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Hellzén O, Ness TM, Ingstad K, Ludvigsen MS, Nissen AM, Devik SA. Adapting to home care in Norway: A longitudinal case study of older Adults' experiences. J Aging Stud 2024; 68:101215. [PMID: 38458722 DOI: 10.1016/j.jaging.2024.101215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 01/31/2024] [Accepted: 02/06/2024] [Indexed: 03/10/2024]
Abstract
This study aimed to describe how older adults with complex health problems manage their everyday lives in their own homes and how they interact with given home care. In this multiple-case study, a total of 14 individual interviews were conducted with five older adults over the course of one year. Deductive and inductive content analyses were performed. Three descriptive categories were each identified in the deductive ('home care as interpersonal continuity', 'home care as information continuity' and 'home care as management continuity') and inductive analyses ('Lack of social contact with carers', 'Desire to be heard throughout the care process' and 'Carers are short on time'). Quality home care services are difficult to realize if interpersonal interaction is subordinated to effective task-solving.
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Affiliation(s)
- Ove Hellzén
- Department of Nursing, Mid-Sweden University, Sundsvall, Sweden.
| | - Tove Mentsen Ness
- Faculty of Nursing and Health Sciences, Nord University, Namsos, Norway.
| | - Kari Ingstad
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway.
| | - Mette Spliid Ludvigsen
- Department of Clinical Medicine-Randers Regional Hospital, Aarhus University, Aarhus, Denmark.
| | | | - Siri Andreassen Devik
- Centre of Care Research, Mid-Norway, Faculty of Nursing and Health Sciences, Nord University, Namsos, Norway..
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Johansson M, Amir LH. 'I don't want to be a guinea pig' - Swedish women's experiences of breast abscess treatment. BMC Womens Health 2024; 24:106. [PMID: 38331786 PMCID: PMC10851594 DOI: 10.1186/s12905-024-02937-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 01/29/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND It is well known that breastfeeding plays an important role in the health of women and children. However, women are not always given optimal support and most do not reach their breastfeeding goals. About one in five, breastfeeding women report mastitis and a small proportion of these develop a breast abscess. Our aim was to describe the experiences of a group of Swedish breastfeeding women who developed a breast abscess. METHODS A qualitative cross-sectional study with 18 study participants was undertaken in Sweden in 2017-2018. Potential participants were identified through electronic medical records at a university hospital and invited to participate in audio-recorded telephone interviews. Women were between 2 and 24 months postpartum at the time of the interview, on average 8 months. We conducted a thematic analysis in six steps according to Braun and Clark. RESULTS Our analysis identified two themes: 1) Seeking care and receiving treatment was long and unpleasant, and 2) Importance of adequate professional care. Women who experienced a breast abscess were uncertain about where to ask for professional help. They often had a long wait for the right time to undergo the unpleasant and painful procedure of draining their breast abscess. The women felt it was important to receive professional care with respectful communication, continuity of care, and to receive adequate information, but they did not always receive this level of care. CONCLUSIONS Women with puerperal breast abscesses often fall between medical specialty areas. No longer under the care of obstetricians and maternity services, their problem is too complicated for general practitioners or emergency departments, but not regarded as serious by breast surgeons. Healthcare professionals urgently need adequate training in order to deal with breastfeeding problems and be able to offer women-centred care.
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Affiliation(s)
- Margareta Johansson
- Department of Women's and Children's Health, Uppsala University, Akademiska University Hospital, SE-751 85, Uppsala, Sweden.
| | - Lisa H Amir
- Judith Lumley Centre, School of Nursing & Midwifery, La Trobe University, Bundoora, Victoria, Australia
- Breastfeeding Service, Royal Women's Hospital, Melbourne, Australia
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King K, Baker E, Baker MJ. Clinical learning for pre-registration nursing students: a viva voce approach during COVID-19. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:260-265. [PMID: 36913333 DOI: 10.12968/bjon.2023.32.5.260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
The COVID-19 pandemic restricted face-to-face contact between students and educators, limiting continual assessment of student's clinical skill development. This led to rapid transformational online adaptations to nursing education. This article will present and discuss the introduction of a clinical 'viva voce' approach, which has been used at one university to formatively assess students' clinical learning and reasoning skills using virtual methods. The Virtual Clinical Competency Conversation (V3C) was developed using the 'Think aloud approach' and involved facilitated one-to-one discussion based on two questions from a bank of 17 predefined clinically focused questions. A total of 81 pre-registration students completed the formative assessment process. Overall, feedback from students and academic facilitators was positive and facilitated both learning and consolidation in a safe and nurturing way. Further local evaluation is continuing to measure the impact of the V3C approach on student learning now that some aspects of face-to-face education have resumed.
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Affiliation(s)
- Kathryn King
- Senior Teaching Fellow, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London
| | - Edward Baker
- Lecturer, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London
| | - Mark J Baker
- Lecturer, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London
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Simpson J, Zarotti N, Varey S, Anestis E, Holland C, Murray C, Eccles FJ. 'It's a double whammy': A qualitative study of illness uncertainty in individuals with Parkinson's disease in the context of COVID-19. Chronic Illn 2022; 18:860-873. [PMID: 34524910 PMCID: PMC9643113 DOI: 10.1177/17423953211043101] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The purpose of this study was to explore the experiences of individuals with Parkinson's through the theoretical lens of illness uncertainty during the first UK full lockdown period (March-June 2020) put in place due outbreak of the COVID-19 pandemic. METHODS Individual semi-structured interviews were carried out via telephone in May 2020 with 10 individuals with Parkinson's (six men and four women) recruited from Parkinson's UK. Interviews were recorded and transcribed verbatim, and thematic analysis was adopted to analyse the resulting data. RESULTS Four overarching themes emerged from the interview data: (1) COVID-19 amplifying existing fears and difficulties around the uncertainty of Parkinson's; (2) practical and psychological efforts to manage uncertainty; (3) benefit-finding as a way of acknowledging the positives of lockdown; (4) risk and future management in the context of uncertainty. DISCUSSION Participants reported a range of implicit and explicit strategies to cope with the 'double whammy' of uncertainty caused by having Parkinson's during a global pandemic. While these were generally successful in maintaining well-being, it is important that such successful accounts are used to help inform novel strategies and interventions targeting individuals who might need additional support.
