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Larsson Gerdin A, Hellzén O, Rising-Holmström M. Nurses' experiences of encounters in home care: a phenomenological hermeneutic study. Int J Qual Stud Health Well-being 2021; 16:1983950. [PMID: 34633907 PMCID: PMC8525981 DOI: 10.1080/17482631.2021.1983950] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/19/2021] [Indexed: 11/21/2022] Open
Abstract
PURPOSE nurses working in home care often encounter patients with multiple diagnoses in unpredictable environments. This may cause ethical and emotional challenges and influence nurses' daily work. The aim of this study was to illuminate the meaning of nurses' lived experiences of encountering patients in home care. METHODS narrative interviews were conducted with 11 nurses. These interviews were audiotaped and transcribed verbatim and analysed using a phenomenological hermeneutic approach. FINDINGS the findings are presented under three main themes: (1)"Being receptive to the other" (with subthemes "Caring about the encounter," and "Establishing trusting relationships"). (2) "Need to handle Handling the unpredictable" (with subthemes "Being alone in the encounter" and "Being experienced and competent"). (3) "Managing frustration" (with subthemes "Feeling insufficient" and "Feeling restricted". Having overall nursing responsibility challenged the nurse's self-confidence in providing care trustfully. CONCLUSIONS encountering patients in home care means relating to the other unconditionally, which aim to highlight patients' needs. Being a nurse in home care is both emotionally demanding and rewarding. Having the courage to face their own and the patients' vulnerabilities will entail the promotion of natural receptivity and responsiveness to patients' needs.
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Affiliation(s)
| | - Ove Hellzén
- Department of Nursing Sciences, Mid Sweden University, Sundsvall, Sweden
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Abstract
PURPOSE OF STUDY The study's purpose was to identify hospital programs, organizational characteristics, and levels of nursing involvement in hospital programs that contribute significantly to reductions in readmission rates and reimbursement penalties for hospital systems in upstate New York. PRIMARY PRACTICE SETTING Hospitals located in upstate New York. METHODOLOGY AND SAMPLE No sampling technique was employed because the cohort included hospitals located in upstate New York. Hospitals in upstate New York were selected (N = 94), representing 53 counties ranging between metropolitan and rural status. Using an ex post facto design within the framework of the ecological and synergy models, organizational characteristics of hospital systems and educational levels of nursing involvement in hospital programs were analyzed and coded. Independent-samples t tests, analysis of variance, and Pearson correlation tests were conducted. RESULTS Organizational programs that reduce various hospital readmission rates and reimbursement penalties for hospitals in upstate New York are (1) certified home health agencies; (2) telehealth; (3) house calls; (4) advanced practice nurses on care management interdisciplinary discharge teams; and (4) increasing the number of hospital readmission reduction programs (HRRPs) utilized. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE Hospitals should.
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Nakrem S, Solbjør M, Pettersen IN, Kleiven HH. Care relationships at stake? Home healthcare professionals' experiences with digital medicine dispensers - a qualitative study. BMC Health Serv Res 2018; 18:26. [PMID: 29334953 PMCID: PMC5769443 DOI: 10.1186/s12913-018-2835-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 01/10/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although digital technologies can mitigate the burdens of home healthcare services caused by an ageing population that lives at home longer with complex health problems, research on the impacts and consequences of digitalised remote communication between patients and caregivers is lacking. The present study explores how home healthcare professionals had experienced the introduction of digital medicine dispensers and their influence on patient-caregiver relationships. METHODS The multi-case study comprised semi-structured interviews with 21 healthcare professionals whose home healthcare service involved using the digital medicine dispensers. The constant comparative method was used for data analyses. RESULTS Altogether, interviewed healthcare professionals reported three main technology-related impacts upon their patient-caregiver relationships. First, national and local pressure to increase efficiency had troubled their relationships with patients who suspected that municipalities have sought to lower costs by reducing and digitalising services. Participants reported having to consider such worries when introducing technologies into their services. Second, participants reported a shift towards empowering patients. Digital technology can empower patients who value their independence, whereas safety is more important for other patients. Healthcare professionals needed to ensure that replacing care tasks with technology implies safe and improved care. Third, the safety and quality of digital healthcare services continues to depend upon surveillance and control mechanisms that compensate for less face-to-face monitoring. Participants did not consider the possibility that surveillance exposes information about patients' everyday lives to be problematic, but to constitute opportunities for adjusting services to meet patients' needs. CONCLUSIONS Technologies such as digital medicine dispensers can improve the efficiency of healthcare services and enhance patients' independence when introduced in a way that empowers patients as well as safeguards trust and service quality. Conversely, the patient-caregiver relationship can suffer if the technology does not meet patients' needs and fails to offer safe and trustworthy services. Upon introducing technology, home healthcare professionals therefore need to carefully consider the benefits and possible disadvantages of the technology. Ethical implications for both individuals and societies need to be further discussed.
