The meanings and implications of receiving care

Nurse-patient interaction and self-transcendence: assets for a meaningful life in nursing home residents?

Background

Due to the shift to an older population worldwide and an increased need for 24-h care, finding new and alternative approaches to increase wellbeing among nursing home (NH) residents is highly warranted. To guide clinical practice in boosting wellbeing among NH residents, knowledge about nurse-patient interaction (NPI), inter- (ST1) and intra-personal (ST2) self-transcendence and meaning-in-life (PIL) seems vital. This study tests six hypotheses of the relationships between NPI, ST1, ST2 and PIL among cognitively intact NH residents.

Methods

In a cross-sectional design, 188 (92% response rate) out of 204 long-term NH residents representing 27 NHs responded to NPI, ST, and the PIL scales. Inclusion criteria were: (1) municipality authority’s decision of long-term NH care; (2) residential time 3 months or longer; (3) informed consent competency recognized by responsible doctor and nurse; and (4) capable of being interviewed. The hypothesized relations between the latent constructs were tested through structural equation modeling (SEM) using Stata 15.1.

Results

The SEM-model yielded a good fit (χ2 = 146.824, p = 0.021, df = 114, χ2/df = 1.29 RMSEA = 0.040, p-close 0.811, CFI = 0.97, TLI = 0.96, and SRMR = 0.063), supporting five of the six hypothesized relationships between the constructs of NPI, ST1, ST2 and PIL.

Conclusion

NPI significantly relates to both ST1, ST2 and PIL in NH residents. ST revealed a fundamental influence on perceived PIL, while NPI demonstrated a significant indirect influence on PIL, mediated by ST.

Joy-of-life in cognitively intact nursing home residents: the impact of the nurse-patient interaction

BACKGROUND

The nursing-home population is at a high risk of declined well-being and quality of life. Finding approaches to increase well-being among older adults in nursing-homes is highly warranted. Responding to this need, the approach framed 'Joy-of-Life-Nursing-Homes' (JoLNH) was developed in Norway.

AIM

To investigate the association between nurse-patient interaction and joy-of-life in the nursing-home population.

METHODS

Cross-sectional data were collected in 2017 and 2018 using the Nurse-Patient Interaction Scale and the Joy-of-Life Scale. A total of 204 cognitively intact nursing-home residents met the inclusion criteria and 188 (92%) participated. A structural equation model (SEM) of the relationship between nurse-patient interaction and joy-of-life was tested by means of STATA/MP 15.1. Ethical approval was given and each participant provided voluntarily written informed consent.

RESULTS

The SEM-model yielded a good fit with the data (χ²  = 162.418, p = 0.004, df = 118, χ² /df = 1.38, RMSEA = 0.046, p-close 0.652, CFI = 0.97, TLI = 0.96, and SRMR = 0.054). As hypothesised, nurse-patient interaction related significantly with joy-of-life (γ1,1 = 0.61, t = 7.07**).

LIMITATIONS

The cross-sectional design does not allow for conclusions on causality. The fact that the researchers visited the participants to help fill in the questionnaire might have introduced some bias into the respondents' reporting.

CONCLUSION

Relational qualities of the nurse-patient interaction should be essential integral aspects of nursing-home care. Consequently, such qualities should be emphasised in clinical practice, and research and education should pay more attention to nurse-patient interaction as an important, integral part of the caring process promoting joy-of-life and thereby well-being.

Case studies of patient interactions, care provision and the impact of emotions: a qualitative study

Caring is a complex phenomenon. Nurses aim to relieve patient suffering, acknowledge subjective experiences, display empathy but also manage emotions related to care provision. This study explored nurses' perceptions, experiences and emotions related to caring for cancer patients. This qualitative study used semi-structured interviews to explore the emotions management of 32 nurses working in a cancer hospital in Pakistan. Data saturation occurred after 20 interviews. Three themes emerged from the data related to caring, acknowledgement of patients' feelings, professional behaviour, patient involvement and emotional control. Some nurses repressed their emotions and feelings over patients who had difficulties sustaining hope. In such cases nurses require supportive networks to assist their emotions management and intra-personal skills. Educational support is needed to help nurses express their views in relation to emotional contagion, significance of repressed emotions and to identify supportive ways to assist nurses to communicate their experiences.

