Patients’ and nurses’ perceptions of individualised care: an international comparative study

Empathic nurses with sufficient job resources are work-engaged professionals who deliver more individualized care

AIMS

This study examined whether nurse work engagement mediated the associations of job resources (collegial support and autonomy) and a personal resource (empathy) with individualized care delivery, in both hospital and long-term care settings. We also explored potential setting-specific differences in how strongly the resources were associated with work engagement and individualized care delivery among nurses.

DESIGN

We conducted a cross-sectional study in three hospitals and two long-term care facilities.

METHODS

In total, 454 nurses completed a web-based survey including validated measures on resources (collegial support, autonomy, empathy), work engagement and individualized care delivery. Data were analysed using mediation and moderated mediation analyses.

RESULTS

In both settings, all resources were indirectly associated with individualized care delivery via work engagement. Empathy was also directly associated with individualized care delivery, and a stronger association was found in the long-term care setting than in the hospital setting.

CONCLUSION

The present study showed work engagement to mediate the associations of job resources and empathy with individualized care delivery in both hospital and long-term care settings. Individualized care delivery was furthermore directly facilitated by high levels of empathy, especially among nurses working in long-term care settings.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Patients may benefit from better individualized care delivery by empathic nurses who are more work-engaged in the face of sufficient job resources in their practice environment.

IMPACT

Nurses are better able to deliver individualized care when provided with sufficient job resources (collegial support and autonomy) that support their being work-engaged professionals. Furthermore, empathic nurses also reported being able to better support patient individuality. These findings can be translated to policies of hospitals and long-term care facilities, to optimize job resources and enhance empathy and thus facilitate the support of patient individuality by nurses.

REPORTING METHOD

This study adhered to the STROBE guidelines.

PATIENT OR PUBLIC CONTRIBUTION

Nurses were involved in the design and data collection of the study.

Individualized care perceptions and moral distress of intensive care nurses

BACKGROUND

Intensive care settings are characterized by their structure, which constantly changes in parallel with scientific and technological developments, the uncertainty of the lifeline between birth and death, the challenges in the fair distribution of limited resources, the participation of individuals in medical decisions, and witnessing the pain experienced by individuals. These characteristics also affect the level of moral distress, which can make it difficult for ICU nurses to provide the most appropriate individualized care for their patients.

AIMS

The purpose of this study was to determine the moral distress levels and individualized care perceptions of intensive care nurses.

STUDY DESIGN

This study employed a cross-sectional descriptive survey design.

METHODS

This descriptive study was conducted with 128 nurses working in the intensive care units of a university hospital in Turkey. Data were collected using an 'Information Form', 'the Moral Distress Scale', and 'the Individualized Care Scale-Nurse Version'.

RESULTS

78.9% of the nurses stated that there was staff shortage, and 36.0% stated that the physical conditions were not suitable for care in the intensive care units in which they worked. The mean score on the Moral Distress Scale was 79.2 ± 46.4. The mean total score on the Individualized Care Scale-Nurse Version was 3.5 ± 0.8.

CONCLUSION

This study revealed that the intensive care nurses had moderate levels of moral distress and good levels of individualized care perceptions although there was no significant relationship between their moral distress levels and individualized care perceptions. Also, the nurses adopted care behaviours supporting patients' feelings and autonomy.

RELEVANCE TO CLINICAL PRACTICE

In our study, the intensive care nurses did not reflect their moderate-level moral distress in the individualized care provided. It could be beneficial to measure intensive care nurses' moral distress and care levels at frequent intervals so that early precautions could be taken to prevent the accumulation of moral distress and care difficulties among intensive care nurses.

Development of patient-centred care in acute hospital settings: A meta-narrative review

BACKGROUND

Patient-centred care is widely recognised as a core aspect of quality health care and has been integrated into policy internationally. There remains a disconnect between policy and practice, with organisations and researchers continuing to offer definitions and frameworks to suit the operational context. It is unclear if and how patient-centred care has been adopted in the acute care context.

AIM

To understand the development of patient-centred care in the context of acute hospital settings over the past decade.

METHODS

A literature review was conducted in accordance with RAMESES standards and principles for meta-narrative reviews. Five databases (Medline, CINAHL, SCOPUS, Cochrane Library, JBI) were searched for full-text articles published between 2012 and 2021 related to patient-centred care in the acute care setting, in the context of nursing, medicine and health policy. Literature reviews and discussion papers were excluded. Articles were selected based on their relevance to the research aim. Descriptive and thematic analysis and synthesis of data were undertaken via an interpretivist process to understand the development of the topic.