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Affiliation(s)
- Sigrid Nakrem
- Department of Public Health and Nursing, Faculty of Medicine and Health Science, NTNU Norwegian University of Science and Technology, Trondheim, Norway.
| | - Marit Solbjør
- Department of Public Health and Nursing, Faculty of Medicine and Health Science, NTNU Norwegian University of Science and Technology, Trondheim, Norway
| | - Ida Nilstad Pettersen
- Department of Design, Faculty of Architecture and Design, NTNU Norwegian University of Science and Technology, Trondheim, Norway
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Garland-Baird L, Fraser K. Conceptualization of the Chronic Care Model: Implications for Home Care Case Manager Practice. Home Healthc Now 2018; 36:379-385. [PMID: 30383597 DOI: 10.1097/nhh.0000000000000699] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
One of the greatest challenges for healthcare systems is the management and prevention of chronic diseases. Wagner's Chronic Care Model aims to transform the daily care of patients with chronic illnesses from acute and reactive to proactive, planned, and population-based. The purpose of this article is to provide a review of the available research relating to the Chronic Care Model and consider the implications for Home Care Case Management practice. A total of 18 research studies (5 qualitative and 13 quantitative) were reviewed. A thematic content analysis approach was used. The findings included three themes: Chronic Care Model and positive chronic illness health behaviors and outcomes; Chronic Care Model and delivery of quality chronic illness care; and the importance of the supportive role of the home care nurse in the role of Home Care Case Management. Gaps and limitations of the Chronic Care Model in relation to Home Care Case Management were identified and discussed in relationship to partnership building and reciprocal trust between patients, family caregivers, and the Home Care Case Manager. Finally, implications for the use of the Chronic Care Model in Home Care Case Manager practice, policy development, and future research were presented.
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Affiliation(s)
- Lisa Garland-Baird
- Lisa Garland-Baird, RN, MN, is a Faculty of Nursing, University of Alberta, Edmonton, Alberta. Kimberly Fraser, PhD, is an Associate Professor, Faculty of Nursing, University of Alberta, Edmonton, Alberta
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Griffiths J. Person-centred communication for emotional support in district nursing: SAGE and THYME model. Br J Community Nurs 2017; 22:593-597. [PMID: 29189053 DOI: 10.12968/bjcn.2017.22.12.593] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Patients on district nursing caseloads have multiple physical morbidities, and related emotional concerns. District nurses are ideally placed to assess and meet patients' emotional needs but in increasingly stretched workplaces, it is difficult to find time. There is also evidence that district nurses sometimes believe they lack skills to address patients' concerns. Traditional communication skills training is useful for encouraging patients to open up about their concerns, but less helpful at finding workable solutions. District nurses can be afraid to open a 'can of worms' of concerns that they are unable to deal with. SAGE and THYME is a person-centred, evidence-based communication skills model that addresses district nurses' concerns about time and skills. It provides a structure for conversations about concerns, and empowers patients to work with district nurses to find solutions. Research suggests that it is a promising model for district nursing practice.
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Affiliation(s)
- Jane Griffiths
- Senior Lecturer, School of Health Sciences, Division of Nursing Midwifery and Social Work, University of Manchester
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Reed FM, Fitzgerald L, Bish MR. A practice model for rural district nursing success in end-of-life advocacy care. Scand J Caring Sci 2017; 32:746-755. [PMID: 28840608 DOI: 10.1111/scs.12505] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 06/20/2017] [Indexed: 11/27/2022]
Abstract
AIM The development of a practice model for rural district nursing successful end-of-life advocacy care. BACKGROUND Resources to help people live well in the end stages of life in rural areas can be limited and difficult to access. District nurse advocacy may promote end-of-life choice for people living at home in rural Australia. The lack of evidence available internationally to inform practice in this context was addressed by exploratory study. METHOD A pragmatic mixed method study approved by the University Faculty Ethics Committee and conducted from March 2014 to August 2015 was used to explore the successful end-of-life advocacy of 98 rural Australian district nurses. The findings and results were integrated then compared with theory in this article to develop concepts for a practice model. RESULTS The model illustrates rural district nurse advocacy success based on respect for the rights and values of people. Advocacy action is motivated by the emotional responses of nurses to the end-of-life vulnerability people experience. The combination of willing investment in relationships, knowing the rural people and resources, and feeling supported, together enables district nurses to develop therapeutic emotional intelligence. This skill promotes moral agency in reflection and advocacy action to overcome emotional and ethical care challenges of access and choice using holistic assessment, communication, organisation of resources and empowering support for the self-determination of person-centred end-of-life goals. Recommendations are proposed from the theoretical concepts in the model. LIMITATIONS Testing the model in practice is recommended to gain the perceptions of a broader range of rural people both giving and receiving end-of-life-care. CONCLUSION A model developed by gathering and comparing district nursing experiences and understanding using mixed methods and existing theory offers evidence for practice of a philosophy of successful person-centred advocacy care in a field of nursing that lacks specific guidance.
