Registered nurses' descriptions of caring: a phenomenographic interview study

Phenomenography: An emerging qualitative research design for nursing

BACKGROUND

Phenomenography emerged from pedagogy to examine the qualitatively different ways that individuals experience and perceive the same phenomenon. Despite its uniqueness, the uptake of phenomenography in nursing research is still limited. Potentially, this may be related to confusion regarding what the design is about, its philosophical underpinnings and how distinct it is from other qualitative designs.

OBJECTIVES

To offer a better understanding of phenomenography by comparing it with other established qualitative research designs, examining its theoretical foundations, highlighting some studies that have employed the approach in nursing and offering methodological guidance to improve its uptake in nursing.

DESIGN

Discussion paper.

FINDINGS

Compared to the traditional qualitative designs employed in nursing, phenomenography has been utilized in fewer studies. The ontological, epistemological and methodological basis of phenomenography highlights it as a distinct design. The strength of phenomenography lies in its emphasis on understanding the collective variations between participants and presenting these holistically as an 'outcome space'.

DISCUSSION

Phenomenography is a distinct qualitative research approach that presents a unique opportunity for nursing to further its use. Issues regarding bracketing, the inclusion of phenomenography studies in qualitative meta-synthesis and employing a hermeneutic approach to phenomenography are avenues for further work in nursing.

PATIENT AND PUBLIC CONTRIBUTION

No patient or public contribution.

Self-Reported eHealth literacy among nursing students in Sweden and Poland: The cross-sectional multicentre study

This study aimed to provide an understanding of nursing students' self-reported eHealth literacy in Sweden and Poland. This cross-sectional multicentre study collected data via a questionnaire in three universities in Sweden and Poland. Descriptive statistics, the Spearman's Rank Correlation Coefficient, Mann-Whitney U, and Kruskal-Wallis tests were used to analyse different data types. Age (in the Polish sample), semester, perceived computer or laptop skills, and frequency of health-related Internet searches were associated with eHealth literacy. No gender differences were evidenced in regard to the eHealth literacy. Regarding attitudes about eHealth, students generally agreed on the importance of eHealth and technical aspects of their education. The importance of integrating eHealth literacy skills in the curricula and the need to encourage the improvement of these skills for both students and personnel are highlighted, as is the importance of identifying students with lacking computer skills.

Phenomenographic Approaches in Research About Nursing

We propose that phenomenography is well-suited to research about nursing, given its focus on identifying variation in individuals' experiences, and inclusion of diverse voices and perspectives. Phenomenography explores qualitatively different ways in which a group of people experience a phenomenon, often using semi-structured interviews. The use of phenomenography is especially relevant in research about nursing which provides accounts of the experiences of nurses and patients within complex practice settings. We consider the tenets of phenomenography and examine phenomenography's relationship to and differences from phenomenology. We review literature published about phenomenographic research in nursing and reflect on the potential benefits of phenomenographic research about nursing. This paper adds to knowledge about use of phenomenography in research about nursing.

Nurses' lived experiences of caring for patients with COVID-19: a phenomenological study

Background

COVID-19 is an infectious disease caused by a novel Coronavirus which transmits from person to person throughout the world. This study aimed to explore the lived experiences of nurses' caring for patients with COVID-2019 in the context of the healthcare system of Iran.

Methods

This is a phenomenological study with 13 participant nurses (6 men and 7 women) who were caring for COVID-19 patients in one of the university hospitals in Southeast of Iran. Qualitative data were analysed by the seven steps of Colaizzi's method.

Results

Participants reported around a five-month history of caring for COVID-19 patients. After analysis, 597 codes, 16 categories, four sub-themes, and one theme were extracted. "Caring from self-sacrifice to avoidance" was the main theme of the study with sub-themes of "Anxiety Chain", "Manifestation of Humanitarian Caring", "Ethical Challenges", and "Challenges of Overcoming Crisis".

Conclusions

Nurses explained their caring experiences with patients on a continuum from humanitarian caring and self-sacrifice to caring avoidance. Because of the multi-sources of psychological stress and ethical challenges together with this infection, healthcare managers should plan for holistic regular psychological support services, prevention of job inequalities, and do strategic planning for access to enough resources in the healthcare system.

