"A becoming in the meeting": the interpretations of competence in home care from the perspectives of older people and registered nurses - a meta-ethnography

AIM

The aim of this meta-ethnography was to identify and synthesize qualitative studies focusing on older people's and registered nurses' interpretations of competence in home care.

METHODS

The meta-ethnography followed the six phases developed by Noblit and Hare (1988).

RESULTS

In Phase 6, the translation process of the included studies, three themes were identified: i) temporality-the feeling of being of value; ii) dignity-a person, not just a patient; and iii) mutuality of being-togetherness. A synthesis was developed, and the phrase "a becoming in the meeting" emerged.

CONCLUSION

The sense of becoming includes progress, which means becoming something other than before in relation with others and refers to what constitutes the meeting between the older person and the registered nurse working in home care. Competence originates from becoming in the meeting, and registered nurses should therefore value what they do and hold on to this aspect of caring competence that centres on a caring relationship. It is important for registered nurses working in home care to be able to cultivate a caring relationship.

Themes of Worry Among Psychiatric Inpatients That Persist Through Acute Hospitalization

INTRODUCTION

Problems that worry patients throughout hospitalization are complex and varied, but they fall within the scope of safe, effective, patient-centered care. To our knowledge, there is no evidence describing the problems that worry patients in inpatient psychiatric units.

AIM

The purpose of this quality improvement project was to describe common themes of worry experienced by individuals in psychiatric inpatient units in order to improve patient experience.

METHOD

This project took place at an urban, safety net hospital at an academic medical center in the northeastern United States between March and December 2019. All patients across five inpatient psychiatric units were offered the Combined Assessment of Psychiatric Environments (CAPE) survey as they approached the end of their stay.

RESULTS

A total of 1,800 patients took the survey. Of these patients, 36% (650/1,800) patients responded never/sometimes to "During my hospitalization, I found solutions to problems that worried me," and 46% (297/650) patients provided a response to the follow-up question "What are the problems that worry you the most?" Common themes of worry for inpatient behavioral health patients include (a) life in the hospital, (b) self, and (c) outside life.

CONCLUSIONS

Each of these worry themes that emerged from this thematic analysis has implications for behavioral health staff who are preparing the psychiatric/behavioral health inpatient for discharge. These themes can also be used to focus on a variety of quality improvement initiatives to improve the patients experience while in an inpatient psychiatric/behavioral health unit.

Non-somatic Suffering in Palliative Care: A Qualitative Study on Patients' Perspectives

Objectives: Suffering is intimately linked to the experience of illness, and its relief is a mandate of medicine. Advances in knowledge around terminal illness have enabled better management of the somatic dimension. Nevertheless, there is what can be called “non-somatic” suffering which in some cases may take precedence. Inspired by Paul Ricoeur's thinking on human suffering, our aim in this qualitative study was to better understand the experience of non-somatic suffering. Methods: Semi-structured interviews were conducted with 19 patients. The results were qualitatively analyzed following a continuous comparative analysis approach inspired by grounded theory. Results: Three key themes synthesize the phenomenon: “the being enduring the suffering”, “the being whose agency is constrained”, and “the being in relationship with others.” The first describes what patients endure, the shock and fears associated with their own finitude, and the limits of what can be tolerated. The second refers to the experience of being restricted and of mourning the loss of their capacity to act. The last describes a residual suffering related to their interactions with others, that of loneliness and of abandoning their loved ones, two dimensions that persist even when they have accepted their own death. Conclusions: Non-somatic suffering can be multifarious, even when minimized by the patient. When evaluating suffering, we must keep in mind that patients can reach a “breaking point” that signals the state of unbearable suffering. In managing it, we probably need to make more room for family and friends, as well as a posture of caring based more on presence and listening.

The effect of hospitalization on patients' emotional and psychological well-being among adult patients: An integrative review

OBJECTIVE

Health care providers need to understand how hospitalization impacts patients' emotional statuses, to provide high quality of care. However, an overview of the literature suggests a dearth of research studies that examine and identify the effects of hospitalization on patients' emotional statuses and their well-being. In addition, no research review has synthesized this evidence before. To close this gap, this integrative review examines and synthesizes prior research findings regarding the effects of hospitalization on adult patients' emotional reactions and psychological well-being.

METHOD

This integrative review has been conducted based on the Whittemore and Knafl (2005) outline, which includes four steps: problem identification, literature search, data analysis, and presentation. Seven databases have been systematically searched, including CINAHL, EMBASE, OVID Medline, PsycINFO, SCOPUS, and Cochrane, with no date limitations through January 2021.