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Affiliation(s)
- Frances M Reed
- La Trobe School of Rural Nursing and Midwifery, La Trobe University, Bendigo, Victoria, Australia
| | - Les Fitzgerald
- La Trobe School of Rural Nursing and Midwifery, La Trobe University, Bendigo, Victoria, Australia
| | - Melanie R Bish
- La Trobe School of Rural Nursing and Midwifery, La Trobe University, Bendigo, Victoria, Australia
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Abstract
BACKGROUND: The concept 'encounter' occurs in caring literature as a synonym for dialogue and relation describing deeper levels of interaction between patient and nurse. In nursing and caring research, the concept 'caring encounter' is often used without further reflection on the meaning of the concept. Encounters are, however, continuously taking place in the world of caring, which calls for a clarification of the concept. OBJECTIVES: This study is an analysis of the concept of caring encounter in nursing from the patients' and nurses' point of view. METHOD: Rodgers' evolutionary view guided the concept analysis within the theoretical perspective of caritative caring. DATA SOURCES: Peer-reviewed articles in English published between 1990 and 2014 were retrieved from the databases: CINAHL, PubMed, Web of Science, ScienceDirect (Elsevier), Springer Link, Primo Central (Ex Libris) and Academic Search Premier (EBSCO) using different combinations of encounter, caring and nursing as keywords. In all, 28 articles related to caring encounters were included in the analysis after applying inclusion and exclusion criteria. ETHICAL CONSIDERATIONS: This study was conducted according to good scientific practice. RESULTS: Four antecedents to the caring encounter are found in the nurse's way of being: a reflective way of being; openness, sensitivity, empathy and ability to communicate; confidence, courage and professionalism; and showing respect and supporting dignity. The attributes are as follows: being there, uniqueness and mutuality. As a consequence, the caring encounter influences both patient and nurse. DISCUSSION AND CONCLUSION: The caring encounter is an encounter between two equal persons where one is nurse and the other is patient. They encounter in mutuality, in true presence, and both have allowed themselves to be the person they are. The results clarify the conceptual differences between relationship and caring communion as the mutuality in the caring encounter differs from the dependence on the other pronounced in the relationship.
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Näsström L, Mårtensson J, Idvall E, Strömberg A. Participation in Care Encounters in Heart Failure Home-Care. Clin Nurs Res 2017; 26:713-730. [DOI: 10.1177/1054773816685744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this qualitative study was to observe care encounters during home visits in Heart failure (HF) home-care to identify and describe participation in care. Seventeen patients diagnosed with HF, and 10 registered nurses participated. Data from 19 video-recorded home visits were analyzed using qualitative content analysis. Two themes were identified: (a) Participation in the care encounter is made possible by interaction, including exchanging care-related information, care-related reasoning, collaboration; and (b) participation in the care encounter is made possible by an enabling approach, including the patients expressing their own wishes, showing an active interest, while the nurse is committed and invites to having a dialogue. The HF home-care context showed good potential for patient participation. Room for discussions and collaboration facilitated for the patients to be active partners in their care, which in turn may have positive effects on outcomes.
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Affiliation(s)
- Lena Näsström
- Research and Development Unit in Local Health Care and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Jan Mårtensson
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Ewa Idvall
- Department of Care Science, Malmö University, Malmö, Sweden
| | - Anna Strömberg
- Department of Medical and Health Sciences, and Department of Cardiology, Linköping University, Linköping, Sweden
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Durkin M, Beaumont E, Hollins Martin CJ, Carson J. A pilot study exploring the relationship between self-compassion, self-judgement, self-kindness, compassion, professional quality of life and wellbeing among UK community nurses. NURSE EDUCATION TODAY 2016; 46:109-114. [PMID: 27621200 DOI: 10.1016/j.nedt.2016.08.030] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 08/12/2016] [Accepted: 08/25/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Compassion fatigue and burnout can impact on performance of nurses. This paper explores the relationship between self-compassion, self-judgement, self-kindness, compassion, professional quality of life, and wellbeing among community nurses. AIM To measure associations between self-compassion, compassion fatigue, wellbeing, and burnout in community nurses. METHOD Quantitative data were collected using standardised psychometric questionnaires: (1) Professional Quality of Life Scale; (2) Self-Compassion Scale; (3) short Warwick Edinburgh Mental Wellbeing Scale; (4) Compassion For Others Scale, used to measure relationships between self-compassion, compassion fatigue, wellbeing, and burnout. PARTICIPANTS A cross sectional sample of registered community nurses (n=37) studying for a postgraduate diploma at a University in the North of England took part in this study. RESULTS Results show that community nurses who score high on measures of self-compassion and wellbeing, also report less burnout. Greater compassion satisfaction was also positively associated with compassion for others, and wellbeing, whilst also being negatively correlated with burnout. CONCLUSION High levels of self-compassion were linked with lower levels of burnout. Furthermore when community nurses have greater compassion satisfaction they also report more compassion for others, increased wellbeing, and less burnout. The implications of this are discussed alongside suggestions for the promotion of greater compassion.
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Affiliation(s)
- Mark Durkin
- School of Health and Human Sciences, University of Bolton, BL3 5AB, UK.
| | - Elaine Beaumont
- School of Nursing, Midwifery, Social Work & Social Sciences Mary Seacole Building, (Room MS3.17), University of Salford, Frederick Road, Salford, Greater Manchester M6 6PU, UK.
| | | | - Jerome Carson
- School of Education and Psychology, University of Bolton, BL3 5AB, UK.
