic illness bring into care and assessing and facilitating this expertise are central to planning sensitive and appropriate care and evaluating outcomes for medical or surgical therapies that are perceived as meaningful to the person.
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Affiliation(s)
- Janice Gullick
- Department of Cardiology, Concord Repatriation General Hospital, University of Sydney, Australia.
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Lomborg K, Kirkevold M. Achieving therapeutic clarity in assisted personal body care: professional challenges in interactions with severely ill COPD patients. J Clin Nurs 2008; 17:2155-63. [PMID: 18710375 DOI: 10.1111/j.1365-2702.2006.01710.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIM AND OBJECTIVES This paper aims to present a theoretical account of professional nursing challenges involved in providing care to patients suffering from chronic obstructive pulmonary disease. The study objectives are patients' and nurses' expectations, goals and approaches to assisted personal body care. BACKGROUND The provision of help with body care may have therapeutic qualities but there is only limited knowledge about the particularities and variations in specific groups of patients and the nurse-patient interactions required to facilitate patient functioning and well-being. For patients with severe chronic obstructive pulmonary disease, breathlessness represents a particular challenge in the performance of body care sessions. DESIGN We investigated nurse-patient interactions during assisted personal body care, using grounded theory with a symbolic interaction perspective and a constant comparative method. METHODS Twelve cases of nurse-patient interactions were analysed. Data were based on participant observation, individual interviews with patients and nurses and a standardized questionnaire on patients' breathlessness. FINDINGS Nurses and patients seemed to put effort into the interaction and wanted to find an appropriate way of conducting the body care session according to the patients' specific needs. Achieving therapeutic clarity in nurse-patient interactions appeared to be an important concern, mainly depending on interactions characterized by: (i) reaching a common understanding of the patient's current conditions and stage of illness trajectory, (ii) negotiating a common scope and structuring body care sessions and (iii) clarifying roles. CONCLUSION It cannot be taken for granted that therapeutic qualities are achieved when nurses provide assistance with body care. If body care should have healing strength, the actual body care activities and the achievement of therapeutic clarity in nurses' interaction with patients' appear to be crucial. RELEVANCE TO CLINICAL PRACTICE The paper proposes that patients' integrity and comfort in the body care session should be given first priority and raises attention to details that nurses should take into account when assisting severely ill patients.
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Affiliation(s)
- Kirsten Lomborg
- Department of Nursing Science, Institute of Public Health, Aarhus University, Aarhus, Denmark.
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Abstract
The purpose of this study was to describe people's experiences of being dependent on others for care in their final stage of life, as well as what they felt made their experience of being dependent easier or more difficult. The phenomenological-hermeneutical method was chosen, where data collection consisted of open-ended interviews with nine people undergoing palliative care at a hospice unit or at home. The meaning of being care dependent is described via the following themes: changed relationship with oneself and with others, striving to adapt oneself to the situation, obstacles, and opportunities along the way while dependent. The result is described as an effort, a journey from independence to moments where it was possible to rest and recuperate while struggling with care dependency. Nursing staff require knowledge and understanding of experiences with care dependency to make life easier for people during increasing dependency in the final stage of life.
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Affiliation(s)
| | - Birgitta Andershed
- Örebro University School of Health and Medical Sciences,
Örebro, Department of Palliative Care Research, Ersta Sköndal
University College, Stockholm, Sweden
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Widäng I, Fridlund B, Mårtensson J. Women patients’ conceptions of integrity within health care: a phenomenographic study. J Adv Nurs 2008; 61:540-8. [DOI: 10.1111/j.1365-2648.2007.04552.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Williams V, Bruton A, Ellis-Hill C, McPherson K. What really matters to patients living with chronic obstructive pulmonary disease? An exploratory study. Chron Respir Dis 2007; 4:77-85. [PMID: 17621574 DOI: 10.1177/1479972307078482] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
There is limited published research into what really matters to people living with chronic obstructive pulmonary disease (COPD). Most previous research in this area focuses on the impact of the symptoms of COPD, rather than on the issues defined as important by patients themselves. This paper describes an exploratory study investigating what is most important to people living with COPD. A qualitative approach employing in-depth interviews with COPD patients was chosen. Thematic analysis was used to code and categorize data. Six patients with 'moderate' to 'very severe' COPD were recruited. They considered engagement in specific activities to be very important (walking, household maintenance and driving), even though these activities were mainly centred around the home environment, or within confined spaces, due to their physical limitations. This restriction led to feelings of social isolation that these patients tried to overcome through social participation (holidays, social interaction). People with COPD often experience physical restrictions, which can lead to reduced community mobility and social isolation. In this study, despite their physical limitations, these patients had a strong desire to participate and be engaged in various activities. The importance of enabling patients to 'participate' rather than just 'do' should be considered when planning and delivering patient-centred interventions across the whole spectrum of severity of COPD.
