Humanistic Nursing Theory: application to hospice and palliative care

Turkish psychometric characteristics of the humanistic practice ability of nursing scale: differences by education, working year, and professional satisfaction

BACKGROUND

Humanistic nursing practices scientifically improve the knowledge structure of nursing, enrich its theoretical system and support its development. Therefore, it is crucial to evaluate the humanistic practice abilities of nurses.

OBJECTIVE

This study aimed to test the psycholinguistic features, language and construct validity of the Humanistic Practice Ability of Nursing Scale and to examine it according to nurses' demographic characteristics.

DESIGN AND METHODS

This study was a methodological type of analytical research conducted with 397 clinical nurses working in a hospital. A questionnaire including demographic information and evaluating empathy and compassion adequacy was used. Data were analyzed using explanatory and confirmatory factor analysis, Cronbach's alpha, item-total score correlation, split-half analysis, t-test, analysis of variance and correlation analysis.

RESULTS

The scale consists of 29 items and four factors, explaining 61.15% of the total variance. Factor loads were > 0.30. confirmatory factor analysis results were χ2/df: 2.58, GFI: 0.86, TLI: 0.91, IFI: 0.92, CFI: 0.92, RMSEA: 0.06, and SRMR: 0.03. The Cronbach alpha value for the full scale is 0.95. A significant relationship was found between the scale and empathy and compassion proficiency. It was observed that the scale scores differed according to the nurses' education level, working years and job satisfaction (p < 0.05).

CONCLUSION

This study shows that the Turkish version of the HPAN scale is valid and reliable for 29 items and four factors. The humanistic practice ability of nurses differ according to postgraduate education, years of working in the profession and professional satisfaction.

Embracing Paradigmatic Diversity in Nursing: The Stadium Model in Nursing

Arguably, the quest for a central, unifying paradigm in nursing has distracted from moving disciplinary knowledge forward in an accessible, meaningful manner. In this discursive philosophical article, we uphold that multiparadigmatic research teams and diverse approaches inform effective nursing praxis. We provide an overview of our worldviews (dialectical pluralism, critical realism, humanism, and pragmatism) and their philosophical assumptions and describe how they are commensurate with nursing. We present the Stadium Model in Nursing as a metaphor to illustrate how various worldviews function like different sections of a stadium to offer diverse, yet important vantages of our nursing phenomena of interest.

Framework of humanistic care for patients in the ICU: A preliminary study

BACKGROUND

Humanistic care involves caring, concern, paying attention to people's individuality, meeting their needs and respecting their rights, which is the core concept and central task of nursing. Effective care can enhance patients' ability to deal with stress and promote patient recovery. Implementing humanistic care in the intensive care unit (ICU) is particularly important for health care providers.

AIM

This study aims to develop a framework of the humanistic care in the ICU.

STUDY DESIGN

The qualitative research followed Strauss' procedural grounded theory approach. Purposive sampling and theoretical sampling were used to select 12 nurses in the Department of Critical Medicine, 16 patients, and eight family members for semi-structured interviews from October 2020 to April 2021. Results were summarized and analysed through three-level coding based on grounded principles.

RESULTS

Sixteen subcategories and six main categories were extracted after three-level coding, and the final ICU humanistic care framework was formed with home, activity, visit, environment, nursing and safety ("HAVENS") as the core.

CONCLUSIONS

This study provides an explanatory theory of humanistic care in the ICU that can guide nurses' practice in ICU clinical work.

RELEVANCE TO CLINICAL PRACTICE

This theory provides guidance for nurses to implement humanistic care in critical care practice to improve the ICU stay experience of critically ill patients.

Effect of Training on the Ability of Nurses to Provide Humanistic Care: Systematic Review and Meta-analysis

BACKGROUND

This article describes a systematic review evaluating the effectiveness of training on the humanistic care abilities of nurses.

METHOD

The literature search was conducted in electronic databases to identify studies that evaluated the effect of training on the humanistic care abilities of nurses. Study selection was based on precise eligibility criteria. After the systematic review, a meta-analysis of standardized mean differences (SMDs) between posttraining and pretraining humanistic care scale scores was performed to evaluate the effect of training.

