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Friedrichsen M, Lythell C, Waldréus N, Jaarsma T, Ångström H, Milovanovic M, Karlsson M, Milberg A, Thulesius H, Hedman C, Schaller AS, Jaarsma P. Ethical challenges around thirst in end-of-life care -experiences of palliative care physicians. BMC Med Ethics 2023; 24:61. [PMID: 37559116 PMCID: PMC10413708 DOI: 10.1186/s12910-023-00943-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 08/01/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Thirst and dry mouth are common symptoms in terminally ill patients. In their day-to-day practice, palliative care physicians regularly encounter ethical dilemmas, especially regarding artificial hydration. Few studies have focused on thirst and the ethical dilemmas palliative care physicians encounter in relation to this, leading to a knowledge gap in this area. AIM The aim of this study was to explore palliative care physicians' experiences of ethical challenges in relation to thirst in terminally ill patients. METHODS A qualitative interview study with an inductive approach was conducted. Sixteen physicians working in four different specialised palliative care units and one geriatric care unit in different hospitals in Sweden were interviewed. The interviews were transcribed verbatim and analysed with a reflexive thematic analysis. RESULTS When presented with an ethical challenge relating to thirst, physicians attempted to balance benefits and harms while emphasizing respect for the patient's autonomy. The ethical challenges in this study were: Starting, continuing or discontinuing drips; lack of evidence and traditions create doubt; and lack of interest and time may result in patient suffering. CONCLUSIONS All physicians in this study reported that "Starting, continuing or discontinuing drips" was the main ethical challenge they encountered, where some were so accustomed to the decision that they had a standard answer ready to offer patients and families. Physicians reported that drips were a symbol of thirst quenching, life and survival but were not necessary in end-of-life care. Others questioned the traditions regarding thirst and emphasised drips in particular.
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Affiliation(s)
- Maria Friedrichsen
- Palliative Education and Research Centre, Vrinnevi hospital, Norrköping, Sweden.
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
| | - Caroline Lythell
- Palliative Education and Research Centre, Vrinnevi hospital, Norrköping, Sweden
| | - Nana Waldréus
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Huddinge, Sweden
- Theme Inflammation and Aging, Karolinska University Hospital, Huddinge, Sweden
| | - Tiny Jaarsma
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Helene Ångström
- Palliative Education and Research Centre, Vrinnevi hospital, Norrköping, Sweden
| | - Micha Milovanovic
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Internal Medicine, Vrinnevi hospital, Norrköping, Sweden
| | - Marit Karlsson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Anna Milberg
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Hans Thulesius
- Department of Medicine and Optometry, Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden and Region Kronoberg, Växjö, Sweden
| | - Christel Hedman
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- R & D Department, Stockholms Sjukhem Foundation, Stockholm, Sweden
| | - Anne Söderlund Schaller
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Pier Jaarsma
- Division of Society and Health, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Thulesius H, Sandén U, Petek D, Hoffman R, Koskela T, Oliva-Fanlo B, Neves AL, Hajdarevic S, Harrysson L, Toftegaard BS, Vedsted P, Harris M. Pluralistic task shifting for a more timely cancer diagnosis. A grounded theory study from a primary care perspective. Scand J Prim Health Care 2021; 39:486-497. [PMID: 34889704 PMCID: PMC8725826 DOI: 10.1080/02813432.2021.2004751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE To explore how cancer could be diagnosed in a more timely way. DESIGN Grounded theory analysis of primary care physicians' free text survey responses to: 'How do you think the speed of diagnosis of cancer in primary care could be improved?'. Secondary analysis of primary care physician interviews, survey responses, literature. SETTING Primary care in 20 European Örenäs Research Group countries. SUBJECTS Primary care physicians: 1352 survey respondents (2013-2016), 20 Spanish and 7 Swedish interviewees (2015-2019). MAIN OUTCOME MEASURES Conceptual explanation of how to improve timeliness of cancer diagnosis. RESULTS Pluralistic task shifting is a grounded theory of a composite strategy. It includes task sharing - among nurses, physicians, nurse assistants, secretaries, and patients - and changing tasks with cancer screening when appropriate or cancer fast-tracks to accelerate cancer case finding. A pluralistic dialogue culture of comprehensive collaboration and task redistribution is required for effective pluralistic task shifting. Pluralistic task shifting relies on cognitive task shifting, which includes learning more about slow analytic reasoning and fast automatic thinking initiated by pattern recognition; and digital task shifting, which by use of eHealth and telemedicine bridges time and place and improves power symmetry between patients, caregivers, and clinicians. Financial task shifting that involves cost tracking followed by reallocation of funds is necessary for the restructuring and retraining required for successful pluralistic task shifting. A timely diagnosis reduces expensive investigations and waiting times. Also, late-stage cancers are costlier to treat than early-stage cancers. Timing is central to cancer diagnosis: not too early to avoid overdiagnosis, and never too late. CONCLUSIONS We present pluralistic task shifting as a conceptual summary of strategies needed to optimise the timeliness of cancer diagnosis.Key pointsCancer diagnosis is under-researched in primary care, especially theoretically. Thus, inspired by classic grounded theory, we analysed and conceptualised the field:Pluralistic task shifting is a conceptual explanation of how the timeliness of cancer diagnosis could be improved, with data derived mostly from primary care physicians.This includes task sharing and changing tasks including screening and cancer fast-tracks to accelerate cancer case finding, and requires cognitive task shifting emphasising learning, and digital task shifting involving the use of eHealth and telemedicine.Financial task shifting with cost tracking and reallocation of funds is eventually necessary for successful pluralistic task shifting to happen.