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Kirchhoff JW, Grøndahl VA, Andersen KL. Betydningen av sosiale nettverk og kvalitet på pleien for opplevelse av ensomhet blant brukere av hjemmesykepleie. ACTA ACUST UNITED AC 2015. [DOI: 10.18261/issn1892-2686-2015-03-04] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Bos E, Silén C, Kaila P. Clinical supervision in primary health care; experiences of district nurses as clinical supervisors - a qualitative study. BMC Nurs 2015; 14:39. [PMID: 26221078 PMCID: PMC4517626 DOI: 10.1186/s12912-015-0089-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 07/14/2015] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Learning in the clinical environment is an important part of nursing education. Several recent studies focusing on clinical learning have been based on hospital settings. Little is known about primary health care (PHC) as clinical environment where district nurses (DNs) or nurses supervise students. It is important to understand more about opportunities and difficulties in supervising in this area in order to develop PHC as an optimal learning environment for nursing students. The main objective of this study was to gain an understanding of supervisors' experiences of supervising undergraduate students at PHC units. METHODS A qualitative research approach was used to collect data and analyse supervisors' experiences. Six focus groups were carried out with 24 supervisors. Focus group data were audio-taped. The data were analysed using an inductive content analysis. RESULTS Three themes illustrated supervisors' experiences: abandonment, ambivalence and sharing the holistic approach. Supervisors felt abandoned by their managers, colleagues and nurse teachers from universities. They experienced ambivalence due to simultaneously being supervisors for students and carrying out their daily work with patients. At the same time, they were proud to be DNs and willing to share their unique role to apply a holistic approach and continuity in patient care with students. CONCLUSION When supervising students in PHC, social support and communication between supervisors and their colleagues and management as well as nurse teachers need to be taken into consideration both at universities and at primary health care units.
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Affiliation(s)
- Elisabeth Bos
- />Karolinska Institutet, Centre for Family Medicine, Department of Neurobiology, Care Sciences and Society, Alfred Nobels Allé 12, SE-141 83, Huddinge, Sweden
| | - Charlotte Silén
- />Karolinska Institutet, Department of Learning, Informatics, Management and Ethic, Stockholm, Sweden
| | - Päivi Kaila
- />Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Huddinge, Sweden
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12
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Griffiths J, Wilson C, Ewing G, Connolly M, Grande G. Improving communication with palliative care cancer patients at home - A pilot study of SAGE & THYME communication skills model. Eur J Oncol Nurs 2015; 19:465-72. [PMID: 25782722 DOI: 10.1016/j.ejon.2015.02.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 02/06/2015] [Accepted: 02/09/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE To pilot an evidence-based communication skills model (SAGE & THYME) with UK District Nurses (DNs) who visit patients with advanced cancer early in the dying trajectory. Evidence suggests that DNs lack confidence in communication skills and in assessing cancer patients' psycho-social needs; also that they lack time. SAGE & THYME is a highly structured model for teaching patient centred interactions. It addresses concerns about confidence and time. METHOD Mixed methods. 33 DNs were trained in SAGE & THYME in a three hour workshop and interviewed in focus groups on three occasions: pre-training, immediately post-training and two months post-training. Questionnaires measuring perceived outcomes of communication, confidence in communication and motivation to use SAGE & THYME were administered at the focus groups. RESULTS SAGE & THYME provided a structure for conversations and facilitated opening and closing of interactions. The main principle of patient centeredness was reportedly used by all. Knowledge about communication behaviours helpful to patients improved and was sustained two months after training. Increased confidence in communication skills was also sustained. Motivation to use SAGE & THYME was high and remained so at two months, and some said the model saved them time. Challenges with using the model included controlling the home environment and a change in style of communication which was so marked some DNs preferred to use it with new patients. CONCLUSION Training DNs in SAGE & THYME in a three hour workshop appears to be a promising model for improving communication skills when working with cancer patients.
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Affiliation(s)
- Jane Griffiths
- University of Manchester, School of Nursing Midwifery and Social Work, Jean McFarlane Building, Manchester, United Kingdom.
