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Jakobsen LM, Lind R. ´You are not yourself anymore´: The place of the ethical demand in a practical home care context. Scand J Caring Sci 2023; 37:79-87. [PMID: 35348235 DOI: 10.1111/scs.13076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/24/2022] [Accepted: 03/12/2022] [Indexed: 11/30/2022]
Abstract
THE STUDY'S RATIONALE The Scandinavian nursing tradition is based on caring science as the ontological backdrop. This means that meeting the patient with openness and respect is essential in care. The experiences of an elderly woman receiving home nursing provide insight into a world many healthcare workers need to understand; meaning what is important in the encounter with the fragile old patient whose voice is not often heard in the society nor in research. Caring science with its person-oriented care clashes with the New Public Management's ideal for municipal health care in Norway, at the expense of the needs of the elderly patients. AIMS AND OBJECTIVES This article aims to express the phenomenon of lived experience as presented by an elderly woman, more specifically her experience of care in home nursing run according to the principles of new public management. METHODOLOGICAL DESIGN The article is based on an empirical narrative in the form of an individual qualitative research interview. FINDINGS The patient has needs that cannot be defined without the nurse having an ethical understanding of what may be important in the patient´s lifeworld. The core findings are: Feeling disregarded as a human being, Broken agreements, Surrendering in anonymous relationships and Each day is a different day with altered needs. CONCLUSION The system of New Public Management sets a strain on the time at hand for the nurse to develop a relationship that acknowledges and supports the patient´s life courage. The ethical demand and care ethics can explain how the patient´s will to live can be preserved, and provide knowledge of how the caregiver can best attend to the patient's ways of expressing what is important to her. Nevertheless, within the time at disposal, the nurse has an opportunity to either marginalize or strengthen the old person´s dignity.
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Affiliation(s)
- Lena M Jakobsen
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromso, Norway
| | - Ranveig Lind
- Department of Health and Care Sciences, UiT The Arctic University of Norway and Research Nurse at Intensive Care Unit, University Hospital of North Norway, Tromso, Norway
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2
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Höglander J, Holmström IK, Lövenmark A, Van Dulmen S, Eide H, Sundler AJ. Registered nurse-patient communication research: An integrative review for future directions in nursing research. J Adv Nurs 2023; 79:539-562. [PMID: 36534429 DOI: 10.1111/jan.15548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 11/02/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022]
Abstract
AIM To explore communication research in nursing by investigating the theoretical approaches, methods, content and perspectives in research on real-time registered nurse (RN)-patient communication. DESIGN An integrative review of real-time communication between RNs and patients. DATA SOURCES Empirical research papers were searched in PubMed, CINAHL Plus and Medline. The results from the database searches were supplemented with results from manual searches in reference lists. REVIEW METHODS A total of 1369 articles published between January 1996 and December 2021 were screened, which resulted in the inclusion of 52 articles. RESULTS The integration of various theories, such as nursing or communication theories, is weak in most of the included studies. RN-patient communication appears to influence relationship building. Even when nurses strive to meet patients' needs, they often focus primarily on nursing routines and physical care. The topic of the communication varies depending on the situation and different communication styles are used. When a patient-centred approach is adopted, the interpersonal communication becomes quite symmetrical, with complementary roles of nurses and patients. Within a more asymmetric communication context, nurses dominate communication, choose topics and function as instructors. How the nurses communicated subsequently influenced the patients' communication styles and strategies. CONCLUSION Communication is multifaceted, contains different strategies and is important for building trust and facilitating patient-centred care. The importance of RNs' communication for interaction and relationship-building seems to be well established within research, but few studies focused on patients' communication with RNs. IMPACT This integrative review gives an overview of the width and depth of observational studies on RN-patient communication research. The variety of studies indicates that this area is a less well-grounded field of research. Future research is warranted to support nurses in their communication, especially regarding the exploration of patients' communication and desired communication skills in nurse-patient interactions. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution was included in this integrative review.