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Affiliation(s)
- Hans Thulesius
- Department of Clinical Sciences Malmö, Family Medicine, Lund University, Lund, Sweden
- Research and Development Centre, Region Kronoberg, Växjö, Sweden
- Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden
- Department of Design Sciences, Faculty of Engineering, Lund University, Lund, Sweden
- CONTACT Hans Thulesius
| | - Ulrika Sandén
- Department of Design Sciences, Faculty of Engineering, Lund University, Lund, Sweden
| | - Davorina Petek
- Department of Family Medicine, Faculty of medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Robert Hoffman
- Departments of Family Medicine & Medical Education, Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Tuomas Koskela
- Department of General Practice, School of Medicine, University of Tampere, Tampere, Finland
| | | | - Ana Luísa Neves
- Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College London, London, UK
- Department of Community Medicine, Health Information and Decision, Faculty of Medicine, University of Porto, Porto, Portugal
| | | | - Lars Harrysson
- Department of Design Sciences, Faculty of Engineering, Lund University, Lund, Sweden
- School of Social Work, Faculty of Social Sciences, Lund University, Lund, Sweden
| | | | - Peter Vedsted
- Department of Clinical Medicine, Research Unit for General Practice, The Research Centre for Cancer Diagnosis in Primary Care, Aarhus University, Aarhus, Denmark
| | - Michael Harris
- College of Medicine & Health, University of Exeter, Exeter, UK
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
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Sandén U, Nilsson F, Thulesius H, Hägglund M, Harrysson L. Cancer, a relational disease exploring the needs of relatives to cancer patients. Int J Qual Stud Health Well-being 2020; 14:1622354. [PMID: 31122166 PMCID: PMC6534208 DOI: 10.1080/17482631.2019.1622354] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Purpose: In this qualitative interview study we investigated the experiences of family members to cancer patients. Our objective was to explore and to differentiate their needs from the needs of cancer patients. Methods: Five focus groups and six individual narrative interviews with 17 family members to cancer patients in Sweden were conducted and compared with 19 cancer patient interviews. Our analysis was inspired by classic grounded theory. Results: Family members to cancer patients expressed own morbidity connected to high stress levels and difficulties in recognizing own stress due to ongoing comparisons with the cancer patient. Family members were trapped in a momentary terror-like situation where they became their sick relative’s safety net. A percieved inability to improve their loved one’s well being contributed to a feeling of guilt. The longing for it all to end was encumbered with shame since the end included possible death. Conclusions: By recognizing cancer as a disease striking both body and relationships, family members are given precedence over their own struggles, differentiated from the patient’s experiences. We define differences in needs between cancer patients and family members. Family members to cancer patients may be supported in developing balancing strategies towards less stress, increased safety and moments of contentment.
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Affiliation(s)
- Ulrika Sandén
- a Department of Design sciences , Lund University , Lund , Sweden
| | - Fredrik Nilsson
- a Department of Design sciences , Lund University , Lund , Sweden
| | - Hans Thulesius
- b Research and Development Kronoberg and Linnaeus University , Växjö , Sweden
| | - Maria Hägglund
- c Department of Women's and Children's Health , Uppsala University and Uppsala University Hospital , Uppsala , Sweden
| | - Lars Harrysson
- d School of Social Work , Lund University , Helsingborg , Sweden
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Holtslander LF, Duggleby W, Williams AM, Wright KE. The Experience of Hope for Informal Caregivers of Palliative Patients. J Palliat Care 2019. [DOI: 10.1177/082585970502100408] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Wendy Duggleby
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan
| | | | - Karen E. Wright
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Prévost P, Roy M. Chapitre 7. La méthodologie de la théorisation enracinée. LES APPROCHES QUALITATIVES EN GESTION 2017:163-195. [DOI: 10.4000/books.pum.2993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Sandén U, Harrysson L, Thulesius H, Nilsson F. Exploring health navigating design: momentary contentment in a cancer context. Int J Qual Stud Health Well-being 2017; 12:1374809. [PMID: 28911272 PMCID: PMC5654017 DOI: 10.1080/17482631.2017.1374809] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/22/2017] [Indexed: 01/08/2023] Open
Abstract
PURPOSE The technocratic and medicalized model of healthcare is rarely optimal for patients. By connecting two different studies we explore the possibilities of increasing quality of life in cancer care. METHODS The first study captures survival strategies in a historically isolated Arctic village in Norway resulting in Momentary contentment theory, which emerged from analysing four years of participant observation and interview data. The second study conceptualizes everyday life of cancer patients based on in-depth interviews with 19 cancer patients; this was conceptualized as Navigating a new life situation. Both studies used classic grounded theory methodology. The connection between the studies is based on a health design approach. RESULTS We found a fit between cancer patients challenging life conditions and harsh everyday life in an Arctic village. Death, treatments and dependence have become natural parts of life where the importance of creating spaces-of-moments and a Sense of Safety is imminent to well-being. While the cancer patients are in a new life situation, the Arctic people show a natural ability to handle uncertainties. CONCLUSION By innovation theories connected to design thinking, Momentary contentment theory modified to fit cancer care would eventually be a way to improve cancer patients' quality of life.
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Affiliation(s)
- Ulrika Sandén
- Department of Design Sciences, Lund University, Lund, Sweden
| | | | - Hans Thulesius
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Fredrik Nilsson
- Department of Design Sciences, Lund University, Lund, Sweden
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Kozar P, Chatterjee K. Competing discourses surrounding primary caregivers of hospice patients. J Health Care Chaplain 2014; 20:125-43. [PMID: 25255146 DOI: 10.1080/08854726.2014.913875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study helps facilitate health care chaplains' awareness of end-of-life communication experienced by primary caregivers. Relational dialectical theory was used to examine the discourse of twenty primary caregivers of hospice patients. The research questions guiding the study were: what competing discourses do primary caregivers experience during end-of-life care, and how do primary caregivers communicatively manage competing end-of-life discourse? In-depth interviews revealed five major competing discourses which were connected physiologically to the patient's dying trajectories: care versus cure; prolong-life versus end-life; open versus hidden; theodicy; and move-on versus don't-move-on discourse. The primary caregivers negotiated these competing discourses through educating the family, by the use of black humor, spiritualizing, ignoring opposing views, and regulating conversations. Theoretical and practical implications for interventions during end-of-life communication are discussed that may help the Chaplain and families of patients negotiate issues such as signing DNRs, impromptu visits to the hospital, and family conflicts about treatments.
