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Bedert M, Moody K, Nieuwkerk P, van Holten N, de Wit J, van der Valk M. Between delivering chronic care and answering patients' burdens: Understanding HIV specialist nurses' experiences in the age of treatment. J Adv Nurs 2024; 80:1943-1954. [PMID: 37983876 DOI: 10.1111/jan.15941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/14/2023] [Accepted: 10/25/2023] [Indexed: 11/22/2023]
Abstract
AIM(S) To understand the experiences of HIV nurses in the context of ambivalence between biomedical treatment advancements and the continuing burden for people living with HIV and negative representations of HIV. DESIGN An interpretative phenomenological study was conducted using in-depth interviews. METHODS Twenty-one interviews with nurses were conducted between November 2021 and March 2022. A thematic analysis was performed. RESULTS Six themes related to the nurses' experiences emerged. Despite effective treatment for most people with HIV, nurses identify patient populations that require additional care. Nurses are flexible in making extra appointments to accommodate complex issues in these patients. Nurses develop a unique relationship with their patients based on trust and empathy, linked to patient's experiences with stigma and discrimination for people with HIV. Nurses perceive their tasks as becoming increasingly complex. There is explicit awareness about the changes in HIV care from acute to chronic care and how this affects nurses' tasks. Nurses continue to differentiate HIV from other chronic conditions. CONCLUSION Biomedical advancements change the organization of HIV care while public health concerns remain and patient population has particular needs due to negative social representations of HIV. Nurses navigate these issues in their everyday care. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE A potential re-evaluation of the role of nurses in providing chronic HIV care. IMPACT Our study addresses the roles of HIV nurses as care is shifting towards chronic care models. The unique relationship between nurses and patients is key in understanding the importance of nurses in the care trajectory. These findings impact the institutional role of nurses in HIV treatment centres and the institutional organization of HIV care. REPORT METHOD The COREQ guideline was used. PATIENT OR PUBLIC CONTRIBUTION Amsterdam UMC (AMC) staff, the national organization of HIV Nurses and patient organizations contributed to the study design.
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Affiliation(s)
- Maarten Bedert
- Division of Infectious Diseases, Amsterdam Infection and Immunity Institute, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Kevin Moody
- Division of Infectious Diseases, Amsterdam Infection and Immunity Institute, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Pythia Nieuwkerk
- Department of Medical Psychology, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Natasja van Holten
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - John de Wit
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, The Netherlands
| | - Marc van der Valk
- Division of Infectious Diseases, Amsterdam Infection and Immunity Institute, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
- HIV Monitoring Foundation, Amsterdam, The Netherlands
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Cilluffo S, Bassola B, Lyons KS, Lee CS, Vellone E, Pucciarelli G, Clari M, Dimonte V, Lusignani M. The role of nurse-patient mutuality on self-care behaviours in patients with chronic illness. J Clin Nurs 2024. [PMID: 38685742 DOI: 10.1111/jocn.17181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 03/11/2024] [Accepted: 04/10/2024] [Indexed: 05/02/2024]
Abstract
AIM To examine the role of nurse-patient mutuality on three self-care behaviours in chronic illness patients. DESIGN A cross-sectional multi-centre study was conducted. METHODS Mutuality was measured with the Nurse-Patient Mutuality in Chronic Illness scale which has the dimensions of developing and going beyond, being a point of reference and deciding and sharing care, and self-care was measured with the Self-care of Chronic Illness Inventory (SC-CII). Multivariable linear regression analyses were used to assess the contribution of three dimensions of mutuality on self-care maintenance, monitoring and management behaviours controlling for patient gender, age, education, number of medications, and presence of a family caregiver. RESULTS The sample included 465 inpatients and outpatients with at least one chronic illness. The three dimensions of mutuality had different roles in their influence on the three dimensions of self-care. Developing and going beyond was significantly associated with self-care maintenance and self-care monitoring behaviours. Point of reference was significantly associated with self-care maintenance behaviour. Deciding and sharing care was significantly associated with self-care monitoring and self-care management behaviours. CONCLUSION The mutuality between nurse and patient may be a novel area of research to support and improve patient self-care behaviours with implications for clinical practice and education. IMPLICATION FOR PROFESSION AND PATIENT CARE Mutuality between nurse and patient increases patient engagement, symptom recognition, decision-making process and patient-centred approach favouring the development of self-care behaviours. IMPACT Mutuality between nurse and patient is a new concept and its association with the patient outcomes could bring relevance to the nursing profession. Self-care behaviours are important in the management of chronic diseases, but are difficult to perform. Mutuality between nurse and patient influences the three different behaviours of self-care in chronic illness, for this reason it is important to increase the level of mutuality in this dyad. REPORTING METHOD STROBE checklist for cross-sectional studies was followed in this study. PATIENT OR PUBLIC CONTRIBUTION Patients were involved in the sample of the study.
