Family participation in the nursing care of the hospitalized patients

"I am the one taking care of her and donating blood": lived experiences of role-routines of hospital-based informal caregiving in Nigeria

PURPOSE

Informal caregivers (ICs) in Africa perform a long list of tasks to support hospitalization care. However, available studies are weak in accounting for the experiences of everyday role-routines of hospital-based informal caregiving (HIC) in under-resourced settings. This article explored the experiences of role-routines among informal caregivers in a Nigerian tertiary health facility.

METHODS

The ethnographic exploratory study relied on primary data collected from 75 participants, including 21 ICs, 15 inpatients, 36 hospital staff, and 3 ad-hoc/paid carers in a tertiary health facility in Southwestern Nigeria.

RESULTS

ICs perform several essential roles for hospitalized relatives, with each role characterized by a range of tasks. An integrative narrative of everyday routines of HIC as experienced by ICs showed critical complexities and complications involved in seemingly simple tasks of assisting hospitalized relatives with hygiene maintenance, medical investigations, blood donation, resource mobilization, errand-running, patient- and self-care and others. The role-routines are burdensome and ICs' experiences of them revealed the undercurrents of how health systems dysfunctions condition family members to support hospitalization care in Nigeria.

CONCLUSION

The intensity and repetitive nature of role-routines is suggestive of "routinization of suffering". We recommend the closing of gaps driving hospital-based informal caregiving in Africa's under-resourced settings.

Attitudes towards family involvement in nursing care among psychiatric nurses in Hong Kong: A cross-sectional descriptive study

WHAT IS KNOWN ON THE SUBJECT?: Family-involved interventions can result in better outcomes than traditional mental health care for both service users and their families. Nurses' attitudes towards family involvement can affect family participation in care. Earlier studies on psychiatric nurses' attitudes towards family involvement in care report ambiguous findings. Hong Kong's unique integrated cultures may influence Hong Kong psychiatric nurses' attitudes towards family involvement in nursing care. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The majority of psychiatric nurses had positive views on family involvement in care in Hong Kong. Four variables (i.e. gender, clinical experience, nature of working unit and family nursing training) of psychiatric nurses are associated with their attitudes towards family involvement in care in Hong Kong. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Policy makers should develop strategies to increase psychiatric nurses' awareness of the importance of family involvement in patient care. Nurse educators help to design family nursing training to enhance psychiatric nurses' competence in collaborating with families of people suffering from mental disorders.

ABSTRACT

INTRODUCTION: In Hong Kong, involving the family in nursing care is still optional and mainly depends on nurses' attitudes and the willingness of the family. Hong Kong psychiatric nurses' attitudes towards family involvement in nursing care may be influenced by the unique integrated Eastern and Western cultures, however earlier studies report ambiguous findings.

AIMS

This study aimed to assess Hong Kong psychiatric registered nurses' attitudes towards family involvement in care and its associated factors.

METHODS

This study is a cross-sectional descriptive online survey with convenience sampling based on the Families' Importance in Nursing Care-Nurses' Attitudes (FINC-NA) instrument.

RESULTS

Most of the psychiatric nurses had supportive attitudes towards family involvement in care. Females with more clinical experience, working in a rehabilitation-related unit and having attended a family nursing education course were associated with positive attitudes towards family involvement in care.

DISCUSSION

The supportive attitude of psychiatric nurses may be explained by the shift of mental health nursing care from hospital care to community care in recent decades.

IMPLICATIONS FOR PRACTICE

Mental health nurse education and training in Hong Kong could place more emphasis on building family work skills, particularly for newly qualified nurses and those working in acute inpatient settings.

Perception of Nurses' Support among Family Members of Hospitalized Patients in A Tertiary Health Facility in South-West, Nigeria

Introduction

Family members of hospitalized patients are often faced with challenges and may experience difficulty in coping without appropriate support. The aim of this study was to assess hospitalized patients' family members' perception of nurses' support.

Methods

A cross-sectional descriptive design was utilized. A total of 138 family members of hospitalized patients in a tertiary health facility were selected using a purposive sampling technique. Data were collected with an adopted structured questionnaire. Analyses of data were performed using frequency, percentage, mean, standard deviation, and multiple regression. The level of significance was set at 0.05 (p < .05. Also, age, gender, and type of family were the predictors of emotional support (R2 = 84, F(6, 131) = 5.92, p < .05.

