Reframing the meaning of life and professional values: A theoretical framework of facilitating professional care for terminally ill patients

Professional values reflect nurses' understanding of how to deliver professional care, which might influence nurses' attitudes and caring behaviors during end‐of‐life care. However, limited research has been conducted to explore nurses' experiences of professional development during end‐of‐life care, and theoretical explanations are scarce about how nurses enact their professional values during the caring process. This study explored the social process of professional values involved in end‐of‐life care in the Chinese cultural context by adopting a constructivist grounded theory approach. Twenty semi‐structured in‐depth interviews with 15 nurses from three hospitals in southeastern China were conducted. A theoretical framework emerged when focusing on the social process of “reframing the meaning of life and professional values” to facilitate professional care for terminally ill patients. Three main categories were sequentially identified as “recognizing the dilemmas when caring for terminally ill patients,” “applying strategies to deal with values conflict,” and “reconstructing values.” This theoretical framework may be applied as a practical framework for equipping nurses with effective strategies to cultivate professional values, including the provision of adequate end‐of‐life knowledge, and a supportive workplace environment.     

The chasm of care: Where does the mental health nursing responsibility lie for the physical health care of people with severe mental illness?

The poor physical health of people with a severe mental illness is well documented and health professionals' attitudes, knowledge and skills are identified factors that impact on clients' access to care for their physical health needs. An evaluation was conducted to determine: (i) mental health nurses' attitudes and beliefs about providing physical health care; and, (ii) the effect that participant demographics may have on attitudes to providing physical health care. It was hypothesized that workplace culture would have the largest effect on attitudes. Nurses at three health services completed the “Mental health nurses' attitude towards the physical health care of people with severe and enduring mental illness survey” developed by Robson and Haddad (2012). The 28‐item survey measured: nurses' attitudes, confidence, identified barriers to providing care and attitudes towards clients smoking cigarettes. The findings demonstrated that workplace culture did influence the level of physical health care provided to clients. However, at the individual level, nurses remain divided and uncertain where their responsibilities lie. Nursing leadership can have a significant impact on improving clients' physical health outcomes. Education is required to raise awareness of the need to reduce cigarette smoking in this client population.     

“So You Are Running Between”—A Qualitative Study of Nurses' Involvement With Diagnostic Imaging in South Africa

Nurses caring for patients in radiology departments are a relatively recent phenomenon. Only a few fragmented studies appear in the literature on the interprofessional nursing domain in these departments. This article attempts to give a more holistic picture of nurses' experiences of patient care related to diagnostic imaging and interprofessional interactions and relations with radiographers and radiologists. Focus groups were held, among others, with nurses at a district hospital and an adjacent academic hospital in South Africa. Participants were questioned about their experiences regarding referrals for diagnostic imaging, their professional roles, views on the roles of other professions, multidisciplinary interaction, and radiation awareness. Three main themes emerged, namely (1) patient care and communication include the subthemes of “being there” for patients and communicating with them; (2) scope of professional practice is divided into activities around the request form, preparation for diagnostic imaging, and further education needs; (3) interprofessional interactions relate to hierarchical and power relations and interprofessional communication and conflict. The study illustrates the collaborative and mediating roles of nurses at various points in the health system, from referral of patients for diagnostic imaging investigations to discharge from the health care facility. More studies are needed on interprofessional relations among radiographers, radiologists, and nurses, and nurses' ability to make appropriate judgments with regard to the completion and interpretation of request forms and preparing patients for specialized investigations.     

Truth-telling to patients' terminal illness: What makes oncology nurses act individually?

PurposeNurses encounter the challenge of truth-telling to patients' terminal illness (TTPTI) in their daily care activities, particularly for nurses working in the pervasive culture of family protectiveness and medical paternalism. This study aims to investigate oncology nurses' major responses to handling this issue and to explore what factors might explain oncology nurses' various actions.MethodsA pilot quantitative study was designed to describe full-time nurses' (n = 70) truth-telling experiences at an oncology centre in Taipei. The potential influencing factors of nurses' demographic data, clinical characteristics, and truth-telling attitudes were also explored.ResultsMost nurses expressed that truth-telling was a physician's responsibility. Nevertheless, 70.6% of nurses responded that they had performed truth-telling, and 20 nurses (29.4%) reported no experience. The reasons for inaction were “Truth-telling is not my duty”, “Families required me to conceal the truth”, and “Truth-telling is difficult for me”. Based on a stepwise regression analysis, nurses' truth-telling acts can be predicted based on less perceived difficulty of talking about “Do not resuscitate” with patients, a higher perceived authorisation from the unit, and more oncology work experience (adjusted R² = 24.1%).ConclusionsOncology care experience, perceived comfort in communication with terminal patients, and unit authorisation are important factors for cultivating nurses' professional accountability in truth-telling. Nursing leaders and educators should consider reducing nursing barriers for truth-telling, improving oncology nurses' professional accountability, and facilitating better quality care environments for terminal patients.     