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Affiliation(s)
- Silvia Cilluffo
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
- School of Nursing, Niguarda Hospital, University of Milan, Milan, Italy
| | - Barbara Bassola
- School of Nursing, Niguarda Hospital, University of Milan, Milan, Italy
| | - Karen S Lyons
- Connell School of Nursing, Boston College, Boston, Massachusetts, USA
| | - Christopher S Lee
- Connell School of Nursing, Boston College, Boston, Massachusetts, USA
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
- Department of Nursing and Obstetrics, Wroclaw Medical University, Wroclaw, Poland
| | - Gianluca Pucciarelli
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | - Marco Clari
- Department of Public Health and Paediatrics Sciences, University of Turin, Turin, Italy
| | - Valerio Dimonte
- Department of Public Health and Paediatrics Sciences, University of Turin, Turin, Italy
| | - Maura Lusignani
- School of Nursing, Niguarda Hospital, University of Milan, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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Wong ELY, Wang K, Cheung AWL, Graham C, Yeoh EK. Thinking beyond the virus: perspective of patients on the quality of hospital care before and during the COVID-19 pandemic. Front Public Health 2023; 11:1152054. [PMID: 37744522 PMCID: PMC10515219 DOI: 10.3389/fpubh.2023.1152054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 08/16/2023] [Indexed: 09/26/2023] Open
Abstract
Objectives The COVID-19 pandemic has a huge impact on the healthcare system and affects the normal delivery of routine healthcare services to hospitalized patients. This study aimed to examine the differences in patient experience of hospital service before and during COVID-19 among the discharged adult population. Methods A territory-wide patient experience survey was conducted before and during COVID-19 (between October 2019 and April 2020) among patients discharged from the main acute and rehabilitation public hospitals in Hong Kong. A hierarchical ordinal logistic model was employed to examine the difference in multiple dimensions of patient experience, with adjustments of covariates. Results In total, 9,800 participants were recruited. During the pandemic, there was a marginally significant increase in overall care rating (AOR: 1.12, 95% CI: 0.99-1.27), and an improvement in the timeliness of admission. However, significant reductions in patients' confidence in nurses were observed. Communication of information regarding medication side effects reduced significantly (AOR: 0.72, 95% CI: 0.64-0.82). Conclusion The patients hospitalized during the pandemic reported worse responsiveness in communication in their patient journey than those admitted before the pandemic. These findings will help develop appropriate strategies to address patients' concerns in the new normal.
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Affiliation(s)
- Eliza Lai-yi Wong
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, Hong Kong SAR, China
- Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, Hong Kong SAR, China
| | - Kailu Wang
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, Hong Kong SAR, China
- Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, Hong Kong SAR, China
| | - Annie Wai-ling Cheung
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, Hong Kong SAR, China
- Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, Hong Kong SAR, China
| | | | - Eng-kiong Yeoh
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, Hong Kong SAR, China
- Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, Hong Kong SAR, China
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Gualandi R, Ivziku D, Caruso R, Di Giacinto C, Lommi M, Tartaglini D, De Benedictis A. Nurse-Patient Communication and Relationship When Wearing Personal Protective Equipment: Nurses' Experience in a COVID-19 Ward. Healthcare (Basel) 2023; 11:1960. [PMID: 37444794 DOI: 10.3390/healthcare11131960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 06/19/2023] [Accepted: 07/06/2023] [Indexed: 07/15/2023] Open
Abstract
Little is known about which communication strategies nurses carried out and whether the nurse-patient relationship has been altered due to the mandated use of personal protective equipment during the COVID-19 pandemic. This study describes how nurse-patient communication and relationships took place from the point of view of nurses engaged in caring for patients with COVID-19. A qualitative descriptive study design following COREQ guidelines was conducted. Semi-structured telephone interviews with nurses working in the COVID ward of an Italian university hospital were performed between September 2020 and June 2021. Ten nurses were recruited using convenience sampling. One overarching theme, three main themes, and nine sub-themes were identified. The overarching theme 'The in-out relationship: 'in here and out there' and 'inside me and out of me' included the main themes 'A closed system different from normal', 'Uncovering meaningful human gestures', and 'A deep experience to live''. The relational nature of nursing-where 'me and you' and the context are the main elements-leads nurses to find new ways of interacting and communicating with patients, even in a new situation that has never been experienced. Enhancing human gestures, thinking about new contexts of care, and educating new generations to maintain human-to-human interaction, regardless of the context of care, are the directives to be explored for creating the future of nursing care.
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Affiliation(s)
- Raffaella Gualandi
- Department of Health Professions, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Dhurata Ivziku
- Department of Health Professions, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Rosario Caruso
- Clinical Research Service, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milano, Italy
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milano, Italy
| | - Chiara Di Giacinto
- Department of Health Professions, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Marzia Lommi
- Department of Biomedicine and Prevention, University Tor Vergata, 00133 Rome, Italy
| | - Daniela Tartaglini
- Department of Health Professions, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Anna De Benedictis
- Clinical Directory, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
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Xu YW, Fan L. Emotional labor and job satisfaction among nurses: The mediating effect of nurse-patient relationship. Front Psychol 2023; 14:1094358. [PMID: 37342648 PMCID: PMC10278545 DOI: 10.3389/fpsyg.2023.1094358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 03/06/2023] [Indexed: 06/23/2023] Open
Abstract
Emotional labor is considered an important part of the role in the nursing field. Previous studies have found inconsistencies between emotional labor and job satisfaction of nurses, this is due to the relationship between them being affected by other factors. However, the current nurse-patient relationship is tense and leads to an unsafe and unstable working environment for nurses. It has yet to be confirmed whether the nurse-patient relationship can be used as a mediating variable to further explain the association that exists between emotional labor and job satisfaction. Therefore, this study tested the mediating effect of the nurse-patient relationship between emotional labor and job satisfaction among Chinese nurses. A total of 496 nurses were included in the study. Data collection was from December 2021 to March 2022 using the convenience sampling method. SPSS 26.0 and AMOS 23.0 software were used to perform structural equation modeling and analyze the relationship between variables. The results showed surface acting negatively affected nurse-patient relationships and job satisfaction, contrary to deep acting and naturally felt emotions. The parallel mediation of nurse-patient trust and patient-centered nursing in the relationship between emotional labor and job satisfaction was found to be statistically significant. Our study highlighted the important mediation of nurse-patient trust and the importance of the positive effects of emotional labor. Future studies can use these findings as a reference to develop interventions.