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Affiliation(s)
- Jessica Höglander
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
| | - Inger K Holmström
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden.,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Annica Lövenmark
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
| | - Sandra Van Dulmen
- Nivel (Netherlands Institute for Health Services Research), Utrecht, the Netherlands.,Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.,Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Hilde Eide
- Centre for Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Annelie J Sundler
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
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3
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How Is Quality of Care in Home Healthcare Created? A Qualitative Study of Health Professionals’ Perspectives. Healthcare (Basel) 2022; 10:healthcare10061021. [PMID: 35742072 PMCID: PMC9222816 DOI: 10.3390/healthcare10061021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 05/24/2022] [Accepted: 05/29/2022] [Indexed: 12/10/2022] Open
Abstract
The demographic challenges with an increase in older adults in need of nursing care has put home healthcare services under pressure. However, research on what constitutes quality of home healthcare services and what factors influence good nursing care and patient safety is scarce. The aim of this study was to gain insight into health professionals’ perceptions of how quality of care in home healthcare is created and what factors put patient safety at risk. The present study was a qualitative study with semi-structured interviews of eight health professionals working in home healthcare services. Qualitative content analysis was used. Four categories of factors the staff thought had to be present to provide good quality services were identified: (1) A workplace with adequate competence; (2) Communication, information flow and collaboration; (3) Continuity and organisation of care; and (4) Resources. Conclusions: The healthcare professionals perceived that the quality of the services overall was good, and if important factors were present, quality of care was achieved. However, they pointed out some factors that were important to prevent inadequate care and improve services, as quality of care was at risk when deficiencies in these areas occurred.
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Söderman A, Werkander Harstäde C, Östlund U, Blomberg K. Community nurses' experiences of the Swedish Dignity Care Intervention for older persons with palliative care needs - A qualitative feasibility study in municipal home health care. Int J Older People Nurs 2021; 16:e12372. [PMID: 33713554 DOI: 10.1111/opn.12372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 12/17/2020] [Accepted: 02/12/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The Swedish Dignity Care Intervention (DCI-SWE) is an intervention for people with palliative care needs to enhance their dignity. The original DCI was developed in Scotland, where it was tested by nurses in municipal care. In this study, the DCI has been tested for the first time in a Swedish home health care context. The aim was to describe experiences of the DCI-SWE from the perspectives of community nurses (CNs). METHODS This was a feasibility study with a qualitative design. Three focus group interviews and one individual interview were performed with CNs (n = 11). Reflective diaries and field notes were written by the CNs and researchers, respectively. Data were analysed using inductive content analysis. RESULTS Two main categories and six subcategories were identified. The first main category, 'Practising the palliative approach while responding to palliative care needs', consisted of the subcategories: gives structure while providing palliative care; gives older people opportunities to be confirmed; and responding to existential and sensitive needs. The second main category, 'Aspects influencing the use of the DCI-SWE' had two subcategories about facilitators and barriers to the use of the DCI-SWE, and another about how to establish the DCI-SWE in the context of home health care. CONCLUSION The DCI-SWE offers CNs an overview of older people's concerns while providing palliative care, and gives the older people opportunities to be listened to. Essential prerequisites for using the DCI-SWE in municipal home health care are that CNs are comfortable holding conversations and are given time and space for these by the organisation. Other aspects facilitating the use of the DCI-SWE are managers' engagement and support, continuing training for CNs and CNs' opportunities for reflection.