Systematic review of the effectiveness of primary care nursing

This paper reports on a systematic review that sought to answer the research question: What is the impact of the primary and community care nurse on patient health outcomes compared with usual doctor‐led care in primary care settings? A range of pertinent text‐words with medical subject headings were combined and electronic databases were searched. Because of the volume of published articles, the search was restricted to studies with high‐level evidence. Overall, 31 relevant studies were identified and included in the review. We found modest international evidence that nurses in primary care settings can provide effective care and achieve positive health outcomes for patients similar to that provided by doctors. Nurses are effective in care management and achieve good patient compliance. Nurses are also effective in a more diverse range of roles including chronic disease management, illness prevention and health promotion. Nevertheless, there is insufficient evidence about primary care nurses' roles and impact on patient health outcomes.     

The Autonomy of Nurses in High Dependency Care.

ABSTRACT. The aim of this study is to enquire into the kind of ethical dilemmas reported by nurses in the high dependency health care sector. Nurses from different intensive care units at one British hospital were interviewed. The interviews, which were tape recorded, show that nurses often found themselves in conflict between the patient's interests and those of other people, such as physicians, relatives, other patients, colleagues, etc. Competing loyalties and role conflicts contributed to complicate the nurses' ethical problems.     

Attitude Disentangled: A Cross-Sectional Study into the Factors Underlying Attitudes of Nurses in Dutch Rehabilitation Centers toward Patients with Comorbid Mental Illness

In rehabilitation centers, many patients suffer a comorbid mental illness. Nurses have different attitudes toward these patients. A cross-sectional, questionnaire-based study among nurses in Dutch rehabilitation centers was undertaken to clarify the factors that underlie attitudes toward patients with comorbid mental illness. The main factors associated with attitudes were feelings of competence and experiences with dealing with patients with mental illness. Other associations were perceived support; frequency of caring for patients with comorbid mental illness; work experience in mental health care; additional psychiatric training; and the personality traits “extraversion,” “emotional stability,” and “openness to experience.” Perceived support had the strongest association with feelings of competence.     

Entangled: A mixed method analysis of nurses with mental health problems who die by suicide

Nurses die by suicide at a higher rate than the general population. Previous studies have observed mental health problems, including substance use, as a prominent antecedent before death. The purpose of this study was to explore the characteristics of nurses who died by suicide documented in the death investigation narratives from the National Violent Death Reporting System from 2003 to 2017 using thematic analysis and natural language processing. One thousand three hundred and fifty-eight subjects met these inclusion criteria. Narratives from 601 subjects were thematically analyzed and 2544 individual narratives were analyzed using natural language processing. The analyses revealed five themes: “mental health treatment,” “poor general health and chronic pain,” “substance use,” “worsening mental health after bereavement,” and “repeating a family member's suicide.” Mental health/substance use, chronic illness, and chronic pain were seen to coexist in a complex, interdependent manner that appeared to be entangled in the nurses' narratives before death. These findings echo the need for reducing the stigmatization of mental health problems in nursing and removing barriers to help-seeking behaviors as early preventative interventions. Future research is needed to determine if a comprehensive healthcare integration approach to address these entangled problems would reduce suicide vulnerability in nurses and improve their quality of life.     

Construction of nursing knowledge in commodified contexts: Views and experiences of nurses regarding primary care

The commodification of health care, particularly primary care, presents challenges to care and knowledge development. The purpose of this study is to examine how nurses perceive and develop their knowledge in a commodified context. A mixed-methods study was conducted that included a closed-question survey and in-depth interviews with nurses in public primary care in Catalonia. There were 104 valid responses to the questionnaire and 10 in-depth interviews. The main findings of the survey were related to workload and limited time for nursing care. Six themes emerged from the in-depth interviews: (1) limited time for nursing, (2) feelings of burnout, (3) awareness of patient and family satisfaction, (4) organizational factors that favor nurses' needs, (5) organizational factors that hinder nurses' needs, and finally (6) public administration requirements. Participants perceive excessive workload and time constraints and feel that this affects their nursing care and their physical and mental health. However, nurses purposefully use knowledge patterns to cope with the problems associated with commodification. Nurses have multidimensional, contextualized, and integrated knowledge that allows them to optimize their care based on the needs of their patients. This research examines many challenges related to nursing practice and the nursing discipline and opens the door for further research that encompasses all areas of nursing.     

