A nursing perspective on inpatient sleep and circadian disruptions for pediatric stem cell transplant patients

BACKGROUND

Children treated with stem cell transplant (SCT) are routinely hospitalized for long periods where they are exposed to significant sleep and circadian disruptions. As nurses play a primary role in symptom management during SCT, we sought to understand their perspective on patient sleep and circadian disruptions, perceived barriers to a good sleep and circadian environment, and suggestions for improvement.

PROCEDURE

Four focus groups were conducted with pediatric SCT nurses (N = 25 participants). A semistructured focus group guide was administered, with the discussions recorded and transcribed. A multistage thematic analysis combining prefigured and emergent dimensions was conducted. Our analysis focused on drawing comparisons within and across focus groups to understand the unique work experiences that participants had related to the patient's sleep and circadian environment.

RESULTS

Three key themes emerged. First, nurses expressed a high awareness of how disruptive the hospital environment is for patients. Second, nurses described their extensive efforts to try to minimize the impact of these disruptions. Finally, they provided clear recommendations for how to improve upon these concerns, along with barriers that they perceive could impede implementation.

CONCLUSIONS

Front-line caregivers on a pediatric SCT unit describe key contributors to sleep/circadian disturbances for patients. Within the constraints of the considerable medical needs of this patient population and the physical room/hospital environment, nurses strive to minimize these disruptions to the best of their ability. It is crucial that hospitals assess and remediate these disturbances for these children that have important implications for overall health.

Need to Intervene: An Exploratory Study of Nurses' Experiences With Patienthood

Much has been written about the patient experience, but there is little information about experiences of providers as patients. Since lay patients and providers have differing perspectives and expectations, it is important to identify those elements shared by those in each group and those that diverge. This study identified experiences of nurses as being a patient or a family caregiver of a patient as well as identified assessments of the healthcare system by nurses. An exploratory study using a self-administered electronic questionnaire with a group of registered nurses was conducted. Assessments of the system by responders were positive when addressing quality of care, interactions among healthcare personnel, and interactions with patients. However, when discussing their experiences as patient, nurses reported they encountered problems with coordination of care, responses of medical personnel, attention to details of care, and responses to their attempts to become more involved. Results confirm issues raised by patients who are not medical experts in patient satisfaction studies. Adding a professional perspective highlights where problems with the healthcare system lie.

Nurses' perceptions of patient participation in the myocardial infarction pathway

Aim

To explore nurses' perceptions of patient participation in different phases of the myocardial infarction pathway.

Design

Qualitative design with a hermeneutical approach.

Methods

Five focus groups were conducted at two hospitals, one with and one without percutaneous coronary intervention facilities, between February-November 2018. Participants were recruited through purposive sampling. Twenty-two nurses experienced in cardiac care participated. The analysis had a hermeneutical approach.

Results

The findings revealed nurses' perceptions of patient participation in different phases of the myocardial infarction pathway. Four themes were identified: (a) variation between paternalism and autonomy in the acute phase; (b) individualization of dialogue and patient participation during treatment; (c) lack of coherence in the pathway hinders patient participation at discharge; and (d) cardiac rehabilitation promotes patients' autonomous decisions in lifestyle changes.

Which client characteristics predict home-care needs? Results of a survey study among Dutch home-care nurses

Fee-for-service, funding care on an hourly rate basis, creates an incentive for home-care providers to deliver high amounts of care. Under casemix funding, in contrast, clients are allocated-based on their characteristics-to homogenous, hierarchical groups, which are subsequently funded to promote more effective and efficient care. The first step in developing a casemix model is to understand which client characteristics are potential predictors of home-care needs. Nurses working in home care (i.e. home-care nurses) have a good insight into clients' home-care needs. This study was conducted in co-operation with the Dutch Nurses' Association and the Dutch Healthcare Authority. Based on international literature, 35 client characteristics were identified as potential predictors of home-care needs. In an online survey (May, 2017), Dutch home-care nurses were asked to score these characteristics on relevance, using a 9-point Likert scale. They were subsequently asked to identify the top five client characteristics. Data were analysed using descriptive statistics. The survey was completed by 1,007 home-care nurses. Consensus on relevance was achieved for 15 client characteristics, with "terminal phase" being scored most relevant, and "sex" being scored as the least relevant. Relevance of the remaining 20 characteristics was uncertain. Additionally, based on the ranking, "ADL functioning" was ranked as most relevant. According to home-care nurses, both biomedical and psychosocial client characteristics need to be taken into account when predicting home-care needs. Collaboration between clinical practice, policy development, and science is necessary to realise a funding model, to work towards the Triple Aim (improved health, better care experience, and lower costs).

Nurse Perspectives of Maintaining Patient Dignity in Indonesian Clinical Care Settings: A Multicenter Qualitative Study

PURPOSE

Nurses have a professional obligation to maintain patient dignity when providing nursing care. The concept of dignity, however, is dependent on cultural context. The aim of this study was to elicit nurses' perspectives for maintaining patient dignity in Indonesian clinical care settings.

DESIGN

A qualitative descriptive study was performed.

METHODS

A total of 40 clinical nurse participants were recruited by purposive sampling from six general public hospitals in Eastern Java, Indonesia, including six medical and six surgical units. Data were collected in 2017 using individual face-to-face semistructured interviews. Inductive content analysis was employed.

FINDINGS

The interview data revealed nurses considered three main elements were necessary to maintain patient dignity in clinical care: personalized care, which included prioritizing patients and treating as individuals; compassionate care, which included empathizing and providing emotional support; and patient care advocacy, which included protecting patient rights and being a representative for the patient.

CONCLUSIONS

This study provided knowledge on how to maintain patient dignity from the cultural perspective of clinical nurses in Indonesia. Our findings highlight the importance of providing dignified care in a manner that is congruent with culture. The nurses in our study considered compassion and beneficence necessary values for providing dignified patient-centered care, which might be qualities that are culturally sensitive for an Indonesian population.

CLINICAL RELEVANCE

Strategies should be developed to improve dignity of care for hospitalized patients in Indonesia as well as other cultural settings, which could be incorporated into patient care. These should include improving patients' health literacy to increase patient-centered communication, eliminating mixed-gender wards to enhance patient privacy, and involving family members as partners in health care.