Return‐to‐work intervention during cancer treatment – The providers' experiences

To explore in‐depth understanding of providers' experiences when involved in a return‐to‐work (RTW) intervention offered during cancer treatment. Semi‐structured individual interviews and participant observations at a hospital department and two municipal job centers were carried out, including ten providers (physicians, nurses and social workers). A phenomenological‐hermeneutic approach was applied, involving coding, identification of themes and interpretation of findings. Three major themes were identified: Treatment first, Work as an integrated component in cancer rehabilitation, and Challenges in bringing up work issues. Differences in providers' experiences of the RTW intervention offered to cancer patients were found: in the hospital setting RTW was a second priority, whereas in the municipality job centers it was an integrated component. Further studies are needed to investigate how and when occupational rehabilitation services can be implemented across sectors to support cancer patients' RTW. In the future, work issues ought to be systematically presented by providers across sectors as early as possible to support cancer patients' RTW. Cancer patients' individual needs and thoughts about RTW are to be identified by both health care providers during treatment and social workers at the municipality level and shared across sectors.     

Teenagers and young adults with cancer in Europe: from national programmes to a European integrated coordinated project

Over 14 000 patients aged 15–24 are estimated to be diagnosed with cancer in the European Union (EU) each year. Teenagers and young adults (TYA) often fall down gaps between children's and adults cancer services. The specific challenges of providing optimal care to them are described, but we present a summary of recent progress. Progress to overcome these challenges is happening at different rates across Europe. We summarise the European national projects in this field but more recently we have seen the beginnings of European coordination. Within the EU 7th Funding Programme (FP7) European Network for Cancer Research in Children and Adolescents programme (ENCCA), a specific European Network for Teenagers and Young Adults with Cancer has held a series of scientific meetings, including professionals, patients and caregivers. This group has proposed unanswered research questions and agreed key features of a high‐quality service that can improve outcomes for TYA with cancer, including the primacy of collaboration between adult and paediatric services to eliminate the gap in the management of TYA with cancer.     

Chinese midwives’ experience of providing continuity of care to labouring women

Objective

to explore and describe Chinese midwives’ experience of providing one-to-one continuity of care to labouring women.

Design

a qualitative study using a phenomenological approach. Data were collected using open-ended, tape-recorded interviews. The analysis of the transcribed texts included searching for themes sorted into clusters for a final expression of the essential structure of the phenomenon.

Setting

Obstetrics and gynaecology hospital of Fudan University, Shanghai, China.

Participants

12 midwives, providing one-to-one continuity of care to labouring women.

Findings

two main categories were identified: (1) midwives’ feelings on providing continuity of care, and (2) impact of on-call system on midwives providing continuity of care. Key themes emerged from each main category: (1) ‘playing important roles in labour care’, ‘gaining a sense of self-achievement’, ‘falling into exhaustion and frustration’ and ‘coping with caring work’; and (2) ‘on-call syndrome’, ‘affecting personal lives’ and ‘managing on-call shift’. The midwives experienced mixed feelings of being with women and expressed their adaptation to being on-call, which was the essence of this study. They played important roles in caring for women, gained a sense of self-achievement and developed suitable coping strategies. However, they also indicated the impact of the on-call system upon them in the process of providing continuity of care.

Conclusion and implications for practice

midwives have gained both positive and negative experiences when providing continuity of care to labouring women. The positive aspects may facilitate other professional midwives working in a similar role, whereas the negative aspects may inform them of learning to live with this situation, and may also have implications for managers to develop new approaches to the organisation and provision of continuity of care to support midwives’ practice, and to fully utilise ‘flexibility’ under an on-call system.     

Towards a comprehensive theory of nurse/patient empowerment: applying Kanter's empowerment theory to patient care

spence laschinger h.k., gilbert s., smith l.m. & leslie k. (2010) Journal of Nursing Management 18, 4–13
Towards a comprehensive theory of nurse/patient empowerment: applying Kanter's empowerment theory to patient care
Aim  The purpose of this theoretical paper is to propose an integrated model of nurse/patient empowerment that could be used as a guide for creating high-quality nursing practice work environments that ensure positive outcomes for both nurses and their patients.
Background  There are few integrated theoretical approaches to nurse and patient empowerment in the literature, although nurse empowerment is assumed to positively affect patient outcomes.
Evaluation  The constructs described in Kanter's (1993) work empowerment theory are conceptually consistent with the nursing care process and can be logically extended to nurses' interactions with their patients and the outcomes of nursing care.
Key issues  We propose a model of nurse/patient empowerment derived from Kanter's theory that suggests that empowering working conditions increase feelings of psychological empowerment in nurses, resulting in greater use of patient empowerment strategies by nurses, and, ultimately, greater patient empowerment and better health outcomes.
Conclusions  Empirical testing of the model is recommended prior to use of the model in clinical practice.
Implications for Nursing Management  We argue that empowered nurses are more likely to empower their patients, which results in better patient and system outcomes. Strategies for managers to empower nurses and for nurses to empower patients are suggested.     