Results

Twenty-seven qualitative studies were included in the review. A thematic synthesis showed over 100 themes and subthemes across the studies. A cluster analysis revealed positive elements and others that were seen in the studies as a barrier (hindrance) to clinical learning. Positive elements included supportive instructors, close supervision, and belonging (in the team). Unsupportive instructors, a lack of supervision and not being included were seen as a hindrance. Three key overarching themes that could describe a successful placement were revealed as "Preparation," "Welcomed and wanted" and "Supervision experiences". A conceptual model of clinical placement elements conducive to nursing students' learning was developed to enhance understanding of the complexities associated with supervision. The findings and model are presented and discussed.

Conclusion

A significant number of families of hospitalized patients reported poor perception of cognitive, emotional, and overall support from nurses. Adequate staffing is a prerequisite for effective family support. Nurses also need appropriate training in providing family support. The focus of family support training should emphasize practices that nurses can use in everyday interactions with patients and family members.

Family Involvement in Caring for Inpatients in Acute Care Hospital Settings: A Systematic Review of Literature

Family members, also known as patients' guardians (PG) are involved in caring for inpatients in acute care hospital settings. The practice is adopted from Family Centred Care (FCC) approach. This literature review aimed to provide an overview of key findings in literature on the practice of involving PGs in acute care hospital settings We used a systematic literature search to select original research articles or systematic reviews published in English between 2008 and 2019 that discussed PGs in acute care hospital settings. Studies that discussed PGs in long-term care hospital or in-home settings were excluded from this literature review. Literature was sought from CINAHL, MEDLINE, and PsycINFO. CASP and JBI checklist was used to appraise the full-text articles for inclusion in the literature review. Twenty-six articles were included. Findings show that there is limited literature on this topic although healthcare institutions involve PGs in their routine inpatient care. Three themes emerged from the review; the FCC approach, roles of PGs in acute care hospitals, and implications of involving PGs in acute care hospitals. PGs offer any care that is left undone by nurses in acute care hospitals to ensure that their patients' needs are met. However, their involvement is not consistent with FCC principles. This leads to physical, psychosocial, and economic implications for PGs. We recommend that nurse practitioners should consistently implement FCC principles to enable PGs to offer meaningful care to their inpatients.

Missed Nursing Care Among Patients With Dementia During Hospitalization: An Observation Study

Patients with dementia (PwD) are characterized as a vulnerable group as they are unable to communicate their needs, putting them at risk for care omissions. The current study aimed to explore care toward PwD and detect if any aspects of care are omitted. An observation study was conducted in three medical-surgical adult wards of an acute general hospital. Data were collected by an observer, through field notes, and were analyzed with content analysis. A face scale was used to assess PwD's mood. Thirteen PwD were observed for 90 hours. Four thematic areas were identified: (a) Unmet Fundamental Patient Needs, (b) Human Right to Dignity and Respect, (c) Communication Deficiencies, and (d) Implementation of Nursing Interventions. Nurse-patient contact lasted from 5 to 7 minutes and numerous care omissions were noted. The face scale assessment revealed that most PwD looked very sad after nursing care. This study enriches insight for the care of PwD during hospitalization and emphasizes the need for health care workers' education and support. [Research in Gerontological Nursing, 14(3), 150-159.].

Impact of Religiosity on Delirium Severity Among Critically Ill Shi'a Muslims: A Prospective Multi-Center Observational Study

This study assesses the impact of religiosity on delirium severity and patient outcomes among Shi'a Muslim intensive care unit (ICU) patients. We conducted a prospective observational cohort study in 21 ICUs from 6 Iranian academic medical centers. Delirium was assessed using the Confusion Assessment Method for the ICU (CAM-ICU) tool. Eligible patients were intubated, receiving mechanical ventilation (MV) for ≥ 48 h. Illness severity was assessed using Acute Physiology and Chronic Health Evaluation II (APACHE II) scores. A total of 4200 patients were enrolled. Patient religiosity was categorized as more (40.6%), moderate (42.3%), or less (17.1%) based on responses to patient and surrogate questionnaires. The findings suggest that lower pre-illness religiosity may be associated with greater delirium severity, MV duration, and ICU and hospital LOS. The lower mortality in the less religiosity group may be related in part to a greater proportion of female patients, but it remains unclear whether and to what extent greater religiosity impacted treatment decisions by patients and families. Further investigation is needed to validate and clarify the mechanism of the mortality findings.