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Affiliation(s)
- Annika Söderman
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Carina Werkander Harstäde
- Centre for Collaborative Palliative Care, Faculty of Health and Life Sciences, School of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
| | - Ulrika Östlund
- Centre for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden
| | - Karin Blomberg
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
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Tomstad S, Sundsli K, Sævareid HI, Söderhamn U. Loneliness Among Older Home-Dwelling Persons: A Challenge for Home Care Nurses. J Multidiscip Healthc 2021; 14:435-445. [PMID: 33642860 PMCID: PMC7903969 DOI: 10.2147/jmdh.s298548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/02/2021] [Indexed: 11/23/2022] Open
Abstract
Aim To explore how nurses working in the home care service sector perceived the loneliness experienced by older people living at home, and how they met these lonely individuals’ needs. Background Loneliness is a well-known phenomenon among groups of older home-dwelling people and has been shown to be a health-related problem. Health care professionals working in the primary care sector, such as home care nurses, may be in the position to identify loneliness among at-home seniors. Identifying and addressing loneliness must become important issues in home care nursing. Design A qualitative study. Methods Focus group interviews were performed with 11 home care nurses in Norway. The interviews were analyzed in accordance with manifest and latent content analysis. The Coreq checklist was followed. Findings Home care nurses identified loneliness among older people as being a complex and sensitive phenomenon that activated conflicted thoughts, feelings and solutions in a system where older people’s loneliness was generally not considered as a need requiring nursing care. Conclusion Loneliness among older people challenged the nurses with regard to communicating older people’s feelings of loneliness and meeting their social needs. Organizational structures were perceived as being the main barriers to meeting these needs. Older people’s feelings of loneliness stimulated nurses’ reflections about the purpose of their nursing role. It is important to address loneliness among older home-dwelling people and include the issue in home care nursing in order to meet their need for social contact. Home nursing leaders must pay attention to the nurses’ experiences, promote the nurses’ acquisition of knowledge about this kind of loneliness and learn how to meet an older individual’s needs. There should be a special focus on communicating with lonely older people in order to address their feelings loneliness.
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Affiliation(s)
- Solveig Tomstad
- Centre for Caring Research, Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway
| | - Kari Sundsli
- Centre for Caring Research, Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway
| | - Hans Inge Sævareid
- Centre for Caring Research, Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway
| | - Ulrika Söderhamn
- Centre for Caring Research, Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway
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Sanerma P, Miettinen S, Paavilainen E, Åstedt-Kurki P. A client-centered approach in home care for older persons - an integrative review. Scand J Prim Health Care 2020; 38:369-380. [PMID: 33201752 PMCID: PMC7781976 DOI: 10.1080/02813432.2020.1841517] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To describe and synthesize client-centered care and service in home care for older persons. METHODS The study was an integrative review using the guidelines for literature reviews by the Joanna Briggs Institute. The research process followed the Whittemore and Knafl framework and PRISMA toolkit in the selection of eligible articles. The CINAHL, Medline, Scopus, Web of Science and Social Sciences abstracts were searched for articles published between January 2007 and May 2020 according to previously designed search strategies. In total, 24 articles were deemed relevant for an analysis using a thematic analysis. RESULTS The analysis resulted in four themes with sub-themes which revealed that client-centered care and service in home care consist of: 1) Clients' involvement in their own care; self-care, decision-making, satisfactory daily life, 2) Family members' and care partners' participation in care; family members' and care partners' commitment to care, family members' and care partners' competence in care, 3) Communication and co-operation; communication models, empowerment, partnership, and 4) Evidence-based service competence; delivery and organization of services, implementation of services, versatile clinical skills, quality outcomes and personnel wellbeing. CONCLUSIONS According to the results, achieving client-centered care and service in home care requires the realization of all of the above aspects. The practice of nursing must better identify all dimensions of client-centered care and take these into account in the delivery of home care services. KEY POINTS Client-centeredness is a fundamental value and the basis of nursing and care in home care provided for older persons This paper: deepens and structures the concept of client-centered care in the context of home care. assists professionals to understand the factors behind client-centered care within the home care environment. provides deeper understanding of the roles of the older person, family members, and the service system in developing client-centered services in home care for older persons.