The relationship between attitudes to homelessness and perceptions of caring behaviours: a cross-sectional study among women experiencing homelessness, nurses and nursing students

Background

Women experiencing homelessness have complex and multifaceted healthcare needs and yet they are an underserved population across healthcare services. Nurses are trained to perform an integral role in the provision of equitable healthcare and their attitudes towards homelessness may therefore influence the care that women experiencing homelessness receive. This study aimed to examine correlations between attitudes towards homelessness and caring behaviours, and to test if these correlations differed between the groups of women experiencing homelessness, registered nurses, and nursing students.

Methods

A cross-sectional design using convenience sampling was used to recruit women experiencing homelessness (n = 37), registered nurses (n = 90), and nursing students (n = 138) in Stockholm, Sweden between August 2019 and December 2020. The participants answered two questionnaires: the Attitudes Toward Homelessness Inventory and the Caring Behaviours Inventory-24. Correlations between ordinal variables were calculated using Spearman’s rank correlation ρ. Tests of equality between two independent correlations were performed using a Z-test applied to Fisher’s z-transformed correlations. An advisory board of women with lived experience of homelessness supported the interpretation of the results.

Results

Weak, negative correlations were identified between the Attitudes Toward Homelessness Inventory and Caring Behaviours Inventory-24. The Attitudes Toward Homelessness Inventory mean total scores (SD) were 4.1 (0.6), 4.2 (0.6), 4.1 (0.5) points for the women experiencing homelessness, registered nurse, and nursing student groups, respectively, with the corresponding scores for the Caring Behaviours Inventory-24 being 4.1 (1.1), 5.2 (0.5), 4.8 (0.7) points, respectively.

Conclusions

To promote equitable health for women experiencing homelessness, healthcare providers and nurse educators should consider the role of stigmatising attitudes in relation to caring behaviours.

Capturing the value and core concepts of the Clinical Research Nurse

Background

As nurses, we identify our profession as a caring one, but how does this identity translate from a conceptual definition, to real-world practice for the Clinical Research Nurse?

Aim

To offer a novel, four-point conceptual model that encapsulates the Clinical Research Nurse's intrinsic value, active leadership, and direct contribution to high quality, person-centered, safe care, addressing current misperceptions of research nursing.

Methods

This paper describes the provision of 'care', safely delivered by the Clinical Research Nurse through a four-point conceptual model and case-driven example.

Discussion

Clinical research nursing is conceptualized within the domains of Care and Trust, Role, Impact, and Integration. The case example demonstrates real-world application of these domains and the expertise required to balance the complexities of clinical needs and research demands in a healthcare environment.

Conclusions

This paper offers a mechanism for understanding the importance of the Clinical Research Nurse and their role in maintaining safety and a high-level view of the care arena. These reflections are considered with an international application for the role.

How emergency nurses cope and motivate themselves to sustain their caring work: An integrative literature review

AIMS AND OBJECTIVES

The aim of this integrative review was to assess how emergency nurses cope and motivate themselves to sustain their caring work.

BACKGROUND

The need to enhance sustainability of the workforce creates a demand to consolidate contemporary evidence related to emergency nurses' motivations, how they cope and sustain themselves for caring work.

DESIGN AND METHODS

The integrative literature review informed by Whittemore and Knafl involved searching four databases, which yielded 977 published research papers (2008-2021). A total of 33 studies met the inclusion and quality assessment criteria. The PRISMA checklist for review was followed.

RESULTS

No studies addressing all three areas (motivations, coping and caring sustainability) together were identified. Integration of evidence from quantitative and qualitative research was achieved in three categories: (1) emergency nurses' motivations to sustain their work, (2) emergency nurses' coping strategies and (3) sustaining care as emergency nurses.

CONCLUSION

To sustain themselves in caring work, emergency nurses need to be intrinsically and extrinsically motivated and know how to cope effectively with stressors and work demands. There is need for research examining the relationships between these aspects of emergency nursing work.

RELEVANCE TO CLINICAL PRACTICE

To ensure the sustainability of emergency nurses' work and careers understanding of the factors that influence and sustain their motivations and coping strategies is important for nurses and their clinical leaders and managers.

