The interplay between children, their parents and anaesthesia staff during the child's anaesthesia - An observational study

AIMS AND OBJECTIVES

To interpret and understand the interplay between children, their parents, and anaesthetic staff to gain a greater understanding of children being anaesthetised.

BACKGROUND

Anaesthesia induction is a stressful procedure for the child and parents in the technologically advanced environment in the operating room (OR). Anaesthesia staff are a key resource for ensuring safety and interplays, but the meeting is often short, intensive, and can affect the child and the parent.

DESIGN

A qualitative observational design with a hermeneutic approach.

METHODS

Twenty-seven non-participant observations were conducted and videotaped when children were being anaesthetised. The SRQR checklist was used.

RESULTS

The result is presented as a theatre play with three headings; the scene, the actors, and the plot. The scene was not designed for the child or the parent's comfort and could lead to anxiety and insecurity. Four themes described the interplays: The need to be inviting and to be invited, The need for varying compliance, The need for mutual dependence, and The need to give and to receive emotional support. The plot could lead to uncertainty, and the interplay could change between being caring and uncaring depending on the actors.

CONCLUSIONS

The technologically advanced environment in the OR constituted an emotional obstacle, but the anaesthesia staff themselves can be a powerful resource creating a caring environment. The outcome of the plot may depend on the anaesthesia staff's bearing.

RELEVANCE TO CLINICAL PRACTICE

A caring approach in the OR requires a willingness from the anaesthesia staff to invite the child to participate and find a balance between helping the parents to find their place in the OR and support them in supporting their child. The findings can start reflections in the unit on how to create a more caring environment.

A randomized clinical trial of a new perioperative practice model on anxiety and health-related quality of life in arthroplasty patients

Aims

To explore the effectiveness of a new perioperative practice model on anxiety and health‐related quality of life in patients undergoing total hip arthroplasty and total knee arthroplasty under spinal anaesthesia.

Design

A randomized clinical trial.

Methods

Control group participants (N = 222) received standard perioperative care, meaning they were cared for by various nurses during their perioperative process without postoperative visits. Intervention group participants (N = 231) were assigned one named anaesthesia nurse during their entire perioperative process who visited them postoperatively. Both groups responded to two self‐reported questionnaires: the generic 15D health‐related quality of life instrument and the State‐Trait Anxiety Inventory (STAI) measuring anxiety two to three weeks pre‐operatively and three months postoperatively.

Results

There were no statistically significant differences between the groups at baseline or at follow‐up in health‐related quality of life or anxiety.

Understanding client satisfaction in elderly care: new insights from social resource theory

Social resource theory suggests that social interaction can be conceived as resource transaction or exchange with behaviours falling within six fundamental resource categories (i.e. love, status, information, money, goods, and services) organised along two underlying dimensions: particularism-universalism and concreteness-abstractness. With the purpose of extending knowledge about quality of care, this study adopts a novel approach in that it describes and categorises care behaviours using social resource theory instead of using single instances of care behaviour. The categorisation is further used to predict client satisfaction in care services targeting older people. Daily interactions between care staff and older persons were observed in two different residential care facilities using a structured non-participant observation design. The data were analysed using principal component analysis, correlation, and regression analysis. The results confirmed the hypothesis that satisfaction with care services is predicted by resource transactions that are high on the underlying dimensions of particularism and abstractness. Thus, the resource categories of love and status (resource categories high on particularism and abstractness) were shown to be strong predictors of client satisfaction. The use of social resource theory is a novel and appropriate approach to examine person-centred care and satisfaction with care. Also, in addition to addressing potential problems in previous self-report studies on care staff behaviour, the observational technique was highly practical to this service area where dealing with clients not always able to provide feedback directly.

Assessment of ethical ideals and ethical manners in care of older people

The aim of this study is to establish structured clusters and well-defined ontological entities (nodes) describing ethical values as both ideal and opportunity for ethical manner as perceived by thecaregiver.In this study, we use Bayesian Belief Networks (BBNs) to analyse ethical values (ethos) and ethical manners in daily work with older people. Material is based on questionnaire data collected by the instrument for the self-assessment of individual ethos in the care of older people(ISAEC) in spring 2007 in a municipality in Western Finland. This study is unique in its kind, both concerning the selected approach and methodological questions. BBNs have not been used significantly in nursing research, nor are there any studies that examine the ethical possibilities with focus on the probable effects upon changing conditions.

Lamentation and loss: expressions of caring by contemporary surgical nurses

AIM

This paper is a report of a phenomenological study of caring from the perspective of nurses working on surgical wards.

BACKGROUND

While care and caring are complex foundational nursing concepts which have received considerable and ongoing attention from theorists, researchers and clinicians, there has been little research into caring on surgical units.

