Patients' perceptions of support

The relationship between Iranian patients' perception of holistic care and satisfaction with nursing care

Background

Holistic care is comprehensive care that emphasizes the interaction of human existential dimensions and has a significant role in accelerating the recovery process. Since nurses interact and communicate with patients more than other health care providers, the current study aimed to determine the Iranian patients’ perceptions of holistic care and overall satisfaction with nursing care.

Methods

It is a descriptive-correlational study done on patients admitted to the oncology wards of hospitals in southeastern Iran. The holistic caring inventory and patient satisfaction instrument were used to measure the patients’ perceptions of holistic care and their satisfaction, respectively. SPSS 19 was used to analyze the data.

Results

The results showed that there is a significant positive correlation between patients’ perception of holistic care and overall satisfaction with nursing care (P < 0.01, r = 032), which means that the higher the patients’ perception of holistic care, the greater their overall satisfaction. Based on the regression model, type of hospital, Patient’s perception of holistic care, education, previous experience of hospitalization, age and marriage are respectively predictors of overall satisfaction with nursing care (P < 0.05).

Conclusion

The present study showed that patients’ overall satisfaction with nursing care depends on holistic nursing care, meaning that nurses should pay attention to patients’ physical, mental, emotional aspects and increase the quality of care.

Emotional Boundary Work in Advanced Fertility Nursing Roles

In this article we examine the nature of intimacy and knowing in the nurse-patient relationship in the context of advanced nursing roles in fertility care. We suggest that psychoanalytical approaches to emotions may contribute to an increased understanding of how emotions are managed in advanced nursing roles. These roles include nurses undertaking tasks that were formerly performed by doctors. Rather than limiting the potential for intimacy between nurses and fertility patients, we argue that such roles allow nurses to provide increased continuity of care. This facilitates the management of emotions where a feeling of closeness is created while at the same time maintaining a distance or safe boundary with which both nurses and patients are comfortable. We argue that this distanced or ‘bounded’ relationship can be understood as a defence against the anxiety of emotions raised in the nurse-fertility patient relationship.

Development of a Quantitative Measure of Holistic Nursing Care

Holistic care has long been a defining attribute of nursing practice. From the earliest years of its formal history, nursing has favored a holistic approach in the care of patients, and such an approach has become more important over time. The expansion of nursing's responsibility in delivering comprehensive primary care, the recognition of the importance of relationship-centered care, and the need for evidence-based legitimation of holistic nursing care and practices to insurance companies, policy-makers, health care providers, and patients highlight the need to examine the holistic properties of nursing care. The Holistic Caring Inventory is a theoretically sound, valid, and reliable tool; however, it does not comprehensively address attributes that have come to define holistic nursing care, necessitating the development of a more current instrument to measure the elements of a holistic perspective in nursing care. The development of a current and more comprehensive measure of holistic nursing care may be critical in demonstrating the importance of a holistic approach to patient care that reflects the principles of relationship-based care, shared decision-making, authentic presence, and pattern recognition.

Nursing support for family members of critically ill adults

Researchers have identified the needs of family members of critically ill adults, explored their experiences, and investigated interventions. To address a gap in the theoretical knowledge about how nurses help these individuals, the authors developed a grounded theory of nursing support from the perspective of family members. Results indicated that family members were initiated into a cycle of Work to meet perceived responsibilities to Get Through the experience. Supportive nurses engaged in the process of Lightening Our Load to mitigate the negative effects of the critical care experience on family members by Engaging With Us, Sustaining Us, and Disengaging From Us. No previous research has yet identified the Work of these family members, the steps they take to gain nurses' respect, and the significance to them of nurses' Welcoming us and Saying goodbye. This theory extends the understanding of nursing support beyond current knowledge of family needs, caring, comfort, supportive care, and social support.

Supportive care: experiences of cancer patients

The aim of this study was to explore how cancer patients with progressive disease perceived and experienced supportive care at the different stages of their cancer journey and to compare this to the perceptions of health care professionals. It was a single centre study using qualitative data obtained from two focus group interviews in an independent centre for specialist palliative care. Eight patients attending the centre were interviewed in two focus groups to ascertain their views on the supportive care that they had experienced during the course of their illness, focusing on: time of diagnosis, acute treatment phase and palliative care phase. Themes that emerged from the analysis of the interview transcripts using the QSR NUD*IST (version 4) software package included the following: manner in which diagnosis was revealed, information made available to family and friends, patients' acceptance of cancer; service provision such as a named contact person, choices in treatment and care, problems of limited resources; feelings of being unsupported, and ways in which supportive care could be improved.