Adverse events and their management during enhanced external counterpulsation treatment in patients with refractory angina pectoris: observations from a routine clinical practice

AIMS 

Enhanced external counterpulsation (EECP) is a non-invasive treatment (35 one-hour sessions) for patients with refractory angina pectoris (RAP). To avoid interruption of treatment, more knowledge is needed about potential adverse events (AE) of EECP and their appropriate management. To describe occurrence of AE and clinical actions related to EECP treatment in patients with RAP and compare the distribution of AE between responders and non-responders to treatment.

METHODS AND RESULTS 

A retrospective study was conducted by reviewing medical records of 119 patients with RAP who had undergone one EECP treatment and a 6-min-walk test pre- and post-treatment. Sociodemographic, medical, and clinical data related to EECP were collected from patients' medical records. An increased walking distance by 10% post-treatment, measured by 6-min-walk test, was considered a responder. The treatment completion rate was high, and the occurrence of AE was low. Adverse events occurred more often in the beginning and gradually decreased towards the end of EECP treatment. The AE were either device related (e.g. muscle pain/soreness) or non-device related (e.g. bradycardia). Medical (e.g. medication adjustments) and/or nursing (e.g. extra padding around the calves, wound dressing) actions were used. The AE distribution did not differ between responders (n = 49, 41.2%) and non-responders. Skin lesion/blister occurred mostly in responders and paraesthesia occurred mostly in non-responders.

CONCLUSION 

Enhanced external counterpulsation appears to be a safe and well-tolerated treatment option in patients with RAP. However, nurses should be attentive and flexible to meet their patients' needs to prevent AE and early termination of treatment.

The critical care nurse's perception of handover: A phenomenographic study

OBJECTIVE

To describe variations in critical care nurses' perceptions of handover.

RESEARCH METHODOLOGY

Phenomenographic design using individual interviews for data-collection.

SETTING

The critical care nurses participating in the study were recruited from critical care units in three hospitals in Sweden.

FINDINGS

Five descriptive categories were identified: Communication between staff, Opportunity for learning, Patient-centred information gathering as a basis for continuous care, Responsibility for transfers, and Patient safety and quality of care.

CONCLUSION

Nursing handover is a complex phenomenon, which is understood in various ways. Handover is mediated through communication and marks a shift in responsibility. Handover seems to be related to patient safety and quality of care. There is potential for improvement in the quality of nursing handover in clinical praxis, but further research is needed to determine ways of improving quality of handover.

Ways of understanding nursing in psychiatric inpatient care - A phenomenographic study

Aim

The aim was to describe the ways that nursing staff in psychiatric inpatient care understand nursing.

Background

Nursing in psychiatric care is marginalized with ambiguous role definitions and imperceptible activities. Nurse managers' capabilities to establish a direction and shared vision are crucial to motivate nursing staff to take part in practice development. However, before establishing a shared vision it is important to identify the different ways nursing can be understood.

Methods

Sixteen individual semi‐structured interviews with nursing staff members were analysed using a phenomenographic approach.

Results

Five ways of understanding nursing were identified. These understandings were interrelated based on the way that the patient, nursing interventions and the goal of nursing were understood.

Conclusion

The diversity of identified understandings illuminates the challenges of creating a shared vision of roles, values and goals for nursing.

Implications for Nursing Management

Awareness of staff members' different understandings of nursing can help nurse managers to establish a shared vision. To be useful, a shared vision has to be implemented together with clear role definitions, professional autonomy of nurses and support for professional development. Implementation of such measures serves as a foundation to make nursing visible and thereby enhance the quality of patient care.

Nurses' experiences of caring for patients with intellectual developmental disorders: a systematic review using a meta-ethnographic approach

BACKGROUND

Research suggests that registered nurses (RNs) do not feel adequately prepared to support patients with intellectual disability disorder (IDD). This is unsurprising, as few European health sciences curricula include undergraduate and graduate training courses in IDD. As RNs are often in the front line of care, eliciting in-depth knowledge about how they experience nursing this group of patients is vital. Our aim in this study was to develop a conceptual understanding about RNs' experiences of nursing patients with IDD.

METHOD

We undertook a systematic review and meta-ethnography to synthesise qualitative research studies found in PubMed, CINAHL, PsycINFO, ERIC databases and by manual searching to identify additional studies. We condensed translatable second-order constructs, and developed an idiomatic translation. Finally, we formulated line of argument (LOA) syntheses to capture the core of the idiomatic translations.