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Affiliation(s)
- Paul Kozar
- a Chaplaincy Consultants , Cedar Hill , Texas , USA
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Olsman E, Leget C, Onwuteaka-Philipsen B, Willems D. Should palliative care patients' hope be truthful, helpful or valuable? An interpretative synthesis of literature describing healthcare professionals' perspectives on hope of palliative care patients. Palliat Med 2014; 28:59-70. [PMID: 23587737 DOI: 10.1177/0269216313482172] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Healthcare professionals' perspectives on palliative care patients' hope influence communication. However, these perspectives have hardly been examined. AIM To describe healthcare professionals' perspectives on palliative care patients' hope found in the literature. DESIGN The interpretative synthesis consisted of a quality assessment and thematic analysis of included articles. DATA SOURCES Literature search of articles between January 1980 and July 2011 in PubMed, CINAHL, PsycINFO and EMBASE and references of included studies. SEARCH STRATEGY (palliat* or hospice or terminal* in title/abstract or as subject heading) AND (hope* or hoping or desir* or optimis* in title or as subject heading). RESULTS Of the 37 articles, 31 articles were of sufficient quality. The majority of these 31 articles described perspectives of nurses or physicians. Three perspectives on hope of palliative care patients were found: (1) realistic perspective - hope as an expectation should be truthful, and healthcare professionals focused on adjusting hope to truth, (2) functional perspective - hope as coping mechanism should help patients, and professionals focused on fostering hope, and (3) narrative perspective - hope as meaning should be valuable for patients, and healthcare professionals focused on interpreting it. CONCLUSIONS Healthcare professionals who are able to work with three perspectives on hope may improve their communication with their palliative care patients, which leads to a better quality of care.
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Affiliation(s)
- Erik Olsman
- 1Department of General Practice, Section of Medical Ethics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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McMillan L, Booth J, Currie K, Howe T. ‘Balancing risk’ after fall-induced hip fracture: the older person's need for information. Int J Older People Nurs 2013; 9:249-57. [DOI: 10.1111/opn.12028] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Accepted: 03/06/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Laura McMillan
- School of Health, Nursing and Midwifery; University of the West of Scotland; Paisley UK
| | - Joanne Booth
- School of Health & Life Sciences; Glasgow Caledonian University; Glasgow UK
| | - Kay Currie
- School of Health & Life Sciences; Glasgow Caledonian University; Glasgow UK
| | - Tracey Howe
- School of Health & Life Sciences; Glasgow Caledonian University; Glasgow UK
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Recognizability: a strategy for assessing external validity and for facilitating knowledge transfer in qualitative research. ANS Adv Nurs Sci 2013; 36:E66-76. [PMID: 23644272 DOI: 10.1097/ans.0b013e318290209d] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
In this article, we argue in favor of quality assessment for qualitative studies and propose using a strategy we have labeled recognizability to assess external validity and facilitate knowledge transfer. To test our idea, we gathered data about recognizability in relation to a specific study on facial disfigurement. Four categories were identified: full recognition; partial recognition; recognition in others; and no recognition. In this article, we show how we used these categories both to evaluate the quality of our study and to assess its external validity. We also discuss the implications of recognizability for knowledge transfer.
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Thulesius HO, Scott H, Helgesson G, Lynöe N. De-tabooing dying control - a grounded theory study. BMC Palliat Care 2013; 12:13. [PMID: 23496849 PMCID: PMC3602181 DOI: 10.1186/1472-684x-12-13] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Accepted: 02/26/2013] [Indexed: 11/23/2022] Open
Abstract
Background Dying is inescapable yet remains a neglected issue in modern health care. The research question in this study was “what is going on in the field of dying today?” What emerged was to eventually present a grounded theory of control of dying focusing specifically on how people react in relation to issues about euthanasia and physician-assisted suicide (PAS). Methods Classic grounded theory was used to analyze interviews with 55 laypersons and health care professionals in North America and Europe, surveys on attitudes to PAS among physicians and the Swedish general public, and scientific literature, North American discussion forum websites, and news sites. Results Open awareness of the nature and timing of a patient’s death became common in health care during the 1960s in the Western world. Open dying awareness contexts can be seen as the start of a weakening of a taboo towards controlled dying called de-tabooing. The growth of the hospice movement and palliative care, but also the legalization of euthanasia and PAS in the Benelux countries, and PAS in Montana, Oregon and Washington further represents de-tabooing dying control. An attitude positioning between the taboo of dying control and a growing taboo against questioning patient autonomy and self-determination called de-paternalizing is another aspect of de-tabooing. When confronted with a taboo, people first react emotionally based on “gut feelings” - emotional positioning. This is followed by reasoning and label wrestling using euphemisms and dysphemisms - reflective positioning. Rarely is de-tabooing unconditional but enabled by stipulated positioning as in soft laws (palliative care guidelines) and hard laws (euthanasia/PAS legislation). From a global perspective three shapes of dying control emerge. First, suboptimal palliative care in closed awareness contexts seen in Asian, Islamic and Latin cultures, called closed dying. Second, palliative care and sedation therapy, but not euthanasia or PAS, is seen in Europe and North America, called open dying with reversible medical control. Third, palliative care, sedation therapy, and PAS or euthanasia occurs together in the Benelux countries, Oregon, Washington and Montana, called open dying with irreversible medical control. Conclusions De-tabooing dying control is an assumed secular process starting with open awareness contexts of dying half a century ago, and continuing with the growth of the palliative care movement and later euthanasia and PAS legislation.
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Affiliation(s)
- Hans O Thulesius
- Department of Clinical Sciences Malmö, Division of Family Medicine, Lund University, Lund, Sweden.