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Affiliation(s)
- V Williams
- University of Southampton, School of Health Professions and Rehabilitation Sciences, UK
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Andersson M, Hallberg IR, Edberg AK. Old people receiving municipal care, their experiences of what constitutes a good life in the last phase of life: a qualitative study. Int J Nurs Stud 2007; 45:818-28. [PMID: 17540379 DOI: 10.1016/j.ijnurstu.2007.04.003] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2006] [Revised: 04/01/2007] [Accepted: 04/05/2007] [Indexed: 11/22/2022]
Abstract
BACKGROUND Old people's life situation when receiving municipal help and care in their last period of life is sparsely investigated from their own perspective. OBJECTIVE The aim of this study was to investigate the experiences of aspects that bring about a good life in the last phase of life among people (75+ years) receiving municipal care. PARTICIPANTS Older people living in a municipality in Southern Sweden being 75 years or older, receiving help and/or care from the municipality, and having a life-threatening disease and/or receiving palliative care were asked to participate. In all 17 people, 10 women and 7 men, aged 78-100 years were included. METHODS Qualitative interviews, with the emphasis on their present life situation especially what brought about a good life, were performed. The interviews were analysed using qualitative content analysis. RESULTS The experience was interpreted to be Turning inwards to come to peace with the past, the present and approaching death while being trapped by health complaints. Six categories embraced the experience of aspects that constitute a good life in the last phase of life: Maintaining dignity, Enjoying small things, Feelings of "being at home", Being in the hands of others, trying to adjust, Still being important for other people and Completing life while facing death. CONCLUSION This study confirm theories suggesting that the last phase of life in old age meant focusing inwards, reflecting on the entire life as a way of completing it as well as enjoying small things and also viewing oneself in the perspective of contributing to the future. It also indicated that this phase of life meant being trapped by health complaints and functional limitations. The struggle to maintaining dignity as opposed to being in the hands of others implies that the concept of palliative care may be useful as a framework for providing nursing care to very old people, especially at the end of life.
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Affiliation(s)
- Magdalena Andersson
- Department of Health Sciences, Division of Gerontology and Caring Sciences, P.O. Box 157, SE-221 00 Lund, Sweden.
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Lomborg K, Kirkevold M. Curtailing: handling the complexity of body care in people hospitalized with severe COPD. Scand J Caring Sci 2005; 19:148-56. [PMID: 15877640 DOI: 10.1111/j.1471-6712.2005.00330.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Assisted personal body care (APBC) tends to be regarded as an unproblematic nursing activity with little professional challenge. For severely ill patient diagnosed with chronic obstructive pulmonary disease (COPD) daily bathing and washing is, however, a significant self-preserving activity that requires substantial efforts on the part of both patients and nurses. The aim of this study was to report on the complex pattern of APBC in hospitalized patients with severe COPD and highlight significant characteristics that should be considered in clinical practice in order to support patients' comfort and well-being. The study used a grounded theory design with a generative and constant comparative approach. The sample consisted of 12 cases of nurse-patient interaction, based on data from participant observation of sessions of APBC, measures of patient's perceived degree of breathlessness and individual interviews with patients and nurses after the sessions. Findings show that APBC in hospitalized patients with severe COPD is a complex integrated pattern of body care activities that can proceed with a greater or lesser degree of success. The main problem is how to keep the patient's breathing under control while optimizing comfort and well-being. Curtailing addresses this problem. Curtailing is a subtle, purposeful balancing of protection from breathlessness and promotion of patients' present and future functional capacity in order to preserve their integrity. The idea that body care is a simple task belonging to patients' private daily lives may obscure the importance of determining a mutual nurse-patient agenda and the professional nurse responsibility may consequently be nebulous. Finding in this study will contribute to the development of a comprehensive and detailed understanding of the APBC and suggest the need for further investigation of the interaction perspective.
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Affiliation(s)
- Kirsten Lomborg
- Department of Nursing Science, Faculty of Health Sciences, Institute of Public Health, University of Aarhus, Aarhus, Denmark.
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