RESULTS

A total of 11 studies were included (624 nurse participants; 97% women; weighted average age = 38.4 years; 95% confidence interval (CI) [31.5, 45.4]). Training schedules varied and ranged from a full-day workshop to brief weekly sessions for up to 2 months. The training framework involved compassion and empathy communication in most of the included studies. Training improved the humanistic care scale scores of the participants (SMD = 1.171; 95% CI [0.626, 1.716]; p < .0001), whereas no significant change was seen in the scores of control subjects (SMD = 0.588; 95% CI [-0.536, 1.713]; p = .305). The effect of training was observable for up to 1 year, although few studies carried out follow-up evaluations.

CONCLUSION

Training has the potential to improve the humanistic care abilities of nurses. [J Contin Educ Nurs. 2023;54(9):430-436.].

Narrative medicine as a teaching strategy for nursing students to developing professionalism, empathy and humanistic caring ability: a randomized controlled trial

BACKGROUND

Narrative medicine has become a solution to cultivate medical students' ability of empathy and humanistic care. However, the role of narrative medicine is lacking in the study of professionalism. The aim of this study was to analyze the effects of narrative medical theory learning and narrative writing on professionalism, empathy and humanistic care ability of nursing students.

METHODS

This cluster randomized controlled trial was conducted between June 2021 and June 2022 in two universities in Jiangsu, China. The participants of this study were 85 nursing students who were randomly divided into the intervention group (n = 43) or the control group (n = 42). Participants in the intervention group were trained in narrative medical theory learning and narrative writing based on a Web-based platform, while those in the control group were not. Self-report questionnaires of professionalism, empathy and humanistic care ability were used before and after intervention.

RESULTS

The results showed that the professionalism score of the intervention group was (68.7 ± 6.8 vs. 64.5 ± 7.5; P = 0.005), empathy (99.4 ± 15.7 vs. 92.2 ± 14.6; P = 0.014) and humanistic care ability (127.6 ± 20.0 vs. 113.3 ± 18.8; P = 0.004) were better than the control group.

CONCLUSION

The results of this quantitative study suggest that narrative medical theory education and narrative writing based on the network platform can promote the development of professionalism, empathy and humanistic care ability of nursing undergraduates.

Perceived stress and humanistic care ability among Chinese healthcare workers: The chain mediating role of social support and life satisfaction

Previous studies have indicated high perceived stress and its relationship with life satisfaction among healthcare workers. However, most of the existing studies have focused on the investigation and evaluation of the humanistic care abilities among nurses, but few studies revealed the levels of humanistic care ability among other healthcare workers including doctors and technicians. The study aimed to investigate the perceived stress and humanistic care abilities among Chinese healthcare workers. In addition, we further examined the mediating and moderating effects of social support and life satisfaction. A convenience sample of 955 health professionals from 29 hospitals in China was recruited to fill out the questionnaires about perceived stress, humanistic care ability, social support, and life satisfaction. The correlation and multivariate logistic regression analysis were carried out by SPSS 24.0. The Hayes SPSS macro program process (version 2.16.3) was used to analyze the significance of mediating and moderating model. The findings indicated that humanistic care ability was negatively associated with perceived stress and positively correlated with social support and life satisfaction. The effect of the path “perceived stress → social support → humanistic care ability” was −0.017, and the path “perceived stress → life satisfaction → social support → humanistic care ability” was −0.129. The current study contributed to a better understanding of humanistic care abilities and influential factors in Chinese healthcare workers. Thus, it may suggest studies on interventions to interventions to alleviate or eliminate the negative impact of perceived stress and improve humanistic care abilities.

Validity and reliability of the Korean version of the Humanism Scale Short Form: A cross-sectional study

AIM

To examine the reliability and validity of a Korean version of the Humanism Scale Short Form.

DESIGN

A cross-sectional descriptive design.

METHODS

This study involved 191 nurses in Korea. Data were collected from 1 May to 30 June 2019. Bilingual nursing professionals translated the scale into Korean, and reverse translation was performed. Validity and reliability were assessed, and the correlation coefficients of the developed scale were compared with those of the Korean version of the Empathy Quotient Scale and Compassion Competence Scale to evaluate concurrent validity.

RESULTS

Exploratory factor analysis with 15 items showed that two factors (human equality and respect for human beings) explained 50.86% of the variance. Cronbach's alpha for the overall scale was 0.88. Thus, the scale has acceptable reliability and validity. Humanism measures can predict a nurse's approach to holistic care and provide fundamental data for developing programs to improve integrated caring capacities.