RESULTS

One hundred and twenty four articles were included that reported observational studies (n = 78), interventions (n = 34), tool development (n = 7), expert consensus (n = 2), quality improvement (n = 2), and reflection (n = 1). Most studies were conducted in developed countries and reported the perspective of patients (n = 33), nurses (n = 29), healthcare organisations (n = 7) or multiple perspectives (n = 50). Key words, key authors and organisations for patient-centred care were commonly recognised and provided a basis for the research. Fifty instruments measuring patient-centred care or its aspects were identified. Of the 34 interventions, most were implemented at the micro (clinical) level (n = 25) and appeared to improve care (n = 30). Four articles did not report outcomes. Analysis of the interventions identified three main types: i) staff-related, ii) patient and family-related, and iii) environment-related. Analysis of key findings identified five meta-narratives: i) facilitators of patient-centred care, ii) threats to patient-centred care, iii) outcomes of patient-centred care, iv) elements of patient-centred care, and v) expanding our understanding of patient-centred care.

CONCLUSIONS

Interest in patient centred care continues to grow, with reports shifting from conceptualising to operationalising patient-centred care. Interventions have been successfully implemented in acute care settings at the micro level, further research is needed to determine their sustainability and macro level implementation. Health services should consider staff, patient and organisational factors that can facilitate or threaten patient-centred care when planning interventions.

TWEETABLE ABSTRACT

Patient-centred care in acute care settings - we have arrived! Is it sustainable?

Critical Care Nurses' Adherence to Ethical Codes and Its Association with Spiritual Well-Being and Moral Sensitivity

Background

Adherence to ethical codes is a major pillar of nursing care that is affected by various factors. Identifying these factors can lead to better ethical performance. The present study was conducted to determine critical care nurses' adherence to ethical codes and its association with spiritual well-being (SWB) and moral sensitivity (MS).

Methods

In this descriptive-correlational study, data were collected using the moral sensitivity questionnaire (MSQ) by Lützén et al., Paloutzian and Ellison's spiritual well-being scale (SWBS), and the adherence to ethical codes questionnaire. The study was conducted on 298 nurses working in critical care units of hospitals affiliated with Shiraz University of Medical Sciences in southern Iran in 2019. This study was examined and approved by the Ethics Committee of Shiraz University of Medical Sciences.

Results

The majority of the participants were female (76.2%) and single (60.1%), with a mean age of 30.69 ± 5.74 years. The mean scores of adherence to ethical codes, SWB, and MS were 64.06 (good), 91.94 (moderate), and 134.08 (moderate), respectively. Adherence to ethical codes had a positive correlation with the total score of SWB (P < 0.001, r = 0.25) and MS (P < 0.001, r = 0.27). A positive correlation was also observed between MS and SWB (P < 0.001, r = 0.41). Meanwhile, MS (β = 0.21) had a greater effect than SWB (β = 0.157) on adherence to ethical codes.

Conclusion

Critical care nurses showed a good adherence to ethical codes. MS and SWB also positively affected their adherence to ethical codes. Nursing managers can use these findings to devise plans for the promotion of MS and SWB in nurses and thus help improve their ethical performance.

Individualised care in Flemish and Dutch hospitals: Comparing patients' and nurses' perceptions

BACKGROUND

Patient-centred care has been recognised as vital for today's healthcare quality. This type of care puts patients at the centre, contributing to positive patient outcomes such as patient autonomy. Empirical research comparing nurses' and patients' perceptions of the support and provision of patient-centred care is limited and focuses solely on nurses and patients working and staying on surgical wards.

AIMS AND OBJECTIVES

Comparing patients' and nurses' perceptions of patient-centred care on different types of hospital wards, and exploring if patient empowerment, health literacy, and certain sociodemographic and context-related variables are associated with these perceptions.

DESIGN

Cross-sectional design.

METHODS

Data were collected in ten Flemish (February-June 2016) and two Dutch (December 2014-May 2015) hospitals using the Individualised Care Scale (ICS). A linear mixed model was fitted. Data from 845 patients and 569 nurses were analysed. As the ICS was used to measure the concept of patient-centred care, it is described using the term 'individualised care.'

RESULTS

Nurses perceived that they supported and provided individualised care more compared with patients as they scored significantly higher on the ICS compared with patients. Patients with higher empowerment scores, higher health literacy, a degree lower than bachelor, a longer hospital stay, and patients who were employed and who were admitted to Dutch hospitals scored significantly higher on some of the ICS subscales/subsections. Nurses who were older and more experienced and those working in Dutch hospitals, regional hospitals and maternity wards scored significantly higher on some of the ICS subscales/subsections.

CONCLUSION

Nurses perceived that they supported and provided individualised care more compared with patients.

RELEVANCE TO CLINICAL PRACTICE

Creating a shared understanding towards the support and provision of individualised care should be a priority as this could generate more effective nursing care that takes into account the individuality of the patient.