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Affiliation(s)
- Jane Simpson
- 83563Division of Health Research, 151268Faculty of Health and Medicine, Lancaster University, UK
| | - Nicolò Zarotti
- 83563Division of Health Research, 151268Faculty of Health and Medicine, Lancaster University, UK
| | - Sandra Varey
- 83563Division of Health Research, 151268Faculty of Health and Medicine, Lancaster University, UK
| | - Eleftherios Anestis
- 83563Division of Health Research, 151268Faculty of Health and Medicine, Lancaster University, UK
| | - Carol Holland
- 83563Division of Health Research, 151268Faculty of Health and Medicine, Lancaster University, UK
| | - Craig Murray
- 83563Division of Health Research, 151268Faculty of Health and Medicine, Lancaster University, UK
| | - Fiona Jr Eccles
- 83563Division of Health Research, 151268Faculty of Health and Medicine, Lancaster University, UK
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5
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Begin AS, Hidrue MK, Lehrhoff S, Lennes IT, Armstrong K, Weilburg JB, del Carmen MG, Wasfy JH. Association of Self-reported Primary Care Physician Tolerance for Uncertainty With Variations in Resource Use and Patient Experience. JAMA Netw Open 2022; 5:e2229521. [PMID: 36048444 PMCID: PMC9437748 DOI: 10.1001/jamanetworkopen.2022.29521] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
IMPORTANCE Inappropriate variations in clinical practice are a known cause of poor quality and safety, with variations often associated with nonclinical factors, such as individual differences in cognitive processing. The differential response of physicians to uncertainty may explain some of the variations in resource use and patient experience. OBJECTIVE To examine the association of physician tolerance for uncertainty with variations in resource use and patient experience. DESIGN, SETTING, AND PARTICIPANTS This survey study linked physician survey data (May to June 2019), patient experience survey data (January 2016 to December 2019), and billing data (January 2019 to December 2019) among primary care physicians (PCPs) at Massachusetts General Hospital with at least 10 visits in 2019. The statistical analysis was performed in 2021. MAIN OUTCOMES AND MEASURES The analysis examined associations of PCP tolerance for uncertainty with the tendency to order diagnostic tests, the frequency of outpatient visits, hospital admissions, emergency department visits, and patient experience data (focused on physician communication and overall rating). A 2-stage hierarchical framework was used to account for clustering of patients under PCPs. Binary outcomes were modeled using a hierarchical logistic model, and count outcomes were modeled using hierarchical Poisson or negative binomial models. The analysis was adjusted for patient demographic variables (age, sex, and race and ethnicity), socioeconomic factors (payer and neighborhood income), and clinical comorbidities. RESULTS Of 217 included physicians, 137 (63.1%) were women, and 174 (80.2%) were adult PCPs. A total of 62 physicians (28.6%) reported low tolerance, 59 (27.2%) reported medium tolerance, and 96 (44.2%) reported high tolerance for uncertainty. Physicians with a low tolerance for uncertainty were less likely to order complete blood cell counts (odds ratio [OR], 0.66; 95% CI, 0.50-0.88), thyroid tests (OR, 0.67; 95% CI, 0.52-0.88), a basic metabolic profile (OR, 0.78; 95% CI, 0.60-1.00), and liver function tests (OR, 0.72; 95% CI, 0.53-0.99) than physicians with a high tolerance for uncertainty. Physicians who reported higher tolerance for uncertainty were more likely to receive higher patient experience scores for listening to patients carefully (OR, 0.65; 95% CI, 0.50-0.83) and higher overall ratings (OR, 0.80; 95% CI, 0.66-0.98) than physicians with medium tolerance. Conversely, no association was found between physician tolerance for uncertainty and patient outpatient visits, hospital admissions, or emergency department visits. CONCLUSIONS AND RELEVANCE In clinical practice, identifying and effectively managing inappropriate variations and improving patient experience have proven to be difficult, despite increased attention to these issues. This study supports the hypothesis that physicians' tolerance for uncertainty is associated with differences in resource use and patient experience. Whether enhancing physicians' tolerance for uncertainty could help reduce unwarranted practice variations, improve quality and patient safety, and improve patient's experience remains to be established.
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Affiliation(s)
- Arabella S. Begin
- Department of Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | | | - Sara Lehrhoff
- Massachusetts General Physicians Organization, Boston
| | | | - Katrina Armstrong
- Department of Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
- Columbia University Irving Medical Center, New York, New York
| | - Jeffrey B. Weilburg
- Massachusetts General Physicians Organization, Boston
- Department of Psychiatry, Massachusetts General Hospital, Boston
| | - Marcela G. del Carmen
- Harvard Medical School, Boston, Massachusetts
- Massachusetts General Physicians Organization, Boston
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology and Reproductive Biology, Massachusetts General Hospital, Boston
| | - Jason H. Wasfy
- Department of Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston
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Ashton J. Editorial. JOURNAL OF PUBLIC MENTAL HEALTH 2022. [DOI: 10.1108/jpmh-09-2022-157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Uncertainty in illness among individuals with schizophrenia: a phenomenology study in Indonesia. JOURNAL OF PUBLIC MENTAL HEALTH 2022. [DOI: 10.1108/jpmh-03-2022-0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Individuals with schizophrenia experience uncertainty due to the unpredictable symptoms, the course of the illness and poor knowledge about the disease, treatment and prognosis. Uncertainty in illness is linked with poor treatment outcomes, coping strategies, check-up decisions and psychological distress. This study aims to explore the uncertainty in illness among individuals with schizophrenia.
Design/methodology/approach
Eight individuals with schizophrenia living in the community were interviewed regarding their illness. The phenomenology approach was used to collect and analyze the data.
Findings
Three themes emerged from the findings of the study; the unpredictable course of the illness, compliance amid uncertainty and uncertainty of information about their illness. This study provides an essential overview of how patients with schizophrenia live in uncertain conditions.
Originality/value
It should be considered by various parties, particularly the community mental health nurses working with individuals with schizophrenia. Considering the uncertainty of illness while looking after or interacting with patients and their family is significant in improving adequate mental health-care delivery.
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Dattilo TM, Roberts CM, Fisher RS, Traino KA, Edwards CS, Pepper-Davis M, Chaney JM, Mullins LL. The Role of Avoidance Coping and Illness Uncertainty in the Relationship Between Transition Readiness and Health Anxiety. J Pediatr Nurs 2021; 59:125-130. [PMID: 33878537 DOI: 10.1016/j.pedn.2021.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 04/05/2021] [Accepted: 04/06/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE The transition to college is associated with numerous stressors, including environmental changes, increased academic expectations, and changes in social support, all of which may be exacerbated by the added responsibility of managing a chronic medical condition. Huang (2019) proposed a model examining the relationships between coping styles, transition readiness, and health anxiety, and suggested that greater transition readiness is associated with adaptive coping strategies and less health anxiety. However, there are limited findings as to how poor transition readiness relates to health anxiety. Therefore, the current study tested a serial mediation model (i.e., poor transition readiness → avoidance coping → illness uncertainty → health anxiety). DESIGN AND METHODS College students (N = 194) with a chronic medical condition completed self-report questionnaires. RESULTS Results indicated several direct effects among the modeled variables and a significant poor transition readiness → avoidance coping → illness uncertainty → health anxiety serial mediation (path a1d21b2 = 0.438, 95% CI = 0.153 to 0.913). CONCLUSIONS Worse transition readiness was associated with increased avoidance as a coping mechanism, which in turn is associated with increased illness uncertainty, and ultimately health anxiety. The current findings identified possible drivers of health anxiety in college students with a chronic medical condition. PRACTICE IMPLICATIONS These findings highlight that good transition readiness skills may buffer against maladaptive avoidance, illness uncertainty, and health anxiety. Modules aimed at improving healthcare management, avoidance, and illness uncertainty may be beneficial additions to interventions to reduce health anxiety.
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Affiliation(s)
- Taylor M Dattilo
- Center for Pediatric Psychology, Department of Psychology, Oklahoma State University, Stillwater, OK, USA.
| | - Caroline M Roberts
- Center for Pediatric Psychology, Department of Psychology, Oklahoma State University, Stillwater, OK, USA
| | - Rachel S Fisher
- Center for Pediatric Psychology, Department of Psychology, Oklahoma State University, Stillwater, OK, USA
| | - Katherine A Traino
- Center for Pediatric Psychology, Department of Psychology, Oklahoma State University, Stillwater, OK, USA
| | - Clayton S Edwards
- Center for Pediatric Psychology, Department of Psychology, Oklahoma State University, Stillwater, OK, USA
| | - Morgan Pepper-Davis
- Center for Pediatric Psychology, Department of Psychology, Oklahoma State University, Stillwater, OK, USA
| | - John M Chaney
- Center for Pediatric Psychology, Department of Psychology, Oklahoma State University, Stillwater, OK, USA
| | - Larry L Mullins
- Center for Pediatric Psychology, Department of Psychology, Oklahoma State University, Stillwater, OK, USA
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What is known about palliative care in adult patients with allogeneic stem cell transplantation (allo-SCT)? Ann Hematol 2021; 100:1377-1389. [PMID: 33954817 PMCID: PMC8116288 DOI: 10.1007/s00277-021-04538-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 04/19/2021] [Indexed: 11/02/2022]
Abstract
Patients undergoing allogeneic stem cell transplantation (allo-SCT) are given a real chance of cure, but at the same time are confronted with a considerable risk of mortality and of severe long-term impediments. This narrative, non-systematic literature review aims to describe the supportive and palliative care needs of allo-SCT recipients, including long-term survivors or those relapsing or dying after transplantation. It also evaluates the feasibility and effectivity of integrating palliative care early in transplant procedures. In this appraisal of available literature, the main findings relate to symptoms like fatigue and psychological distress, which appear to be very common in the whole allo-SCT trajectory and might even persist many years post-transplantation. Chronic GvHD has a major negative impact on quality of life. Overall, there is a paucity of research on further issues in the context of allo-SCT, like the distress related to the frequently unpredictable post-transplant trajectory and prognosis, as well as the end-of-life phase. First randomized controlled results support the effectiveness of early integration of specialized palliative care expertise into transplant algorithms. Barriers to this implementation are discussed.