A window into pain: American Indian cancer survivors' drawings

In order to explore the cultural constructs of pain, a series of focus groups were held among adult American Indian (AI) cancer survivors and their caregivers in the Southwest USA. Thirteen focus groups held at four sites (reservation, urban setting, hospital and clinic) elicited information on the barriers to cancer pain management. In response to facilitator questions about cancer pain and existing measurement scales, participants drew pictures to better explain their pain type (i.e., "pounding"), intensity (i.e., "spider web-like"), and other more abstract aspects of their pain episodes. Noting this novel outlet, subsequent groups were prompted for illustrations of pain. A total of 17 drawings were collected from focus group participants. We discuss seven of the drawings that best opened a window into the lived experience of pain, reflected through the eyes of cancer survivors. This study provides evidence that self-expression through color, imagery and written personal accounts provides more accurate depictions of pain for Southwest AI cancer survivors than pain scales alone. It is hypothesized that cultural modes of communication (i.e., storytelling) and intergenerational influences of artwork led to the depiction of pain in drawings. Suggestions for further exploration of the use of the pain drawings for pain assessment in healthcare settings are included.

An Evolutionary Concept Analysis of Palliative Care in Oncology Care

This evolutionary concept analysis reports on the concept of palliative care in oncology. Despite its relevance to oncology, the concept of palliative care remains misunderstood, resulting in erroneous interpretations by nurses and health care providers alike. Consequently, integration of palliative care remains heterogeneous and highly contextual. Findings highlight the complexity and ambiguity of the concept of palliative care in the context of oncology care. The nuances and complexity of when to integrate palliative care for patients living with cancer, as well as its evolution from its origins in the hospice movement, have led to its ambiguity in clinical practice.

The Impact of Cultural Diversity on End-of-Life Care

Despite the universality of death for humanity, end-of-life care needs and expectations are highly unique and influenced by the individual’s cultural conditioning, values, and beliefs. In the pursuit of quality end-of-life care provision within the increasingly complex and diverse contemporary medical context, it is vital for cultural idiosyncrasies to be taken into consideration in order to attend to the individual patient’s needs and end-of-life goals. Palliative chaplains, as the spiritual care specialists within the multidisciplinary healthcare team, play a crucial role in the support and facilitation of the holistic vision of end-of-life care delivery. However, the capacity of the chaplains to become culturally competent practitioners are often insufficiently addressed in their professional educational pathways, creating additional challenges for them in their practice. Using Hong Kong as a case study, this article examines the impact of cultural diversity on the effectiveness of the chaplains’ delivery of end-of-life spiritual care. Specifically, special attention will be focused on two identified challenges resulting from the lack of integration of local cultural understandings within the religion-cultural practice framework of chaplaincy formation: the cultural taboo of death, and the cultural idiosyncrasies in end-of-life communication. This article hopes to raise awareness of cultural incongruencies within the current chaplaincy professional formation and development, and to initiate further attention and efforts to support chaplains in becoming culturally competent practitioners in the pluralistic healthcare landscape.

The Effect of Narrative Nursing Intervention on Shame in Elderly Patients with Bladder Cancer after Ileal Bladder Replacement: A Cohort Study

Background

The standard treatment for bladder cancer (BC) is transurethral resection (TURBt), intravesical chemotherapy, and regular follow-up cystoscopy after surgery. However, some patients experience relapse or progression. Narrative care refers to a nursing model in which nurses put themselves into the patient's position through communication and listening, thereby alleviating the patient's negative emotions. This study analyzed narrative nursing interventions in elderly patients with BC after vesicoileal replacement.

Objective

To explore the positive stimulating effect of narrative nursing intervention on the sense of shame in elderly patients with bladder cancer (BC) after ileal bladder replacement.

Methods

A total of 60 elderly patients with BC who went through ileal replacement of the bladder from February 2019 to April 2021 in our hospital were enrolled. The patients were divided into the control group and the study group by the arbitrary number table method. The former group received routine care, and the latter group received a narrative nursing intervention model. The nursing satisfaction, stigma score, self-care ability score, SAS score, SDS score, and quality of life score were compared.