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How can nurses facilitate patient's transitions from intensive care? Intensive Crit Care Nurs 2012; 28:224-33. [DOI: 10.1016/j.iccn.2012.01.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Revised: 12/06/2011] [Accepted: 01/03/2012] [Indexed: 11/19/2022]
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McMillan L, Booth J, Currie K, Howe T. A grounded theory of taking control after fall-induced hip fracture. Disabil Rehabil 2012; 34:2234-41. [DOI: 10.3109/09638288.2012.681006] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Harmonizing hope: a grounded theory study of the experience of hope of registered nurses who provide palliative care in community settings. Palliat Support Care 2012; 9:281-94. [PMID: 21838949 DOI: 10.1017/s147895151100023x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The purpose of this study was to explore the hope experience of registered nurses (RNs) who provide palliative care services in community settings. The specific aims of the study were to (1) describe their hope experience, (2) develop a reflexive understanding of the processes of their hope, and (3) construct a substantive theory of hope of palliative care RNs. METHODS Using constructivist grounded theory methodology, purposeful theoretical sampling was used to enroll 14 practicing community palliative care RNs in the study. Twenty-seven open-ended telephone interviews were conducted and nine daily journal entries on hope were copied. Interviews and journals were transcribed verbatim and analyzed using Charmaz's grounded theory approach. RESULTS Participants described their hope as a positive state of being involving a perseverant and realistic understanding of future possibilities. Their hope sustained and motivated them, and helped them to strive to provide high-quality care. The main concern for participants was keeping their hope when faced with work life challenges and contrasting viewpoints (i.e., when their hopes differed from the hopes of others around them). They dealt with this through harmonizing their hope by the processes of "looking both ways," "connecting with others," "seeing the bigger picture," and "trying to make a difference." Their experience of hope was defined within the social context of their work and lives. SIGNIFICANCE OF RESULTS The results of this study suggest that hope is very important to palliative care RNs, in that it helps them to persevere and sustains them when faced with work life challenges in their practice. This study also highlights the need for continued research in this area as there appears to be a lack of evidence on the meaning of hope for healthcare professionals, and, in particular, understanding hope in the context of palliative and end-of-life care delivery.
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Stenberg U, Ruland CM, Olsson M, Ekstedt M. To live close to a person with cancer--experiences of family caregivers. SOCIAL WORK IN HEALTH CARE 2012; 51:909-926. [PMID: 23151286 DOI: 10.1080/00981389.2012.714847] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The purpose of this study was to obtain a deeper understanding of the experiences of Family Caregivers (FC) living close to a patient with cancer. This article reports on the findings from individual interviews with 15 FCs of patients with cancer. The interview transcripts were analyzed using qualitative hermeneutic analysis. This study revealed that living close to a cancer patient over the course of his or her illness affected many aspects of FCs lives in significant ways. Their experiences can be summarized with two major themes: (1) living in an ever changing life world and (2) balancing between conflicting interests and dilemmas. This study contributed to deeper insights into FC's experiences than previously reported in the literature.
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Affiliation(s)
- Una Stenberg
- Center for Shared Decision Making and Collaborative Care Research, Oslo University Hospital, Oslo, Norway.
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Pergert P, Lützén K. Balancing truth-telling in the preservation of hope: a relational ethics approach. Nurs Ethics 2011; 19:21-9. [PMID: 22140184 DOI: 10.1177/0969733011418551] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Truth-telling in healthcare practice can be regarded as a universal communicative virtue; however, there are different views on what consequence it has for giving or diminishing hope. The aim of this article is to explore the relationship between the concepts of truth-telling and hope from a relational ethics approach in the context of healthcare practice. Healthcare staff protect themselves and others to preserve hope in the care of seriously sick patients and in end-of-life care. This is done by balancing truth-telling guided by different conditions such as the cultural norms of patients, family and staff. Our main conclusion is that the balancing of truth-telling needs to be decided in a mutual understanding in the caring relationship, but hope must always be inspired. Instead of focusing on autonomy as the only guiding principle, we would like to propose that relational ethics can serve as a meaningful perspective in balancing truth-telling.
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Affiliation(s)
- Pernilla Pergert
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden.
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Woodby LL, Williams BR, Wittich AR, Burgio KL. Expanding the notion of researcher distress: the cumulative effects of coding. QUALITATIVE HEALTH RESEARCH 2011; 21:830-838. [PMID: 21393618 DOI: 10.1177/1049732311402095] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Qualitative researchers who explore the individual's experience of health, illness, death, and dying often experience emotional stress in their work. In this article, we describe the emotional stress we experienced while coding semistructured, after-death interviews conducted with 38 next of kin of deceased veterans. Coding sensitive topic data required an unexpected level of emotional labor, the impact of which has not been addressed in the literature. In writing this discussion article, we stepped back from our roles as interviewers/coders and reflected on how our work affected us individually and as a team, and how a sequence of exposures could exert a cumulative effect for researchers in such a dual role. Through this article, we hope to generate an expanded discourse on how qualitative inquiry impacts the emotional well-being of researchers.
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Affiliation(s)
- Lesa L Woodby
- Department of Veterans Affairs, Birmingham VA Medical Center, Birmingham, Alabama 35233, USA.
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Martins Pereira S, Fonseca AM, Sofia Carvalho A. Burnout in palliative care: A systematic review. Nurs Ethics 2011; 18:317-26. [DOI: 10.1177/0969733011398092] [Citation(s) in RCA: 154] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Burnout is a phenomenon characterized by fatigue and frustration, usually related to work stress and dedication to a cause, a way of life that does not match the person’s expectations. Although it seems to be associated with risk factors stemming from a professional environment, this problem may affect any person. Palliative care is provided in a challenging environment, where professionals often have to make demanding ethical decisions and deal with death and dying. This article reports on the findings of a systematic review aimed at identifying described burnout levels in palliative care nurses and physicians, and the related risks and protective factors. The main findings indicate that burnout levels in palliative care, or in health care settings related to this field, do not seem to be higher than in other contexts.