Individualized Health Care for Older Diabetes Patients from the Perspective of Health Professionals and Service Consumers

Background: Individualized nursing care as a form of person-centered care delivery is a well-known approach in the health care context and is accepted as best practice by organizations and professionals, yet its implementation in everyday practice creates serious challenges. The aim was to assess and compare the perceptions of health professionals and older diabetes patients on their individual care in regard to the patient’s clinical situation, personal life situation, and decisional control. Methods: The quantitative study with a cross-sectional survey design was conducted from March 2019 until January 2021. The Individualized Care Scale was applied for the data collection. Health professionals (nurses and physicians, n = 70) and older diabetes patients (n = 145) participated in the study. The average duration of diabetes was 15.8 years (SD = 10.0) and type 2 diabetes was the most common (89.0%). The current glucose-lowering therapy for 51.0% of the patients was oral medications, 37.9% used injected insulin, and 11.1% were treated by combined therapy. Results: The highest-rated aspects of individualized care on both dimensions of the scale from the health professionals’ perspective related to the clinical situation, and the scores for provision were significantly higher than those for support. The highest means of patients’ ratings on the support dimension related to the clinical situation and the decisions over care sub-scale; for the care provision dimension, the highest individuality in care was assigned to the decisions over care sub-scale. The lowest ratings of individualized care, both in the health professionals’ and patients’ samples, related to the personal life situation sub-scale. Conclusions: Health professionals are more positive in regard to individualized care support and provisions for older diabetes patients than the patients themselves. Patient characteristics, such as the type of glucose-lowering therapy, education, and nutritional status, make a difference in patients’ understanding and experience of individuality in care.

Association between Turkish clinical nurses' perceptions of individualized care and empathic tendencies

PURPOSE

This study aimed to determine the association between nurses' perceptions of individualized care and empathic tendencies.

DESIGN AND METHODS

This cross-sectional study was conducted with 269 nurses working in Yozgat City Hospital between June 2018 and December 2018. Data were collected with the Personal Information Form, Individualized Care Scale-A-Nurse Version, Empathic Tendencies Scale. For the analysis, descriptive statistics, t test, analysis of variance, Pearson's correlation, multivariate linear regression analysis were used.

FINDINGS

Marital status, education level, length of service, clinic worked in, number of patients, and empathic tendency level was determined to be statistically significant predictive factors for nurses' perceptions of individualized care (P < .05).

PRACTICE IMPLICATIONS

Nurse managers can organize in-service training programs to improve clinical nurses' perceptions of individualized care, empathic tendencies, and skills.

Interactional practices in person-centred care: Conversation analysis of nurse-patient disagreement during self-management support

Background

Person‐centred care implies a change in interaction between care professionals and patients where patients are not passive recipients but co‐producers of care. The interactional practices of person‐centred care remain largely unexplored.

Objective

This study focuses on the analysis of disagreements, which are described as an important part in the co‐production of knowledge in interaction.

Design

A qualitative exploratory study using conversation analysis.

Setting and participants

Data were collected from a nurse‐led person‐centred intervention in a hospital outpatient setting. Interactions between adult patients with irritable bowel syndrome (n = 17) and a registered nurse were audio‐recorded. COREQ guidelines were applied.

Results

Disagreements were found after demonstration of the nurse's or patients’ respective professional or personal knowledge. Disagreements were also evident when deciding on strategies for self‐management. Although negotiations between opposing views of the nurse and patient were seen as important, the patient generally claimed final authority both in knowing how IBS is perceived and in the right to choose self‐management strategies. The nurse generally oriented towards patient authority, but instances of demonstration of nurse authority despite patient resistance were also found.

Discussion and conclusions

This study provides information on how co‐production of knowledge and decisions occur in the context of a person‐centred care intervention. Negotiations between nurse and patient views require a flexible approach to communication, adapting interaction to each context while bearing in mind the patients having the final authority. To facilitate co‐production, the patient's role and responsibilities in interaction should be explicitly stated.

Effect of an intervention on the congruence of nurses' and patients' perceptions of patient-centred care: A pre-test post-test study

AIMS AND OBJECTIVES

To evaluate measurement invariance of the Individualized Care Scale (ICS) across patients and nurses, and assess the degree of congruence in nurses' and patients' perceptions on patient-centredness and the impact of an intervention there on.

METHODS

A pre-post intervention study design with an expert by experience intervention was conducted in 2016 to 2017. Nurses (n = 138) and patients (n = 199) of two hospital departments in Belgium were surveyed. Patient-centredness was measured using the ICS (ICS-Nurse and ICS-Patient). Measurement invariance was evaluated by conducting multiple-group confirmatory factor analysis. Unpaired t tests and difference in difference analysis were used to evaluate the degree of congruence in nurses' and patients' perceptions on patient-centredness and assess pre-post changes in nurses' and patients' scores, respectively. SQUIRE guidelines were followed to report the study.

RESULTS

There was no evidence of measurement non-invariance. Nurses perceived the individuality of care more positively than patients both before and after the implementation of the intervention. Pre-post changes in nurses' and patients' scores were not statistically significant.