RESULTS

The current review synthesizes the findings of 18 publications to identify patients' experiences and factors that evoked emotional reactions during hospitalization. Factors include the effect of admission to a hospital, length of stay, and readmission; these also influence hospitalization experience, the role of health care providers, and patient's characteristics.

CONCLUSION

The current review's findings yield essential information by confirming that hospitalization negatively affects patients' abilities to cope and adjust. Hospitalization demonstrably exacerbates patients' emotions and increases feelings of depression and anxiety. Understanding these findings may help to support patients throughout their hospital stays. Gaps in the evidence and future research recommendations are also explored and discussed to establish a stronger foundation.

Bladder and bowel preferences of patients at the end of life: a scoping review

BACKGROUND

Following patient preferences at the end of life should improve outcomes of care, yet patient preferences regarding bladder and bowel care are not often accommodated, as they are not well known in the literature.

AIMS

This scoping review sought to identify bladder and bowel care preferences of patients at the end of life in published literature.

METHODS

Papers published in or after 1997 (in English) that focused on adult preferences for bladder and bowel care at the end of life were included.

FINDINGS

Scant literature exists on preferences for bladder and bowel care for adult patients at end of life. Further investigation is warranted to arrive at a better understanding of preferences regarding bladder and bowel symptom management.

CONCLUSIONS

Future research should explore if prioritising the symptoms caused by incontinence, among the many symptoms experienced at the end of life, could be achieved through careful questioning and development of a standardised tool focused on improving patient care and incorporating patient preferences for care.

From the crisis in acute care to postdischarge resilience - The communication experience of Geriatric patients: A qualitative study

BACKGROUND

Hospital readmissions due to illness among geriatric patients result in human suffering and psychological trauma. Resilience in chronic illness protects geriatric patients from outcomes of trauma leads to psychological and physical well-being and enables bouncing back to life. While communication has been linked to improved health outcomes, little is known about communication pathways in the context of postdischarge resilience.

AIM AND OBJECTIVE

To explore the role of communication pathways that acute-care clinicians used with geriatric patients in postdischarge resilience.

METHODOLOGICAL DESIGN AND JUSTIFICATION

Participants were ten geriatric patients who were readmitted several times in the past year. Twenty narrative interviews were conducted, one upon discharge and the other a month thereafter. Data for each phase of interviews were analysed using methods of selection mechanisms and Bricolage.

ETHICAL ISSUES

The ethics committee approved the study. Participants signed an informed-consent form for participation and publication.

FINDINGS

Communication in acute care that enhanced health literacy, perceived control and reflection, contributed to higher comprehensibility and manageability during the hospitalisation and postdischarge meaningfulness postdischarge, contributing resilience. Participants who experienced other forms of communication demonstrated anxiety and helplessness with lingering psychological trauma postdischarge.

CONCLUSIONS

Acute care may provide clinicians with opportunities to alleviate the suffering of geriatric patients and contribute to their postdischarge resilience. The suggested T.E.R model delineates communication pathways to fuel the trajectory from psychological trauma to postdischarge resilience in practice.

The pre- and postoperative illness trajectory in patients with pituitary tumours

OBJECTIVE

Experiences and need of support during surgery and start of replacement therapy in patients with pituitary tumours are highly unknown. This study aimed at exploring patient experiences during pre- and postoperative care and recovery after pituitary surgery in patients with a pituitary tumour.

METHODS

Within a qualitative study design, 16 consecutive patients who underwent surgery for pituitary tumours were repeatedly interviewed. In total, 42 interviews were performed before and after surgery. Analysis was performed using qualitative interpretation.

RESULTS

Suffering a pituitary tumour was overwhelming for many patients and struggling with existential issues was common. Patients expressed loneliness and vulnerability before and after surgery. How professionals handled information in connection with diagnosis greatly affected the patients. Other patients with the same diagnosis were experienced as the greatest support. Normalisation of bodily symptoms and relationships with others were reported during postoperative recovery. However, a fear that the tumour would return was present.

CONCLUSIONS

Patients with pituitary tumours need structured support, including peer support, which acknowledges physical, cognitive as well as emotional and existential concerns. Information related to diagnosis and surgery should be adapted in relation to the loneliness and the existential seriousness of the situation. Care and support for patients with pituitary tumours should preferably be organised based on continuity and an unbroken care pathway from the first pre-operative evaluation through to postoperative care and the start of a life-long endocrine treatment and tumour surveillance.