| | - Charlotte Wilson
- Barts & The London School of Medicine, Centre for Primary Care and Public Health, Yvonne Carter Building, 58 Turnser Street, London, United Kingdom
| | - Gail Ewing
- University of Cambridge, Centre for Family Research, Free School Lane, Cambridge, United Kingdom
| | - Michael Connolly
- University Hospital of South Manchester NHS Foundation Trust, Southmoor Lane, Wythenshawe, Manchester, United Kingdom
| | - Gunn Grande
- University of Manchester, School of Nursing Midwifery and Social Work, Jean McFarlane Building, Manchester, United Kingdom
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14
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Pusa S, Hägglund K, Nilsson M, Sundin K. District nurses' lived experiences of meeting significant others in advanced home care. Scand J Caring Sci 2014; 29:93-100. [DOI: 10.1111/scs.12134] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 03/04/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Susanna Pusa
- Department of Nursing; Umeå University; Örnsköldsvik Sweden
| | | | | | - Karin Sundin
- Department of Nursing; Umeå University; Örnsköldsvik Sweden
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Redshaw S, Harrison K, Johnson A, Chang E. Community nurses' perceptions of providing bereavement care. Int J Nurs Pract 2013; 19:344-50. [PMID: 23730867 DOI: 10.1111/ijn.12069] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This study explored the perceptions of bereavement support offered to clients and their carers and family by community nurses (CNs) in three community health centres located in a single area health service. In the context of an ageing population, it is pertinent to review CNs' perceptions in providing bereavement services. Early assessment and intervention is likely to prevent complicated grief occurring in the community. The bereavement support provided by CNs, considered here within a person-centred framework, enables identification of complicated grief. Semistructured interviews were held with 10 CNs and were transcribed verbatim. Transcriptions were analysed for major themes, and responses were grouped in relation to the study aims and themes emerging from the interviews. The themes discussed in this paper are as follows: the carer as a focus of palliative care; bereavement support as an outlet for carers; and the ending of the relationship between carers and CNs that is facilitated through bereavement support. The study provides evidence that supports the adoption of a model of bereavement support delivered by CNs as a means of reducing the likelihood of complicated grief occurring in the community. Further, the visits provide an important opportunity for nurses and carers to satisfactorily complete their relationship.
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Affiliation(s)
- Sarah Redshaw
- Department of Sociology, Macquarie University, Sydney, New South Wales, Australia.
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Lucas S. The missing link: district nurses as social connection for older people with type 2 diabetes mellitus. Br J Community Nurs 2013; 18:388, 390-7. [PMID: 24225474 DOI: 10.12968/bjcn.2013.18.8.388] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Sandra Lucas
- School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
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Brownhill S, Chang E, Bidewell J, Johnson A. A decision model for community nurses providing bereavement care. Br J Community Nurs 2013; 18:133-9. [PMID: 23653962 DOI: 10.12968/bjcn.2013.18.3.133] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Community (district) nurses play a significant role in assisting and supporting bereaved informal carers (family members and friends) of recently decease clients of palliative care. Bereavement care demands a wide range of competencies including clinical decision-making. To date, little has been known about the decision-making role of community nurses in Australia. The aim of this study was to conduct in-depth examination of an existing data set generated from semi-structured interviews of 10 community nurses providing follow-up bereavement care home visits within an area health service of a metropolitan region of Sydney, Australia. A grounded theory approach to data analysis generated a model, which highlights an interaction between 'the relationship','the circumstances' (surrounding the bereavement),'the psychosocial variant', 'the mix of nurses', 'the workload', and 'the support' available for the bereaved and for community nurses, and elements of 'the visit' (central to bereavement care). The role of community nurses in bereavement care is complex, particularly where decision-making is discretionary and contingent on multiple variables that effect the course of the family's grief. The decision model has the potential to inform community nurses in their support of informal carers, to promote reflective practice and professional accountability, ensuring continuing competence in bereavement care.
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Affiliation(s)
- Suzanne Brownhill
- School of Nursing and Midwifery, University of Western Sydney, Australia.
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Bliss J, Bain H. Care closer to home: the role of district nurses. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2013; 22:676. [PMID: 24151702 DOI: 10.12968/bjon.2013.22.12.676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Julie Bliss
- Department of Mental Health, Florence Nightingale School of Nursing and Midwifery, King's College London
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Griffiths J, Ewing G, Rogers M. Early support visits by district nurses to cancer patients at home: a multi-perspective qualitative study. Palliat Med 2013; 27:349-57. [PMID: 22801979 DOI: 10.1177/0269216312451949] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Many palliative cancer patients spend much of their last year at home. In the UK, district nurses make frequent support visits to patients and carers at this time, yet surprisingly little is known about their supportive role in palliative care. Current studies are limited to district nurses' reports of practice, which offer limited insight into their content. Patients' and carers' views on district nurse support visits are largely unknown. AIM To present findings of a multi-perspective study that explored how district nurse early support visits are both described and carried out. DESIGN Focus groups with district nurses to explore views on the purpose of early support visits. Observation of support visits to identify how they are conducted. Patient and carer interviews to elucidate and verify district nurse data. SETTING AND PARTICIPANTS Participants included 58 district nurses, 10 palliative care patients and nine carers from four Primary Care Trusts in contrasting urban and rural locations. RESULTS District nurses had difficulty articulating early support visits. Observations however revealed a complex role comprising extensive physical and practical assessments, practical interventions, information giving, liaison, facilitation and referral. Patients and carers confirmed that they felt valued, reassured and supported by district nurses. CONCLUSIONS A multi-perspective approach provided new insights into district nurse support visits. Monitoring work described appears to have additional psycho-social benefits for patients and carers. The supportive role of district nurses needs to be clearly articulated and recognised so that colleagues, patients and carers access this valuable resource for palliative care patients.