CONCLUSION

There is a significant gap between the perceptions of nurses and patients regarding the support and provision of individual care: nurses consider provided care as more individualized than patients do. To orient nurses' perspectives more towards their patients' perspective, multicomponent interventions are needed. Researchers and hospital managers may use the ICS to evaluate interventions that have the ability to close the gap in nurses' and patients' perceptions of patient-centredness. Embedding experts by experience in the professionals' team has the potential to foster patient-centredness but needs to focus on patients and nurses equally.

Validation of the Finnish Person-Centered care Climate Questionnaire-Patient and testing the relationship with individualised care

AIMS

The aim of the study was two-fold: (1) to test the psychometric properties of the Person-Centered care Climate Questionnaire-Patient-Finnish version (PCQ-P-Fin), and (2) to examine the associations between older patients' perceptions of the PCC climate and their perceptions of individuality in care delivered within acute care settings for older people.

DESIGN

An exploratory, correlational, cross-sectional survey design.

METHODS

The study was conducted within acute care settings for older people with heart failure (n = 111, response rate 54%). Data were collected with self-completed questionnaires, the Person-Centered care Climate Questionnaire-Patient version (PCQ-P-Fin) and the Individualized Care Scale-Patient (ICS-Patient-B), between 6/2016 and 5/2017. Data were analysed using descriptive statistics, Pearson's correlation coefficients, exploratory factor analysis and a Rasch analysis.

RESULTS

The PCQ-P-Fin showed satisfactory structural, construct and concurrent validity and high reliability. The ICS-B-Patient and the PCQ-P-Fin correlated strongly positive suggesting an association between the perceptions of individuality in care and the care climate.

CONCLUSION

The PCQ-P-Fin is a useful, reliable and valid tool. Characteristics of the care environment, especially the climate and the extent to which this is perceived to be person-centred, may be used to enhance perceptions of individualised care.

Factors associated with the provision of individualized care during hospitalization: A systematic review

AIM

To analyse and integrate the existing literature on nurses' perceptions regarding factors associated with the provision of individualized care in hospital contexts.

BACKGROUND

Individualized care considers the personal characteristics of patients and promotes their participation in decision-making. The application of individualized care is not standardized among professionals.

METHODS

A systematic literature search was performed in Scopus, Web of Science, MEDLINE, Índice Médico Español, CUIDEN, ProQuest, PsycoINFO, CINAHL and the Cochrane Library, for studies published in English or Spanish analysing nurses' perceptions on factors associated with the provision of individualized care.

RESULTS

A total of 6,330 articles were retrieved, of which 13 fulfilled the inclusion criteria. The provision of individualized care was influenced by the nurses' personal characteristics (academic training, being a specialist, age, professional experience, personal motivation, empathy and culture) and by organisational factors (staff ratio, routinization and standardization of care, autonomous professional practice, leadership and positive work environment).

CONCLUSIONS

Nurses' perceptions on the provision of individualized care are influenced by their personal characteristics and organisational factors.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers may optimize personalization of care by encouraging positive work environments; ensuring adequate staffing; avoiding routinization or standardization of care; and promoting training, leadership and autonomy of nursing professionals.

Contemporaneous patient and health professional views of patient-centred care: a systematic review

OBJECTIVE

To understand the domains of agreement and disagreement, related to person-centred care, between the patient and healthcare professional during a shared episode of care.

DESIGN

A systematic review following the PRISMA protocol searched PubMed (Medline), CINAHL, PsychInfo and Scopus using keywords for health professionals, patients and patient-centred care. A descriptive-interpretive method was used to identify domains described in the person-centred care framework.

SETTING

Research conducted in all healthcare settings (inpatient, outpatient, community) were included.

PARTICIPANTS

Research which presented the contemporaneous perspectives of a health professional and the person they were providing services to were included.

INTERVENTION(S)

Research regarding the delivery of any type of health service was included.

MAIN OUTCOME MEASURE(S)

The person-centred care framework which includes Structure, Process and Outcome as measures for implementing person-centred care was used to interpret and summarize the data.

RESULTS

After title and abstract screening against inclusion and exclusion criteria, 15 of 1,406 studies were critically appraised. High levels of contemporaneous agreement were identified for easily accessible, supportive and accommodating environments, where information sharing occurred. Contemporaneous agreement occurred most often between patients and healthcare professionals in the importance of sharing information across all geographical settings, with greatest disagreement of patient involvement in the European and American hospital environments.

CONCLUSIONS

Greater understanding of the context of information sharing and drivers for management preferences may support shared decision-making and increase satisfaction. More information regarding contemporaneous experiences of healthcare episodes is required to further inform patient-centred care practices and optimize health outcomes.

Exploring person-centred fundamental nursing care in hospital wards: A multi-site ethnography

Objective

To explore how nurses in hospitals enact person‐centred fundamental care delivery.