METHOD

A convenience sample of ten nurses working on surgical units in a public teaching hospital in Canada was interviewed using van Manen's phenomenological approach. Data were collected during 2001 using semi-structured interviews.

FINDINGS

The major theme of lamentation and loss was identified from the data. Participants revealed a dichotomous tension between what caring should be and what actually occurs. This tension was pervasive and generated lament - an expression of grief and mourning for the loss of caring. The essential structures supporting this theme included lack of time, lack of caring support, tasking, increased acuity, lack of continuity of care, emotional divestment and not caring for each other. Loss and sadness were articulated and participants lamented and grieved about the loss of care in contemporary practice.

CONCLUSION

The forces and influences described by participants undermined caring in the new practice milieu. If this is a glimpse of the future, then the values of the nursing profession may be under siege. Caring as the central core, the essence or unifying concept of nursing may be subject to marginalization in contemporary practice.

Family suffering related to war experiences: an interpretative synopsis review of the literature from a caring science perspective

The aim of this study was to conduct a synopsis review of findings from families' experiences related to combat and war events and to interpret these findings from the perspective of theories of suffering. The method used in the study was a synopsis review of 12 articles dealing with family suffering related to war or combat experiences and an interpretation of the articles from a caring science perspective. Findings from the synopsis review were that the dominant part of the articles viewed suffering in general and post-traumatic stress disorders (PTSD) in particular from a medical, psychiatric or psychologically behaviouristic perspective. PTSD and other distress-related conditions were mainly described in terms of their symptoms and dealt with in terms of pathology. The interpretation of the articles from a caring science perspective generated three significant themes: first, interdependence as a spiritual dimension of dependence, secondly, familial communion as sharing moral and spiritual values and thirdly, familial suffering visualized by compassion. The study's conclusion is that, from a caring science perspective, the appearance of family suffering should be comprehended in terms of expressed compassion and that any disturbance within familial communion is likely to have an emotional impact on all of the family members, as a result of their interdependence.

The aesthetic experience of nursing

This article highlights the distinction between the 'art of nursing' and 'fine art'. While something in the nature of nursing can be described as 'the art of nursing', it is not to be misunderstood as 'fine art' or craft. Therefore, the term 'aesthetic' in relation to nursing should not be linked to the aesthetic of modern art, but instead to a broader and more general meaning of the word. The paper's main focus is the aesthetic experience, which is treated in a hermeneutic way and elucidated from classical sources and the philosophy of nursing and from Art. The paper argues that the pioneers used the term 'art of nursing' in a metaphorical way to say something more specific on the nature of nursing. The term illustrates the nurse's ability to practise at the highest possible level of excellence.

The presence of love in ethical caring

Caring as a virtue and an act of ethics is from both a natural and a professional point of view inseparably related to love as a universal/ontological value. Love is shown, like suffering and death, to be a concept of universal or metacharacter. From current nursing/caring science as well as from ethical and philosophical perspectives, this paper explores how love can be visible in caring through virtue and that the art of caring creates its evidence. The ethical and existential practicing of love, particularly unselfish love, allows a caregiver to come distinctly closer to the essence of his or her own personality and to live in a more authentic manner. Obstacles and alienation in caregivers that induce a holding back of one's own natural impulses to give the suffering patient tender, dignified care are examined. Economy, paradigm, and caring culture are cited, but ultimately it is a question concerning every caregiver's decision and responsibility to come forward to serve those the caregiver is actually there to represent, the suffering patient. This does not always require new knowledge, rather, liberation of the inner life and authenticity in caregivers. Love, if viewed only as a phenomenon without connection to a universal or ontological philosophy, risks being a problematic concept for caring science. If, on the other hand, it is viewed as the ontological basis for caring and ethical acts, then we can look for and practice phenomenological expressions for love that can enhance the patient's understanding of life as well as giving relief from suffering.

A Framework for Integrating NANDA, NIC, and NOC Terminology in Electronic Patient Records

PURPOSE

To describe the methods used in design of a framework that (a) encompasses nursing knowledge, (b) functions as a cognitive map for clinicians, and (c) increases the efficiency of using the North American Nursing Diagnosis Association (NANDA), Nursing Intervention Classification (NIC), and Nursing Outcome Classification (NOC) terminologies together in the electronic patient record.

METHODS

The taxonomies of the NANDA, NIC, and NOC terminologies were integrated to form a preliminary structure of domains and classes. New concepts and collocations of concepts were constructed using Walker and Avant's (1983, 1988) method for concept synthesis. The framework was validated using an expert group and clinical testing.