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10
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Ueland V, Rørtveit K, Dysvik E, Furnes B. Life after cancer treatment - existential experiences of longing. Int J Qual Stud Health Well-being 2020; 15:1838041. [PMID: 33112718 PMCID: PMC7599008 DOI: 10.1080/17482631.2020.1838041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Purpose: The study aimed to gain insight into existential longing as experienced by people treated for cancer. Method: An exploratory phenomenological–hermeneutical design was used, and data were collected through in-depth interviews with 21 people recruited from a cancer organization. Results: Three themes emerged: longing to be oneself, longing for relief from suffering, and longing for rootedness. The theoretical understanding of well-being developed by Todres and Galvin was used to illuminate how the life-fulfilling power of longing is inherent in dwelling–mobility. Conclusions: During the theoretical interpretation and discussion of these findings, a new analytic step revealed a state of uncertainty that can influence longing. The findings of this study may help fill the gap in the current health-care approach to cancer survivors by highlighting the importance of a new professional perspective of listening to patients describe their existential burden. Such an approach may create greater clarity and thereby allow longing to flow more freely towards future possibilities and well-being.
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Affiliation(s)
- Venke Ueland
- Faculty of Health Sciences, University of Stavanger , Stavanger, Norway
| | - Kristine Rørtveit
- Faculty of Health Sciences, University of Stavanger , Stavanger, Norway.,Researcher of Psychiatric Nursing at Department of Research, Stavanger University Hospital , Stavanger, Norway
| | - Elin Dysvik
- Faculty of Health Sciences, University of Stavanger , Stavanger, Norway
| | - Bodil Furnes
- Faculty of Health Sciences, University of Stavanger , Stavanger, Norway
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Ahmadi M, Gheibizadeh M, Rassouli M, Ebadi A, Asadizaker M, Jahanifar M. Experience of Uncertainty in Patients with Thalassemia Major: A Qualitative Study. Int J Hematol Oncol Stem Cell Res 2020; 14:237-247. [PMID: 33603985 PMCID: PMC7876423 DOI: 10.18502/ijhoscr.v14i4.4479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background: Uncertainty leads to a stressful situation in patients with thalassemia major that can dramatically affect their psychosocial coping ability, treatment process and disease outcomes, and reduce patients' quality of life. As one of the important factors affecting the health of thalassemia patients, understanding the concept of uncertainty is of major importance to health care providers especially nurses as the first line of exposure to these patients. The present study aimed to explore the experiences of uncertainty in patients with thalassemia major. Materials and Methods: The present qualitative study was conducted through in-depth face-to-face semi-structured interviews held with 18 patients with major thalassemia selected through purposive sampling. Interviews continued until saturation of data. All interviews were recorded, transcribed and analyzed with conventional content analysis method of Landman and Graneheim using MAXQDA10 software. Results: Two main themes, including 'living in the shadow of anxiety' and 'coping with uncertainty' emerged from patients’ experiences of illness uncertainty of thalassemia. 'Living in the shadow of anxiety' included four categories of 'fear of complications', 'contradictory views on treatment', 'unknown future' and 'stigma'. 'Coping with uncertainty' included three categories of 'spiritual coping', 'psychosocial coping' and 'knowledge acquisition'. Conclusion: According to the results of this study, uncertainty is a major psychological stress in patients with thalassemia major. Healthcare providers should therefore consider the challenges and concerns faced by patients and, through utilizing appropriate training and communicational practices, plan interventions and strategies to empower patients for coping with uncertainty.
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Affiliation(s)
- Mehrnaz Ahmadi
- Department of Nursing, Student Research Committee, School of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mahin Gheibizadeh
- Nursing Care Research Center in Chronic Diseases, Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Maryam Rassouli
- School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abbas Ebadi
- Behavioral Sciences Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran.,Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Marziyeh Asadizaker
- Nursing Care Research Center in Chronic Diseases, Jundishapur University of Medical Sciences, Ahvaz, Iran
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Hardy MS, Dallaire C. [Using lived experiences and theoretical insights to gain a better understanding of the adaptation difficulties encountered by elderly patients with chronic heart failure during the hospital-to-home transition]. Rech Soins Infirm 2020; 141:38-48. [PMID: 32988188 DOI: 10.3917/rsi.141.0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Heart failure is one of the most common reasons for hospitalization in older people, and the hospital-to-home transition can be unsuccessful for these patients. Existing care programs focus primarily on the physiological aspects of the disease and are rarely based on theory. Using Roy's adaptation model (1), the aim of this study was to develop a thorough understanding of the adaptation difficulties and factors that influence how well elderly patients with chronic heart failure cope with the hospital-to-home transition, in order to develop a nursing interventions program. Based on the process proposed by Sidani and Braden (2011), this qualitative descriptive study adopted a deductive approach, with the use of intermediary theories and empirical data, as well as an inductive approach, where older people with chronic heart failure (n=7), caregivers (n=6), and healthcare professionals (n=14) participated in semi-structured individual interviews. The triangulation of data highlights the difficulties and factors influencing adaptation at the physical, psychological, and social levels. Gaining a better understanding of the experience of older people with heart failure when it comes to their transition from hospital to home, and doing so with a holistic vision, provides information for interventions that can contribute to better management of chronic disease and a better quality of life for these elderly patients.
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13
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Rørtveit K, Saetre Hansen B, Joa I, Lode K, Severinsson E. Qualitative evaluation in nursing interventions-A review of the literature. Nurs Open 2020; 7:1285-1298. [PMID: 32802349 PMCID: PMC7424442 DOI: 10.1002/nop2.519] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 05/01/2020] [Indexed: 11/17/2022] Open
Abstract
Aim To identify and synthesize qualitative evaluation methods used in nursing interventions. Design A systematic qualitative review with a content analysis. Four databases were used: MEDLINE, PsycINFO, Embase and CINAHL using pre-defined terms. The included papers were published from 2014-2018. Methods We followed the guidelines of Dixon-Woods et al., Sandelowski and Barroso, the Critical Appraisal Skills Programme qualitative checklist and The Confidence in the Evidence from Reviews of Qualitative Research Approach. Results Of 103 papers, 15 were eligible for inclusion. The main theme Challenging complexity by evaluating qualitatively described processes and characteristics of qualitative evaluation. Two analytic themes emerged: Evaluating the implementation process and Evaluating improvements brought about by the programme. Conclusion Different qualitative evaluation methods in nursing are a way of documenting knowledge that is difficult to illuminate in natural settings and make an important contribution when determining the pros and cons of an intervention.