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Affiliation(s)
- Jane Griffiths
- University of Manchester, School of Nursing Midwifery and Social Work, Manchester, UK.
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Chang E, Bidewell J, Hancock K, Johnson A, Easterbrook S. Community palliative care nurse experiences and perceptions of follow-up bereavement support visits to carers. Int J Nurs Pract 2013; 18:332-9. [PMID: 22845632 DOI: 10.1111/j.1440-172x.2012.02046.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Community (district) nurses (CNs) are well positioned to provide follow-up home visits to bereaved families and carers of their recently deceased palliative clients. An Australian survey of CN's (n = 58, response rate 29%) described their experiences of bereavement support visits, perceptions of their role in bereavement care and their professional support needs. Although positive experiences were commonly reported, with 95% of participants considering bereavement follow-up visits as consistent with their role, 53% found the visits difficult for reasons such as the nurse or client not understanding the purpose, the CN's excessive personal identification with the client's situation, the emotional intensity of visits, and lack of confidence or skills despite prior training. The nature and quality of the CN's prior relationship with the bereaved family was an important determinant of the visits' success. Results highlight the value of bereavement support visits, while identifying professional development needs. Managing emotionally intense episodes should receive priority in preparing CN's for this challenging role.
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Affiliation(s)
- Esther Chang
- School of Nursing and Midwifery, University of Western Sydney, Penrith, New South Wales, Australia.
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Karlsson M, Karlsson C, Barbosa da Silva A, Berggren I, Söderlund M. Community nurses' experiences of ethical problems in end-of-life care in the patient's own home. Scand J Caring Sci 2012; 27:831-8. [DOI: 10.1111/j.1471-6712.2012.01087.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Accepted: 08/13/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Margareta Karlsson
- Department of Caring Science; Åbo Academy University; Vasa Finland
- Department of Nursing; Health and Culture, University West; Trollhättan Sweden
| | | | | | - Ingela Berggren
- Department of Nursing; Health and Culture, University West; Trollhättan Sweden
| | - Maud Söderlund
- Department of Caring Science; Åbo Academy University; Vasa Finland
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Corrales-Nevado D, Alonso-Babarro A, Rodríguez-Lozano MÁ. [Continuity of care, innovation and redefinition of professional roles in the healthcare of chronically and terminally ill patients. SESPAS report 2012]. GACETA SANITARIA 2012; 26 Suppl 1:63-8. [PMID: 22336324 DOI: 10.1016/j.gaceta.2011.09.032] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Revised: 09/27/2011] [Accepted: 09/30/2011] [Indexed: 11/16/2022]
Abstract
Continuity of care is essential to address the multiple needs of the chronically and terminally ill. To achieve this aim, the organizational barriers of the different levels of care must be overcome by establishing appropriate coordination mechanisms. Interest in finding effective solutions to the problems that threaten continuity of care is increasing, favoring the continued development of professional and institutional strategies to improve coordination. The present article explores some of the proposals to improve the coordination of care in primary care settings, from the point of view of nursing, social work and palliative care. Due to the increase in patients with chronic and complex needs and multimorbidity, the number and quality of home visits should be increased. The effectiveness of home care depends on the regularity of follow-up and the stability of the healthcare programs, rather than on the service responsible for monitoring the patient or the professional responsible for home visits.
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Griffiths J, Ewing G, Rogers M. "Moving Swiftly On." Psychological Support Provided by District Nurses to Patients With Palliative Care Needs. Cancer Nurs 2010; 33:390-7. [DOI: 10.1097/ncc.0b013e3181d55f9b] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Walshe C, Luker KA. District nurses’ role in palliative care provision: A realist review. Int J Nurs Stud 2010; 47:1167-83. [DOI: 10.1016/j.ijnurstu.2010.04.006] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2009] [Revised: 04/01/2010] [Accepted: 04/22/2010] [Indexed: 11/16/2022]
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Abstract
Community nurses play a key part in palliative care for patients and their families, yet there is relatively little research examining how their role is understood by nurses themselves. This paper presents findings from a qualitative study exploring how district nursing teams and community matrons (CMs) understood their own and each other's roles in palliative care. Twenty-four district nurses (DNs), 15 CMs and seven other key stakeholders were interviewed. DNs saw themselves as having a pivotal role, often coordinating other services as well as providing hands-on care. CMs agreed with the importance of the DN role, but had doubts about whether DNs had the capacity or skills to provide genuine case management. Both sets of nurses varied in their views of the CM role in palliative care, from seeing it as negligible to extensive and valuable. Organizational change contributed to the defensiveness of many DNs about their role, and to CMs' experiences of suspicion towards theirs.
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Affiliation(s)
- Nigel King
- Applied Psychology, Centre for Applied Psychological Research, University of Huddersfield.