RESULTS

A framework organized as a taxonomy with eight domains (Physiological, Functional, Psychocognitive, Safety, Existential, Lifestyle, Family, and Environment) and 29 classes.

CONCLUSIONS

The framework has the potential to enhance the quality of nursing documentation, contribute to nursing research and education, and reduce job stress.

Recording the content of the caring process

In the present study, a theoretical basis for the content of caring and nursing documentation is described. The goal was to find out to what extent documentation based on the theory might reveal the patients' experience and views of their care. Documenting according to Eriksson's (1997, 2001) caring science theory was tried out in an intervention study. The content of nursing care records was evaluated before the intervention and after completing it. After the intervention the nurses' experiences of the theory-based recording were collected by means of questionnaires. According to the evaluation performed after the intervention, the content of the documentation had improved on several wards. The nurses paid more attention to the patients' views than before when documenting care in the way introduced in the study. According to the results nurses need strong support from their managers in order to successfully be able to implement a theoretical basis of documentation of care.

Some remarks on the relevance of basic research in nursing inquiry

The aim of this article was to illuminate the issue of basic research in nursing and to problematize its relevance for our discipline. First, we asked leading nursing scholars in the Nordic countries to share their views on basic research in nursing. Thereafter, the ideas, views and suggestions of the scholars were amalgamated with insights from the literature and from the discussions in our project team. Our two guiding questions were: What role can basic research be assigned? Which, if any, forms of basic research can be identified? We found that basic nursing research may be seen as a necessary basis for applied research, as a contribution to applied research, or that the whole issue is seen as a pseudo-issue. We further found that basic nursing research can be seen as either contextual or general as well as either intradisciplinary or multidisciplinary in form. We conclude by the following three succinct remarks or assertions: that basic nursing research is not to be equated with biomedical conceptions of basic research; that basic nursing research may take place on several theoretical levels; and finally, that an indiscriminate dismissal of basic research in nursing may affect the cognitive autonomy of our discipline.

Suffering related to health care: A study of breast cancer patients' experiences

A previous study indicated that patient narratives include experiences of suffering caused or increased by health-care encounters. The aim of this study was to interpret and understand the meaning of patients' experiences of suffering related to health care from an ethical, existential and ontological standpoint. Sixteen women with breast cancer in Sweden and Finland took part in qualitative interviews analysed with a hermeneutic, interpretive approach. The outcome showed that suffering related to health care is a complex phenomenon and constitutes an ethical challenge to health-care personnel. The women's experiences of suffering related to health care tended to be of similar seriousness as their experiences of suffering in relation to having cancer. In an ethical, existential and ontological sense, suffering related to health care is basically a matter of neglect and uncaring where the patient's existential suffering is not seen and she is not viewed as a whole human being.

The relational core of nursing practice as partnership

BACKGROUND

Consideration of the relational core of nursing has gained significance in today's health systems, where the work of nurses is dominated by technologically-driven, prescriptive, and outcome-oriented approaches. This has led to disregard for individual experiences of living life with diverse health conditions.

AIM

The aim of this paper is to articulate the relational core of nursing practice as partnership.

DISCUSSION

The relational core of nursing practice is explicated as a process of professional partnership, focusing on the evolving dialogue between nurse and patient. In partnership, the dialogue is open, caring, mutually responsive and non-directive. The nurse attends to that which is of concern to patients in relation to their health predicaments and the meaning in the health experience unfolds. Nurse and patient reach insight that represents more useful ways of comprehending and acting on their health predicaments.

CONCLUSIONS

Partnership represents theoretically-driven practice that invites nurses to meet patients where they are in understanding their health predicaments and what can be done about them. As such, partnership strengthens the resolve of nurses to resist the pressures of contemporary health service delivery to provide a technical form of practice and it protects the relational core of a fully professional practice.

Structuring the documentation of nursing care on the basis of a theoretical process model

The aim of this study was to develop the documentation of the substance of nursing care on the basis of a theoretical caring process model. The theory is Eriksson's caring process model and her theory of health, suffering and caring. The approach of the research task was dialogue. As a research method Koski's adaptation of Gadamer's theory of hermeneutic experience was used, in which Gadamer's hermeneutic text interpretation is divided into four phases. The phases are the explicit analysis of preunderstanding, hermeneutic dialogue, the merging of horizons and active application. The dialogue is carried on between Eriksson's theory of health, suffering and caring and clinical nursing practice and between the caring process model and nursing practice. The goal is to achieve a new scientific view on which to base the documentation of nursing care. As a result of the dialogue a classification in accordance with Eriksson's caring-process model is presented. In the next phase of the study the classification is piloted in a clinical context. The purpose is to obtain knowledge of whether the suggested classification describes what, according to the theory, it should describe.