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Affiliation(s)
- Kristine Rørtveit
- Department of Research, Nursing and Healthcare Research GroupStavanger University HospitalStavangerNorway
| | - Britt Saetre Hansen
- Department of Research, Nursing and Healthcare Research GroupStavanger University HospitalStavangerNorway
| | - Inge Joa
- Department of Research, Nursing and Healthcare Research GroupStavanger University HospitalStavangerNorway
| | - Kirsten Lode
- Department of Research, Nursing and Healthcare Research GroupStavanger University HospitalStavangerNorway
| | - Elisabeth Severinsson
- Department of Research, Nursing and Healthcare Research GroupStavanger University HospitalStavangerNorway
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Unson C, Flynn D, Chukwurah Q, Glendon MA, Testut T. Uncertainty in Transition of African American Caregivers. Issues Ment Health Nurs 2020; 41:445-454. [PMID: 32186923 DOI: 10.1080/01612840.2019.1678080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The purpose of this study was to gain an understanding of the ambiguities and uncertainties experienced by a diverse group of African-American caregivers. The study applied Schlossberg's transition theory (TT) and Mishel's revised uncertainty theory to narratives of self-identified African-American caregivers who provided care at least 5 h a week. The men (6) and women (8) were mostly unmarried, mostly caring for a parent or grandparent. The caregivers' average age was 52 (SD = 19; ages ranged from 24 to 82 years); and the care recipients' average age was 84 (SD = 9). Six care recipients had dementia and the remainder had multiple disease diagnoses. Narratives were obtained by in-depth interviews or focus group discussions. These were audio-recorded, transcribed verbatim professionally and analyzed independently by trained coders. Schlossberg's TT contextualized whereas Mishel's RUIT illuminated the characteristics of the transition, its associated uncertainty, and their relationship to the development of caregiver stress. Situational factors such as difficulties with illness symptoms of the care recipient, conflict between previous experience and current expectations and the adjustments to the new caregiving role, burdened younger caregivers more than older caregivers. Self-factors related to lack of knowledge about the illness and feelings of lack of control. Social support was predominantly provided by family members, and its absence resulted in conflict among siblings and caregiver stress. The most common coping strategies include religiosity, expectations of reciprocity, and coming to terms with the uncertainty. Understanding the feelings, perceptions and needs of caregivers in transition is tantamount to providing nursing care.
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Affiliation(s)
- Christine Unson
- Department of Public Health, Southern Connecticut State University, New Haven, Connecticut, USA
| | - Deborah Flynn
- Department of Public Health, Southern Connecticut State University, New Haven, Connecticut, USA
| | | | - Mary Anne Glendon
- Department of Nursing, Southern Connecticut State University, New Haven, Connecticut, USA
| | - Tammy Testut
- Sacred Heart University, College of Nursing, Fairfield, Connecticut, USA
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Communicating Uncertainty: a Narrative Review and Framework for Future Research. J Gen Intern Med 2019; 34:2586-2591. [PMID: 31197729 PMCID: PMC6848305 DOI: 10.1007/s11606-019-04860-8] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 12/03/2018] [Accepted: 01/02/2019] [Indexed: 10/26/2022]
Abstract
Discussing the uncertainty associated with a clinical decision is thought to be a critical element of shared decision-making. Yet, empirical evidence suggests that clinicians rarely communicate clinical uncertainty to patients, and indeed the culture within healthcare environments is often to equate uncertainty with ignorance or failure. Understanding the rationale for discussion of uncertainty along with the current evidence about approaches to communicating and managing uncertainty can advance shared decision-making as well as highlight gaps in evidence. With an increasing focus on personalized healthcare, and advances in genomics and new disease biomarkers, a more sophisticated understanding of how to communicate the limitations and errors that come from applying population-based, epidemiologic findings to predict individuals' futures is going to be essential. This article provides a narrative review of studies relating to the communication of uncertainty, highlighting current strategies together with challenges and barriers, and outlining a framework for future research.
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Kropf-Staub S, Eicher M, Haslbeck J, Metzenthin P. Selbstmanagement bei Krebstherapien fördern: Das Symptom-Navi-Programm. Pflege 2019; 32:267-276. [PMID: 31441714 DOI: 10.1024/1012-5302/a000696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Support self-management of symptoms in cancer therapies:The Symptom-Navi-Program Abstract. Background: Cancer patients experience a variety of symptoms associated with their disease and treatment. Many patients express uncertainty how to self-manage these symptoms. We developed the Symptom-Navi-Program (SNP) to support cancer patients' symptom self-management. The SNP comprises concise information leaflets, Symptom-Navi-Flyers (SNF), with content tailored to the needs of patients and nurse-led semi-structured consultations. AIM The aim of the study was to to explore if patients experienced with the SNP with a focus on the perceived usefulness. METHOD In a qualitative study, we conducted ten semi-structured interviews with cancer patients undergoing treatment. The interviews conduct and data analysis was based on thematic analysis as defined by 1-2Braun and Clarke (2006). RESULTS Overall, patients described the SNP as a helpful facilitator for their self-management of symptoms. They highlighted its usefulness in an emotionally challenging situation. Nurse-led education and SNF tailored to the individual situation were experienced as self-management empowering elements. Consequently, patients experienced to know and have more choices in their symptom management strategies. Patients also described to use SNF to inform their relatives. CONCLUSIONS Patients experience the SNP as a promising tool to facilitate their symptom self-management. Its implementation in clinical practice will now be further evaluated.
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Affiliation(s)
| | - Manuela Eicher
- Institut Universitaire de Formation et de Recherche en Soins, Université de Lausanne / Fachdozentin Hochschule für Gesundheit, Freiburg HES-SO
| | - Jörg Haslbeck
- Krebsliga Schweiz, Bern.,Institut für Pflegewissenschaft, Universität Basel
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Palese A, Rossettini G, Colloca L, Testa M. The impact of contextual factors on nursing outcomes and the role of placebo/nocebo effects: a discussion paper. Pain Rep 2019; 4:e716. [PMID: 31583342 PMCID: PMC6749917 DOI: 10.1097/pr9.0000000000000716] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 11/23/2018] [Accepted: 01/05/2019] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Placebo and nocebo effects represent one of the most fascinating topics in the health care field. OBJECTIVES the aims of this discussion paper were (1) to briefly introduce the placebo and nocebo effects, (2) to elucidate the contextual factors able to trigger placebo and nocebo effects in the nursing field, and (3) to debate the impact of contextual factors on nursing education, practice, organisation, and research. METHODS a narrative review was conducted based on the available evidence. RESULTS Placebo responses (from Latin "I shall please") are a beneficial outcome(s) triggered by a positive context. The opposite are the nocebo effects (from Latin "I shall harm"), which indicates an undesirable outcome(s) caused by a negative context. Both are complex and distinct psychoneurobiological phenomena in which behavioural and neurophysiological changes arise subsequent to an interaction between the patient and the health care context. CONCLUSION Placebo and nocebo concepts have been recently introduced in the nursing discipline, generating a wide debate on ethical issues; however, the impact on nursing education, clinical practice, nursing administration, and research regarding contextual factors triggering nocebo and placebo effects has not been debated to date.
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Affiliation(s)
- Alvisa Palese
- Department Biological and Medical Science, University of Udine, Italy, Udine, Italy
| | - Giacomo Rossettini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, Italy, Savona, Italy
| | - Luana Colloca
- Department of Pain Translational Symptom Science, School of Nursing, University of Maryland, Baltimore, MD, USA
- Departments of Anesthesiology and Psychiatry, School of Medicine, Center to Advance Chronic Pain Research, University of Maryland, Baltimore, MD, USA
| | - Marco Testa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, Italy, Savona, Italy
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Arias Rojas EM, Carreño Moreno SP, Chaparro Díaz OL. Incertidumbre ante la enfermedad crónica. Revisión integrativa. REVISTA LATINOAMERICANA DE BIOÉTICA 2018. [DOI: 10.18359/rlbi.3575] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Este estudio tiene como objetivo integrar la evidencia acerca de la incertidumbre ante la enfermedad en el paciente con enfermedad crónica y su cuidador familiar, guiados por la teoría de la incertidumbre ante la enfermedad. Para esto se realizó una síntesis integrativa de la literatura durante los años 2007 a 2017. Se usaron las bases de datos Medline, Science Direct, Ovid Nursing, Scielo, Scopus, CINAHL y Psycinfo en los idiomas inglés y español. Para realizar la síntesis integrativa se incluyeron 46 publicaciones, con 21 estudios de tipo cualitativo, 19 cuantitativo, 2 mixtos y 4 revisiones. Los estudios se realizaron en su mayoría en pacientes con cáncer, enfermedades neurodegenerativas, fallos orgánicos, falla cardiaca, EPOC y en cuidados paliativos de distintas enfermedades. Dentro de las principales conclusiones del estudio se plantea que la persona con enfermedad crónica y su cuidador familiar desarrollan incertidumbre ante la enfermedad crónica debido a falencias en la educación acerca de la enfermedad y el cuidado, así como el soporte social que reciben del equipo de salud y de sus redes de apoyo.