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Lipworth WL, Hooker C, Carter SM. Balance, balancing, and health. QUALITATIVE HEALTH RESEARCH 2011; 21:714-725. [PMID: 21343435 DOI: 10.1177/1049732311399781] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
In this article we explore the concept of balance in the context of health. We became interested in balance during a grounded theory study of lay conceptualizations of cancer risk in which participants were concerned with having a good life, which relied heavily on balancing processes. This led us to the qualitative literature about balance in the context of health, which was large and in need of synthesis. We identified 170 relevant studies and used Thomas and Harden's technique of thematic synthesis to identify key balance-related themes and develop these into more abstract analytic categories. We found that balance and balancing were salient to people in three health-related contexts: health maintenance, disease or disability management, and lay or professional caregiving. In each of these contexts, balance or imbalance could be a state or a process. In addition, those using the word balance had either an internally or externally focused orientation to the world around them. Clinicians and public health practitioners might benefit from using these insights in their research and communication.
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Walking a fine line: an exploration of the experience of finding balance for older persons bereaved after caregiving for a spouse with advanced cancer. Eur J Oncol Nurs 2011; 15:254-9. [PMID: 21247803 DOI: 10.1016/j.ejon.2010.12.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2010] [Revised: 10/04/2010] [Accepted: 12/14/2010] [Indexed: 11/24/2022]
Abstract
PURPOSE OF THE RESEARCH During the past decade, research regarding cancer patients has become more prevalent, however research regarding the needs of their family caregivers is limited. The purpose of this study was to explore the ways in which caregivers, who survive the loss of their spouse to cancer, find balance in their lives. METHODS AND SAMPLE A constructivist grounded theory approach was undertaken which included the analysis of in depth interviews, journal entries and the researcher's field notes and memos. Interviews were conducted with 10 bereaved caregivers (7- females, 3-males) ranging in age from 66 to 83 years old. The data included 21 interviews and 8 journals. KEY RESULTS For bereaved caregivers "walking a fine line" emerged as a major process, balancing between "deep grieving" and "moving forward" in order to successfully create a new life without their partner. The main concern of the participants was "losing control" of balance. The emergence of these processes reveals the importance of addressing the bereaved caregivers' need to find balance within their new lives. CONCLUSIONS The findings of this study highlight the unique needs of bereaved caregivers who have lost a spouse to cancer, and provides a basis for ongoing research focused on assessment and intervention. Further research is needed to determine whether the process of finding balance is similar in other groups of caregivers who are bereaved.
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Hjörleifsdóttir E, Óskarsson GK. Psychological distress in Icelandic patients with repeated recurrences of cancer. Int J Palliat Nurs 2010; 16:586-92. [DOI: 10.12968/ijpn.2010.16.12.586] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Elísabet Hjörleifsdóttir
- Associate Professor, School of Health Sciences, University of Akureyri, 600 Akureyri, Iceland and a palliative care nurse at the hospice home care service in Akureyri
| | - Guðmundur Kr. Óskarsson
- Associate Professor, School of Business and Science, University of Akureyri, 600 Akureyri, Iceland
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Northfield S, Nebauer M. The Caregiving Journey for Family Members of Relatives With Cancer. Clin J Oncol Nurs 2010; 14:567-77. [DOI: 10.1188/10.cjon.567-577] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Sandgren A, Thulesius H, Petersson K, Fridlund B. “Doing Good Care”—a study of palliative home nursing care. Int J Qual Stud Health Well-being 2009. [DOI: 10.1080/17482620701650299] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Giske T, Artinian B. Patterns of 'balancing between hope and despair' in the diagnostic phase: a grounded theory study of patients on a gastroenterology ward. J Adv Nurs 2008; 62:22-31. [PMID: 18352961 PMCID: PMC2440414 DOI: 10.1111/j.1365-2648.2007.04523.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM The aim of the study was to learn how patients going through the diagnostic phase experienced and handled their situation. BACKGROUND Many studies report about the stressful diagnostic phase; however, none has presented a conceptual theory where the concepts are sufficiently related to each other. The Theory of Preparative Waiting has previously been published as a descriptive grounded theory and describes the experience of a group of gastroenterology patients going through the diagnostic phase. METHOD A classical grounded theory design was used, with data derived from 18 in-depth interviews with 15 patients in a gastroenterology ward at a Norwegian University Hospital. Interviews were conducted during 2002-2003. FINDINGS Participants' main concern was found to be how they could prepare themselves for the concluding interview and life after diagnosis. The theoretical code of 'balancing' had four patterns; controlling pain, rational awaiting, denial, and accepting. These patterns of 'balancing' guided how participants used the categories of 'Preparative Waiting Theory''seeking and giving information', 'interpreting clues', 'handling existential threats' and 'seeking respite'. Patterns were strategies, so one person could use more than one pattern. CONCLUSION The diagnostic phase was a difficult time for the participants and the 'Preparative Waiting Theory' can assist nurses in assessing how patients prepare themselves differently for getting a diagnosis. All patients would find it helpful to be followed up by a designated contact person at the ward; however, patients using mostly the patterns of controlling pain and denial would benefit most from such support.
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Affiliation(s)
- Tove Giske
- Bergen Deaconess University College and Haukeland University Hospital, Bergen, Norway.
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Dumont I, Dumont S, Mongeau S. End-of-life care and the grieving process: family caregivers who have experienced the loss of a terminal-phase cancer patient. QUALITATIVE HEALTH RESEARCH 2008; 18:1049-1061. [PMID: 18650561 DOI: 10.1177/1049732308320110] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Family caregivers of a loved one with advanced cancer are at risk for developing bereavement complications following the loss of the person they cared for. However, little research has studied caregiving and bereavement experiences as an ongoing process. This study was conducted with the aim of identifying the main elements constitutive of the experience of providing care and assistance to a patient with terminal cancer that influence the grieving process. This qualitative study, conducted among 18 family caregivers, led to the specification of six principal dimensions of the caregiving experience: characteristics of the family caregiver and of the patient, symptoms of the illness, the relational context, social and professional support, and circumstances surrounding the death. Among these dimensions, the constituent elements of the caregiving experience that might positively or negatively influence the grieving process were identified. This knowledge is useful for a more perspicuous identification of caregivers who might experience bereavement complications.