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Affiliation(s)
- Päivi Sanerma
- Department of Health Sciences, Faculty of Social sciences, University of Tampere, Tampere, Finland
- Hamk Smart Reseach Unit, Hamk University of Applied Sciences, Hämeenlinna, Finland
- CONTACT Päivi Sanerma ; Department of Health Sciences, Faculty of Social Sciences, University of Tampere, 100, Tampere, PL, 33014, Finland; Hamk Smart Reseach Unit, Hamk University of Applied Sciences, 230, Hämeenlinna, PL, 13100, Finland
| | - Sari Miettinen
- Hamk Smart Reseach Unit, Hamk University of Applied Sciences, Hämeenlinna, Finland
- Information Services Unit, Research Unit, The Social Insurance Institution of Finland, Helsinki, Finland
| | - Eija Paavilainen
- Department of Health Sciences, Faculty of Social sciences, University of Tampere, Tampere, Finland
| | - Päivi Åstedt-Kurki
- Department of Health Sciences, Faculty of Social sciences, University of Tampere, Tampere, Finland
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Höglander J, Eklund JH, Spreeuwenberg P, Eide H, Sundler AJ, Roter D, Holmström IK. Exploring patient-centered aspects of home care communication: a cross-sectional study. BMC Nurs 2020; 19:91. [PMID: 33013200 PMCID: PMC7526395 DOI: 10.1186/s12912-020-00483-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 09/17/2020] [Indexed: 11/29/2022] Open
Abstract
Background Communication is a cornerstone in nursing and aims at both information exchange and relationship building. To date, little is known about the naturally occurring communication between older persons and nurses in home care. Communication might heal through different pathways and a patient- or person-centered communication could be important for health and well-being of older persons. However, the delivery of individualized home care is challenged by routines and organizational demands such as time constraints. Therefore, the aim of this study was to explore the patient-centered aspects of home care communication between older persons and registered nurses. Methods In total 37 older persons (aged 65 years or older) and eleven RNs participated in 50 audio-recorded home care visits. Roter Interaction Analysis System (RIAS) was used to code verbal communication. A ratio from these codes, establishing the degree of patient-centeredness, was analyzed using a Generalized Linear Mixed Model. Results The present home care communication contained more socio-emotional than task-oriented communication and the emotional tone was largely positive. The global affect ratings reflected an overall positive tone (m = 39.88, sd = 7.65), with higher ratings on dimensions of, for example, responsiveness/engagement and interactivity or interest were more frequent than those that may be considered as less-positive emotions (m = 15.56, sd = 3.91), e.g. hurried, dominance or anger. The ratio of the degree of patient-centered communication in the home care visits was an average of 1.53, revealing that the communication could be considered as patient-centered. The length of the visits was the only characteristic significantly associated with the degree of patient-centeredness in the communication, with a peak in patient-centeredness in visits 8–9 min long. Sex, age or procedural focus showed no significant effects on the degree of patient-centeredness. Conclusion Overall, the degree of patient-centeredness and a positive emotional tone, which might have a positive outcome on older persons’ health, was high. Longer visits provided a higher degree of patient-centeredness, but no linear increase in patient-centeredness due to length of visit could be observed. The findings can be used for education and training of nurses, and for providing individualized care, e.g. patient- or person-centered care.
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Affiliation(s)
- Jessica Höglander
- School of Health, Care and Social Welfare, Mälardalen University, SE-721 23 Västerås, Sweden
| | - Jakob Håkansson Eklund
- School of Health, Care and Social Welfare, Mälardalen University, SE-721 23 Västerås, Sweden
| | - Peter Spreeuwenberg
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, the Netherlands
| | - Hilde Eide
- Science Centre Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Annelie J Sundler
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Debra Roter
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Inger K Holmström
- School of Health, Care and Social Welfare, Mälardalen University, SE-721 23 Västerås, Sweden.,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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8
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Kraus-Hoogeveen S, Peters P, Van der Pool E, Van der Heijden B. Creating public value in the care at home sector: a mixed-method study about expectations of primary stakeholders using a social exchange perspective. J Health Organ Manag 2020; ahead-of-print. [PMID: 32969624 DOI: 10.1108/jhom-11-2019-0317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE This mixed-method study aims to contribute to the scholarly debate by outlining an individual-level theoretical framework for public value creation and evaluation that builds upon a social exchange perspective. It provides insights into the normative frames of primary stakeholders in the Dutch care at home sector, that is professionals, managers, clients and informal care providers. DESIGN/METHODOLOGY/APPROACH A mixed-method design comprising a customized survey among 349 stakeholders, preceded by 31 in-depth interviews was used. FINDINGS This empirical work shows differences and similarities in the stakeholders' normative frames revealed via three dimensions of expectations regarding the process of care delivery: personal contact, impact of rules and procedures and communication. SOCIAL IMPLICATIONS These differences in interpretation have implications for the measurement and evaluation of public value creation. ORIGINALITY/VALUE By statistically and methodologically exploring the different expectations' scales that are developed, we intend to work toward a measure for public value creation, which can be used in future empirical work.
