Stroke patients’ experiences of being admitted to and nursed within a mixed sex environment: a qualitative study

Objectives: Explore, from a consumer’s perspective, experiences of being admitted to, and nursed within, a mixed sex environment (MSE).Design: Structured and semi-structured interviews.Setting: An acute stroke unit (ASU) in a UK teaching hospital, which includes a MSE, stroke monitoring bay (SMB).Subjects: Consecutive males (15) and females (15) admitted to the ASU, without severe cognitive and/or communication problems.Methods: For consenting patients, basic demographic details were collected and structured questionnaires and semi-structured interviews performed. Answers to structured questionnaires were collated. Interviews were tape-recorded, transcribed verbatim and content analysed to reveal themes.Results: 30 patients were included (median age 68 years, inter-quartile range 60–73). Only 21(70%) patients were informed that the SMB was a MSE before admission, with 6(20%) being offered an alternative. Patients were generally happy with staffs’ attention to their privacy and dignity. Overall, 21(70%) expressed their willingness to be readmitted to the SMB. Knowing they would be in the MSE for only 72 hours was important to 27(90%) patients. The semi-structured interviews revealed three main themes: information/knowledge, procedure for communication, and experiences.Conclusions: Few patients objected to being nursed in a MSE in the acute stage of stroke. Care pathways should ensure adequate and timely information. Staff were respectful of privacy and dignity issues.     

‘Struggling to be an insider’: a phenomenological design of new nurses’ transition

Aims and objectives. To obtain a comprehensive understanding of the transition process of new nurses in Taiwan. Background. The transition period for new nurses can be a daunting and traumatic experience. The large number of newly graduated Taiwanese nurses who resign from their jobs within three months indicates that this process can be complicated. However, the problems associated with the experiences of new nurses have not yet been recognised. Design. We adopted a phenomenological design using focus group interviews. Methods. Sixteen new nurses (less than one year working experience) participated in eight weekly group interviews lasting two hours each to grasp their experience of ‘being new’. Interview data were analysed according to Sloan’s (2002) three moments, and the whole process of analysis followed the suggestions of Agar (1986) , which was performed in a close collaboration between researchers until the consensus about the findings could be reached. Results. The overarching pattern of the transition process of new nurses becoming experienced members of the clinical nursing team was revealed as a journey of ‘struggling to be an insider’. This phenomenon was characterised by four themes, including (1) ‘being new as being weak’, (2) ‘masking myself’, (3) ‘internalising the unreasonable’ and (4) ‘transforming myself to get a position’. Conclusions. While Western culture view abusive indoctrination of new nurses as toxic behaviour, under the Chinese traditions of yield, tolerance and self‐oppression, following the power hierarchy and seeking harmony, the transition of new nurses is interpreted differently. Relevance to clinical practice. Recognition of the journey of ‘struggling to be an insider’ helps nurse administrators to (1) gain a better understanding of what new nurses encounter in their transition process, (2) help new nurses without harm, (3) improve in‐service training programmes and (4) retain future nurses.     

Women’s experiences of recovery from childbirth: Focus on pelvis problems that extend beyond the puerperium

Aims. This study aimed to build understandings of women’s recovery experiences in the presence of continued pelvic problems extending beyond the puerperium to provide nurses and other health care professionals with information to enhance current practice. Background. Trauma to the pelvic floor during childbirth is a relatively common occurrence and can include damage to structures and nerves. A significant number of women will experience ongoing physical pelvic problems resulting from childbirth that extend past the puerperium; however, little is known about the experiential aspects of recovery for these women. Design. A qualitative, phenomenological study. Method. Narrative data were collected during conversational interviews with 10 mothers who had sustained pelvic injury during the birth process that persisted past the puerperium. Recruitment was via media releases and brochures distributed through childcare facilities. The data was analysed using Van Manen’s thematic analysis. Results. The themes that arose from the analysis were: ‘fearing intimacy’, ‘managing an unpredictable body’, ‘being resigned’ and ‘feeling devalued and dismissed’. Conclusions. Pelvic injuries that extend beyond the postpartum period are distressing for women. They negatively affect women’s views of themselves and have an impact on various aspects of life including intimate relationships and social activities. Relevance to clinical practice. Currently, postpartum care may have a focus on baby rather than mother and this focus may impede women making full disclosures of ongoing health needs arising from their delivery. Findings of this study suggest that women may have specific needs that extend beyond the puerperium, indicating a need for continued holistic assessments and extending practice to identify and support women experiencing persistent pelvic postpartum complications.     