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Affiliation(s)
- Isabelle Dumont
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
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Pergert P, Ekblad S, Enskär K, Björk O. Protecting professional composure in transcultural pediatric nursing. QUALITATIVE HEALTH RESEARCH 2008; 18:647-657. [PMID: 18337617 DOI: 10.1177/1049732308315736] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
In this qualitative study, we used grounded theory to explore the category of "overwhelming emotional expressions" that emerged in a previous study. Using theoretical sampling, 12 individual interviews were conducted with nurses in Swedish pediatric care. Overwhelming emotional expressions have been found to override nurses' professional preparedness; they continuously resolve this by protecting professional composure. Various strategies are used to protect professional composure, including rationalizing, controlled expression, power display, escape/avoidance, distancing, sharing, and management of space. Some of these strategies are similar to coping strategies. However, they differ in that they are about managing the situation and also include protecting the professional composure of the individual as well as the whole care situation. Nurses need to gain preparedness to meet overwhelming emotional expressions in transcultural care and to be aware of strategies for protecting professional composure so as to use them consciously and positively.
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Williams BR, Woodby LL, Bailey FA, Burgio KL. Identifying and responding to ethical and methodological issues in after-death interviews with next-of-kin. DEATH STUDIES 2008; 32:197-236. [PMID: 18705168 DOI: 10.1080/07481180701881297] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
After-death research with next-of-kin can enhance our understanding of end-of-life care and translate into better services for dying persons and their survivors. This article describes ethical and methodological issues that emerged in a pilot of a face-to-face interview guide designed to elicit next-of-kin's perceptions of end-of-life care. The pilot study was part of a larger Veterans Affairs (VA) Health Services Research protocol to improve end-of-life care in VA Medical Centers. By deconstructing the research process from an ethical perspective and engaging in critical self-assessment, the authors aim to inform other researchers of potential problems involved in after-death research with next-of-kin.
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Affiliation(s)
- Beverly R Williams
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Department of Veterans Affairs Medical Center, 700 South 19th Street, 11-G, Birmingham, Alabama, USA.
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Draucker CB, Martsolf DS, Ross R, Rusk TB. Theoretical sampling and category development in grounded theory. QUALITATIVE HEALTH RESEARCH 2007; 17:1137-1148. [PMID: 17928484 DOI: 10.1177/1049732307308450] [Citation(s) in RCA: 183] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Theoretical sampling is a hallmark of grounded theory methodology, and yet there is little guidance available for researchers on how to implement this process. A review of recently published grounded theory studies in Qualitative Health Research revealed that researchers often indicate that they use theoretical sampling to choose new participants, to modify interview guides, or to add data sources as a study progresses, but few describe how theoretical sampling is implemented in response to emergent findings. In this article, two issues that arose relative to theoretical sampling in an ongoing grounded theory study are discussed. A theoretical sampling guide that was developed by the authors' research team to facilitate systematic decision making and to enhance the audit trail relative to theoretical sampling is described, and an example of how the guide was used to develop a category is presented.
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Thulesius HO, Sallin K, Lynoe N, Löfmark R. Proximity morality in medical school--medical students forming physician morality "on the job": grounded theory analysis of a student survey. BMC MEDICAL EDUCATION 2007; 7:27. [PMID: 17683618 PMCID: PMC1964757 DOI: 10.1186/1472-6920-7-27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2006] [Accepted: 08/06/2007] [Indexed: 05/16/2023]
Abstract
BACKGROUND The value of ethics education have been questioned. Therefore we did a student survey on attitudes about the teaching of ethics in Swedish medical schools. METHODS Questionnaire survey on attitudes to ethics education with 409 Swedish medical students participating. We analyzed > 8000 words of open-ended responses and multiple-choice questions using classic grounded theory procedures. RESULTS In this paper we suggest that medical students take a proximity morality stance towards their ethics education meaning that they want to form physician morality "on the job". This involves comprehensive ethics courses in which quality lectures provide "ethics grammar" and together with attitude exercises and vignette reflections nurture tutored group discussions. Goals of forming physician morality are to develop a professional identity, handling diversity of religious and existential worldviews, training students described as ethically naive, processing difficult clinical experiences, and desisting negative role modeling from physicians in clinical or teaching situations, some engaging in "ethics suppression" by controlling sensitive topic discussions and serving students politically correct attitudes. CONCLUSION We found that medical students have a proximity morality attitude towards ethics education. Rather than being taught ethics they want to form their own physician morality through tutored group discussions in comprehensive ethics courses.
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Affiliation(s)
- Hans O Thulesius
- Department of Clinical Sciences Malmö, Division of Family Medicine, Lund University, Sweden
- Research and Development Centre, Kronoberg County Council, Box 1223, SE-351 12 Växjö, Sweden
| | - Karl Sallin
- Centre for Bioethics, LIME, Karolinska Institutet, Stockholm, Sweden
| | - Niels Lynoe
- Centre for Bioethics, LIME, Karolinska Institutet, Stockholm, Sweden
| | - Rurik Löfmark
- Centre for Bioethics, LIME, Karolinska Institutet, Stockholm, Sweden
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Reincentivizing--a new theory of work and work absence. BMC Health Serv Res 2007; 7:100. [PMID: 17608942 PMCID: PMC1950498 DOI: 10.1186/1472-6963-7-100] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2006] [Accepted: 07/03/2007] [Indexed: 11/30/2022] Open
Abstract
Background Work capacity correlates weakly to disease concepts, which in turn are insufficient to explain sick leave behavior. With data mainly from Sweden, a welfare state with high sickness absence rates, our aim was to develop an explanatory theory of how to understand and deal with work absence and sick leave. Methods We used classic grounded theory for analyzing data from >130 interviews with people working or on sick leave, physicians, social security officers, and literature. Several hundreds of typed and handwritten memos were the basis for writing up the theory. Results In this paper we present a theory of work incentives and how to deal with work absence. We suggest that work disability can be seen as hurt work drivers or people caught in mode traps. Work drivers are specified as work capacities + work incentives, monetary and non-monetary. Also, people can get trapped in certain modes of behavior through changed capacities or incentives, or by inertia. Different modes have different drivers and these can trap the individual from reincentivizing, ie from going back to work or go on working. Hurt drivers and mode traps are recognized by driver assessments done on several different levels. Mode driver calculations are done by the worker. Then follows employer, physician, and social insurance officer assessments. Also, driver assessments are done on the macro level by legislators and other stakeholders. Reincentivizing is done by different repair strategies for hurt work drivers such as body repair, self repair, work-place repair, rehumanizing, controlling sick leave insurance, and strengthening monetary work incentives. Combinations of these driver repair strategies also do release people from mode traps. Conclusion Reincentivizing is about recognizing hurt work drivers and mode traps followed by repairing and releasing the same drivers and traps. Reincentivizing aims at explaining what is going on when work absence is dealt with and the theory may add to social psychological research on work and work absence, and possibly inform sick leave policies.