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Affiliation(s)
- Sascha Kraus-Hoogeveen
- Institute for Management Research, Radboud Universiteit Nijmegen, Nijmegen, The Netherlands.,HAN, Arnhem, The Netherlands
| | - Pascale Peters
- Institute for Management Research, Radboud Universiteit Nijmegen, Nijmegen, The Netherlands.,Nyenrode Business Universiteit, Breukelen, The Netherlands
| | | | - Beatrice Van der Heijden
- Institute for Management Research, Radboud Universiteit Nijmegen, Nijmegen, The Netherlands.,Open University of the Netherlands, Heerlen, The Netherlands.,Ghent University, Ghent, Belgium.,Hubei University, Wuhan, China.,Kingston University, London, UK
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Sundling V, Hafskjold L, Eklund JH, Holmström IK, Höglander J, Sundler AJ, van Dulmen S, Eide H. Emotional communication in home care: A comparison between Norway and Sweden. PATIENT EDUCATION AND COUNSELING 2020; 103:1546-1553. [PMID: 32173215 DOI: 10.1016/j.pec.2020.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 01/16/2020] [Accepted: 03/01/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Given the free movement of workers across countries, knowledge regarding communication differences between countries is imperative. In this study, we explored and compared the supportive responses of nursing staff to older persons' emotions in home care in Norway and Sweden. METHODS The study had an observational, cross-sectional, comparative design, which included 383 audio-recorded home-care visits. Communication was coded using Verona Coding Definitions of Emotional Sequences. Worries and responses were categorised with regard to reference, communicative function and level of person-centredness. Standard statistical tests were used to analyse the data. RESULTS The Swedish nursing staff provided space for further disclosure of worry more frequently than the Norwegian nursing staff (75.0 % versus 60.2 %, χ2 = 20.758, p < 0.01). In all, 65 % of the responses were supportive. Multiple logistic regression analyses showed that highly person-centred responses were independently associated with worries phrasing an emotion, OR (95 % CI) 3.282 (1.524-7.067). CONCLUSION The level of person-centredness was associated with the way in which older persons expressed their distress. The Swedish nursing staff provided opportunities for further disclosure of worries more frequently than the Norwegian nursing staff. PRACTICE IMPLICATIONS Findings of intercultural differences should be incorporated into the training of nursing staff.
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Affiliation(s)
- Vibeke Sundling
- Department of Optometry, Radiography and Lighting Design, Faculty of Health and Social Sciences, University of South-Eastern Norway, Norway; National Centre for Optics, Vision and Eye Care, Faculty of Health and Social Sciences, University of South-Eastern Norway, Norway; Science Centre Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Norway.