Background

Effective person‐centred care is at the heart of fundamental nursing care, but it is deemed to be challenging in acute health care as there is a strong biomedical focus and most nurses are not trained in person‐centred fundamental care delivery. We therefore need to know if and how nurses currently incorporate a person‐centred approach during fundamental care.

Design

Focused ethnography approach.

Methods

Observations of 30 nurses on three different wards in two Dutch hospitals during their morning shift. Data were collected through passive observations and analysed using framework analysis based on the fundamentals of care framework. The COREQ guideline was used for reporting.

Results

Some nurses successfully integrate physical, psychosocial and relational elements of care in patient interactions. However, most nurses were observed to be mainly focused on physical care and did not take the time at their patients’ bedside to care for their psychosocial and relational needs. Many had a task‐focused way of working and communicating, seldom incorporating patients’ needs and experiences or discussing care planning, and often disturbing each other.

Conclusions

This study demonstrates that although some nurses manage to do so, person‐centred fundamental care delivery remains a challenge in hospitals, as most nurses have a task‐focused approach and therefore do not manage to integrate the physical, relational and physical elements of care. For further improvement, attention needs to be paid to integrated fundamental care and clinical reasoning skills.

Relevance to clinical practice

Although most nurses have a compassionate approach, this study shows that nurses do not incorporate psychosocial care or encourage patient participation when helping patients with their physical fundamental care needs, even though there seems to be sufficient opportunity for them to do so.

Quality of life and satisfaction affect individualized nursing care perceptions in intensive care

This study was conducted as a cross-sectional and correlational study in order to determine the affects of quality of life and life satisfaction on individualized nursing care perceptions in intensive care patients. This study was conducted with the participation of 317 patients who were treated as inpatients in the adult intensive care units of two state hospitals between 15.02.2017-15.08.2017. The data were collected using the patient information form, SF-36 Quality of Life scale, Satisfaction with Life scale, ICS-A Patient Version and ICS-B Patient Version. The patients' mean total score of the ICS-A Patient Version was 3.5±0.7 while that of the ICS-B Patient Version 3.3±0.6, and that of the Satisfaction with Life scale was found to be 21.7±5.9. The scores of the ICS-A and ICS-B Patient Version as well as SF-36 Quality-of-Life Scale and Satisfaction with Life scalewere identified to differ depending on some sociodemographic and clinical characteristics of the patients. The individualized nursing care perceptions of the patients in the intensive care unit were found to be above moderate, and a relationship between quality of life, life satisfaction, and individualized care perceptions was found.

Improved patient satisfaction 2 years after introducing person-centred handover in an oncological inpatient care setting

AIMS AND OBJECTIVES

To investigate patients' satisfaction with care, 2 years after the introduction of person-centred handover (PCH) in an oncological inpatient setting, and to describe patients' perceptions of individualised care.

BACKGROUND

To obtain higher levels of patient satisfaction, bedside nursing handovers have been evaluated with positive results. One such model is PCH, which blends aspects of person-centred care with the bedside report and provides the opportunity for nursing staff and patients to perform the handover together.

DESIGN

A survey-based design was used with one data collection period. Patient satisfaction scores were compared with baseline data from a previous study that has been conducted in the same wards.

METHOD

Patient satisfaction was measured with the EORTC IN-PATSAT32 questionnaire, and individualised care was assessed with the Individualized Care Scale. A total of 120 adult patients with cancer were invited to participate from August 2017-March 2018. Of these, 90 chose to participate. The STROBE checklist for cross-sectional studies was used when preparing the paper.

RESULTS

Compared to the previous study, statistically significant improvements in patient satisfaction were observed in the subscales "Exchange of information between caregivers" and "Nurses' information provision" postimplementation of PCH. Regarding patients' perceptions of individualised care, the highest scores were in the ICS-A subscale "Clinical situation" and ICS-B "Decisional control," while "Personal life situation" scored the lowest overall.

CONCLUSIONS

Person-centred handover seems to have sustainable positive effects on important outcomes regarding patient satisfaction. A novel finding is the positive impact on nurses' information provision, indicating that PCH can facilitate effective information exchange between patients and nurses.

RELEVANCE TO CLINICAL PRACTICE

Person-centred handover seems to improve patients' satisfaction with nurses' provision and exchange of information. Nurses and managers should carefully consider the implementation process of PCH and evaluate its long-term effects. PCH can be recommended in the oncology inpatient setting.

Organizational and Managerial Resources and Quality of Care in French Pediatric Oncology Nursing

The purpose of this study was to examine the relationships between nurses' organizational and managerial resources (ie, perceived organizational support and transformational leadership) and their quality of patient care, and second, the mediating role of job satisfaction in these relationships. Participants were 510 nurses from 25 out of 29 French pediatric oncology units. Structural equation modeling results revealed that perceived organizational support and transformational leadership were related to nurses' perceived quality of care and that job satisfaction acted as a mediator between these 2 antecedents (ie, organizational and managerial determinants) and this outcome (ie, quality of care). Based on these findings, practical suggestions and directions for future research are discussed.