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James I, Andershed B, Ternestedt BM. A family's beliefs about cancer, dying, and death in the end of life. JOURNAL OF FAMILY NURSING 2007; 13:226-52. [PMID: 17452604 DOI: 10.1177/1074840707300849] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
The purpose of this case study was to describe the beliefs over time of a Swedish family and individual family members about cancer and death and how these beliefs affected their daily lives. Data were collected over 10 months using interviews, conversations, and diary notations. The beliefs were aggregated into eight main beliefs and four themes: Cancer is a deadly threat/death is a liberator, death can be held at bay/death can be lived near, dying is done alone/dying should not be done alone, and life has an end/life is endless. These beliefs appear to oscillate between seemingly contrasting poles. Some beliefs were shared by all family members, whereas others were described by only one or more members of the family. The complexity of daily life in families experiencing life-shortening illness underscores the need of individualized nursing care with openness to difference and collaboration as guiding principles.
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Pettersson KO, Christensson K, de Freitas EDGG, Johansson E. Strategies Applied by Women in Coping With ad-hoc Demands for Unauthorized User Fees During Pregnancy and Childbirth. A Focus Group Study From Angola. Health Care Women Int 2007; 28:224-46. [PMID: 17364983 DOI: 10.1080/07399330601179885] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Our aim in this study was to explore women's responses to reported ad-hoc demands for unauthorized user fees during pregnancy and childbirth in Luanda, Angola. Ten focus group discussions were conducted and data were analysed using grounded theory. Women were found to apply six strategies as they "endeavored to cope with demands for unauthorized user fees" (core category): (i) blowing the whistle, (ii) searching for comprehension, (iii) manipulating the system, (iv) bargaining, (v) extending the limits, and (vi) balancing. The system of unauthorized user fees appears to be a symptom of a deeper structural problem, which requires multifaceted and long-term interventions such as insti-tutional reforms and clear policies on accountability and transparency. Better resource availability for the MHC sector is required in order to secure adequate salaries to maternal health care providers. The fact that unethical behavior is unveiled implies that interventions also need to target the national midwifery training.
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Affiliation(s)
- Karen Odberg Pettersson
- Department of Health Sciences, Division of Social Medicine & Global Health, Lund University, Malmö, Sweden.
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Rydé K, Friedrichsen M, Strang P. Crying: A force to balance emotions among cancer patients in palliative home care. Palliat Support Care 2007; 5:51-9. [PMID: 17461371 DOI: 10.1017/s1478951507070071] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Objective: Crying is a common but seldom studied phenomenon in palliative care. The aim of this study was to explore the significance of patients crying in a palliative care context.Methods: Tape-recorded interviews with 14 cancer patients in palliative home care were carried out. To gain deeper understanding, a hermeneutic analysis and interpretation was used.Results: Crying was described in different dimensions: (1) intense and despondent crying as a way of ventilating urgent needs, (2) gentle, sorrowful crying as a conscious release of emotions, and (3) quiet, tearless crying as a protection strategy. Crying seems to be an expression for an inner emotional force, provoked by different factors, which cause changes in the present balance. To cry openly but also to cry on the inside meant being able to achieve or maintain balance. Crying may be something useful, which could create release and help reduce tension, but it may also have a negative impact as it consumes energy and creates feelings of shame.Significance of results: Professionals need to understand the different levels of crying. In such situations sometimes comforting the patient may not be the best solution, as some may need privacy.
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Affiliation(s)
- Kerstin Rydé
- Department of Social and Welfare Studies, Faculty of Health Sciences, Campus Norrköping, Linköping University, Norrköping, Sweden.
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Lobchuk MM, Degner LF, Chateau D, Hewitt D. Promoting Enhanced Patient and Family Caregiver Congruence on Lung Cancer Symptom Experiences. Oncol Nurs Forum 2007; 33:273-82. [PMID: 16518443 DOI: 10.1188/06.onf.273-282] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To test the effects of different perspective-taking instructional sets, gender, caregivers' personal histories with cancer, and caregiving relationship factors on family caregiver and patient perceptual agreement of symptom experiences of patients with lung cancer. DESIGN Counterbalanced. SETTING Thoracic oncology outpatient clinical setting in Canada. SAMPLE 98 dyads consisting of patients with lung cancer and their family caregivers. METHODS Data were collected on a one-time basis by employing an abbreviated version of the Memorial Symptom Assessment Scale targeting lack of energy and worrying. Caregivers were randomized to one of six counterbalanced conditions of perspective-taking instructions. MAIN RESEARCH VARIABLES Caregiver discrepancy scores, instructional sets (i.e., neutral, self-report, and imagine-self and imagine-patient perspective-taking), order effects, gender, caregivers' personal history with cancer, and caregiving relationship factors. FINDINGS No order effects were found for the instructional sets. Instructions to imagine the patient's perspective over imagining how the caregiver would feel if he or she had cancer were most effective in enhancing the caregiver's ability to estimate the patient's lack of energy and worrying. Gender had no significant effects. The amount of patient-caregiver communication had a positive impact on the accuracy of caregivers' perspectives. CONCLUSIONS The patient-oriented instructions had a limited impact on enhancing patient-caregiver congruence on patient symptoms. This likely is related to the study's convenience sample of caregivers who appear to naturally engage in empathic processes of patient-oriented perspective-taking when they assessed and reported on patient symptom conditions. IMPLICATIONS FOR NURSING Further exploratory work should identify interpersonal conditions that negatively hamper the effects of caregiver perspective-taking on their reasonable understanding of patient symptoms.