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Guo S, Chang Y, Chang H, He X, Zhang Q, Song B, Liu Y. Patient satisfaction with nurses' care is positively related to the nurse-patient relationship in Chinese hospitals: A multicentre study. Front Public Health 2023; 10:1109313. [PMID: 36761322 PMCID: PMC9906944 DOI: 10.3389/fpubh.2022.1109313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 12/30/2022] [Indexed: 01/18/2023] Open
Abstract
Background The nurse-patient relationship and nursing care satisfaction are important factors that represent whether patients experience the care they expect from nurses. However, research is lacking on the relationship between nursing staff and patients, and the correlation between nursing care satisfaction and relationship care in China. Therefore, this study aimed to explore the correlation between the nurse-patient relationship and patients' satisfaction with nursing care, to form a basis for corresponding intervention measures. Methods A total of 29,108 patients from 107 hospitals in 30 provinces/municipalities in China completed a general information questionnaire, the Nursing Care Satisfaction Scale, and Relational Care Scale. Results The average nurse-patient relational care scale score was 4.38 ± 0.57, and the average patients' satisfaction with nursing care scale score was 5.40 ± 0.86. Nursing care satisfaction score was significantly related to differences among patients in different age, gender, marital status, education level, occupation, residence, family per capita monthly income, type of medical insurance, medical department, and regional patient characteristics. The correlation analysis showed that the total nurse-patient relational care score and its three dimensions of caring, trust, and professional ethics correlated positively with nursing care satisfaction scores. The multiple linear regression analysis showed that patients' age, marital status, region, department, income, type of medical insurance and the caring, trust, and professional ethics dimensions of relational care predicted nursing care satisfaction. Conclusion Enhancing nurse-patient relational care improves nursing care satisfaction, reduces nurse-patient disputes, promotes early rehabilitation of patients, and ensures patient safety.
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Affiliation(s)
- Shujie Guo
- Henan Provincial People's Hospital, Zhengzhou, Henan, China
| | - Yulan Chang
- Department of Nursing, Henan Vocational College of Nursing, Anyang, Henan, China
| | - Hongwei Chang
- Nursing College of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiaoxiao He
- Nursing College of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Qiuxue Zhang
- Department of Anesthesiology, Qilu Hospital of Shandong University, Dezhou Hospital, Dezhou, Shandong, China
| | - Baoyun Song
- Department of Nursing, Henan Province People's Hospital, Zhengzhou, Henan, China,*Correspondence: Yilan Liu ✉
| | - Yilan Liu
- Department of Nursing, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China,Baoyun Song ✉
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Abstract
The nurse-patient relationship involves complex attitudes and behaviours with ethical and deontological implications. It has been linked to improvements in patient health outcomes, although there is still no consensus in the scientific literature as to the definition and characterisation of the concept. This article aim to define the concept of the nurse-patient relationship. A concept analysis was conducted using the Walker and Avant method to identify the attributes defining the nurse-patient relationship. An integrative review of the literature was conducted using the PubMed, Web of Science, Scopus, and Cumulative Index to Nursing & Allied Health Literature databases. A review of the grey literature and other minor non-indexed publications on the topic was also conducted. A total of 36 articles were included in the review. A model case, a contrary case, a related case, and empirical references were produced to clarify the concept and identify its essential attributes. The concept is defined as a helping relationship involving interaction between different players. It is the basis of nursing care and is intended to meet the healthcare needs of the individual receiving this care. It is also viewed as an intervention in itself, requiring a specific training process just like any other nursing skill. The essential attributes of the relationship are empathy, presence, contact, authenticity, trust, and reciprocity. In conclusion, the nurse-patient relationship is a helping relationship established with the patient and/or their family based on interaction, communication, respect for ethical values, acceptance, and empathy in order to encourage introspection and behavioural change. Key components include communication, active listening, and respect. Bioethical values and confidentiality must also be present to ensure that the relationship is built on equality and intimacy.
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Thornberry A, Garcia TJ, Peck J, Sefcik E. Occupational Health Nurses' Self-Efficacy in Implementing Smoking Cessation Interventions for Workers: A Manufacturing Company Quality Improvement Project. Workplace Health Saf 2021; 70:63-72. [PMID: 34338092 DOI: 10.1177/21650799211022991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Effective smoking cessation interventions (SCIs) are urgently needed for the working population where smoking continues at high rates. Occupational health nurses (OHNs) could be effective in providing SCI, but self-efficacy was found to be a major barrier. The purpose of this study was to improve the delivery of SCI to those who smoke in the workplace and to explore nurse self-efficacy. METHODS Pretest and posttest were conducted on two groups, OHNs (n = 5) and smokers (n = 11) working at U.S. manufacturing facilities. OHNs were trained on motivational interviewing (MI) techniques who then recruited smokers to help them practice their newly acquired skills. The two groups were measured by Likert-type scale for OHN self-efficacy and smoker level of change toward quitting. FINDINGS Paired t-tests detected statistically significant differences in OHN's preintervention and postintervention self-efficacy scores, t(4) = -4.46, p < .001,; d = 2.92) and smokers' preintervention and postintervention stage of change toward quitting scores, t(10) = -9.07, p < .001,; d = 2.09), suggesting that the training and MI intervention were effective in increasing OHN self-efficacy and smokers' motivation to change. CONCLUSION/APPLICATION TO PRACTICE This quality improvement (QI) project indicated smokers can be successfully recruited and counseled using MI techniques, while simultaneously improving OHN self-efficacy toward helping patients. Theory-based applications brought OHNs and smokers together in a new paradigm resulting in positive changes for both. Secondary findings in the reverse nurse-patient role revealed success in an innovative recruitment method for smoking cessation.