Person-centred inpatient care - A quasi-experimental study in an internal medicine context

AIM

The aim of this study was to evaluate effects of person-centred inpatient care on care processes in terms of satisfaction with care and person-centred content in medical records, and to evaluate effects on self-reported health and self-efficacy.

BACKGROUND

Internal medicine inpatient care is complex, covering patients varying in age, medical conditions, health status, and other aspects. There has been limited research on the impact of person-centred care (PCC) on satisfaction with care and health outcomes in internal medicine care environments regardless of diagnosis and care pathway.

DESIGN

A quasi-experimental study with pre- and postmeasurements.

METHODS

Adult patients admitted to an internal medicine inpatient unit were consecutively included over 16 weeks in 2014 and 24 weeks in 2015-2016. Data were collected before a person-centred inpatient care intervention (N = 204) and 12 months after the intervention was implemented (N = 177). Data on satisfaction with care and self-reported health were collected at discharge and medical records were reviewed. The intervention included systematically applied person-centred assessment, health plans, and persistent PCC.

RESULTS

After the intervention, patients rated higher satisfaction with care regarding essential components of PCC and more patients had received effective pain relief. There were no differences in information on self-care or medications, self-rated health, or self-efficacy.

CONCLUSION

Care focused on the foundations of person-centredness seems to enhance both patients' perceptions of satisfaction and symptom management. Situational aspects such as care pathways should be considered when implementing person-centred inpatient care.

TRIAL REGISTRATION

CLINICALTRIALS.

GOV, REGISTRATION NUMBER

NCT03725813.

Facilitating a dedicated focus on the human dimensions of care in practice settings: Development of a new humanised care assessment tool (HCAT) to sensitise care

There is limited consensus about what constitutes humanly sensitive care, or how it can be sustained in care settings. A new humanised care assessment tool may point to caring practices that are up to the task of meeting persons as humans within busy healthcare environments. This paper describes qualitative development of a tool that is conceptually sensitive to human dimensions of care informed by a life-world philosophical orientation. Items were generated to reflect eight theoretical dimensions that constitute what makes care feel humanly focused. An action research group process in 2014-2015 with researchers, service users, healthcare professionals in two diverse clinical settings (stroke rehabilitation and dermatology) was used. Feedback on conceptual content, transparency of meaning and readability was then gained from a panel in Sweden and third-year student nurses in the UK. The tool can be applied to attune staff to human dimensions of care, offering items which point to concrete examples of humanising and dehumanising features of practice in ways that have not yet been fully captured in the caring literature. Based on theoretically led experiential items, with dedicated focus on what makes people feel more, or less than human, it may offer improvement on available assessments of care.

Differences in Symptom Distress Based on Gender and Palliative Care Designation Among Hospitalized Patients

PURPOSE

To explore patient-reported symptom distress in relation to documentation of symptoms and palliative care designation in hospital inpatients.

DESIGN

This cross-sectional study analyzed data from 710 inpatients at two large hospitals in Sweden using the Edmonton Symptom Assessment Scale and the Memorial Symptom Assessment Scale. Chart reviews focused on nurses' and physicians' symptom documentation and palliative turning point.

METHODS

Descriptive statistics were calculated for all variables and provided summaries about the sample. Patients were grouped according to gender, age, palliative care designation, and symptom documentation. The t test and chi-square test were used to calculate whether symptom distress varied between groups. A two-way analysis of variance was conducted for multiple comparisons to explore the impact of gender and age on mean symptom distress.

FINDINGS

Females reported higher levels of symptom distress than did males related to pain, fatigue, and nausea. When comparing symptom distress between males and females with documentation pertaining to symptoms, there were significant differences implying that females had to report higher levels of symptom distress than males in order to have their symptoms documented.

CONCLUSIONS

Females need to report higher levels of symptom distress than do males for healthcare professionals to identify and document their symptoms. It can be hypothesized that females are not receiving the same attention and symptom alleviation as men. If so, this highlights a serious inequality in care that requires further exploration.

CLINICAL RELEVANCE

Considering that common reasons why people seek health care are troublesome symptoms of illness, and that the clinical and demographic characteristics of inpatients are changing towards more advanced ages with serious illnesses, inadequate symptom assessment and management are a serious threat to the care quality.