Nursing students' perceptions of their instructors' caring behaviors: A four-country study

BACKGROUND

Caring is the core and essence of the nursing profession. Nurse educators, are in a key position to role model for perspective nurses the role of caring while including caring as a vital component in a nursing curriculum.

OBJECTIVES

This paper is a report on students' perceptions of instructors' caring behavior in four countries: India, Greece, Nigeria, and the Philippines.

METHODS

This study utilized a quantitative, cross-sectional, comparative approach. A total of 450 nursing students participated with an almost equal nursing student frequency distribution. The main instrument used in this study was the Nursing Students' Perceptions of Instructor Caring (NSPIC). The study was conducted during the months of September 2013 to January 2014. Descriptive statistics, correlations analysis, linear regression model and one-way analysis of variance (ANOVA) were used to analyze the data collected.

FINDINGS

The highest rated subscale in the NSPIC was "instills confidence through caring" (M=4.268, SD=0.964), while the lowest ranked subscale was for the subscale "Control versus flexibility" (M=3.609, SD=1.076). No significant correlations were found between the NSPIC scale and gender (F=0.060, p=0.807), age (F=3.220, p=0.073), educational level (F=0.100, p=0.752) and family status of students (F=1.417, p=0.235), except the country of origin (F=3.703, p=0.012, η(2)=0.024).

CONCLUSION

With this study as an initial investigation into ascertaining nursing instructors caring focused on a cross-country approach, nurse educators can utilize this information to better portray their role as a nurse educator when being perceived by their nursing students.

Educational strategies and challenges in peritoneal dialysis: a qualitative study of renal nurses' experiences

AIMS AND OBJECTIVES

The aim of the study was to explore renal nurses' experiences, strategies and challenges with regard to the patient education process in peritoneal dialysis.

BACKGROUND

Patient education in peritoneal dialysis is essential to developing a successful home-based peritoneal dialysis program. In this area research is scarce and there is a particular lack of focus on the perspective of the renal nurse.

DESIGN

Qualitative design formed by thematic qualitative text analysis.

METHODS

Five group interviews (n = 20) were used to explore the challenges peritoneal dialysis nurses face and the training strategies they use. The interviews were analyzed with thematic qualitative content analysis using deductive and inductive subcategory application.

RESULTS

The findings revealed the education barriers perceived by nurses that patients may face. They also showed that using assessment tools is important in peritoneal dialysis patient education, as is developing strategies to promote patient self-management. There is a need for a deeper understanding of affective learning objectives, and existing teaching activities and materials should be revised to incorporate the patient's perspective. Patients usually begin having questions about peritoneal dialysis when they return home and are described as feeling overwhelmed. Adapting existing conditions is considered a major challenge for patients and nurses.

CONCLUSIONS

The results provided useful insights into the best approaches to educating peritoneal dialysis patients and served to raise awareness of challenges experienced by renal nurses. Findings underline the need for nosogogy - an approach of teaching adults (andragogy) with a chronic disease. Flexibility and cooperation are competencies that renal nurses must possess.

RELEVANCE TO CLINICAL PRACTICE

Still psychomotor skills dominate peritoneal dialysis patient training, there is a need of both a deeper understanding of affective learning objectives and the accurate use of (self-)assessment tools, particularly for health literacy.

The meaning of slow nursing in dementia care

Research literature in the dementia field lacks examples of ‘best-practices’ demonstrating concretely how it is possible to support the sense of coherence in people with dementia. The purpose of this study was to elucidate the nurses’ views concerning a caring approach that may support the sense of coherence in people with dementia. The data were collected through participant observation and focus group interviews during a four-month period in 2011. Sixteen registered nurses recruited from two Norwegian nursing homes participated in this study. The data were interpreted using a phenomenological-hermeneutical method. Three themes were identified: ‘being in the moment’, ‘doing one thing at a time’, and ‘creating joy and contentment’. An overall interpretation of these themes is described by the metaphor ‘slow nursing’, a caring approach that may lead to supporting the sense of coherence in people with dementia.

Spiritual wellbeing, Attitude toward Spiritual Care and its Relationship with Spiritual Care Competence among Critical Care Nurses

Introduction: Nurses’ spiritual wellbeing and their attitude toward spirituality and competence of nurses in providing of spiritual care can affect the quality of care in nursing. The aim of this study was to evaluate spiritual wellbeing, attitude toward spiritual care and its relationship with the spiritual care competence among nurses.