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Lobchuk MM. Concept analysis of perspective-taking: meeting informal caregiver needs for communication competence and accurate perception. J Adv Nurs 2006; 54:330-41. [PMID: 16629917 DOI: 10.1111/j.1365-2648.2006.03815.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM This paper is a report of an analysis of perspective-taking as presented in the nursing and psychological literature between 1972 and 2004. BACKGROUND Little is known about the caregiving processes that drive communication competence in patient and informal caregiver relationships. Evidence to date suggests that the empathic perspective-taking process plays a key role in promoting communication competence, perceptual accuracy and enhanced ability by caregivers to meet patients' needs arising in illness. Perspective-taking is a concept that has been explored extensively in health or social psychology, but not in nursing literature. METHOD Guided by Morse's typology of attributes and rules of relation, the concept of perspective-taking is explored as it is presented in nursing and social psychology literature, and in accordance with Davis's empathy model. FINDINGS Extant research and theory suggest that perspective-taking is an interpersonal empathic process involving a conscious effort in differentiating one's view from the view of another that can bring the caregivers' viewpoints in closer alignment with patients' viewpoints. Beginning evidence suggests that observers might achieve accurate perceptual accuracy about patients' illness experiences if they are prompted to imagine how patients perceive the situation and how they feel as a result. Research also needs to analyse the characteristics of the patient, informal caregiver and illness situation in order to comprehend more fully which caregiver dyads need assistance with perspective-taking to optimize their skill in providing sufficient patient care. CONCLUSION The current emphasis for empirical research in caregiving is to uncover underlying caregiving processes that exist in pre-existing patient and informal caregiver relationships. Once further evidence is found to further corroborate the perspective-taking process and perceptual accuracy linkage and factors that moderate this linkage, then evidence-based interventions can be designed and tested to optimize empathic processes that minimize perceptual differences between patients and informal caregivers.
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Rodham K, Brewer H, Mistral W, Stallard P. Adolescents’ perception of risk and challenge: A qualitative study. J Adolesc 2006; 29:261-72. [PMID: 16214211 DOI: 10.1016/j.adolescence.2005.05.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2003] [Revised: 11/19/2004] [Accepted: 05/20/2005] [Indexed: 11/22/2022]
Abstract
Concern has been mounting about the increasing numbers of adolescents who engage in risky behaviours. This qualitative study aimed to identify adolescents' perception of risk and explored the factors that adolescents felt influenced their decisions about engaging in risky behaviours. The results indicated that adolescents perceived risk to be something where the outcome was uncontrollable. In contrast, challenges were thought of as having a known end point that was difficult to achieve. They considered themselves to be well-informed about health risks facing them, yet mentioned occasions when they lacked the ability to state that they did not want to engage in certain "risky" behaviours. The implications of the findings for future interventions are discussed.
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Affiliation(s)
- Karen Rodham
- Department of Psychology, University of Bath, UK.
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Sandgren A, Thulesius H, Fridlund B, Petersson K. Striving for emotional survival in palliative cancer nursing. QUALITATIVE HEALTH RESEARCH 2006; 16:79-96. [PMID: 16317178 DOI: 10.1177/1049732305283930] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
In this grounded theory study, the authors analyze interviews and participant observation data related to palliative cancer nursing in hospitals. Striving for Emotional Survival emerged as the pattern of behavior through which nurses deal with their main concern, the risk of being emotionally overloaded by their work. It involved three main strategies: Emotional Shielding through Professional Shielding or Cold Shielding; Emotional Processing through Chatting, Confirmation Seeking, Self-Reflecting, or Ruminating; and Emotional Postponing through Storing or Stashing. Emotional Competence is a property of Striving for Emotional Survival that explains more or less adequate ways of dealing with emotional overload. The theory Striving for Emotional Survival can be useful in the nurses' daily work and provides a comprehensive framework for understanding how nurses deal with emotional difficulties. The authors suggest that health care organizations encourage self-care, prioritize time to talk, and offer counseling to nursing staff with emotionally difficult working conditions.
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Affiliation(s)
- Anna Sandgren
- Department of Primary Health Care, University of Gothenburg, Sweden
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Abstract
Corneal donation occurs infrequently within palliative care, even though the majority of the public say they are in favour of donating organs and tissue after death. One of the roles of the health professional is to provide patients with the necessary information to make choices, and this should include the option of donating their corneas should they so wish. This literature review explores how the subject can be raised in a systematic manner within palliative care. It looks at the potential benefits and dangers of involving the patient in such discussions, and the effects on the families. Practical issues, such as when to raise the issue, are also considered. Finally, the review discusses the implications for nursing practice and research.
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Affiliation(s)
- Philip Edwards
- St Margaret's Hospice, Little Tarrant Lane, Yeovil, Somerset BA20 2HU, UK.
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Abstract
Good communication with patients can be a powerful tool in palliative care. However, discussing fears and anxieties at length is also something that many nurses find difficult. This article provides an overview of one approach to using the power of communication, the end-of-life discussion. Practical issues are considered, as well as suggestions as to what to include in such a discussion. Concepts of loss and meaning for the person with advanced disease are looked at. The article also considers some of the key communication skills that are especially valuable, such as active listening, ways of encouraging disclosure and the handling of silences.
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Affiliation(s)
- Phil Edwards
- St Margaret's Hospice, Heron Drive, Bishop's Hull, Taunton, Somerset TA1 5HA, UK
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