Results

First, we compared the nursing satisfaction. In the research group, 23 cases were very satisfied, 6 cases were satisfied, and 1 case was normal, and the satisfaction rate was 100.00%. In the control group, 13 cases were very satisfied, 8 cases were satisfied, 4 cases were general, and 5 cases were dissatisfied, with a satisfaction rate of 83.33%. The nursing satisfaction of the research group was significantly higher compared to that of the control group (P < 0.05). Secondly, we compared the stigma scores. The stigma scores of the study group at the time of discharge, 1 month, 3 months, and 6 months after discharge were lower compared to those of the control group (P < 0.05). In terms of the scores of self-care ability, the total scores of self-concept, self-care responsibility, self-care knowledge, self-care skills, and self-care ability of the research group were higher compared to those of the control group (P < 0.05). With regard to SAS scores, before nursing, there was no significant difference exhibited (P > 0.05). After nursing, the patient's SAS score decreased. Compared with the two groups, the SAS scores of the study group at discharge, 1 month, 3 months, and 6 months after discharge were all lower (P < 0.05). In terms of SDS score, there was no significant difference before nursing (P > 0.05). After nursing, the SDS scores of patients decreased. Compared between the two groups, the SDS scores of the study group at the time of discharge, 1 month, 3 months, and 6 months after discharge were lower (P < 0.05). Finally, we compared the life quality scores. Before nursing, there was no significant difference exhibited (P > 0.05). After nursing, the scores of life quality of patients improved. Compared with the two groups, the physical function, psychological function, social function, and healthy self-cognition scores of the research group were all lower compared to those of the control group (P < 0.05).

Conclusion

Narrative nursing can reduce anxiety and depression in elderly patients with BC after ileal replacement of the bladder, enhance the quality of life, reduce the patient's stigma, and play a positive motivating role. This nursing model is worthy of promotion in clinic.

Design of a Palliative Care Program for Nursing Students in the Neonatal Intensive Care Unit: A Mixed-Method Study

This study introduces an innovative design for a palliative care program by nursing students in an internship in a neonatal intensive care unit. An embedded mixed-method approach simultaneously collected quantitative and qualitative data. Themes identified were supporting and encouraging palliative care, changing the nursing culture, and promoting quality of care. Teaching palliative care during this internship rotation helped promote quality care by the students, with positive results for infants and their families, and empowerment of the students through increased knowledge and awareness of human needs for high-quality nursing care.

Determinants of Location of Death: A Secondary Analysis Utilizing Multinomial Logistic Regression

STATEMENT OF PROBLEM

A discrepancy exists between where people would like to die and what actually occurs. More research about the factors influencing the location of death is required. Sources of Data and Research Design: Multinomial logistic regression was used to examine a sample taken from the fourth round of data collection performed by the National Health and Aging Trends Study conducted in 2014. Conclusions Reached: Census location, age, dementia, and use of hospice were found to have a statistically significant (P < .05) influence on the location of death (P = .000). The results suggest that the use of hospice increased the odds of dying at home (OR = 17.467, CI = 7.43-41.063) and in a nursing home (OR = 34.334, CI = 12.444-94.727) as compared to dying in the hospital. Further research is required on the topic of geographic location and place of death.

Concept Analysis of Interpersonal Skills in Nursing

Objective: To determine a broad definition of the term interpersonal skills in nursing. Materials and methods: This theoretical study follows Walker and Avant’s method of concept analysis to examine the defining attributes of the concept. A literature search on interpersonal aspects of nursing was conducted in databases, e-books, and institutional repositories to recognize the uses, attributes, antecedents, consequences, and empirical referents of the concept. Experts on professional and relationship skills were consulted between 2009 and 2019. Results: This information was analyzed, concluding that interpersonal skills in nursing are defined as the abilities of professional nurses to express their knowledge, abilities, attitudes, and values in relationships with colleages, patients, and their relatives and achieve a humane and person- centered practice. Conclusion: The concept of interpersonal skills in nursing is limited, given a lack of clarity in practice and research on the indistinct use of terms related to interpersonal skills and interpersonal knowledge. This analysis advances nursing theory towards practice and research.