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Cao C, Sullivan SD, Underhill-Blazey ML. Creative Art Expression: Using Hand-Lettering Techniques to Reduce Stress and Anxiety in Patients With Cancer. Clin J Oncol Nurs 2021; 25:97-99. [PMID: 33480879 DOI: 10.1188/21.cjon.97-99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A creative art expression intervention using hand lettering was implemented on an outpatient oncology unit and evaluated for feasibility and its relationship with stress and anxiety in patients with cancer. Results suggest that a hand lettering intervention is feasible in this type of setting and may benefit patients experiencing stress and anxiety during outpatient treatment.
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Evald L, Graarup J, Højskov IE. Diary for self-observation: A self-management tool for recipients of lung transplantation-A pilot study. Nurs Open 2020; 7:1766-1773. [PMID: 33072360 PMCID: PMC7544857 DOI: 10.1002/nop2.562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/05/2020] [Accepted: 06/16/2020] [Indexed: 11/17/2022] Open
Abstract
Aim To (a) explore how the diary contributes to patient motivation for monitoring self‐management and (b) explore the nurses' experience of how the diary supports the patients' self‐management after lung transplantation. Design A quantitative and qualitative study design. Methods Fifteen patients and four nurses participated. Data were analysed descriptively and thematically. Results This pilot study shows that the diary strengthens patients' self‐management in the first postoperative period. Nurses were confident that the patients were structured about self‐observation when using the diary.
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Affiliation(s)
| | - Jytte Graarup
- Department of Cardiothoracic Surgery The Centre for Cardiac Vascular-, Pulmonary and Infectious Diseases Rigshospitalet University of Copenhagen Copenhagen Denmark
| | - Ida Elisabeth Højskov
- Department of Cardiothoracic Surgery The Centre for Cardiac Vascular-, Pulmonary and Infectious Diseases Rigshospitalet University of Copenhagen Copenhagen Denmark
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Abstract
This short memoir conveys a special relationship between a nurse and her patient, a 13-year-old girl who had a liver transplant.
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Winther S, Fredens M, Hansen MB, Benthien KS, Nielsen CP, Grønkjær M. Proactive Health Support: Exploring Face-to-Face Start-Up Sessions Between Participants and Registered Nurses at the Onset of Telephone-Based Self-Management Support. Glob Qual Nurs Res 2020; 7:2333393620930026. [PMID: 32656297 PMCID: PMC7328475 DOI: 10.1177/2333393620930026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 04/27/2020] [Accepted: 04/30/2020] [Indexed: 12/04/2022] Open
Abstract
Proactive Health Support (PaHS) is a large-scale intervention in Denmark
carried out by registered nurses (RNs) who provide self-management
support to people at risk of hospital admission to enhance their
health, coping, and quality of life. PaHS is initiated with a
face-to-face session followed by telephone conversations. We aimed to
explore the start-up sessions, including if and how the relationship
between participants and RNs developed at the onset of PaHS. We used
an ethnographic design including observations and informal interviews.
Data were analyzed using a phenomenological–hermeneutical approach.
The study showed that contexts such as hospitals and RNs legitimized
the intervention. Face-to-face communication contributed to
credibility, just as the same RN throughout the intervention ensured
continuity. We conclude that start-up sessions before telephone-based
self-management support enable a trust-based relationship between
participants and RNs. Continuous contact with the same RNs throughout
the session promoted participation in the intervention.
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Affiliation(s)
| | - Mia Fredens
- DEFACTUM, Social & Health Services and Labor Market, Aarhus, Denmark
| | | | | | | | - Mette Grønkjær
- Aalborg University Hospital, Aalborg, Denmark.,Aalborg University, Aalborg, Denmark
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Delmas P, Antonini M, Berthoud L, O’Reilly L, Cara C, Brousseau S, Bellier‐Teichmann T, Weidmann J, Roulet‐Schwab D, Ledoux I, Pasquier J, Boillat E, Brandalesi V, Konishi M. A comparative descriptive analysis of perceived quality of caring attitudes and behaviours between haemodialysis patients and their nurses. Nurs Open 2020; 7:563-570. [PMID: 32089853 PMCID: PMC7024631 DOI: 10.1002/nop2.421] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 09/30/2019] [Accepted: 11/01/2019] [Indexed: 11/23/2022] Open
Abstract
Aim Despite its importance in nursing, perceived quality of the nurse-patient relationship has seldom been researched. This study sought to examine and compare the quality of caring attitudes and behaviours as perceived by haemodialysis patients and their nurses. Design This comparative descriptive study involved 140 haemodialysis patients and 101 nurses caring for them in ten haemodialysis units in the French-speaking part of Switzerland. Methods Participants completed a sociodemographic questionnaire and the Caring Nurse-Patient Interaction Scale (CNPI-70). Results Both nurses and patients reported a high frequency of caring attitudes and behaviours. Patients gave higher ratings than nurses did on all the caring dimensions, except spirituality. Implications are discussed.