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Strang S, Osmanovic M, Hallberg C, Strang P. Family Caregivers' Heavy and Overloaded Burden in Advanced Chronic Obstructive Pulmonary Disease. J Palliat Med 2018; 21:1768-1772. [PMID: 30118371 DOI: 10.1089/jpm.2018.0010] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Due to severe symptoms and poor prognosis in advanced cases, chronic obstructive pulmonary disease (COPD) is today seen as a palliative diagnosis. The everyday lives of patients as well as their relatives are restricted and affected by significant psychosocial problems. OBJECTIVE To obtain detailed knowledge about people's experiences, for example, transitions in relationships, responsibility, and possible changes in communication, caused by the illness. DESIGN This is a qualitative interview study using both focus group interviews and individual interviews. SETTING/SUBJECTS In total, 35 family members with personal experience of living with a person with severe COPD were interviewed. MEASUREMENTS The semistructured interviews were audio-recorded, transcribed verbatim, and analyzed with a qualitative content analysis. RESULTS Three themes emerged: (1) A restricted everyday life. The family caregivers felt confined to their own home, they had to be constantly attentive, and their lives became increasingly restricted. (2) A changed relationship. There was a shift in responsibility and their mutual communication. The family caregivers' own needs were neglected and the relationship was affected. (3) Joy through adaption. Still, caregivers strived for normality and, through gradual adaption, they could still experience joy. CONCLUSIONS Being a family caregiver is a burdensome and complex situation. Besides providing practical help, the family caregiver needs to support the ill person. Roles and communication patterns are changed. Healthcare staff must identify the needs of the family caregivers. A family caregiver who feels acknowledged and confident can support their severely ill family member.
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Affiliation(s)
- Susann Strang
- 1 Angered Hospital, Angered, Sweden.,2 Institute of Caring Sciences and Health, University of Gothenburg, Gothenburg, Sweden
| | | | | | - Peter Strang
- 3 Department of Oncology-Pathology, Karolinska Institutet, Stockholm and Stockholms Sjukhem, Stockholm, Sweden
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Carlbo A, Claesson HP, Åström S. Nurses' Experiences in using Physical Activity as Complementary Treatment in Patients with Schizophrenia. Issues Ment Health Nurs 2018; 39:600-607. [PMID: 29505316 DOI: 10.1080/01612840.2018.1429508] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Schizophrenia is a common disease with a high risk of comorbidity in both psychiatric and somatic diseases. Physical activity is proven effective in reducing symptoms of schizophrenia and increasing overall health. Still it is not used systematically in the care of persons with schizophrenia. AIM The aim of this study is to describe nurses' experience, including personal motivation, in using physical activity as complementary treatment in patients with schizophrenia. METHOD Interviews in three focus groups with 12 participating nurses were conducted. Qualitative content analysis was used to analyze data. RESULTS Physical activity was commonly used. Although several nurses signaled positive patient response, i.e. less anxiety and better quality of sleep, the overall consensus was an uncertainty regarding the benefits. It was perceived as non-evidence based form of intervention. CONCLUSION The uncertainty of the benefits of physical activity is evident in nursing staff and poses a resistance to implement systematic physical activity as a complementary treatment in schizophrenia. A new awareness of evidence based nursing is suggested to promote a wider and more receptive attitude to reduce patient vulnerability in persons with schizophrenia.
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Affiliation(s)
- Adam Carlbo
- a University West, Faculty of Health Sciences , Trollhättan , Sweden
| | | | - Sture Åström
- b Umeå University, Faculty of Nursing , Umeå , Sweden
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Berntsen G, Høyem A, Lettrem I, Ruland C, Rumpsfeld M, Gammon D. A person-centered integrated care quality framework, based on a qualitative study of patients' evaluation of care in light of chronic care ideals. BMC Health Serv Res 2018; 18:479. [PMID: 29925357 PMCID: PMC6011266 DOI: 10.1186/s12913-018-3246-z] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 05/29/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Person-Centered Integrated Care (PC-IC) is believed to improve outcomes and experience for persons with multiple long-term and complex conditions. No broad consensus exists regarding how to capture the patient-experienced quality of PC-IC. Most PC-IC evaluation tools focus on care events or care in general. Building on others' and our previous work, we outlined a 4-stage goal-oriented PC-IC process ideal: 1) Personalized goal setting 2) Care planning aligned with goals 3) Care delivery according to plan, and 4) Evaluation of goal attainment. We aimed to explore, apply, refine and operationalize this quality of care framework. METHODS This paper is a qualitative evaluative review of the individual Patient Pathways (iPP) experiences of 19 strategically chosen persons with multimorbidity in light of ideals for chronic care. The iPP includes all care events, addressing the persons collected health issues, organized by time. We constructed iPPs based on the electronic health record (from general practice, nursing services, and hospital) with patient follow-up interviews. The application of the framework and its refinement were parallel processes. Both were based on analysis of salient themes in the empirical material in light of the PC-IC process ideal and progressively more informed applications of themes and questions. RESULTS The informants consistently reviewed care quality by how care supported/ threatened their long-term goals. Personal goals were either implicit or identified by "What matters to you?" Informants expected care to address their long-term goals and placed responsibility for care quality and delivery at the system level. The PC-IC process framework exposed system failure in identifying long-term goals, provision of shared long-term multimorbidity care plans, monitoring of care delivery and goal evaluation. The PC-IC framework includes descriptions of ideal care, key questions and literature references for each stage of the PC-IC process. This first version of a PC-IC process framework needs further validation in other settings. CONCLUSION Gaps in care that are invisible with event-based quality of care frameworks become apparent when evaluated by a long-term goal-driven PC-IC process framework. The framework appears meaningful to persons with multimorbidity.
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Affiliation(s)
- Gro Berntsen
- Norwegian center for eHealth research, University Hospital of Northern Norway, PB. 35, 9038 Tromsø, Norway
- Department of primary care, Institute of community medicine, UIT – The Arctic University of Norway, PB 6050, Langnes, 9037 Tromsø, Norway
| | - Audhild Høyem
- Department of Integrated Care, University Hospital of Northern Norway, PB. 35, 9038 Tromsø, Norway
| | - Idar Lettrem
- General Practice Health Centre, 9050, Storsteinnes, Norway
| | - Cornelia Ruland
- Department of Integrated Care, University Hospital of Northern Norway, PB. 35, 9038 Tromsø, Norway
| | - Markus Rumpsfeld
- Department of primary care, Institute of community medicine, UIT – The Arctic University of Norway, PB 6050, Langnes, 9037 Tromsø, Norway
- Department for Internal Medicine, University Hospital of Northern Norway, PB 101, 9038 Tromsø, Norway
| | - Deede Gammon
- Norwegian center for eHealth research, University Hospital of Northern Norway, PB. 35, 9038 Tromsø, Norway
- Center for Shared Decision Making and Collaborative Care Research, Oslo University Hospital, Sogn Arena, Pb 4950 Nydalen, N-0424 Oslo, Norway
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Bhise V, Meyer AND, Menon S, Singhal G, Street RL, Giardina TD, Singh H. Patient perspectives on how physicians communicate diagnostic uncertainty: An experimental vignette study. Int J Qual Health Care 2018; 30:2-8. [PMID: 29329438 DOI: 10.1093/intqhc/mzx170] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 12/29/2017] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE We evaluated the effects of three different strategies for communicating diagnostic uncertainty on patient perceptions of physician competence and visit satisfaction. DESIGN/SETTING Experimental vignette-based study design involving pediatric cases presented to a convenience sample of parents living in a large US city. PARTICIPANTS/INTERVENTION(S) Three vignettes were developed, each describing one of three different ways physicians communicated diagnostic uncertainty to parents-(i) explicit expression of uncertainty ('not sure' about diagnosis), (ii) implicit expression of uncertainty using broad differential diagnoses and (iii) implicit expression of uncertainty using 'most likely' diagnoses. Participants were randomly assigned to one of the three vignettes and then answered a 37-item web-based questionnaire. MAIN OUTCOME MEASURE(S) Outcome variables included parent-perceived technical competence of physician, trust and confidence, visit satisfaction and adherence to physician instructions. Differences between the three groups were compared using analysis of variance, followed by individual post hoc analyses with Bonferroni correction. RESULTS Seventy-one participants completed the vignette questions. Demographic characteristics and scores on activation (parent activation measure [PAM]) and intolerance to uncertainty were similar across the three groups. Explicit expression of uncertainty was associated with lower perceived technical competence, less trust and confidence, and lower patient adherence as compared to the two groups with implicit communication. These latter two groups had comparable outcomes. CONCLUSION Parents may react less negatively in terms of perceived competence, physician confidence and trust, and intention to adhere when diagnostic uncertainty is communicated using implicit strategies, such as using broad differential diagnoses or most likely diagnoses. Evidence-based strategies to communicate diagnostic uncertainty to patients need further development.