Patterns of nursing: a review of nursing in a large metropolitan hospital

In this Clinical Practice Development (CPD) project we set out to identify and describe current approaches to the management and delivery of nursing care in an Australian Metropolitan Teaching Hospital. Using a simple descriptive design, data were collected to elicit patterns of care provided by nursing teams. We sought to demonstrate patterns described by nursing teams (interviews) and actual patterns of care (observation). As expected there was a degree of incongruence between the espoused and actual patterns of care. Interview data revealed that most study wards had a view of nursing that emphasizes meeting the total care needs of patients and their families through offering biopsychosocial and educative care. The observational data revealed that a relatively large proportion of time was expended on activities that were not regarded as important by staff when interviewed (e.g. documentation) while relatively small amounts of time were observed to be spent educating patients or communicating with relatives of patients. The identification of this type of gap creates a dissonance in clinicians that can be used to stimulate change through CPD. Clinicians used the information to stimulate discussion and to rewrite team value statements.

Nursing presence, patient satisfaction, and the bottom line

Hospital planners rely on a number of motivational models to increase patient satisfaction. Missing is the user friendly model oriented to nursing presence. Absent is the approach which taps into that contribution particular nurses might make to increase patient satisfaction and enhance the bottom line. This paper remedies this circumstance by the introduction of the Nursing Presence Grid model. The model is based upon a review of the literature conducted in the manner of Polit and Hungler (1995) and appearing since 1983. Nursing presence is defined. The Nursing Presence Grid matches the various dimensions of nursing presence with various courses of action thought to attain nursing presence. An explanation of how the model might be applied is presented.

Nursing the clinic, being there and hovering: ways of caring in a British fertility unit

AIM

To explore the meaning of caring in a fertility unit and to present the findings and discuss their implications for practice.

BACKGROUND

Little research has been published internationally on the nature of nursing care in the fertility field. This study was intended to stimulate debate over the nature of care in fertility work.

METHODOLOGY

An ethnographic approach, which included part-time participant observation and in-depth focused interviews with staff and patients. Data were also collected using a field and a research diary. Data were analysed using a modified thematic analysis.

FINDINGS

The data suggest that caring is strongly linked with nurses and that patients' expectations of nurses may be more practically than emotionally focused. I argue that the organization of nursing work, which I call 'nursing the clinic and the doctor', facilitated this practical approach to caring. I discuss two features of nursing the clinic and the doctor: hovering and being there.

CONCLUSIONS

While there may be other factors that influence the practice of this form of non-intimate caring, nursing in this way may be what patients desire and may be congruent with managing emotions. The findings have implications for the discourse on intimacy and caring within fertility nursing as well as in different outpatient settings.

Healing presence

Since the introduction of presence as a concept in nursing literature in the early 1960s, nurse philosophers, theorists, and researchers have attempted to define and describe presence as it relates to nursing practice. Understanding of nursing presence and its link, if any, to nurse-patient interaction is basically subjective and intuitive. This article is based on the assumption that nursing presence fully understood may result in greater patient satisfaction and healing potential. A three-stage, hierarchical model culminating in healing presence is used to understand the nurse-patient dyad. The model is calibrated in terms of nursing maturity using Benner's novice nurse/expert nurse idea, Hanneman's expert nurse/nonexpert nurse view, Zaner's vivid-presence/copresence, and Doona, Chase, and Haggerty's nursing presence.

A 'good enough' nurse: supporting patients in a fertility unit

In this paper, I discuss the findings of an ethnographic study of a fertility unit. I suggest that caring as 'emotional awareness' and 'non-caring' as 'emotional distance' may be forms of nursing akin to Fabricius's (1991) arguments around the 'good enough' nurse. This paper critiques caring theories and contributes to the debates over the nature of caring in nursing. I discuss the implications raised for nurses if patients want a practical approach to caring and do not expect an emotionally intimate relationship from nurses.

The nurse parent support tool

This report describes the development of an instrument, the Nurse-Parent Support Tool (NPST) designed to measure parents' perception of nursing support during their child's hospitalization. The NPST was based on the Nurse Parent Support Model developed from House's conceptualizations of four domains of support. Thus, the 21-item NPST assesses four dimensions of support: (1) supportive communication and provision of information related to the child's illness, treatments, care, and related issues; (2) parental esteem support focused on respecting, enhancing, and supporting the parental role; (3) emotional support to help the parents cope with their own emotional responses and needs related to the child's illness; and (4) caregiving support involving the quality of care provided to the child. Strong support for the content validity of the NPST derives from the steps used in constructing the instrument. This includes use of a conceptual framework, generating items from the literature, using data from interviews with parents of hospitalized children, and pilot testing with parents and experts. Factor analysis provides support for the underlying construct and significant correlations with another instrument measuring a similar construct provides support for the concurrent validity. The internal consistency reliability is very high. The NPST holds promise for use in nursing research and quality improvement programs in pediatric and neonatal in-patient settings.