Robots and the Possibility of Humanistic Care

Care robots are likely to perform increasingly sophisticated caring activities that some will consider comforting and valuable. They will get increasingly humanlike and lifelike. This paper addresses the conceptual question: Even if robots can assist and ease people's suffering, can such machines provide humanistic care? Arguably, humanistic care is the most humanly distinctive and deepest form of care there is. As such, it may be thought to show most starkly the gulf between human and robot caregiving. The paper argues that humanistic caregiving is indeed a distinctive form of 'affective' care dependent on certain uniquely human characteristics or aspects of our humanity which can provide a profound kind of comfort to suffering people. It then argues that there is an important conceptual sense in which robots cannot provide humanistic care. Nonetheless, the paper subsequently suggests that we may recognize a useful sense in which robots, of a suitably anthropomorphic type, can provide humanistic care. Robots might 'express' to people with physical, social, or emotional needs the kind of humanistic care that only human beings can provide but that sufferers can nonetheless receive comfort from precisely because of what is expressed to them. Although this sense of humanistic robot care is derivative from uniquely human care, and although it is wide open to social and ethical criticism, it is nonetheless an idea worth clarifying for anyone interested in the possibilities and limits of robot care.

Design and Initial Validation of a Humanistic Care Evaluation Tool

Objective

This study aimed at developing and validating a humanistic care tool in Anhui province that could be used across Chinese public hospitals, and to reflect the humanistic care from patients’ perspective.

Participants

A cross-sectional survey was conducted in three public hospitals of Anhui Province, China by adopting simple random sampling, which included 312 outpatients and 323 inpatients.

Methods

The dimensions of the tool were set according to “Further Improve Medical Service Action Plan” in China and Patient-Doctor Relationship Questionnaire. Cronbach’s alpha values were calculated and used to evaluate the reliability of this tool. Construct validity was tested by the exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The associations between characteristics and humanistic care were analyzed by binary logistic regression.

Results

These initial findings showed that about two-thirds of the respondents experienced humanistic care. Both the reliability and construct validity of the humanistic care evaluation tool were suitable Social aspects (location and yearly income), treatment style and having a regular doctor were significantly associated with better humanistic care (all P<0.05).

Conclusion

The humanistic care tool can directly reflect the humanistic care from patients’ perspective, and can be popularized and applied across Chinese public hospitals. These findings have important implications to further improve medical service in Chinese public hospitals.

An Evaluation of Patient Satisfaction with Nursing Care: A Qualitative Study in an Indonesian Hospital

Background

Patients experience first-hand quality services from nurses who are directly responsible for their welbeing. However, patient dissatisfaction with nursing services remains a problem in most developing countries. Therefore, this study aims to explore patient satisfaction with nursing care services in an Indonesian hospital.

Method

A qualitative study with a descriptive phenomenology method was employed. Also, in-depth interviews were conducted with 15 informants, and thematic analysis was adopted to analyze the data.

Results

The results of this study are described in the following themes and sub-themes: (1) hospital existence in public eyes: a) service commitment b) accessibility; (2) patients' background: a) religious aspect, b) cultural influence on perceiving health and sickness.

Conclusion

Hospital management needs to enhance the quality of nursing services through sustainable education programs and continuous training. These are important to improve nurses' cognition and skills, and further to ensure patient satisfaction and hospital quality.

When breaking the rule becomes necessary: The impact of leader-member exchange quality on nurses pro-social rule-breaking

Aim

Despite the literature on nursing leadership, the research on the quality of exchange relationship between nursing leaders and nurses is in its initial stages. Also, the underlying mechanism that exists between leader–member exchange and employee outcomes warrants further inquiry. This study aimed to fill these gaps by investigating the role of leader–member exchange relationships and organizational identification in nurses' intentional violation of hospital regulations to promote their patients' welfare, also called pro‐social rule‐breaking. In contrast to a vast number of previous studies, we argue that pro‐social rule‐breaking can be positive for organizations. Therefore, nurses should be given margin and autonomy to break hospital rules when needed by establishing a high‐quality exchange relationship with the supervisor.

Design

A quantitative study was conducted on nurses working in hospitals in Pakistan by utilizing a non‐probability convenience sampling technique.

Method

Data from nurses and their colleagues (n = 224) were collected at three‐time points between June 2019 and August 2019 through questionnaires.

Results

The results proved that nurses' possessing a high‐quality exchange relationship with their supervisor feels a higher level of identification with their organization. In turn, they are more likely to engage in pro‐social rule‐breaking as a form of constructive deviance.

Emotional Bond: The Nature of Relationship in Palliative Care for Cancer Patients

Aim

Relationship between care providers and cancer patients is one of the main elements in providing healthcare to these patients. Understanding the characteristics and the nature of the relationship is a basis for further organization of palliative care and will enhance the performance of care providers. The purpose of this study was to investigate the nature of the relationship in palliative care for cancer patients.