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Affiliation(s)
- Viraj Bhise
- Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Boulevard, Houston, TX 77030, USA
- Department of Medicine, Section of Health Services Research, Baylor College of Medicine, 2002 Holcombe Boulevard, Houston, TX 77030, USA
| | - Ashley N D Meyer
- Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Boulevard, Houston, TX 77030, USA
- Department of Medicine, Section of Health Services Research, Baylor College of Medicine, 2002 Holcombe Boulevard, Houston, TX 77030, USA
| | - Shailaja Menon
- Houston Community College, 1300 Holman Street, Houston, TX 77004, USA
| | - Geeta Singhal
- Pediatric Hospital Medicine, Texas Children's Hospital, 6621 Fannin Street, Houston, TX 77030, USA
| | - Richard L Street
- Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Boulevard, Houston, TX 77030, USA
- Department of Medicine, Section of Health Services Research, Baylor College of Medicine, 2002 Holcombe Boulevard, Houston, TX 77030, USA
- Department of Communication, Texas A&M University, 4234 TAMU, College Station, TX 77843, USA
| | - Traber D Giardina
- Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Boulevard, Houston, TX 77030, USA
- Department of Medicine, Section of Health Services Research, Baylor College of Medicine, 2002 Holcombe Boulevard, Houston, TX 77030, USA
| | - Hardeep Singh
- Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Boulevard, Houston, TX 77030, USA
- Department of Medicine, Section of Health Services Research, Baylor College of Medicine, 2002 Holcombe Boulevard, Houston, TX 77030, USA
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Keer-Keer T. The lived experience of adults with myasthenia gravis: A phenomenological study. AUSTRALASIAN JOURNAL OF NEUROSCIENCE 2018. [DOI: 10.21307/ajon-2017-112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Kim YS, Tae YS, Nam KH, Kim HY. The Experience of Uncertainty in Cancer Patients Undergoing Chemotherapy. ASIAN ONCOLOGY NURSING 2018. [DOI: 10.5388/aon.2018.18.3.115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Yoon Sun Kim
- Dongnam Institute of Radiological & Medical Sciences, Busan, Korea
| | | | - Keum Hee Nam
- Department of Nursing, Masan University, Changwon, Korea
| | - Heui Yeoung Kim
- Department of Nursing, Dong-A University Hospital, Busan, Korea
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Pizer SD, Davies ML, Prentice JC. Consult Coordination Affects Patient Experience. AMERICAN JOURNAL OF ACCOUNTABLE CARE 2017; 5:23-28. [PMID: 34466768 PMCID: PMC8404203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVES The Medicare accountable care organization (ACO) program financially rewards ACOs for providing high-quality healthcare, and also factors in the patient experience of care. This study examined whether administrative measures of wait times for specialist consults are associated with self-reported patient satisfaction. STUDY DESIGN Analyses used administrative and survey data from a clinically integrated healthcare system similar to an ACO. METHODS Veterans Health Administration (VHA) data from 2012 was obtained. Administrative access metrics included the number of days between the creation of the consult request and: 1) first action taken on the consult, 2) scheduling of the consult, and 3) completion of the consult. The Survey of Healthcare Experiences of Patients-which is modeled after the Consumer Assessment of Healthcare Providers and Systems family of survey instruments used by ACOs to measure patient experience-provided the outcome measures. Outcomes included general VHA satisfaction measures and satisfaction with timeliness of care, including wait times for specialists and treatments. Logistic regression models predicted the likelihood of patients reporting being satisfied on each outcome. Models were risk adjusted for demographics, self-reported health, and healthcare use. RESULTS Longer waits for the scheduling of consults and completed consults were found to be significantly associated with decreased patient satisfaction. CONCLUSIONS Because patients often report high levels of powerlessness and uncertainty while waiting for consultation, these wait times are an important patient-centered access metric for ACOs to consider. ACOs should have systems and tools in place to streamline the specialist consult referral process and increase care coordination.
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Affiliation(s)
- Steven D Pizer
- Partnered Evidence-based Policy Resource Center (SDP, JCP), Boston VA Healthcare System, Boston, MA and Office of Veterans Access to Care (MLD), Department of Veterans Affairs, Washington, DC; Department of Pharmacy and Health System Sciences, Northeastern University (SDP), Boston, MA; School of Medicine and Public Health, Boston University (JCP), Boston, MA
| | - Michael L Davies
- Partnered Evidence-based Policy Resource Center (SDP, JCP), Boston VA Healthcare System, Boston, MA and Office of Veterans Access to Care (MLD), Department of Veterans Affairs, Washington, DC; Department of Pharmacy and Health System Sciences, Northeastern University (SDP), Boston, MA; School of Medicine and Public Health, Boston University (JCP), Boston, MA
| | - Julia C Prentice
- Partnered Evidence-based Policy Resource Center (SDP, JCP), Boston VA Healthcare System, Boston, MA and Office of Veterans Access to Care (MLD), Department of Veterans Affairs, Washington, DC; Department of Pharmacy and Health System Sciences, Northeastern University (SDP), Boston, MA; School of Medicine and Public Health, Boston University (JCP), Boston, MA
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Etkind SN, Bristowe K, Bailey K, Selman LE, Murtagh FE. How does uncertainty shape patient experience in advanced illness? A secondary analysis of qualitative data. Palliat Med 2017; 31:171-180. [PMID: 27129679 PMCID: PMC5302072 DOI: 10.1177/0269216316647610] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Uncertainty is common in advanced illness but is infrequently studied in this context. If poorly addressed, uncertainty can lead to adverse patient outcomes. AIM We aimed to understand patient experiences of uncertainty in advanced illness and develop a typology of patients' responses and preferences to inform practice. DESIGN Secondary analysis of qualitative interview transcripts. Studies were assessed for inclusion and interviews were sampled using maximum-variation sampling. Analysis used a thematic approach with 10% of coding cross-checked to enhance reliability. SETTING/PARTICIPANTS Qualitative interviews from six studies including patients with heart failure, chronic obstructive pulmonary disease, renal disease, cancer and liver failure. RESULTS A total of 30 transcripts were analysed. Median age was 75 (range, 43-95), 12 patients were women. The impact of uncertainty was frequently discussed: the main related themes were engagement with illness, information needs, patient priorities and the period of time that patients mainly focused their attention on (temporal focus). A typology of patient responses to uncertainty was developed from these themes. CONCLUSION Uncertainty influences patient experience in advanced illness through affecting patients' information needs, preferences and future priorities for care. Our typology aids understanding of how patients with advanced illness respond to uncertainty. Assessment of these three factors may be a useful starting point to guide clinical assessment and shared decision making.