Using Standardized Patients and Standardized Physicians to Improve Patient-Care Quality: Results of a Pilot Study

BACKGROUND

We conducted evaluation research with a sample of registered professional staff nurses in a large, inner-city, tertiary medical center for a pilot study of videotaped case scenarios using standardized patients and standardized physicians to enhance nurses' communication and collaboration skills.

METHOD

Change scores from pre-test to post-test on a self-reported rating scale to assess nurse-physician-patient interactions and communications for 28 nurses were compared with a control group of 38 nurses who did not participate in the videotaped sessions.

RESULTS

Repeated measures of analysis of variance (ANOVA) detected no statistically significant differences between the intervention and control groups. However, positive changes were noted in some aspects of nurse-physician and nurse-patient interactions in the intervention group. Immediate feedback from the videotaped scenarios heightened nurses' awareness of the impact of their body language.

CONCLUSIONS

Nurses must continuously practice and enhance their collaborative and communication skills. This pilot study suggests that it is beneficial to use videotaping with standardized patients and standardized physicians to enhance such nurses' skills.

Older adults' descriptions of their role expectations of nursing

A qualitative descriptive approach was used to identify 28 older adults' role expectations of nursing. This study describes elders' opinions, expectation and health care preferences which influence their judgments about nursing. Three categories emerged from analyzing transcripts of the audiotaped interviews. The older adults expected the nurse to be knowledgeable, caring and attentive by: demonstrating professional competence when recognizing patients' needs, as well as being concerned for the individual in the responsive delivery of services. The results of this study are congruent with descriptions of valued nursing behaviors that have been identified in previous studies. Additional findings, also corroborated by prior research, indicated that nursing roles and actions may not be accurately perceived or understood by the older consumer. Nurses therefore not only need to be vigilant in eliciting and evaluating consumer expectations but also need to be diligent in explaining their role and informing the public of their qualifications.

Predictors of patient outcomes following interactions with nurses

A research and theory-based model was used to identify outcome predictors of hospitalized patients' perceptions of caring and support by nurses. The model tested the effects of cogent personal characteristics of patients (general level of self-esteem and need for control while hospitalized) on their perceptions of humanistic caring and support from nurses and, in turn, considered the effect of these variables on situational appraisal, coping strategies, psychological distress, and coping effectiveness. The 120 hospitalized adult patients indicated that the moderate amount of humanistic caring they received was beneficial. Several factors influenced caring ratings. Higher positive ratings were received from younger patients; however, people with low self-esteem and those desiring more control over their care or reporting a high degree of pain tended to perceive more threat and psychological distress as a results of their encounters with nurses. Following positive caring experiences with nurses, patients with higher self-esteem levels reported effective coping. Overall, positive caring experiences, along with coping strategies and decreased psychological distress levels, explained 40% of the variance of hospitalized patients' ability to cope effectively following their encounters with nurses.

Personal and professional support for mothers of NICU and healthy newborns

Personal support provided by close social network members and professional support provided by nurses were studied in 83 postpartum mothers and newborns in neonatal intensive care units and newborn nurseries. Mothers perceived each type of support differently in terms of outcomes. Only personal support was significantly related to emotional affect and life satisfaction outcomes. Both personal and professional support were related to relationship satisfaction outcomes. Findings suggest that personal support and professional support be treated as separate concepts.

HOW ARE YOU DOING? Patient Evaluations of Nursing Actions

1. Quality of patient care can be enhanced if we know what nursing actions psychiatric patients perceive as helpful. Previous research has focused on perceptions of patients on medical-surgical units. 2. Patients diagnosed with bipolar disorder tended to see nursing actions as more helpful and performed more frequently than patients diagnosed with substance abuse. 3. Although positive feedback was identified as one of the most helpful nursing actions, it was rated only average in frequency of performance. 4. Even patients who had histories of long hospitalization did not want nursing staff to do things for them that they could do for themselves. Nurses need to focus on teaching self-care skills rather than "doing for" the patient.

Target populations of nursing research on social support

Nurses contribute to the social support field primarily through study of clinical and community populations. A review of the target populations identified in 63 empirical studies of social support conducted in the past decade revealed that nurses have, to date, studied populations central to their profession's activities and concerns. They have uniquely focused on surgical patients, the chronically ill, expectant couples and parents of infants, the bereaved, and lay caregivers. These target groups have suffered from maturational (transitional) and/or situational stressors. However, some at-risk groups have been overlooked; in particular, children, males only, native peoples, the poor, the unemployed, and the victims of child and elder abuse. Nurses practice in diverse institutional and community-based sites, and hence have direct contact with all these population groups. Once the features of a population that make it a fruitful focus of study by nurse investigators are identified, pertinent interventions can be tested.