| | - Linda Hafskjold
- Department of Optometry, Radiography and Lighting Design, Faculty of Health and Social Sciences, University of South-Eastern Norway, Norway; Science Centre Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Norway
| | | | - Inger K Holmström
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden; Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Jessica Höglander
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
| | - Annelie J Sundler
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Sweden
| | - Sandra van Dulmen
- Science Centre Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Norway; NIVEL (Netherlands Institute for Health Services Research), Utrecht, the Netherlands; Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, the Netherlands
| | - Hilde Eide
- Science Centre Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Norway
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van Eikenhorst L, van Dijk L, Cords J, Vervloet M, de Gier H, Taxis K. Pharmacists' responses to cues and concerns of polypharmacy patients during clinical medication reviews-A video observation study. PATIENT EDUCATION AND COUNSELING 2020; 103:930-936. [PMID: 31859122 DOI: 10.1016/j.pec.2019.11.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 11/28/2019] [Accepted: 11/30/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE The research questions of this study are 1) How do pharmacists respond to negative emotions of patients during a clinical medication review (CMR)? 2) How do patients express negative emotions during a CMR? 3) Who (pharmacist or patient) initiates a negative emotion to be discussed during a CMR? METHODS We used video-recordings to observe 132 CMR interviews of 49 pharmacists. Videos were coded with the Verona coding definitions on emotional sequences(-provider responses) (VR-CoDES(-P)). RESULTS In total 2538 negative emotions were identified, mainly expressed as cues (95.0 %). Often cues were expressed as verbal hints to hidden concerns (33.2 %) or were related to cognitive or physical causes (28.3 %).Three-quarters of the negative emotions were elicited by patients. 2670 pharmacists' responses were coded. The most common response was non-explicit providing space (77.6 %) and the least common response was explicit reducing space (5.8 %). CONCLUSION Pharmacists are mainly non-explicitly providing space in their responses. While this hinders their ability to capture patients' problems it also may enable patients to initiate topics. PRACTICE IMPLICATIONS Pharmacists are able to respond to patients' negative emotions. Training should focus on developing pharmacist's skills to be more explicit in their responses to get more in-depth knowledge of patients' problems.
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Affiliation(s)
- Linda van Eikenhorst
- PharmacoTherapy, Epidemiology and Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, the Netherlands.
| | - Liset van Dijk
- PharmacoTherapy, Epidemiology and Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, the Netherlands; Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Jasper Cords
- PharmacoTherapy, Epidemiology and Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, the Netherlands
| | - Marcia Vervloet
- Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Han de Gier
- PharmacoTherapy, Epidemiology and Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, the Netherlands
| | - Katja Taxis
- PharmacoTherapy, Epidemiology and Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, the Netherlands
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Dignity-conserving care for persons with palliative care needs — identifying outcomes studied in research: An integrative review. Palliat Support Care 2020; 18:722-740. [DOI: 10.1017/s1478951520000139] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectivesWith people living longer, palliative care may be required for lengthier periods of time. This puts demands on healthcare organizations to provide optimal palliative care. Maintaining dignity is central for any person's health and quality of life, but especially for a person with palliative care needs. Dignity-conserving care needs to be evaluated to increase knowledge about outcomes and how to assess these. The purpose of this integrative review was to identify outcomes studied within dignity-conserving care and how these have been operationalized.MethodsAn integrative review was conducted in 26 quantitative or mixed-method studies and study protocols. Thematic synthesis with an abductive approach was used for analysis.ResultsSeven themes of studied outcomes were identified, as well as four cluster themes: themes related to Illness-Related Concerns, themes related to the Dignity-Conserving Repertoire, themes related to the Social Dignity Inventory, and themes regarding Overarching Dignity Issues. Most outcomes studied dealt with Illness-Related Concerns within the themes of “Performance, symptoms and emotional concerns” and “End-of-life and existential aspects”. Themes linked to the Social Dignity Inventory had the lowest number of outcomes studied. Outcomes regarding overarching dignity issues such as “Dignity-related distress” and “Quality of life” were common. However, the results lacked concrete communication outcomes.Significance of resultsThe results will underpin future research in which dignity-conserving care is implemented and evaluated, and contribute to the provision of evidence-based palliative care. A greater focus on outcomes within cluster themes related to the Dignity-Conserving Repertoire and the Social Dignity Inventory is needed, as is more focus on communication outcomes.