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Nilsson C, Skär L, Söderberg S. Swedish District Nurses' experiences on the use of information and communication technology for supporting people with serious chronic illness living at home--a case study. Scand J Caring Sci 2009; 24:259-65. [PMID: 20030770 DOI: 10.1111/j.1471-6712.2009.00715.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The aim of this case study was to describe two District Nurses' (DN) experiences of using information and communication technology (ICT) to communicate with chronically ill people in their homes. An electronic messaging program via computers and mobile phones with an Internet connection was used, enabling DNs and the ill people to exchange messages to and from anywhere. The program comprised different virtual rooms, and communication was via text messages. The DNs in this study used the program two to four times each week from November 2003 to March 2004. Semi-structured interviews were performed before, during and after the implementation of the new technology and were analysed using thematic content analysis. The results showed that the DNs felt that the technology increased accessibility to nursing care through a more direct communication with the ill person meaning that a more trusting relationship could be created. The DNs also experienced that the use of ICT saved working time. This study indicates that the use of ICT for communication allowed the DN to better support a chronically ill person at home leading to improved home nursing care. This method of communication cannot replace physical presence, but can be seen as a complement to nursing care at home.
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Affiliation(s)
- Carina Nilsson
- Division of Nursing, Department of Health Science, Luleå University of Technology, Luleå, Sweden.
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Valente SH, Teixeira MB. Estudo fenomenológico sobre a visita domiciliária do enfermeiro à família no processo de terminalidade. Rev Esc Enferm USP 2009; 43:655-61. [DOI: 10.1590/s0080-62342009000300022] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Pesquisa qualitativa e fenomenológica que teve como proposta compreender o fenômeno: Enfermeiros que atuam no PSF e o cuidado, em domicilio, à família que vivencia, nele, ao término de um dos seus membros. O estudo foi realizado com enfermeiros que atuam na Região Sudeste do município de São Paulo, SP. Utilizou-se como referencial teórico a fenomenologia existencial. Com este estudo foi possível desvelar que essa vivência significou para os enfermeiros um momento para estar-com-a-família em uma situação existencial de perda e morte, construindo no domicílio uma rede de proteção para que o processo de terminalidade de um de seus membros fosse o mais ameno possível. Apesar de ter sido permeada por um cuidado de enfermagem repleto de humanidade, significando uma vivência única e singular, foi também uma experiência difícil, desgastante, representando situações geradoras de agravos a sua saúde enquanto trabalhador.
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Sandgren A, Thulesius H, Petersson K, Fridlund B. “Doing Good Care”—a study of palliative home nursing care. Int J Qual Stud Health Well-being 2009. [DOI: 10.1080/17482620701650299] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Kennedy C, Christie J, Harbison J, Maxton F, Rutherford I, Moss D. Establishing the contribution of nursing in the community to the health of the people of Scotland: integrative literature review. J Adv Nurs 2008; 64:416-39. [DOI: 10.1111/j.1365-2648.2008.04621.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Nilsson C, Skär L, Söderberg S. Swedish district nurses' attitudes to implement information and communication technology in home nursing. Open Nurs J 2008; 2:68-72. [PMID: 19319223 PMCID: PMC2600856 DOI: 10.2174/1874434600802010068] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2008] [Revised: 10/21/2008] [Accepted: 10/28/2008] [Indexed: 11/22/2022] Open
Abstract
The use of information and communication technology has increased in the society, and can be useful in nursing care. The aim of this study was to describe district nurses' attitudes regarding the implementation of information and communication technology in home nursing. The first and third authors performed five focus group discussions with 19 district nurses' from five primary healthcare centres in northern Sweden. During the focus group discussions, the following topics were discussed: the current and future use of information and communication technology in home nursing; expectations, advantages, disadvantages and hindrances in the use of information and communication technology in home nursing; and the use of information and communication technology from an ethical perspective. The transcribed focus group discussions were analysed using qualitative content analysis. The results showed that district nurses' attitudes were positive regarding the use of information and communication technology in their work. They also asked for possibilities to influence the design and its introduction. However, the use of information and communication technology in home nursing can be described as a complement to communication that could not replace human physical encounters. Improvements and risks, as well as the importance of physical presence in home nursing were considered vital. The results revealed that the use of information and communication technology requires changes in the district nurses' work situation.
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Affiliation(s)
- Carina Nilsson
- Division of Nursing, Department of Health Science, Luleå University of Technology, Luleå, Sweden
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Blomberg AM, Hylander I, Törnkvist L. District nurses' involvement in pain care: a theoretical model. J Clin Nurs 2008; 17:2022-31. [PMID: 18720560 DOI: 10.1111/j.1365-2702.2007.02222.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To explore district nurses care of chronic pain sufferers and to create a theoretical model that can explain the variation in district nurses experiences when caring for these patients. BACKGROUND Many people suffer from chronic pain, which greatly affects their wellbeing and causes physical suffering and psychosocial limitations. District nurses frequently meet patients who suffer from chronic pain and consequent problems. District nurses often feel powerless and ill-equipped, and they experience difficulties during interactions with these patients. METHOD This is a qualitative study with a theory-generating approach. Data were collected from interviews with 20 district nurses in five focus groups. Interviews were taped, transcribed and then analysed as per the grounded theory method. RESULTS The result is a theoretical model of district nurses' involvement in pain care. The model: (1) illustrates three main conditions in the care situation that influence district nurses' involvement in pain care and (2) explains the connection between how district nurses actively or passively detect and actively or passively respond to patients with pain problems. CONCLUSIONS The model explains why district nurses sometimes feel powerless or ill-equipped in dealing with chronic pain problems. Insufficient conditions make it difficult for district nurses to become involved with pain problems and thus result in passive detection of and passive response to pain problems. Supporting patients to communicate their pain, collaboration with and involvement from other professionals regarding pain care, the organisation's guidelines and support for pain care and training in pain care are interventions that will contribute to district nurses' involvement in pain care. RELEVANCE TO CLINICAL PRACTICE Through the model, chronic pain care can be better explained and understood; consequently chronic pain care can be improved. The model can be used in each, unique, case-study analysis. Nursing staff and students can also use the model as a basis for discussions about chronic pain sufferers.