Methods

In this qualitative study, 16 participants with rich experiences in the field of cancer patient's palliative care were selected by purposive sampling. A semi-structured face-to-face interview was conducted with each of the participants. After data collection, all interviews were transcribed and reviewed, and then primary codes, sub-categories, and categories were extracted.

Results

Data analysis emerged three categories; being alongside the patient, establishing and maintaining cordiality relationship, and mutual understanding with the patient. Moreover, an emotional bonding was the main theme that defined the nature of relationship between the care provider team and cancer patients in a palliative care approach.

Conclusion

Effective relationship based on emotional bonding is the foundation of palliative care in cancer patients. Considering the structures and palliative care settings in health systems, it is possible to provide training programs regarding the strategies related to establishing emotional bond for effective delivery of palliative care.

The current status and the influencing factors of humanistic care ability among a group of medical professionals in Western China

BACKGROUND

Previous research regarding the humanistic care ability of Chinese medical professionals was limited to small groups of nurses or students. More systemic analyses involving more general medical professionals are scarce and urgently needed.

OBJECTIVE

To survey the sense and ability of humanistic care on medical professionals in China and to identify the potential influencing factors.

METHODS

A novel scale of humanistic care indicators was developed. Based on the new scale, a questionnaire was designed, tested and used to survey a total of 928 medical professionals recruited from three hospitals in the Chinese Western city Chongqing. Chi-square test was used for single factor analyses. For multiple factor analyses, multivariate logistic regression was performed.

RESULTS

Our selected group of medical professionals scored nearly 4 or above on a 1-5 scale for all our query items related to the sense and ability of humanistic care. The main factors affecting humanistic care ability of medical professionals in Chongqing include gender, nature of department/division, modes of employment and participation in humanistic care ability training and so on.

CONCLUSIONS

In general, the participants in our study group had a humanistic care ability score lower than the aimed value, suggesting that the ability of humanistic care of these medical professional was not satisfactory. The study also shows that one effective way to enhance the humanistic care ability is to provide more targeted training.

Building Bridges, Paediatric Palliative Care in Belgium: A secondary data analysis of annual paediatric liaison team reports from 2010 to 2014

Background

Although continuity of care in paediatric palliative care (PPC) is considered to be an essential element of quality of care, it’s implementation is challenging. In Belgium, five paediatric liaison teams (PLTs) deliver palliative care. A Royal Decree issued in 2010 provides the legal framework that defines the PLTs’ missions, as ensuring continuity of curative and palliative care between the hospital and home for children diagnosed with life-limiting conditions. This national study describes how PLTs ensure continuity of care by describing their activities and the characteristics of the children they cared for from 2010 to 2014.

Methods

Thematic analysis of open-ended questions was performed and descriptive statistics of aggregated data issued from annual reports, collected by the Belgian Ministry of Public Health through the Cancer Plan was used. A review panel of PLT members discussed the results and contributed to their interpretation.

Results

Between 2010 and 2014, 3607 children and young adults (0–21 years) were cared for by the 5 Belgian PLTs (mean of 721/per year). Of these children, 50% were diagnosed with an oncological disease, 27% with a neurological or metabolic disease. Four hundred and twenty eight (428) children had died. For 51% of them, death took place at home. PLT activities include coordination; communication; curative and palliative care; education; research and fundraising. Different perceptions of what constitutes a palliative stage, heterogeneity in reporting diagnosis and the current lack of specific valid indicators to report PPC activities were found.

Conclusion

PLTs are offering highly individualised, flexible and integrated care from diagnosis to bereavement in all care settings. Improvements in data registration and implementation of outcome measures are foreseen.