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Affiliation(s)
- Simon Noah Etkind
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, London, UK
| | - Katherine Bristowe
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, London, UK
| | - Katharine Bailey
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, London, UK
| | - Lucy Ellen Selman
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, London, UK
| | - Fliss Em Murtagh
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, London, UK
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Rørtveit K, Furnes B, Dysvik E, Ueland V. Struggle for a Meaningful Life after Obesity Treatment—A Qualitative Systematic Literature Review. ACTA ACUST UNITED AC 2017. [DOI: 10.4236/ojn.2017.712103] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Mehrabi E, Hajian S, Simbar M, Hoshyari M, Zayeri F. The Lived Experience of Iranian Women Confronting Breast Cancer Diagnosis. J Caring Sci 2016; 5:43-55. [PMID: 26989665 PMCID: PMC4794544 DOI: 10.15171/jcs.2016.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 09/17/2015] [Indexed: 02/01/2023] Open
Abstract
Introduction: The populations who survive from
breast cancer are growing; nevertheless, they mostly encounter with many cancer
related problems in their life, especially after early diagnosis and have to
deal with these problems. Except for the disease entity, several socio-cultural
factors may affect confronting this challenge among patients and the way they
deal with. Present study was carried out to prepare clear understanding of
Iranian women's lived experiences confronting breast cancer diagnosis and coping
ways they applied to deal with it. Methods: This study was carried out by using
qualitative phenomenological design. Data gathering was done through purposive
sampling using semi-structured, in-depth interviews with 18 women who survived
from breast cancer. The transcribed interviews were analyzed using Van Manen’s
thematic analysis approach. Results: Two main themes were emerged from the
interviews including "emotional turbulence" and "threat control". The first,
comprised three sub themes including uncertainty, perceived worries, and living
with fears. The second included risk control, recurrence control, immediate
seeking help, seeking support and resource to spirituality. Conclusion: Emotional response was the immediate
reflection to cancer diagnosis. However, during post-treatment period a variety
of emotions were not uncommon findings, patients' perceptions have been changing
along the time and problem-focused coping strategies have replaced. Although
women may experience a degree of improvement and adjustment with illness, the
emotional problems are not necessarily resolved, they may continue and gradually
engender positive outcomes.
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Affiliation(s)
- Esmat Mehrabi
- Department of Midwifery, Faculty of Nursing & Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sepideh Hajian
- Department of Nursing, Department of Midwifery And Reproductive Health, Faculty of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoomeh Simbar
- Department of Nursing, Department of Midwifery And Reproductive Health, Faculty of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Hoshyari
- Department of Radiation Oncology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farid Zayeri
- Department of Biostatistics, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Östman M, Jakobsson Ung E, Falk K. Continuity means "preserving a consistent whole"--A grounded theory study. Int J Qual Stud Health Well-being 2015; 10:29872. [PMID: 26714652 PMCID: PMC4695618 DOI: 10.3402/qhw.v10.29872] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/24/2015] [Indexed: 11/26/2022] Open
Abstract
Living with a chronic disease like chronic heart failure (CHF) results in disruptions, losses, and setbacks in the participants' daily lives that affect health and well-being. By using grounded theory method, we illuminate whether persons with CHF experience discontinuity in life and, if so, what helps them to preserve and strengthen continuity in their daily lives. Thirteen individual interviews and one group interview with five participants, aged 62 to 88 years, were carried out. Through data collection and data analysis, we constructed three concepts that make up a model illustrating the participants' experiences in daily life in relation to corporeality, temporality, and identity: experiences of discontinuity, recapturing approaches, and reconciliation. The first concept, experiences of discontinuity, was constructed from the following categories: the alienated body, the disrupted time, and the threatened self. The second concept, recapturing approaches, consists of categories with continuity creative constructions: repossessing the body, maintaining a façade, seizing the day, restoring the balance of time, and preserving self. These actions are intended to overcome problems and master changes in order to maintain balance in daily life through constructions that recreate normality and predictability. The third concept, reconciliation, was constructed from three categories: feel normal, set to adjust, and be positioned. These categories describe how the participants minimize their experiences of discontinuity by recapturing approaches in order to reconcile with various changes and maintain continuity in daily life. Our findings provide a fresh perspective on continuity that may contribute to the development of significant interventions in continuity of care for persons with CHF. However, continuity requires that healthcare systems support each patient's ability to manage change, reorientation, and adjustment to the new situation in order to make it easier for the patient to create and continue living their daily lives as they desire.
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Affiliation(s)
- Malin Östman
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Närhälsan Källstorp Health Centre, Trollhättan, Region Västra Götaland, Sweden;
| | - Eva Jakobsson Ung
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kristin Falk
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Jeon BH, Choi M, Lee J, Noh SH. Relationships between gastrointestinal symptoms, uncertainty, and perceived recovery in patients with gastric cancer after gastrectomy. Nurs Health Sci 2015; 18:23-9. [PMID: 26284952 DOI: 10.1111/nhs.12219] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 02/24/2015] [Accepted: 02/24/2015] [Indexed: 12/14/2022]
Abstract
This study examines relationships between gastrointestinal symptoms, uncertainty, and perceived recovery in gastric cancer patients after gastrectomy. Data were collected from 146 patients at an outpatient clinic of a university hospital in Seoul, Korea from October to November 2012. The Gastrointestinal Symptoms Rating Scale, the Mishel Uncertainty in Illness Scale, and questions on perceived recovery of physical, psychological, and social functions were analyzed. High gastrointestinal symptom scores were reported in women younger patients (F = 5.55, P = 0.005), and in patients without a family history of gastric cancer. The uncertainty score was higher in patients with low economic (F = 3.84, P = 0.024) and educational status and no family history. Regression analysis revealed uncertainty was the strongest factor associated with recovery. Nurses can assist patients and families to predict and deal with health problems by offering education on progress from diagnosis to postoperative management, promoting all aspects of recovery after gastrectomy.
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Affiliation(s)
- Byeong Hee Jeon
- Department of Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Mona Choi
- College of Nursing, Yonsei University, Seoul, Korea
| | - JuHee Lee
- College of Nursing, Yonsei University, Seoul, Korea
| | - Sung Hoon Noh
- Department of Surgery, College of Medicine, Yonsei University, Seoul, Korea
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Rørtveit K, Sætre Hansen B, Leiknes I, Joa I, Testad I, Severinsson E. Patients’ Experiences of Trust in the Patient-Nurse Relationship—A Systematic Review of Qualitative Studies. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/ojn.2015.53024] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Borneman T, Irish T, Sidhu R, Koczywas M, Cristea M. Death awareness, feelings of uncertainty, and hope in advanced lung cancer patients: can they coexist? Int J Palliat Nurs 2014; 20:271-7. [PMID: 25040862 DOI: 10.12968/ijpn.2014.20.6.271] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Patients diagnosed with stage-IV lung cancer are forced to quickly transition from a cancer-free and perhaps healthy life to one of serious illness, uncertainty, and anticipation of a premature death. Health professionals may be too quick to label the patient as being in denial if they hope for healing. Hope may not be lost when reality is accepted. Studies have investigated what it is like to live with awareness of impending death. Using a patient case study this paper discusses the concepts of death awareness, uncertainty, and hope. The aim is to provide a deeper understanding of how these seemingly antithetical emotions can coexist to the benefit of the patient, and to provide clinicians with practical considerations for supporting patients' hope throughout their terminal illness.