Caring with difficulty: Brazilian nurses' experiences of gynaecological surgery care

da Costa Vargens OM, Berterö CM. International Journal of Nursing Practice 2010; 16 : 159–165
Caring with difficulty: Brazilian nurses' experiences of gynaecological surgery care This study was made by a qualitative approach based on symbolic interactionism and grounded theory. The subject was defined as what mutilation means for nurses who take care of women submitted to gynaecological surgery. The aim was to identify the interaction relationship of nurses as female with the phenomenon of mutilation in gynaecological surgeries and how it affects their relationship with female patients in this situation. Data were obtained by interviews with 16 nurses who work in gynaecology units. The findings present two core categories: speaking as a professional and speaking as female. When they spoke as professional nurses they defined mutilation technically. As females they verbalized their conflict and difficulty in working with mutilation and redefined it as being the loss of something very important for themselves. We conclude that female nurses when confronting female surgery distances themselves behind the professional nurse and performs nursing care as a daily routine. It means that these nurses live a personal conflict that influences directly on how they supply care. They care for but do not care about, the ethos of biomedicine leads carers on to a technical path from which it is difficult to get off.     

Enhancing cultural competence: Trans‐Atlantic experiences of European and Canadian nursing students

This paper describes the enhancement of cultural competence through trans‐Atlantic rural community experiences of European and Canadian nursing students using critical incident technique (CIT) as the students' reflective writing method. The data generated from 48 students' recordings about 134 critical incidents over a 2‐year project were analysed by qualitative content analysis. Five main learning categories were identified as: cross‐cultural ethical issues; cultural and social differences; health‐care inequalities; population health concerns; and personal and professional awareness. Four emergent cultural perspectives for the health sector that became apparent from the reflections were: health promotion realm; sensitivity to social and cultural aspects of people's lives; channels between the health sector and society; cultural language and stories of local people. CIT was successfully used to foster European and Canadian undergraduate students' cultural reflections resulting in considerations and suggestions for future endeavours to enhance cultural competence in nursing education.     

Medical and nursing clinical decision making: a comparative epistemological analysis

Abstract The aim of this article is to explore the complex forms of knowledge involved in diagnostic and interventional decision making by comparing the processes in medicine and nursing, including nurse practitioners. Many authors assert that the practice of clinical decision making involves the application of theoretical knowledge (acquired in the classroom and textbooks) as well as research evidence, upon concrete particular cases. This approach draws on various universal principles and algorithms to facilitate the task. On the other hand, others argue that this involves an intuitive form of judgement that is difficult to teach, one that is acquired principally through experience. In an exploration of these issues, this article consists of three sections. A clarification of terms commonly used when discussing decision making is provided in the first section. In the second section, an epistemological analysis of decision making is presented by examining several perspectives and comparing them for their use in the nursing and medical literature. Bunge's epistemological framework for decision making (based on scientific realism) is explored for its fit with the aims of medicine and nursing. The final section presents a discussion of knowledge utilization and decision making as it relates to the implications for the education and ongoing development of nurse practitioners. It is concluded that Donald Schön's conception of reflective practice best characterizes the skilful conduct of clinical decision making.     

A collaborative model for the clinical education of baccalaureate nursing students

Quality clinical supervision is fundamental for the consolidation of knowledge and the development of a professional identity for baccalaureate nursing students. Problems in providing high-quality clinical supervision range from a lack of practitioner role models to inadequate or unsupportive learning environments. Collaboration between the education and service sectors allows for the development of enriched clinical learning experiences for students. This paper describes an innovative collaborative educational process developed by McMaster University School of Nursing and the Nursing and Education Departments at Hamilton Psychiatric Hospital, Hamilton, Ontario, Canada. Front-line nursing staff are the clinical supervisors, with support from clinical nurse specialists, the hospital educator and the university faculty member. When compared to more traditional approaches, this model ensures that the students receive more variety in placements and access to expert human resources.