Seeking Humanizing Care in Patient-Centered Care Process: A Grounded Theory Study

Patient-centered care is both a goal in itself and a tool for enhancing health outcomes. The application of patient-centered care in health care services globally however is diverse. This article reports on a study that sought to introduce patient-centered care. The aim of this study is to explore the process of providing patient-centered care in critical care units. The study used a grounded theory method. Data were collected on 5 critical care units in Tehran University of Medical Sciences. Purposive and theoretical sampling directed the collection of data using 29 semistructured interviews with 27 participants (nurses, patients, and physician). Data obtained were analyzed according to the analysis stages of grounded theory and constant comparison to identify the concepts, context, and process of the study. The core category of this grounded theory is "humanizing care," which consisted of 4 interrelated phases, including patient acceptance, purposeful patient assessment and identification, understanding patients, and patient empowerment. A core category of humanizing care integrated the theory. Humanizing care was an outcome and process. Patient-centered care is a dynamic and multifaceted process provided according to the nurses' understanding of the concept. Patient-centered care does not involve repeating routine tasks; rather, it requires an all-embracing understanding of the patients and showing respect for their values, needs, and preferences.

Beyond the Medical Model

The medical model continues to dominate research and shape policy and service responses to suicide. In this work we challenge the assumption that the medical model always provides the most effective and appropriate care for persons who are suicidal. In particular, we point to service user perspectives of health services which show that interventions are often experienced as discriminatory, culturally inappropriate, and incongruent with the needs and values of persons who are suicidal. We then examine “humanistic” approaches to care that have been proposed as a corrective to an overly medical model. We argue that the focus on improving interpersonal relations set out in humanistic approaches does not mitigate the prevailing risk management culture in contemporary suicide prevention and may impede the provision of more effective care. Finally, we draw attention to the tradition of non-medical approaches to supporting persons who are suicidal. Using Maytree (a U.K. crisis support service) as a case study, we outline some of the key features of alternative service models that we consider central to the design of more culturally appropriate and effective interventions. We conclude by making three key recommendations for improving services to persons who are suicidal.

Prosocial behaviour in palliative nurses: psychometric evaluation of the prosociality scale

AIM

The aim of this study was to examine the psychometric properties of a prosociality scale within the palliative nursing context, and then examine the impact of prosocial behaviour in relation to job and educational satisfaction among palliative nurses.

METHODS

An online cross-sectional survey was conducted in 25 Italian palliative care centres, with a total of 107 nurses completing the prosociality scale by Caprara et al (2005) . Exploratory and confirmatory factor analyses were examined to evaluate a multidimensional model of prosociality.

RESULTS

A three-factor solution with a second order factor fitted the data well. The three dimensions extracted were labelled as helping, empathy, and sharing. Participants reported high levels of prosociality. In addition, prosociality was positively associated with job and educational satisfaction.

CONCLUSIONS

The prosociality scale was valid and reliable when tested with palliative nurses. Although prosociality may be embedded in nurses' personalities, this quality should be actively promoted to expand and improve the culture and the ethics of nursing.

Time pressure and regulations on hospital-in-the-home (HITH) nurses: An on-the-road study

This study investigated both causal factors and consequences of time pressure in hospital-in-the-home (HITH) nurses. These nurses may experience additional stress from the time pressure they encounter while driving to patients' homes, which may result in greater risk taking while driving. From observation in natural settings, data related to the nurses' driving behaviours and emotions were collected and analysed statistically; semi-directed interviews with the nurses were analysed qualitatively. The results suggest that objective time constraints alone do not necessarily elicit subjective time pressure. The challenges and uncertainty associated with healthcare and the driving period contribute to the emergence of this time pressure, which has a negative impact on both the nurses' driving and their emotions. Finally, the study focuses on anticipated and in situ regulations. These findings provide guidelines for organizational and technical solutions allowing the reduction of time pressure among HITH nurses.

Nurse Practitioners

An impending policy change in Medicare will provide reimbursement for the end-of-life conversation. The rise in numbers of older adults who face serious illness coupled with advances in healthcare technology are increasing the need for providers to address end of life issues in the acute care setting. Doctoral-level nurse practitioners who specialize in acute care of older adults are poised to be leaders and facilitators of this conversation in a particularly challenging context–the intensive care unit. The focus of this article is the new end-of-life policy in relation to the particular contributions that adult gerontology acute care nurse practitioners offer in the acute care setting.

A qualitative exploration of perceived key knowledge and skills in end-of-life care in dementia patients among medical, nursing, and pharmacy students

BACKGROUND

The steady increase in the number of people living and dying with dementia, coupled with the recent focus on quality of care, has highlighted the importance of dementia training for health care professionals. This exploratory study aimed to discover which skills health care students felt were important in providing quality end-of-life care to dementia patients.