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Affiliation(s)
- Philippe Delmas
- La SourceSchool of NursingHES-SO University of Applied Sciences WesternSwitzerland
| | - Matteo Antonini
- La SourceSchool of NursingHES-SO University of Applied Sciences WesternSwitzerland
| | - Laurent Berthoud
- La SourceSchool of NursingHES-SO University of Applied Sciences WesternSwitzerland
| | | | | | | | | | - Jean Weidmann
- School of Management and Engineering VaudYverdon‐les‐BainsSwitzerland
| | | | | | - Jérôme Pasquier
- Institute of Social and Preventive MedicineLausanne University HospitalLausanneSwitzerland
| | - Evelyne Boillat
- La SourceSchool of NursingHES-SO University of Applied Sciences WesternSwitzerland
| | - Vanessa Brandalesi
- La SourceSchool of NursingHES-SO University of Applied Sciences WesternSwitzerland
| | - Mario Konishi
- School of Management and Engineering VaudYverdon‐les‐BainsSwitzerland
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Mancina RM, Pagnotta R, Pagliuso C, Albi V, Bruno D, Garieri P, Doldo P, Spagnuolo R. Gastrointestinal Symptoms of and Psychosocial Changes in Inflammatory Bowel Disease: A Nursing-Led Cross-Sectional Study of Patients in Clinical Remission. ACTA ACUST UNITED AC 2020; 56:medicina56010045. [PMID: 31968710 PMCID: PMC7022245 DOI: 10.3390/medicina56010045] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 01/14/2020] [Accepted: 01/15/2020] [Indexed: 12/22/2022]
Abstract
Background and Objectives: Nursing management in Inflammatory Bowel Disease (IBD) is focused on global patient care. Starting from basic knowledge of diagnostic and therapeutic management, nurses can assess the impact of IBD on patients’ quality of life not only at the physical level, but also at the psychological, social, and emotional levels. The aim of this study was to evaluate the impact of gastrointestinal symptoms on psychosocial changes in IBD patients in remission through nursing-led Patient-Reported Outcomes. Materials and Methods: We performed a cross-sectional study of 109 IBD patients in clinical and endoscopic remission. Specialist nurses invited patients to complete questionnaires on gastrointestinal symptoms and quality of life through the Patient-Reported Outcomes Measurement Information System (PROMIS). Results: We found that the gastrointestinal symptoms that the patients reported had a significant impact on the analyzed aspects of health. More specifically, belly pain, diarrhea, and bloating were associated with depressive symptoms (p < 0.001), anxiety (p < 0.001), fatigue (p < 0.001), and sleep disturbances (p < 0.001). Moreover, these symptoms also significantly affected patients’ social dimension in terms of satisfaction with participation in social roles (p < 0.001, p < 0.05, and p < 0.001 for belly pain, diarrhea, and bloating, respectively) and physical functions (p < 0.001). The results were virtually the same in a multivariable analysis adjusted by age, gender, body mass index (BMI), and disease duration. Conclusions: Even during remission, gastrointestinal symptoms are the main factors that influence quality of life in IBD patients. This exploratory study highlights the need to adopt validated questionnaires in clinical practice, and demonstrates that PROMIS is a valid, objective, and standardized instrument that can help nursing staff to better define the consequences of the disease in a patient’s daily life.
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Affiliation(s)
- Rosellina Margherita Mancina
- Department of Molecular and Clinical Medicine, The Sahlgrenska Academy at the University of Gothenburg, The Wallenberg Laboratory, Bruna Straket 16, SE-413 45 Gothenburg, Sweden;
| | - Raffaele Pagnotta
- University Medical Hospital “Mater Domini”, Viale Europa, 88100 Catanzaro, Italy; (R.P.); (C.P.)
| | - Caterina Pagliuso
- University Medical Hospital “Mater Domini”, Viale Europa, 88100 Catanzaro, Italy; (R.P.); (C.P.)
| | - Vincenzo Albi
- School of Nursing, University “Magna Graecia”, Viale Europa, 88100 Catanzaro, Italy; (V.A.); (D.B.); (P.D.)
| | - Daniela Bruno
- School of Nursing, University “Magna Graecia”, Viale Europa, 88100 Catanzaro, Italy; (V.A.); (D.B.); (P.D.)
| | - Pietro Garieri
- Department of Biomedical Sciences for Health, University of Milan, 20122 Milano, Italy;
| | - Patrizia Doldo
- School of Nursing, University “Magna Graecia”, Viale Europa, 88100 Catanzaro, Italy; (V.A.); (D.B.); (P.D.)
- Department of Clinical and Experimental Medicine, University “Magna Graecia”, Viale Europa, 88100 Catanzaro, Italy
| | - Rocco Spagnuolo
- School of Nursing, University “Magna Graecia”, Viale Europa, 88100 Catanzaro, Italy; (V.A.); (D.B.); (P.D.)
- Department of Clinical and Experimental Medicine, University “Magna Graecia”, Viale Europa, 88100 Catanzaro, Italy
- Correspondence: ; Tel.: +39-0961-3697021
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Ohlsson‐Nevo E, Andersson G, Nilsing Strid E. In the hands of nurses: A focus group study of how nurses perceive and promote inpatients' needs for physical activity. Nurs Open 2020; 7:334-344. [PMID: 31871718 PMCID: PMC6917955 DOI: 10.1002/nop2.401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 08/29/2019] [Accepted: 09/09/2019] [Indexed: 01/02/2023] Open
Abstract
Aims To describe how nurses perceive and promote inpatients' needs for physical activity during their stay at the ward. Design A qualitative descriptive design was employed providing an exploration of how nurses perceive and promote inpatients' need for physical activity. Methods Seven semi-structured focus group discussions were held between November 2016 and February 2017 with 29 nurses in three hospitals in Sweden. Both interaction analysis and content analysis of the data were conducted. Results Patients are dependent on nurses' prioritizations and promotions to be sufficiently physically active during their stay at the ward. The external environment and the integration of physical activity affected the promotion of physical activity. The nurses perceived that understanding the patient's expectations was important and that promotion of physical activity was a joint responsibility of patient, relatives and healthcare professionals. The interaction analysis revealed no clear hierarchical pattern as all members in each focus group took initiative to open the discussions. The Registered Nurses contributed with more new ideas.