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Affiliation(s)
- Tami Borneman
- Oncology Clinical Nurse Specialist and Senior Research Specialist
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Holm AL, Lyberg A, Severinsson E. Living with stigma: depressed elderly persons' experiences of physical health problems. Nurs Res Pract 2014; 2014:527920. [PMID: 25013728 PMCID: PMC4074963 DOI: 10.1155/2014/527920] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 05/19/2014] [Accepted: 05/20/2014] [Indexed: 12/25/2022] Open
Abstract
The aim of this paper is to deepen the understanding of depressed elderly persons' lived experiences of physical health problems. Individual in-depth interviews were conducted with 15 depressed elderly persons who suffer from physical health problems. A hermeneutic analysis was performed, yielding one main theme, living with stigma, and three themes: longing to be taken seriously, being uncertain about whether the pain is physical or mental, and a sense of living in a war zone. The second theme comprised two subthemes, feeling like a stranger and feeling dizzy, while the third had one subtheme: afraid of being helpless and dependent on others. Stigma deprives individuals of their dignity and reinforces destructive patterns of isolation and hopelessness. Nurses should provide information in a sensitive way and try to avoid diagnostic overshadowing. Effective training programmes and procedures need to be developed with more focus on how to handle depressive ill health and physical problems in older people.
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Affiliation(s)
- Anne Lise Holm
- Centre for Women's, Family and Child Health, Faculty of Health Sciences, Buskerud and Vestfold University College, P.O. Box 235, 3603 Kongsberg, Norway
| | - Anne Lyberg
- Centre for Women's, Family and Child Health, Faculty of Health Sciences, Buskerud and Vestfold University College, P.O. Box 235, 3603 Kongsberg, Norway
| | - Elisabeth Severinsson
- Centre for Women's, Family and Child Health, Faculty of Health Sciences, Buskerud and Vestfold University College, P.O. Box 235, 3603 Kongsberg, Norway
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Moi AL, Gjengedal E. The lived experience of relationships after major burn injury. J Clin Nurs 2014; 23:2323-31. [PMID: 24393409 DOI: 10.1111/jocn.12514] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2013] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To explore and describe the meaning of relationships after major burn injury. BACKGROUND A major burn injury may represent a threat to preburn appearance and level of functioning. Social resources and interaction are considered important for minimising the negative impacts on life after burn through all phases of care and rehabilitation. Yet, the subjective experiences of relating to others after burns have not been extensively explored. DESIGN The study was performed by using a phenomenological approach. METHODS A purposive sample (n = 14) of patients who had experienced major burns were interviewed in average 14 (5-35) months postinjury. The interviews were analysed by the phenomenological method of Giorgi. RESULTS The essence of the experience of relationships was constituted by other people re-anchoring the burn-injured persons to preburn life, being confirming of the new self, as well as being sensitive, competent and safeguarding with respect to actual and potential problems and harms. New bodily limitations demanded assistive others. Moreover, a worry about the overall burden on close family was typical. The supportive actions from others were mostly described as positive, but could also be experienced as challenging, and sometimes even unwanted and interfering with the struggle for regained freedom. CONCLUSIONS Across variation, an increased awareness of the meaning of mutual interdependence was typical. Supportive relationships with family, friends and health professionals were important for the return to society, preburn activities and a meaningful life. RELEVANCE TO CLINICAL PRACTICE A perspective that values the significance of social support from family, friends, health professionals and others who are important for the burn-injured person, and that does not underestimate challenges that may be involved, is recommended during all phases of burn care. Health professionals should also acknowledge the importance of relationships when developing structured educational programmes and organising peer support.
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Affiliation(s)
- Asgjerd L Moi
- Department of Nursing, Faculty of Health and Social Sciences, Bergen University College, Bergen, Norway
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Røysland IØ, Dysvik E, Furnes B, Friberg F. Exploring the information needs of patients with unexplained chest pain. Patient Prefer Adherence 2013; 7:915-23. [PMID: 24043934 PMCID: PMC3772772 DOI: 10.2147/ppa.s47120] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Unexplained chest pain is a common condition. Despite negative findings, a large number of these patients will continue to suffer from chest pain after being investigated at cardiac outpatient clinics. Unexplained chest pain covers many possible complaints, and diagnosing a single cause for a patient's pain is often described as difficult, as there are a number of possible factors that can contribute to the condition. For health professionals to meet patients' expectations, they must know more about the information needs of patients with unexplained chest pain. The aim of this study was to describe information needs among patients with unexplained chest pain and how those needs were met by health professionals during medical consultations. METHODS A qualitative design was used. Data were collected by means of seven individual interviews with four women and three men, aged 21-62 years. The interviews were analyzed by qualitative content analysis. RESULTS The results are described in two subthemes, ie, "experiencing lack of focus on individual problems" and "experiencing unanswered questions". These were further abstracted under the main theme "experiencing unmet information needs". CONCLUSION Existing models of consultations should be complemented to include a person-centered approach to meeting patients' beliefs, perceptions, and expressions of feelings related to experiencing unexplained chest pain. This is in line with a biopsychosocial model with active patient participation, shared decision-making, and a multidisciplinary approach. Such an approach is directly within the domain of nursing, and aims to take into account patient experience.
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Affiliation(s)
- Ingrid Ølfarnes Røysland
- Department of Health Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
| | - Elin Dysvik
- Department of Health Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
| | - Bodil Furnes
- Department of Health Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
| | - Febe Friberg
- Department of Health Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
- Institute of Health and Care Sciences, Sahlgrenska Academy at Göteborg University, Göteborg, Sweden
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Dudas K, Olsson LE, Wolf A, Swedberg K, Taft C, Schaufelberger M, Ekman I. Uncertainty in illness among patients with chronic heart failure is less in person-centred care than in usual care. Eur J Cardiovasc Nurs 2013; 12:521-8. [PMID: 23303766 DOI: 10.1177/1474515112472270] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Many patients with chronic heart failure (CHF) experience uncertainty regarding the treatment and characteristics of their illness. Person-centred care (PCC) emphasizes patient involvement in care. We have previously shown that PCC improved outcomes such as length of hospital stay and activities of daily living in patients with CHF. The impact of PCC on self-reported uncertainty in illness among patients hospitalized for CHF is still unknown. AIM To evaluate whether PCC is associated with less self-reported uncertainty in illness compared with usual care in patients hospitalized for worsening CHF. METHODS Using a controlled before-and-after design, eligible CHF patients were assigned to either a usual care group or a PCC intervention group. Patient-reported uncertainty in illness was assessed at hospital discharge with the Cardiovascular Population Scale (CPS). The CPS consists of two domains: 1) Ambiguity (about illness severity); and 2) Complexity (of treatment and system of care). RESULTS Two hundred and forty-eight patients were included in the study; 123 in the usual care group and 125 in the PCC intervention. The PCC group had better scores than the usual care group in the CPS domains complexity (M=15.2, SD=4.7 vs. M=16.8, SD=4.7; p=0.020) and ambiguity (M=27.8, SD=6.6 vs. M=29.8, SD=6.9; p=0.041). CONCLUSION Patients with CHF were less uncertain in their illness after PCC, which may help to equip and empower patients to manage their illness. Together with earlier findings of shortened hospital stay and improved activities of daily living, this indicates that PCC should be a standard approach for hospital care of patients with worsening CHF.
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Affiliation(s)
- Kerstin Dudas
- 1Institute of Health and Care Science, Gothenburg, Sweden
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Severinsson E, Johansson I, Lindquist I. Effects of process-oriented group supervision - a comparison of three groups of student nurses. J Nurs Manag 2012; 22:443-51. [PMID: 23409832 DOI: 10.1111/j.1365-2834.2012.01463.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2012] [Indexed: 11/27/2022]
Affiliation(s)
- Elisabeth Severinsson
- Centre for Women's, Family and Child Health, Faculty of Health Sciences; Vestfold University College; Tønsberg Norway
| | - Ingrid Johansson
- The Sahlgrenska Academy, Institute of Health and Care Sciences; University of Göteborg; Göteborg Sweden
| | - Ingegerd Lindquist
- The Sahlgrenska Academy, Institute of Health and Care Sciences; University of Göteborg; Göteborg Sweden
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Severinsson E, Holm AL. Knowledge gaps in nursing leadership - focusing on health care systems organisation. J Nurs Manag 2012; 20:709-12. [PMID: 22967290 DOI: 10.1111/j.1365-2834.2012.01472.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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