Methods: This was a correlational descriptive study conducted on 109 nurses working in the Intensive Care Units of Imam Reza and Madani hospitals in 2015, Tabriz, Iran. Data collection tools were a demographic data form and three standard questionnaires including Spiritual Wellbeing Scale, Spirituality and Spiritual

Results: The mean score of the spiritual wellbeing was 94.45 (14.84), the spiritual care perspective was 58.77 (8.67), and the spiritual care competence was 98.51 (15.44). The linear regression model showed 0.42 variance between the spiritual care competence scores which were explained by the two aspects of spiritual wellbeing (religious health, existential health) and three aspects of spiritual care perspective (spirituality, spiritual care, personalized care). The spiritual care competence had a positive relationship with spiritual wellbeing and spiritual care perspective.

Conclusion: Because of the nature of nursing and importance of close interaction of nurses with patients in ICUs, the higher nurses’ SW and the more their positive attitude toward spiritual care, the more they can provide spiritual care to their patients.

Patients' decision-making experiences in the acute healthcare setting--a case study

BACKGROUND

The transition from being an ordinary citizen to a hospitalised patient can be a daunting experience particularly for the uninitiated and inexperienced. Patients are likely to have questions such as 'where do I go?', 'what should I do?', 'when?' and 'who should I ask?' The process for making practical moment-to-moment decisions is often complex and fraught with difficulties. Identifying critical points in the hospitalisation experience may provide insights into the quality of hospital management systems and professional practices from a patient perspective.

OBJECTIVE

This study aimed to identify institutional practices and structures in the context of acute healthcare settings which impact on patient moment-to-moment decision-making experiences.

METHOD

A case study approach was used as the exploratory methodology, and interviews were conducted with three former adult inpatients. In order to gain an understanding of each participant's experiences, data collecting strategies used in this research were a semistructured interview and document analysis of information documents, such as hospital supplied pamphlets, provided to the researcher by the participants.

RESULTS

The study identified five major themes. Identified as being critical to the participants were information sharing by healthcare professionals, professional advice and professional role identification. Less so were environment and everyday life. Associated with these themes were the participant's common experience of being confined in unfamiliar surroundings, adjusting to institutional routines and of being heavily dependent on others.

CONCLUSION

Findings indicate that patient moment-to-moment decision-making may be informed and enhanced in several areas: relevant and timely information sharing, varying the dress code between the different professions, reducing conflicting professional advice, clear signage around the hospital, and flexible visiting hours, telephones and clocks in patient rooms.

The German version of the Individualized Care Scale - assessing validity and reliability

AIM

To assess validity and reliability of the German version of the Individualized Care Scale (ICS).

BACKGROUND

Individualized nursing care plays a pivotal role in establishing patient-centered care. To assess individualized nursing care and to compare it in different settings and countries, valid and reliable instruments are needed. No psychometric-tested instrument for comparing individualized nursing care with other countries is available in Germany.

DESIGN

Cross-sectional study.

METHODS

Data were collected between September 2013 and June 2014 from 606 patients in 20 wards in five hospitals across Germany. Unidimensionality of the ICS scales ICSA (patients' views on how individuality is supported through nursing interventions) and ICSB (patients' perceptions of individualized nursing care) was analyzed by confirmatory factor analysis. Internal consistency was assessed by calculating Cronbach's alpha. The Smoliner Scale (patients' perceptions of the decision-making process in nursing care) and results from participating hospitals' assessment of the nursing care delivery systems were used to assess known-groups validity and concurrent validity.

RESULTS

Fit indices of confirmatory factor analysis indicate unidimensionality of the ICSA (Comparative Fit Index: 0.92; Tucker-Lewis Index: 0.902; root mean square error of approximation: 0.09; standardized root mean square residual: 0.05) and the ICSB (Comparative Fit Index: 0.91; Tucker-Lewis Index: 0.89; root mean square error of approximation: 0.09; standardized root mean square residual: 0.05). Internal consistency using Cronbach's alpha was 0.95 (95% confidence interval: 0.94-0.95) for ICSA and 0.93 (95% confidence interval: 0.92-0.94) for the ICSB. Concurrent validity was established by a significant relationship between the Smoliner Scale and ICSA (r=0.66; P<0.01) and ICSB (r=0.72; P<0.01). Known-groups validity was approved by ICSA/ICSB score differences related to nursing care delivery systems and patients' perceptions of decision-making style.

CONCLUSION

The German version of the ICS is deemed a valid and reliable instrument for use in practice and research with hospitalized patients.

Difference between received and expected knowledge of patients undergoing knee or hip replacement in seven European countries

The purpose of the study was to examine received and expected knowledge of patients with knee/hip arthroplasty in seven European countries. The goal was to obtain information for developing empowering patient education. The data were collected (during 2009-2012) from patients (n = 943) with hip/knee arthroplasty prior to scheduled preoperative education and before discharge with the Received Knowledge of hospital patient scale (RKhp) and Expected Knowledge of hospital patient scale (EKhp). Patients' knowledge expectations were high but the level of received knowledge did not correspond to expectations. The difference between received and expected knowledge was higher in Greece and Sweden compared with Finland (p < .0001, p < .0001), Spain (p < .0001, p = .001), and Lithuania (p = .005, p = .003), respectively. Patients' knowledge expectations are important in tailoring patient education. To achieve high standards in the future, scientific research collaboration on empowering patient education is needed between European countries.