RESULTS

We included eighteen published studies from eight countries involving 190 RNs. The RNs' experience of nursing patients with IDD were reflected in 14 LOAs. Six of these reflected a tentatively more distinctive and at times unique conceptualisation of RNs' experience of nursing this group of patients. The remaining eight LOAs represented a conceptualisation of nursing per se, a conceptualisation of nursing that was interpreted as a universal experience regardless of context and patient group.

CONCLUSION

Lack of awareness and knowledge are likely breeding grounds for the 'otherness' that still surrounds this group of patients. In encounters between patients and RNs, focusing on the person behind the disability label could be one way to secure relevant nursing care for patients with IDD. Undertaking appropriate under- and postgraduate education alongside the implementation of nursing models focusing on patient-centred care would help RNs in reducing the health and care inequalities this group of patients still face.

TRIAL REGISTRATION

PROSPERO 2017: CRD42017077703.

Can nurses remain relevant in a technologically advanced future?

Technological breakthroughs occur at an ever-increasing rate thereby revolutionizing human health and wellness care. Technological advancements have drastically changed the structure and organization of the healthcare industry. McKinsey Global Institute estimates that 800 million workers worldwide could be replaced by robots by the year 2030. There is already a robotic revolution happening in healthcare wherein robots have made tasks and procedures more efficient and safer. Locsin and Ito has addressed the threat to nursing practice with human nurses being replaced by humanoid robots. Routine nursing care dictated solely by prescribed procedures and accomplishment of nursing tasks would be best performed by machines. With the future practice of nursing in a technologically advanced future transcending the implementation of nursing actions to achieve predictable outcomes, how can human nurses remain relevant as practitioners of nursing? Nurses should be involved in deciding which aspects of their practice can be delegated to technology. Nurses should oversee the introduction of automated technology and artificial intelligence ensuring their practice to be more about the universal aspects of human care continuing under a novel system. Nursing education and nursing research will change to encompass a differentiated demand for professional nursing practice with, and not for, robots in healthcare.

Handling the inpatient's hospital 'Career' - Are nurses laying the groundwork for healthy meal and nutritional care transitions?

This qualitative study examined hospital nurses' methods in handling meal and nutrition care during inpatient time, with an underlying focus on undernourished older adult. Observations and interviews were used to document nurses' methods through the span of a transition (defined by an entry, passage, and exit). The study finds inconsistencies in care methods due to institutional processes restricting both mealtime care and nutritional logging of information throughout hospitalization. It is concluded that the consequences of these inconsistencies must be recognized and that new approaches to meals and nutritional care should be introduced in order to provide greater flexibility. Based on the assumption that mobilizing patient resources is pivotal for meal and nutritional care, it is argued that it may be important to mobilize patient resources during mealtime and in nutritional logging of information in order to increase the visibility of meal and nutritional care in patient transitions within the institution and across settings. Both nurses' methods and institutions developmental initiatives regarding meal and nutritional care need to accommodate the differences between what in this paper is defined as social-bodily care and text-based care. This could be met through care methods that take place with, more than for the patient.

Caring characters and professional identity among graduate nursing students in China-A cross sectional study

BACKGROUND

Caring is recognized as the essence of nursing and the core of nursing practice while a positive professional identity can lead to personal, social and professional fulfillment. Analyzing caring characters and professional identity yields important indications for the improvement of teaching methods. This study aims to explore the graduate nursing students' professional identity and caring characters in China, and analyze their correlation.

METHOD

A descriptive cross-sectional study was used to collect data from 216 graduate nursing students between January and February 2017 in China.

RESULTS

Graduate nursing students perceived they possessed positive caring characters while their professional identity was at a low level. A significant positive correlation was found between the Nursing Caring Characters Assessment Tool and Professional Identity Scale for Nursing Students.

CONCLUSION

Graduate nursing students' professional identity was not satisfactory and one strategy to improve this is to internalize caring into the education process. Nursing educators should focus more on the formation of the students' professional identity and caring as a contributing factor to it.