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Affiliation(s)
- Emma Ohlsson‐Nevo
- Department of SurgeryÖrebro UniversityÖrebroSweden
- Faculty of Medicine and HealthUniversity Health Care Research CentreÖrebro UniversityÖrebroSweden
| | - Gunnel Andersson
- Faculty of Medicine and HealthSchool of Health SciencesÖrebro UniversityÖrebroSweden
| | - Emma Nilsing Strid
- Faculty of Medicine and HealthUniversity Health Care Research CentreÖrebro UniversityÖrebroSweden
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Abstract
BACKGROUND Respectful care is central to ethical codes of practice and optimal patient care, but little is known about the influences on and challenges in communicating respect. RESEARCH QUESTION What are the intra- and inter-personal influences on nurses' communication of respect? RESEARCH DESIGN AND PARTICIPANTS Semi-structured interviews with 12 hospital-based UK registered nurses were analysed using interpretative phenomenological analysis to explore their experiences of communicating respect to patients and associated influences. ETHICAL CONSIDERATIONS The study was approved by the Institutional ethics board and National Health Service Trust. FINDINGS Three interconnected superordinate themes were identified: 'private self: personal attitudes', 'outward self: showing respect' and 'reputational self: being perceived as respectful'. Respectful communication involved a complex set of influences, including attitudes of respect towards patients, needs and goals, beliefs around the nature of respectful communication, skills and influencing sociocultural factors. A tension between the outward self as intended and perceived presented challenges for nurses' reputational self as respectful, with negative implications for patient care. DISCUSSION The study offers an in-depth understanding of intra- and inter-personal influences on communicating respect, and sheds light on challenges involved, helping provide practical insights to support respectful care. CONCLUSION Findings stress the need for improved conceptualisations of respect in healthcare settings to formally recognise the complex attitudinal and socially constructed nature of respect and for appropriate professional training to improve its communication.
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Bergdahl E, Ternestedt B, Berterö C, Andershed B. The theory of a co-creative process in advanced palliative home care nursing encounters: A qualitative deductive approach over time. Nurs Open 2019; 6:175-188. [PMID: 30534407 PMCID: PMC6279716 DOI: 10.1002/nop2.203] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 06/02/2018] [Accepted: 08/06/2018] [Indexed: 11/09/2022] Open
Abstract
AIMS AND OBJECTIVES The aim of this study was to test the theoretical conceptualization of the co-creative process in home care nursing encounters over time. METHOD AND DESIGN This was a multiple case study with a deductive analysis of qualitative data over time, using interviews and observations collected from three cases. RESULTS The co-creative process was complex and contained main, sub- and micro-processes. Time was important and valuable, giving the patient and relatives space to adjust the process to their own pace. Some processes were worked on more intensively in accordance with the patients' and relatives' needs, and these are considered the main-process. The further developed theory of the co-creative process and its main, sub- and microprocesses can be understood as a concretization of how good nursing care can be performed within caring relationships in the context of advanced palliative home care.
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Affiliation(s)
| | - Britt‐Marie Ternestedt
- Department of Health Care Science/Palliative Research CentreErsta Sköndal Bräcke University CollegeStockholmSweden
| | - Carina Berterö
- Division of Nursing Science, Department of Medical and Health SciencesLinköping UniversityLinköpingSweden
| | - Birgitta Andershed
- Department of Health Care Science/Palliative Research CentreErsta Sköndal Bräcke University CollegeStockholmSweden
- Faculty of Health, Care and NursingNorwegian University of Science and TechnologyGjøvikNorway
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Abstract
BACKGROUND: Discussing direct-to-consumer advertising of prescription drugs during a visit could affect prescribing practices and provider-patient relationship. RESEARCH OBJECTIVES: The study examines advanced practice nurse prescribers' perceptions of direct-to-consumer advertising and its effects on nurse-patient relationship, prescriptive authority, and appropriateness of patient clinical requests. RESEARCH DESIGN: A cross-sectional survey design was implemented. PARTICIPANTS AND RESEARCH CONTEXT: The random sample consisted of 316 nurses (27.17% response rate) in one of the Midwestern states in the United States. Pearson's chi-square analysis and multiple/multinomial logistic regression analyses were used. ETHICAL CONSIDERATIONS: Permission to conduct the study was obtained from the university's Institutional Review Board. Participation was voluntary, and measures were taken to protect the anonymity and confidentiality of consenting participants. FINDINGS: Most nurses (69%) believed that patients were "poor or very poor" at assessing the relevance of drug advertisements, 61% reported that the increase in drugs advertisements directed at patient was "a bad or a very bad thing," and only 16% thought the advertisements were accurate to "a very or to a great extent." Improved nurse-patient relationship was associated with factors such as the patient not bringing printed material, seeking nurse's opinion only, taking responsibility for their health, and not challenging nurse's prescriptive authority. DISCUSSION: Advertising discussion during a visit could improve as well as pose a challenge to a nurse-patient relationship and nurse's prescriptive authority. CONCLUSION: The positives of discussing advertising information can be maximized and the negatives minimized through enhanced interpersonal nurse-patient communication.
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Abstract
BACKGROUND Nurse-delivered hand massage is a safe and effective intervention that has potential for positively affecting nursing and patient outcomes.
. OBJECTIVES Nurses in a National Cancer Institute-designated academic health center outpatient chemotherapy infusion suite were taught how to administer a hand massage to strengthen the nurse-patient relationship and improve patient experience, comfort, satisfaction, stress, and anxiety.