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Yin L, Yin M, Wang Q, Yan Y, Tang Q, Deng Y, Liu X. Can Verona Coding Definitions of Emotional Sequences (VR-CoDES) be applied to standardized Chinese medical consultations? - A reliability and validity investigation. PATIENT EDUCATION AND COUNSELING 2019; 102:1460-1466. [PMID: 30981409 DOI: 10.1016/j.pec.2019.03.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 03/25/2019] [Accepted: 03/29/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To investigate the reliability and validity of the Chinese version of VR-CoDES. METHODS The VR-CoDES was translated into Chinese, and a focus group was held to discuss its cultural adaptation. Video consultations between 75 fourth-year medical students and 2 standardized patients (SPs) were coded by two raters with the Chinese VR-CoDES. Inter-rater reliability was tested by using ICC. To obtain validity, the SPs reviewed the video consultations to confirm the cues and concerns. RESULTS ICC was 0.79. Specificity and sensitivity were 0.99 and 0.96 respectively. The SPs expressed considerably more cues (mean = 7.00) than concerns (mean = 0.32). Half of the responses of medical students were explicit reducing space. Focus group participants raised some cultural considerations, and some interactions were difficult to code due to cultural differences. CONCLUSION The Chinese VR-CoDES obtained good reliability and validity. Due to differences in the expression of emotions and other differences such as different medical systems between China and Western countries, the Chinese VR-CoDES needs further cultural adaptation. PRACTICE IMPLICATION More consultations in real clinical settings need to be gathered to further support the Chinese VR-CoDES both on validation and cultural adaptation.
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Affiliation(s)
- Lanyi Yin
- Third Xiangya Hospital of Central South University, Department of Psychology, 138 Tong Zi Po road, Changsha, United States
| | - Meng Yin
- Third Xiangya Hospital of Central South University, Department of Psychology, 138 Tong Zi Po road, Changsha, United States
| | - Qingyan Wang
- Third Xiangya Hospital of Central South University, Department of Psychology, 138 Tong Zi Po road, Changsha, United States
| | - Yaxin Yan
- Third Xiangya Hospital of Central South University, Department of Psychology, 138 Tong Zi Po road, Changsha, United States
| | - Qiuping Tang
- Third Xiangya Hospital of Central South University, Department of Psychology, 138 Tong Zi Po road, Changsha, United States
| | - Yunlong Deng
- Third Xiangya Hospital of Central South University, Department of Psychology, 138 Tong Zi Po road, Changsha, United States
| | - Xinchun Liu
- Third Xiangya Hospital of Central South University, Department of Psychology, 138 Tong Zi Po road, Changsha, United States.
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Höglander J, Sundler AJ, Spreeuwenberg P, Holmström IK, Eide H, van Dulmen S, Eklund JH. Emotional communication with older people: A cross-sectional study of home care. Nurs Health Sci 2019; 21:382-389. [PMID: 30957364 DOI: 10.1111/nhs.12611] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 02/05/2019] [Accepted: 03/09/2019] [Indexed: 01/25/2023]
Abstract
The aim of this study was to explore the influence of characteristics of nurses and older people on emotional communication in home care settings. A generalized, linear, mixed model was used to analyze 188 audio-recorded home care visits coded with Verona Coding Definitions of Emotional Sequences. The results showed that most emotional distress was expressed by older females or with female nurses. The elicitation of an expression of emotional distress was influenced by the nurses' native language and profession. Older women aged 65-84 years were given the most space for emotional expression. We found that emotional communication was primarily influenced by sex for nurses and older people, with an impact on the frequency of expressions of and responses to emotional distress. Expressions of emotional distress by older males were less common and could risk being missed in communication. The results have implications for students' and health professionals' education in increasing their knowledge of and attentiveness to the impacts of their and others' characteristics and stereotypes on emotional communication with older people.
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Affiliation(s)
- Jessica Höglander
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
| | - Annelie J Sundler
- Department of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Peter Spreeuwenberg
- Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Inger K Holmström
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden.,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Hilde Eide
- Science Centre Health and Technology, University of South-Eastern Norway, Drammen, Norway
| | - Sandra van Dulmen
- Netherlands Institute for Health Services Research, Utrecht, the Netherlands.,Science Centre Health and Technology, University of South-Eastern Norway, Drammen, Norway.,Department of Primary and Community Care, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Jakob H Eklund
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
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