Understanding the Essence of Caring from the Lived Experiences of Filipino Informatics Nurses

Caring is considered a unique concept in nursing because it subsumes all intrinsic attributes of nursing as a human helping discipline. Scholars have argued that caring is usually seen as an encounter between nurses and patients, but how about nurses with minimal or absent nurse-patient encounters, like informatics nurses? In this study, we explored the meaning of the phenomenon of caring to present lived experiences of caring, namely caring as actions of coming in between; caring as expressed within embodied relations; and caring and the path traversed by informatics nurses. The informatics nurse-cyborg-patient triad speaks of Filipino informatics nurses’ insightful understanding of the phenomenon of caring.

Caring for patients with spinal metastasis during an MRI examination

INTRODUCTION

Magnetic resonance imaging (MRI) is without question the best tool used for diagnosing and evaluating spinal metastasis. An MRI examination is known to be of great value for the treatment planning and survival of these patients. Radiographers have an important role in how the quality of care is experienced by the patients during an MRI examination. The purpose of the study was to describe the radiographers' perceptions of caring for patients with spinal metastasis during an examination with MRI.

METHODS

Phenomenography was used to analyze the data in this study. Ten radiographers, one male and nine females were interviewed about their perception of caring for patients with spinal metastasis during an MRI examination.

RESULTS

The findings showed that the radiographers' caring perspective influenced their approach towards what they consider to be essential in the care of patients with spinal metastasis. This can impact the extent of the adjustment to the care needs of the patients. Furthermore, the findings showed that there was a strong connection between the radiographers' care approach and preparedness to personalize the care.

CONCLUSION

This study shows that it is important to be flexible when providing care for the patients. A person-centered care is achieved when the caring perspective is based on the patient's view and adjustments are made in agreement with the patient.

Can Nursing Drive Technological Advances in Healthcare in the Asia-Pacific?

The Asia-Pacific healthcare industry is expected to grow at 11.1% in 2018. This has been considered one of the fastest growing regions in the world. The positive growth occurring in the Asia-Pacific region is due to the increasing adoption of technology. While it is understood that technology drives advances in nursing and the health sciences, would it be possible that nursing can or will also drive technological advancements in human caring? All too often, nurses are employed in health care as simply the end-users of technologies. It is the purpose of this paper to engage a discourse towards advancing nursing as driving technological improvements aimed for human caring. How can nursing facilitate this powerful dynamic, and what will it take for nursing as a discipline and a profession to occupy a primary role in this all too often unrecognized view, that nursing can and will drive technological advancements for human caring?

Workplace violence against emergency nurses in Taiwan: A phenomenographic study

BACKGROUND

Workplace violence (WPV) is a serious problem in health care in Taiwan, as it is worldwide. Among all nursing staff, emergency department (ED) nurses are at the highest risk of WPV; yet, little attention has been paid to nurses as WPV victims.

PURPOSE

The purpose of the study was to understand ED nurses' WPV experiences and perspectives.

METHODS

An interpretive qualitative phenomenographic design was used to answer the following research question: what are the qualitatively different ways in which nurses in Taiwan experience WPV in the ED? Thirty ED nurses who identified as experienced with WPV were interviewed, and phenomenographic analysis was used to assess the data.

FINDINGS

Four categories of description emerged. WPV was seen as a continuing nightmare, a part of daily life, and a direct threat, and it had a negative impact on nurses' passion for emergency care. WPV adversely affected nurses on physical, psychological, social, personal, and professional levels.

CONCLUSION

The findings of this study have practical implications for in-service WPV training programs and may be used to inform potential changes to policy and legislation designed to establish a safer ED environment for staff.

Nurse students' experiences with clinical placement in outpatient unit - a qualitative study

BACKGROUND

The recent reforms in the health care sector have changed the requirements for professional nursing competence in the clinical field. The reforms have also required nursing education to consider different areas for clinical placements for their students, and outpatient units in hospitals have been increasingly formalized as clinical learning environments. The complex technologies in some of these units represent a challenge for students who have limited existing knowledge or experience. More focus on outpatient care has also led to fewer opportunities for studying the continuity of a patient's life situation. In order to meet these challenges, structured learning activities with special forms were developed by nursing educators and nurses at outpatient units. The aim of this study was to explore students' experiences of using structured learning activities as unit-specific learning outcomes and targeted reflection during clinical placements in an outpatient unit.

METHODS

Two focus group interviews were conducted with a total of seven nursing students who had experienced structured learning activities during clinical placements in an outpatient unit. Data were analyzed by means of content analyses.