Nurse-patient interaction is a resource for hope, meaning in life and self-transcendence in nursing home patients

BACKGROUND

Spiritual dimensions such as hope, meaning in life and self-transcendence have been found to be predictors of successful ageing, life satisfaction and well-being in older individuals. Connectedness and communicating with others have been seen to facilitate hope, meaning in life and self-transcendence among nursing home patients.

AIMS

This study aimed to investigate the associations between hope, meaning in life, self-transcendence and nurse-patient interaction in a nursing home population.

DESIGN AND METHODS

A cross-sectional design was employed, collecting data in 44 different Norwegian nursing homes (NHs) from 250 patients who met the inclusion criteria. Approval by all regulatory institutions dealing with research issues in Norway and the Management Unit at the 44 NHs was obtained. A sample of 202 cognitively intact nursing home patients responded to the Herth Hope Index, the Purpose in Life test, the Self-Transcendence Scale and the Nurse-Patient Interaction Scale. A structural equation model (SEM) of the hypothesized relationships between the constructs was tested.

RESULTS

The SEM model fit well with the present data. Significant direct relationships of nurse-patient interaction on hope, meaning in life and self-transcendence were displayed. Meaning and the interconnectedness dimension of hope appeared to be particularly dynamic resources, revealing significant influences on all the constructs in the SEM model tested.

CONCLUSION

Nurse-patient interaction influences hope, meaning in life and self-transcendence in cognitively intact nursing home patients and might be an important resource in relation to patients' health and global well-being. Thus, care providers are above all fundamental for nursing home patients. Advancing caregivers' interacting and communicating skills might facilitate patients' health and global well-being and inspire professional caregivers as they perform their daily care practices. More research of the effectiveness of such strategies is greatly needed.

LIMITATIONS

The SEM model tested comprised 20 variables, indicating a desirable sample size of n = 200, while the present effective sample was n = 187. Also, cross-sectional data do not allow making conclusion on the causality.

Humiliation or care? A qualitative study of patients' and health professionals' experiences with tuberculosis treatment in Norway

AIM

Directly observed treatment (DOT) has been implemented globally as a strategy in treatment of tuberculosis. Studies from high-endemic settings show that DOT involves social and economical burdens for patients, but little is known about experiences with practicing DOT in low-endemic settings. The present study explores patients' and health professionals' views and experiences with DOT in Norway.

METHOD

In-depth interviews were conducted with 22 patients originating from Somalia and Ethiopia and with 20 health professionals. Data from the interviews were analysed using systematic text condensation.

FINDINGS

We found that there was little room for patients to negotiate whether or not to consent to the organization of treatment (DOT). Patients told that it was difficult to question the way treatment was organized, as they got the impression that there was no other way of gaining access to medication. Both patients and health professionals reported that persuasion based on authority and subtle threats was used as means to facilitate patients' acceptance of DOT. A majority of patients experienced DOT as humiliating and discriminating, while some had the experience of being cared for. Patients who attended school or had occupational obligations reported high social costs related to the treatment. Patients with positive experiences told that they had been given an opportunity to negotiate flexible treatment schedules and emphasized the importance of continuity among health professionals. Health professionals had divergent views and practices. Some argued that patients should be treated equally, while others argued for an individualized and flexible approach.

CONCLUSION

The practice of DOT reflects societal power structures that influence the clinical interactions between health professionals and patients. To avoid experiences of disempowerment and humiliation among patients, treatment and care should be organized in a way that safeguards patients' right to consent to treatment and that allows patients to negotiate an individualized treatment schedule.