The relationship between individualized care and the practice environment: an international study

BACKGROUND

Previous research studies have found that the better the quality of practice environments in hospitals, the better the outcomes for nurses and patients. Practice environment may influence nurses' ability to individualize care but the detailed relationship between individualized care and the professional practice environment has not been investigated widely. Some evidence exists about the association of practice environments with the level of individualization of nursing care, but this evidence is based on single national studies.

OBJECTIVES

The aim of this study was to determine whether nurses' views of their professional practice environment associate with their views of the level of care individualization in seven countries.

DESIGN

This study had an international, multisite, prospective, cross-sectional, exploratory survey design.

SETTINGS

The study involved acute orthopedic and trauma surgical inpatient wards (n=91) in acute care hospitals (n=34) in seven countries, Cyprus, Finland, Greece, the State of Kansas, USA, Portugal, Sweden, and Turkey.

PARTICIPANTS

Nurses (n=1163), registered or licensed practical, working in direct patient care, in orthopedic and trauma inpatient units in acute care hospitals in seven countries participated in the study.

METHODS

Self-administered questionnaires, including two instruments, the Revised Professional Practice Environment and the Individualized Care Scale-Nurse (Individualized Care Scale-Nurse A and B) were used for data collection. Data were analyzed statistically using descriptive statistics, simultaneous multiple regression analysis, and generalized linear model.

RESULTS

Two regression models were applied to assess the predictive validity of the Revised Professional Practice Environment on the Individualized Care Scale-Nurse-A and B. The results showed that elements of the professional practice environment were associated with care individualization. Internal work motivation, cultural sensitivity, control over practice, teamwork, and staff relationship with physicians were predictors of support (Individualized Care Scale-A) for and the delivery (Individualized Care Scale-B) of individualized care.

CONCLUSIONS

The results of this study provide evidence that environment aspect could explain variations in care individualization. These findings support the assertion that individualized care needs to be understood in a broader context than the immediate nurse-patient relationship and that careful development of the care environment may be an effective way to improve care quality and outcomes.

Patients' Point of View about Nurses' Support of Individualized Nursing Care in Training Hospitals Affiliated with Tabriz University of Medical Sciences

INTRODUCTION

Individualized nursing care is the key element in quality of nursing care. In fact, it changes all standardized nursing procedures and activities. In addition, it tailored nursing activities with unique peculiarity of each patient. Focusing on patient during care process is one main reason for supporting individualized care. Individual differences among patients in terms of their health, illness and needs which emphasize on providing individualized care. This research aimed to demonstrate patients' point of view about nurses' support of individualized care.

METHODS

A descriptive study conducted with participation of 400 being discharged patients from internal and surgical units in teaching hospitals of Tabriz University of Medical Sciences. Proportional stratified random sampling method was used. Data was collected by interviewing with patients using Suhonen Individualized Care Scale, after assessing its content validity and reliability with Chronbach's alpha method. Data analysis were done by using SPSS ver. 13.

RESULTS

The mean of patients' point of view about nurses' support of individualized care was 2.60 (1.14). The results showed the mean of support for clinical situation 2.61 (1.27), support for personal life situation 2.36 (1.28), and support for decisional control over care 2.77 (1.17). Comparing aspects of support showed that support for decisional control over care was the highest and the lowest was support for personal life situation.

CONCLUSION

According to results of the study and comparison with other researches in other countries, it is recommended that nursing care planners pay more attention to the aspects of nursing support based on individuals.

Rationing of Nursing Care Within Professional Environmental Constraints

The purpose of this study was to examine rationing of nursing care and the possible relationship between nurses’ perceptions of their professional practice environment and care rationing. A total of 393 nurses from medical and surgical units participated in the study. Data were collected using the Basel Extent of Rationing of Nursing Care (BERNCA) instrument and the Revised Professional Practice Environment (RPPE) Scale. The highest level of rationing was reported for “reviewing of patient documentation” ( M = 1.15, SD = 0.94; 31.2% sometimes or often) followed by “oral and dental hygiene” ( M = 1.06, SD = 0.94; 31.5% sometimes or often) and “coping with the delayed response of physicians” ( M = 1.04, SD = 0.96; 30% sometimes or often). Regression analyses showed that teamwork, leadership and autonomy, and communication about patients accounted in total 18.4% of the variance in rationing. In regard to application, the association between the practice environment and rationing suggests improvements in certain aspects that could minimize rationing.