RESULTS

This study shows that preparedness and guidance during placement were imperative for making the week in the outpatient unit meaningful. 'Being prepared', which was one of the categories, incorporated the subcategories 'being able to understand what to do', 'being at the right place at the right time' and 'being alert for new experiences'. The category 'being guided' which incorporated the subcategories 'from uncertainty to more confidence', 'from observer to seeking knowledge' and 'from focusing on technology to seeing the person' showed that the forms guided the students through the placement in the outpatient unit.

DISCUSSION

Students take a more active approach to seeking knowledge when given structured learing activities during clinical placement in outpatient unit.

CONCLUSIONS

This study shows that use of outpatient units for clinical placement in nursing studies has several challenges but also the potential for creating positive experiences for the students.

Confirming mental health care in acute psychiatric wards, as narrated by persons experiencing psychotic illness: an interview study

Background

It is important that mental health nurses meet the safety, security and care needs of persons suffering from psychotic illness to enhance these persons’ likelihood of feeling better during their time in acute psychiatric wards. Certain persons in care describe nurses’ mental health care as positive, whereas others report negative experiences and express a desire for improvements. There is limited research on how persons with psychotic illness experience nurses’ mental health care acts and how such acts help these persons feel better. Therefore, the aim of this study was to explore, describe and understand how the mental health nurses in acute psychiatric wards provide care that helps persons who experienced psychotic illness to feel better, as narrated by these persons.

Method

This study had a qualitative design; 12 persons participated in qualitative interviews. The interviews were transcribed, content analysed and interpreted using Martin Buber’s concept of confirmation.

Results

The results of this study show three categories of confirming mental health care that describe what helped the participants to feel better step-by-step: first, being confirmed as a person experiencing psychotic illness in need of endurance; second, being confirmed as a person experiencing psychotic illness in need of decreased psychotic symptoms; and third, being confirmed as a person experiencing psychotic illness in need of support in daily life. The underlying meaning of the categories and of subcategories were interpreted and formulated as the theme; confirming mental health care to persons experiencing psychotic illness.

Conclusion

Confirming mental health care acts seem to help persons to feel better in a step-wise manner during psychotic illness. Nurses’ openness and sensitivity to the changing care needs of persons who suffer from psychotic illness create moments of confirmation within caring acts that concretely help the persons to feel better and that may enhance their health. The results show the importance of taking the experiential knowledge of persons who have experienced psychotic illness seriously to develop and increase the quality of mental health care in acute psychiatric wards.

Registered nurses views of caring in coronary care--a deductive and inductive content analysis

AIMS AND OBJECTIVES

To extend nurses' descriptions of how they understood caring, as reflected in the findings of an earlier study (i.e. the hierarchical outcome space) and to gain additional understandings and perspectives of nurses' views of caring in relation to a coronary care patient case.

BACKGROUND

Scientific literature from the 1970s-1990s contains descriptions of caring in nursing. In contrast, the contemporary literature on this topic--particularly in the context of coronary care--is very sparse, and the few studies that do contain descriptions rarely do so from the perspective of nurses.

DESIGN

Qualitative descriptive study.

METHODS

Twenty-one nurses were interviewed using the stimulated recall interview technique. The data were analysed using deductive and inductive qualitative content analysis.

RESULTS

The results of the iterative and integrated content analysis showed that the data mainly reproduced the content of the hierarchical outcome space describing how nurses could understand caring; however, in the outcome space, the relationship broke up (i.e. flipped). The nurses' views of caring could now also be understood as: person-centredness 'lurking' in the shadows; limited 'potential' for safeguarding patients' best interests; counselling as virtually the 'only' nursing intervention; and caring preceded by the 'almighty' context. Their views offered alternative and, at times, contrasting perspectives of caring, thereby adding to our understanding of it.

CONCLUSION

Caring was described as operating somewhere between the nurses caring values and the contextual conditions in which caring occurred. This challenged their ability to sustain caring in accordance with their values and the patients' preferences.

RELEVANCE TO CLINICAL PRACTICE

To ensure that the essentials of caring are met at all times, nurses need to plan and deliver caring in a systematic way. The use of systematic structures in caring, as the nursing process, can help nurses to work in a person-centred way, while sustaining their professional values.