Rehabilitation nurses practices in relation to urinary incontinence following stroke: a cross‐cultural comparison

Aim. To explore nurses’ practices and influences in relation to urinary incontinence following stroke, in the UK, Sweden and China. Background. Urinary incontinence following stroke is common, under‐recognised and poorly researched. Before appropriate rehabilitation interventions can be developed, an understanding of nurses’ current management approaches and cultural influences is required. Design. Qualitative. Methods. Semi‐structured interviews were undertaken with ten registered nurses from at least four different stroke units in three countries (n = 30). Interviews were carried out in the participants’ first language, using an agreed interview guide. Following translation, thematic analysis focusing on manifest meaning was undertaken, using an iterative approach involving electronic and face‐to‐face discussions. Results. The consequence of only superficial assessment was no systematic identification of types or causes of urinary incontinence and no individualised plans developed. A process model of practice, common to all three countries, was identified for stroke survivors with urinary incontinence. Routine core activities were followed by the palliative pathway (most frequently), where urinary incontinence was contained to protect the stroke survivors’ safety and ensure social continence; or the rehabilitative route (more rarely), where simple continence promoting activities were implemented with the purpose of facilitating recovery of bladder function. Conclusions. Nurses’ reactively manage urinary incontinence following stroke, adopting a routinised approach based on local custom and practice. Promotion of urinary continence is not a priority area of stroke rehabilitation for nurses in western or eastern countries. Relevance to clinical practice. The dearth of evidence‐based interventions available to rehabilitate bladder function following stroke means that stroke nursing practice is an experience‐based endeavour. This study explains the nurses’ focus on containment and social continence and highlights the need to systematically assess stroke survivors’ bladder rehabilitation needs, identify types of urinary incontinence and adopt appropriate urinary continence promoting practices.     

Patients’ experiences of everyday life after lung transplantation

Aim. To investigate the experiences of everyday life after lung transplantation of patients with previous chronic obstructive pulmonary disease (COPD). Background. Compared with patients being transplanted due to other indications, those with COPD prior to lung transplantation report more problems in the form of shortness of breath, fatigue, sexual problems, insomnia and increased appetite. In addition, they are often faced with problems returning to normal working life. How these problems influence the patient’s everyday life is unknown. Design. An exploratory qualitative study. Methods. Ten COPD patients (five females and five males) aged 51–69 and more than six months post transplantation, were interviewed using of a semi‐structured interview guide. All interviews were taperecorded, transcribed verbatim and analysed using qualitative content analysis. Findings. The analysis revealed four themes of experience: a second chance; an ordinary life without chronic rejection; even minor daily activities take time with chronic rejection; and need for support and knowledge that were considered important by the participants for their situation and daily life. Conclusions. This is the first study describing the experiences of everyday life after lung transplantation of patients with COPD prior to surgery. The findings highlight the importance of addressing these patients’ experiences of gratitude, positive life orientation and informational needs in relation to everyday life. Relevance to clinical practice. Health professionals should be aware of the kind of problems both women and men may experience a long time after the lung transplantation. They constitute a basic knowledge of a patient’s everyday life that is important when planning individual counselling and rehabilitation.     

综合护理对脑卒中尿失禁患者康复的影响

目的探讨综合护理对脑卒中后尿失禁患者康复的影响。方法将60例脑卒中尿失禁患者随机分为观察组和对照组各30例,对照组给予常规治疗和护理,观察组在常规治疗和护理基础上,同时接受膀胱功能训练、站立训练、心理情感护理等综合护理。60d后观察两组患者治疗效果。结果观察组治疗总有效率为96.67%,对照组为66.67%,两组比较,P〈0.05,差异具有统计学意义。结论综合护理能促进脑卒中尿失禁患者康复。