Patient's companions as a vulnerable group in Turkish hospitals: A descriptive study

BACKGROUND

In Turkish hospitals, in addition to health care professionals, there are people who are also a significant part of the health care services; even though they are not professionals. In Turkey, these people are known as refakatçi (a patient's companion).

OBJECTIVES

The purpose of this study was to identify and describe the concept of the patient's companion from their own perspective and to evaluate the concept of the patient's companion in terms of biomedical ethics.

METHODS

This was a descriptive study. Personal interviews were conducted via a structured questionnaire containing open-ended questions with the patients' companions. Thematic text analysis method was used to analyze the open-ended questions. The study was conducted at a University Research and Training Hospital in the Aegean Region of Turkey.

RESULTS

A total of 118 patient companions participated in the study. These patient companions stayed with the patients because of their concerns about trusting the health care professionals in caring for the patients. During their stay, the companions encountered several problems, including staying in ward-type rooms and resting in a single armchair, as well as staying for a mean time span of 4 days, primarily for 24 consecutive hours in each day. Despite these conditions, most of the companions surprisingly declared their satisfaction with their stays.

CONCLUSIONS

Patients' companions should be defined as bioethical subjects; more specifically, they should be defined as vulnerable subjects and should not be taken advantage of. The description of patient companions as a vulnerable group allows for the ethical evaluation of similar systems, such as those in Israel, Greece, Korea, and Iran, and could allow for the development of a common solution for these systems. Moreover, such a definition provides an important basis for social, ethical, or legal studies on the health care systems in all of these countries.

Perceptions of female Saudi undergraduate nursing students toward family-centered care

BACKGROUND

While family-centered care is considered a vital part of nursing care, nursing students seem to struggle in incorporating family-centered care in the clinical setting. Several factors such as minimal exposure in family interactions throughout their clinical practice, lack of experience in organizing family-centered clinical experiences, access to restricted clinical areas, and inadequate supervision from clinical instructors present as challenges among nursing students in practicing family-centered care.

OBJECTIVES

This study explored the perceptions of nursing students toward family-centered care in Saudi Arabia.

DESIGN

This study used the quantitative approach through the cross-sectional survey method.

SETTINGS

The study was conducted in the Faculty of Nursing of a government university in Saudi Arabia.

PARTICIPANTS

A total population sample comprising 232 female junior and student nurses participated in the study.

METHODS

After the approval of the Ethical Board Committee had been secured, a survey containing a demographic information sheet and the Family-Centered Care Questionnaire was distributed to the students from June 2018 to February 2019.

RESULTS

The overall mean of the students' responses in the questionnaire was 3.76 (SD = 0.67, range = 3.40-4.08), indicating a modest perception toward family-centered care. The dimension "family is the constant" received the most positive response from the students (M = 3.90, SD = 0.77), whereas the dimension "parent-to-parent support" was rated the lowest with a mean of 3.64 (SD = 0.89). Junior nursing students had more positive perception toward family-centered care than the seniors. Weak negative correlations were observed between students' age and family-centered care perception.

CONCLUSIONS

This study provides insights into family-centered care, which could be used in crafting policies and interventions in various health care settings and nursing education in Saudi Arabia. Such insights could foster positive perceptions toward family-centered care among student nurses and guarantee excellent family-centered care nursing practice.

Family's Supportive Behaviors in the Care of the Patient Admitted to the Cardiac Care Unit: A Qualitative Study

Introduction: A life-threatening illness can cause the involvement of family members and the imposition of psychological and physical stress on them. Certainly, the family is a very valuable resource in patient care and plays an important role in maintaining the emotional support and patient’s recovery. The aim of this study was to explain the family members’ supporting behaviors of the patient admitted to the cardiac special units.

Methods: This qualitative study was performed in the cardiac special units in Isfahan. The number of participants was 20, including 5 nurses, 8 family members, and 7 patients. The data were collected through interview and observation by purposive sampling. Then, the data were analyzed by Graneheim and Lundman’s qualitative content analysis method. The study lasted 12 months.

Results: Data analysis showed that family’s support can be classified into three levels, including support by the therapeutic alliance (attempts to console and reassure, restoration of selfesteem, diminishing patient’s insensitivity, commitment to the patient, and visiting the patient ), participatory information (obtaining reliable information from the nurse, active role in providing meaningful information about the patient’s prognosis), practical and instrumental support (searching for economic support resources, providing the patient with the necessary equipment, trying to do the right care taking into account the family culture).