METHODS

Ninety-four medicine, nursing, and pharmacy students participated in a larger study using open-ended and closed questions to explore attitudes related to caring for dementia patients at the end of life. This study looks at the student responses to an open-ended question regarding the skills and knowledge they believe are needed to provide end-of-life care to dementia patients. Individual responses were reviewed by the researchers, coded into key issues, and tabulated for frequency of occurrences and group differences.

RESULTS

Several common issues emerged: knowledge, patience, empathy, understanding, family involvement, compassion, medication knowledge, respect/patient autonomy, communication, quality of life, and patient education. Significant differences were observed among the participant groups on the following issues: Patience and understanding (pharmacy students mentioned these issues less frequently than medical and nursing students), compassion (medical students mentioned this issue more frequently than pharmacy students), and medication knowledge (pharmacy students mentioned this issue more frequently than medical and nursing students).

CONCLUSIONS

Different health care disciplines (in-training) value different skill sets for the provision of dementia care at the end-of-life. As health care education for dementia patients at the end of life is expanded, it will be important to understand which skills both patients and health care students value.

Development of a questionnaire to measure the key attributes of the community palliative care specialist nurse role

BACKGROUND

Recent worldwide economic events have forced an examination of the nurse's contribution to high-quality, effective, person-centred care. Since the role of specialist nurses is considered one of the least understood or valued developments in nursing, specialist nurses must demonstrate their contribution to quality, person-centred health care.

AIM

To develop a questionnaire which aims to measure the quality of care provided by palliative care specialist nurses from the patients' perspective and to undertake initial validation.

METHOD

The process of questionnaire development involved six phases including systematic literature reviews, patient advisory groups and expert panel reviews, each of which contributed to the questionnaire face and content validity. Johnston's Expert Palliative Care Nurse Model (2002; 2005) provided an evidence-based framework for the development of the questionnaire, and enabled the identification of the key attributes of the palliative care specialist nurse role, thereby providing the themes on which to base the questionnaire.

RESULTS

The Quality Measure for Palliative Nursing, a questionnaire, was developed. The themes identified in the questionnaire--personal characteristics, communication skills, knowledge, relationship with patient and providing comfort--aim to facilitate measurement of the quality of care provided by palliative care specialist nurses. Designed for use by palliative patients the Quality Measure for Palliative Nursing is a one-page questionnaire comprising of 15 questions.

CONCLUSIONS

The Quality Measure for Palliative Nursing is unique since it aims to measure the quality of care provided by community palliative care specialist nurses, and could also be used to measure patient satisfaction with the quality of care provided. Further testing is recommended to ensure that this questionnaire can provide reliable and valid results.

Frommelt Attitudes Toward Care of the Dying Scale Form B

Nurses' attitudes toward caring for dying patients have an impact on the quality of the care provided. Education can improve knowledge and attitudes toward end-of-life care. No validated tool that measures such attitudes is available for Italian nursing students. The aim of this study was to translate the Frommelt Attitudes Toward Care of the Dying Scale (FATCOD) Form B from English into Italian and to establish its validity and reliability within an Italian population of students. A two-stage design was used. Stage 1 adapted the original version of the tool and tested it for content validity through a multistep process. Stage 2 tested its psychometric properties by analyzing internal consistency, test–retest reliability, and construct validity. The convenience sample consisted of 465 nursing students from all the universities of one Italian region. Measures of stability showed a very good overall (0.87) intraclass correlation coefficient (ICC). The discriminating capacity of the scale was adequate with good values of asymmetry and kurtosis for most of the items. Good internal consistency was found. The six factors derived from the factor analysis are the following: Fear/Malaise, Communication, Relationship, Care of the family, Family as Caring, and Active Care. FATCOD Form B-I is a valid, reliable, and acceptable tool for evaluation of attitudes toward end-of-life care in Italian students. It measures six specific dimensions that should be highlighted during health care student education and training.

End of life and beyond as hidden curriculum

End-of-life experiences are unique. Most can vividly recall feelings during those times. Governing boards in the United States attempt to guide nursing faculty regarding end of life curriculum. Yet, the beliefs of faculty members arising from those unique experiences can alter the tone and message of what students are actually taught--often surfacing as hidden curriculum. In this column the authors discuss hidden curriculum while presenting the beliefs regarding end of life, of four nursing faculty members from a single university. Heightened awareness and respect for the beliefs of all faculty members within any university setting is imperative in decreasing the development of hidden curriculum.