. METHODS A pre-/postimplementation group comparison design was used. Patients in both groups completed self-reported measures of stress, comfort, satisfaction, and anxiety. Nurses completed Likert-type scales pre- and postimplementation on the perceived benefits of hand massage to the patient and nursing practice, impact on patient anxiety, and preparation in providing a hand massage.
. FINDINGS A positive trend was seen in all indicators. Patients who received a hand massage had a statistically significant improvement in comfort (p = 0.025) compared to those who did not. A statistically significant improvement was seen in all nurse indicators pre- to postimplementation.
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Abstract
Aim To explore patient-reported complaints regarding communication and healthcare encounters and how these were responded to by healthcare professionals. Design A retrospective and descriptive design was used in a County Council in northern part of Sweden. Both quantitative and qualitative methods were used. Methods The content of 587 patient-reported complaints was included in the study. Descriptive statistical analysis and a deductive content analysis were used to investigate the content in the patient-reported complaints. Results The results show that patients' dissatisfaction with encounters and communication concerned all departments in the healthcare organization. Patients were most dissatisfied when they were not met in a professional manner. There were differences between genders, where women reported more complaints regarding their dissatisfaction with encounters and communication compared with men. Many of the answers on the patient-reported complaints lack a personal apology and some of the patients failed to receive an answer to their complaints.
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Affiliation(s)
- Lisa Skär
- Department of Health Blekinge Institute of Technology Karlskrona Sweden
| | - Siv Söderberg
- Department of Nursing Sciences Mid Sweden University Östersund Sweden
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21
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Abstract
An oncology nurse's warmth, humor, and compassionate care have helped even the odds in my wife's decade-long battle with incurable cancer. Needle phobia and a complex chemotherapy regimen have made for a challenging course of treatment. However, working closely with us, my wife's care team has given us back the control that can so easily ebb with remission and relapse.
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Abstract
OBJECTIVE This study was designed to examine the internal consistency, test-retest reliability, construct, and concurrent validity of the Trust in Nurses Scale (TNS) in hospitalized patients with cancer in China. METHODS Between October and December 2016, the Chinese version of TNS and Nurse-Patient Trust Scale were applied to assess 190 patients with cancer in a general hospital. A subsample of 70 patients completed the TNS again 1 week later. RESULTS The Chinese version of the TNS had good internal consistency (α=0.817), fair test-retest reliability (r=0.866), and confirmatory factor analysis demonstrated good fit for a four-item version of the TNS. CONCLUSION The Chinese TNS exhibited sufficient validity and reliability in hospitalized patients with cancer.
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Affiliation(s)
- Ling Zhao
- Department of Clinical Psychological Nursing, Xiangya Nursing School, Central South University, Changsha
- Department of International and Humanistic Nursing, School of Nursing, University of South China
| | | | - Shan Liu
- Department of Hematology, The First Affiliated Hospital of University of South China, Hengyang
| | - Jin Yan
- Department of Nursing, The Third Xiangya Hospital, Changsha, China
- Correspondence: Jin Yan, Department of Nursing, The Third Xiangya Hospital, 138 Tongzipo Road, Changsha 410013, China, Tel +86 0731 8861 8626, Email
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Abstract
The primary nursing care model optimizes relationship-based care. Despite using a primary nursing model on a pediatric hematology/oncology inpatient unit, it was hypothesized patients and nurses were dissatisfied with the structure of primary care teams and inconsistency of primary assignments. The purpose of this study was to evaluate patient/family and nurse perceptions of our current care model through assessing gaps in its operationalization and satisfaction. This study used a descriptive cross-sectional design featuring patient/family and nurse surveys. Of the 59 patient/family respondents, 93.2% prefer to have a primary nurse care for them and 85% are satisfied with how often they are assigned a primary care team member. Similarly, 63% of the 57 nurse respondents are satisfied with the current implementation of our primary nursing model and 61% state the model reflects good continuity of care. Yet 80.7% of nurses believe safety would improve for a patient whose nurse works shifts consecutively even if not a primary nurse. Overall, patients, families, and nurses value care continuity and meaningful nurse-patient relationships, which is fundamental to primary nursing.
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Vallier T. Bill and Jean: A Lifetime Together. Clin J Oncol Nurs 2015; 19:776. [PMID: 26583644 DOI: 10.1188/15.cjon.776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Shattell M, Bartlett R, Beres K, Southard K, Bell C, Judge CA, Duke P. How Patients and Nurses Experience an Open Versus an Enclosed Nursing Station on an Inpatient Psychiatric Unit. J Am Psychiatr Nurses Assoc 2015; 21:398-405. [PMID: 26597907 DOI: 10.1177/1078390315617038] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The inpatient environment is a critical space for nurses and patients in psychiatric settings. In this article, we describe nurses' and patients' perceptions of the inpatient environment both before the removal of a Plexiglas enclosure around a nurses' station and after its removal. Nurses had mixed feelings about the enclosure, reporting that it provided for confidentiality and a concentrated work space but also acknowledged the challenge of the barrier for communication with their patients. Patients unanimously preferred the nurses' station without the barrier, reporting increased feelings of freedom, safety, and connection with the nurses after its removal. It is important to consider the implications of environmental decisions in inpatient settings in order to promote a healthy workplace and healing environment for all community members.