Conclusion: Understanding family’s supportive behaviors can help improve counseling and planning for quality care of patients admitted to the cardiac care units (CCUs).

Informal carers' experiences and feelings during rehabilitation

The purpose of this study was to explore the experiences and feelings of people caring for patients with long-term diseases in a rehabilitation centre. A qualitative research approach was used. Fifteen informal carers were interviewed. The study was conducted in a rehabilitation centre in Greece. Three themes emerged. The first was feelings regarding the patient and the carers themselves, as well as the type of care provided and life at home after discharge from the rehabilitation unit. The second was experiences regarding health professionals and delivered care, and other carers. The third theme was expectations and thoughts about the future. Health professionals should plan and implement support interventions within rehabilitation settings in order to address carers' needs in terms of practical guidance not only within the framework of patient care but also relating to the psychological and physical wellbeing of informal carers.

Contingency Help: The Main Strategy of Iranian Nurses in Dealing With the Family of the End-of-Life Patients

Families are struggling with many challenges in the final stages of patient life. It is important to understand what actions nurses do for the family of the end-of-life (EOL) patients. This study aimed to explain the main strategy of nurses' dealing with the family of the EOL patients. Data were analyzed using conventional content analysis. Semistructured interviews were conducted on 32 nurses from hospitals in Tehran. Nurses used six measures of explaining the bitter reality, effective communication, management of violence, referral, consolation, and reinforcement. "Contingency help" was conceptualized as the main strategy. Nurses through "contingency help" were involved in solving the emotional, physical, financial, and spiritual needs of the family. Nurses will be able to apply the results of this study to the development of care policies for the family of the EOL patients.

Effects of family-centered empowerment intervention on stress, anxiety, and depression among family caregivers of patients with epilepsy

OBJECTIVES

Family caregivers face numerous challenges in taking care of their family members with epilepsy. The empowerment of this group of people, who can be described as forgotten patients, should always be considered through supportive interventions; therefore, this study investigated the effect of a family-centered intervention program on stress, anxiety, and depression among family caregivers of patients with epilepsy.

METHODS

In 2017, a trial was conducted in Iran among subjects selected by the convenience sampling method and randomly assigned to two groups: intervention and control. After five sessions per week over a four-week period, the intervention- and control-group data were collected using the Depression Anxiety Stress Scale (DASS) in three stages: before, immediately after, and two months after the intervention. Data were analyzed with Statistical Package for the Social Sciences (SPSS) software using descriptive and analytical statistics, an independent t-test, and repeated measures Analysis of variance (ANOVA).

RESULTS

In this study, the family caregivers included 61.3% women and 38.7% men, with a mean age of 37.5 years. The findings showed no significant differences in the mean scores of stress (p = 0.93), anxiety (p = 0.91), and depression (p = 0.56) before the interventional program between the intervention and control groups, but these differences were statistically significant in the mean score of stress (p = 0.003) in the immediately after the interventional program, whereas the mean scores of depression were not decreased significantly (p = 0.3). Two months after the interventional program the mean scores of stress (p = 0.001) and anxiety (p = 0.001) were significantly decreased in the intervention group, but the mean score of depression was not decreased significantly (p = 0.09).

CONCLUSION

The results suggested that a family-centered intervention program reduced the stress, anxiety, and depression of caregivers because of feasibility, simplicity, and utility of intervention. This program was focused on psychological issues of caregivers, and an emphasis on their empowerment helped them in managing their problems in the caregiving situation and achieved greater psychological potency in the caring process.

Perspectives of Oncology Unit Nurse Managers on Missed Nursing Care: A Qualitative Study

Objective:

The main objective of this study was to explore factors affecting missed nursing care in oncology units from the perspective of nurse managers.

Methods:

Twenty nurse managers working at oncology units of referral teaching hospitals in Iran participated in this study. Data were collected through individual face-to-face and telephonic interviews using an interview guide. Focus groups were also conducted. Data were analyzed using conventional content analysis.

Results:

System structure, underlying factors, and barriers to missed-care reports were identified as factors that affect missed nursing care.

Conclusions:

Nurse managers should reduce the effects of nursing staff shortages and increased workloads in addition to providing materials and equipment. They need to distribute experienced staff according to the type of ward or patients' needs. Nurse managers should create a favorable environment for reporting missed nursing care by having an open relationship with nurses by teaching and emphasizing nursing practice. Moreover, using a nonpunitive managerial approach and minimizing the use of an apathetic management style can be helpful.