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Affiliation(s)
- Anne-Marie Blomberg
- Center for Family and Community Medicine Stockholm, Karolinska Institutet, Huddinge, Sweden.
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Barrett A, Latham D, Levermore J. Part 2: Defining the unique role of the specialist district nurse practitioner. Br J Community Nurs 2007; 12:522-526. [PMID: 18073638 DOI: 10.12968/bjcn.2007.12.11.27486] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
This is the second of a series of articles exploring the unique role of the district nurse. Case scenarios demonstrate the value of high quality care provided when delivering, home IV therapy, Catheterization, Medicine reviews, risk assessments, referrals and acting as the patients advocate.
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McKenzie H, Boughton M, Hayes L, Forsyth S, Davies M, Underwood E, McVey P. A sense of security for cancer patients at home: the role of community nurses. HEALTH & SOCIAL CARE IN THE COMMUNITY 2007; 15:352-9. [PMID: 17578396 DOI: 10.1111/j.1365-2524.2007.00694.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
The present paper reports on a qualitative research project designed to expose the presently unrecognised minutiae of community nurses' work with cancer patients at home, and to identify the ways in which these, combined to form comprehensive care episodes, contribute to physical and psychosocial well-being. The project was conducted in two locations in New South Wales, Australia, one metropolitan and one rural. The research model focused on particular nurse-patient encounters, and involved pre- and post-encounter interviews with nurses, post-encounter interviews with patients and carers, and observation of the encounters themselves. Participants included generalist community nurses, cancer patients being cared for at home, and their primary carers where appropriate. This research demonstrates that regular contact with generalist community nurses is associated with a strong sense of security about the immediate situation for home-based cancer patients and their primary carers. This sense of security is a significant component of patient and carer physical and psychosocial well-being, and may have implications for health services utilisation. In the present paper, the authors outline the factors underpinning this sense of security, and argue that these findings contribute important new knowledge that is vital for contemporary debates about role responsibilities and continuity of care for cancer patients.
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Affiliation(s)
- Heather McKenzie
- Faculty of Nursing and Midwifery, University of Sydney, Sydney, New South Wales, Australia.
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Griffiths J, Ewing G, Rogers M, Barclay S, Martin A, McCabe J, Todd C. Supporting Cancer Patients With Palliative Care Needs. Cancer Nurs 2007; 30:156-62. [PMID: 17413782 DOI: 10.1097/01.ncc.0000265013.63547.4a] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this study was to examine UK district nurses' perceptions of their role in supporting palliative care cancer patients. Patients with cancer are living longer with the disease. District nurses are the largest UK workforce caring for people with cancer at home, the preferred place of care. Meeting patients' supportive and palliative care needs is complex. Little is known about district nurses' supportive role in the early phase of palliative care. Semistructured interviews were conducted with 34 district nurses. Data were analyzed thematically, with assistance from Atlas/ti. A dominant theme emerging from the interviews was ambiguity in the district nurses' supportive role in early palliative care. District nurses discussed the importance of making contact early on to support cancer patients and their families but had difficulty articulating this "support." Ambiguity, lack of confidence, and perceived skill deficits presented district nurses with dilemmas that were difficult to resolve. District nurses have great potential for meeting cancer patients' supportive and palliative care needs, a potential not currently realized. Education alone is unlikely to improve practice without an understanding of the tensions faced by district nurses in their work. Recognizing and addressing dilemmas in the everyday work of district nurses is central to moving practice forward.
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Affiliation(s)
- Jane Griffiths
- School of Nursing Midwifery and Social Work, University of Manchester, Manchester, United Kingdom.
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Abstract
This article explores the challenges of long-term case management for patients who have multiple sclerosis (MS). Currently there is scant research into district nursing input into long-term management of patients who have MS. Until now the role of the community nurses has been confined to palliation or terminal care, focusing on the more physical manifestations of MS. The contemporary role of district nurse is going to evolve to include proactive approaches. Governmental initiatives demand proactive services, and place emphasis on self-care for patients with MS. Themes that emerge from this article relate to the pre-existing skills--such as managing patients with complex needs and the advanced assessment skills--that will be required to achieve this. What is clear is that community nurses already possess many of the prerequisite skills needed for long-term management, and they should not be daunted by this prospect.
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