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Affiliation(s)
- Mona Shattell
- Mona Shattell, PhD, RN, FAAN, DePaul University, Chicago, IL, USA
| | - Robin Bartlett
- Robin Bartlett, PhD, RN, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Kyle Beres
- Kyle Beres, MS, RN, DePaul University, Chicago, IL, USA
| | - Kelly Southard
- Kelly Southard, RN, BSN, MBA, Cone Health Behavioral Health Hospital, Greensboro, NC, USA
| | - Claire Bell
- Claire Bell, MA, East Carolina University, Greenville, NC, USA
| | - Christine A Judge
- Christine A. Judge, RN, BSN, BC, Cone Health Behavioral Health Hospital, Greensboro, NC, USA
| | - Patricia Duke
- Patricia Duke, RN, BC, Cone Health Behavioral Health Hospital, Greensboro, NC, USA
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Corsano P, Cigala A, Majorano M, Vignola V, Nuzzo MJ, Cardinale E, Izzi G. Speaking about emotional events in hospital: the role of health-care professionals in children emotional experiences. J Child Health Care 2015; 19:84-92. [PMID: 23908370 DOI: 10.1177/1367493513496912] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
This paper presents a qualitative study aimed at exploring the role of health-care professionals in hospitalized children's emotional experiences. A total of 27 children and adolescents from ages 6 to 15 years admitted to the Pediatric Hematology and Oncology ward of an Italian hospital participated in the study. Each participant was asked to talk about an emotional experience of happiness, anger, sadness and fear, felt in the presence of a doctor or nurse on the ward. The emotional tales were coded and analyzed qualitatively. The results showed that all the emotions considered were experienced when the staff was present, nurses in particular. Doctors and nurses played a role of active participants, encouraging children's emotions, especially for happy events. More research is needed to clarify the role of the staff in supporting children to cope with negative emotions.
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Sanders C, Bray L. Examining professionals' and parents' views of using transanal irrigation with children: Understanding their experiences to develop a shared health resource for education and practise. J Child Health Care 2014; 18:145-55. [PMID: 23423999 DOI: 10.1177/1367493512474866] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Irrigation as a bowel management approach has been reportedly used with children for more than 20 years. Parents managing their child's chronic bowel problem have previously been shown to have increased emotional stress. The aim of this study was to explore professionals' (n = 24) understanding and parents' (n = 18) experiences of using transanal irrigation with children at home as a mid to longer term bowel management approach. This study was underpinned by action research methodology and used mixed methods determined by an action research group of parents, professionals, researchers, a voluntary sector worker, commercial representative and independent observer. Data informed the study outcome which was the development and evaluation of a shared health resource to support professionals in their holistic approach when prescribing transanal irrigation and guide parents in the areas of education, management, problem solving, support and goal setting. The resource includes constructed case studies from parents of their experiences to inform choice and decision-making between parents and professionals. The shared health resource provides an approach to initiating and evaluating transanal irrigation and is available in a paper format from key Internet sites across hospital, community and voluntary services.
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Affiliation(s)
| | - Lucy Bray
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
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Abstract
This qualitative descriptive study explored grand multiparous women's perceptions of the evolving changes in birthing, nursing care, and technology. A purposive sample of grand multiparous women (N = 13) from rural, eastern Washington State were interviewed as they shared their 105 birth stories. Eight themes were identified: (1) providing welcome care, (2) offering choices, (3) following birth plans, (4) establishing trust and rapport, (5) being an advocate, (6) providing reassurance and support, (7) relying on electronic fetal monitors and assessments versus nursing presence, and (8) having epidurals coupled with loss of bodily cues. Results from this study may be used to educate women, intrapartum nurses, and childbirth educators on nursing care and on the evolving use of technology to better manage intrapartum care in hospitals. The results can also add to the extant knowledge of childbirth nursing practices.
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Abstract
This paper focuses on the experiences of four community nursing teams responsible for the care of a small group of patients with leg ulcers who they had identified as 'non healing' and 'non concordant' with treatment. Four focus groups were held, one with each community nursing team, to examine the issues underpinning the labelling of these patients as 'non healing' and 'non concordant'. There was an expectation that patients should obey treatment instructions and be positive and participative and there was a strongly felt link between concordance and healing of the ulcer. However, limited non concordance was considered to be acceptable as long as the patient continued to progress. Nurses viewed ulcer healing as the priority even though this was unlikely and differed from the patient's priority of achieving comfort. Patient behaviour was an important determinant of labelling by nurses. Efforts by patients to exert some control over their own care were met with them being viewed as 'difficult', 'uncooperative' and 'non compliant'. There was also a pervasive level of stress, distress and anxiety among the community nurse participants, which led to distancing and blaming that undermined the nurse-patient relationship. At the centre of a successful nurse-patient relationship is a non judgemental partnership that can often be challenging to achieve especially when ulcers fail to heal.
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Affiliation(s)
- Philip A Morgan
- Centre for Research and Implementation of Clinical Practice, Thames Valley University, 32-38 Uxbridge Road, London W5 2BS, UK.
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Abstract
This paper reports on a study that explored the relationship between patients with non healing leg ulcers and the nurses providing their care in a community setting. Qualitative data were collected from five patients whose leg ulcers were healing and who had been identified as experiencing difficulty with adhering to treatment. Single semi-structured interviews were used and participants were asked to share key events in their care prompted by the question 'how are you coping with your leg ulcer?' Striving to maintain balance by developing strategies to cope with the physical effects of an unhealed ulcer as well as ensuring the care they received met their unique needs was central to the experience of participants. From the participant's perspective, however, nurses often showed little understanding of the complex issues patients were grappling with. Patients, in viewing nurse behaviour, often concluded that leg ulceration was an insignificant problem that nurses had little interest in. The need to establish and to maintain a trusting therapeutic relationship with patients is essential if they are to feel they matter, that they are important as individuals and that their suffering can be eased by sensitive collaboration.
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Affiliation(s)
- Philip A Morgan
- Centre for Research and Implementation of Clinical Practice, Thames Valley University, 32-38 Uxbridge Road, London W5 2BS, UK.
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