Identifying feelings engendered during triage assessment in the accident and emergency department: the use of visual analogue scales

• ? Feelings engendered during 585 triage nursing assessments made by a total of 10 nurses were studied.
• ? Marked differences in nurses' feelings were demonstrated towards patients attending the accident and emergency (A&E) department with ‘primary care’ needs compared with those assessed as having ‘A&E&’ needs. In particular, nurses demonstrated more negative feelings, in the form of less sympathy, more irritation and less motivation to help, towards patients with ‘primary care’ needs. Nurses' feelings were adversely affected by delays in patient presentation following the occurrence of illness or injury.
• ? Nurses perceived patients' attendance as illegitimate when it had deviated from expected norms of health-care-seeking behaviour.
• ? These findings were elicited using visual analogue scales completed immediately following the triage assessment of the patients. This work is part of a larger study into developing the primary care role of accident and emergency nurses.
• ? The culture of the A&E department is discussed, and the need to challenge and change this culture to ensure it becomes more responsive to individual patients' needs is advocated. This paper calls for development of triage training and education and further investigation into the effects of nurses' attitudes on patient assessment.

     

Cancer rehabilitation from the perspectives of oncology nurses in Korea

The purpose of this study was to understand the perception of oncology nurses and how it is related to cancer rehabilitation in Korea. A qualitative study with three focus groups consisting of 6–8 Korean oncology nurses (n = 21) was conducted. The interviews were thematically analyzed. Two main themes for the attributes of cancer rehabilitation were “comprehensive activities of nurses” and “active involvement of survivors.” Six subthemes from the oncology nurses' care experiences were identified: “incorporating partnership and sharing feelings,” “fulfilling individualized needs,” “providing timely and practical support,” “enhancing internal strength with optimistic mindset,” “regaining functional independence,” and “getting family members in.” The findings suggest that oncology nurses can play a key role in rehabilitation for cancer survivors. Nursing interventions focused on comprehensive activities of nurses as well as active involvement of survivors can be effective in enhancing cancer survivors' strength and resilience in order to lead a healthy life. Oncology nurses need to be taught a psychosocial intervention based on individualized assessment and family partnership for cancer survivors.     

Meaning of hygiene care for patients as perceived by clinical nurses through an interactive care process: A grounded theory approach

Aim

This study aimed to explore the meaning of hygiene care for patients from the perspective of nurses, who provide them with care through an interactive process.

Methods

Sixteen registered nurses working in general wards for over 5 years were selected through purposive and snowball sampling. Individual semi-structured interviews were conducted between May and August 2021. Data were analyzed using a grounded theory approach, and the Consolidated Criteria for Reporting Qualitative Research was used to ensure quality and transparency.

Results

The participants recognized the core category “realizing oneself alive here,” where hygiene care energized patients and promoted their realization of “feeling alive.” Hygiene care created “time of relief, temporarily forgetting the illness,” and “restoring a sense of oneself.” A situation of care also created an “opportunity to treat each other as unique individuals,” “opportunity to face self,” and “encouraging the recovery and disease-fighting process.”

Conclusions

This study highlights the value of hygiene care provided by nurses to patients. The meaning of hygiene care conceptualized in this study should help build a conceptual framework for understanding the patient's experience and reaffirming the value of hygiene care.     

The Opinions of District Nurses regarding the Knowledge,Management and Documentation of Patients with Chronic Pain

This is the first of two studies investigating district nurses' opinions regarding the knowledge, management and nursing documentation of patients with chronic pain conditions, before and after the introduction of ‘pain advisers’ in one health care region in Stockholm. Seventy (97%) district nurses at 12 selected primary health care centres (PHCCs) answered a questionnaire. The study showed that 85% of the district nurses met patients with chronic pain conditions at least once a week. None of the 12 PHCCs had any written information/policies on pain control. Many district nurses did not perform any individual analysis of the patients' pain and very few used any tool, such as VAS, to assess or evaluate the patients' pain. The district nurses reported insufficient pain documentation. A number of district nurses were dissatisfied with the present management of patients with chronic pain at their PHCCs, their own knowledge of pain control, their own preparedness to meet these patients, their own follow-ups and their own documentation. The study also showed that the district nurses' attitudes to pain and pain control varied, depending on how satisfied they were with their own management of patients with chronic pain conditions.     

Relationship between nurses' perceptions of nursing assistant roles and information‐sharing behaviors: A cross‐sectional study

Information‐sharing between nurses and nursing assistants is necessary for appropriate inpatient care. Nurses who perceive nursing assistant roles highly may display positive behaviors related to information‐sharing with nursing assistants. This study aims to examine the relationship between nurses' perceptions of nursing assistant roles and the frequency of their sharing information with nursing assistants. Using a self‐administered, cross‐sectional survey questionnaire, data from 2,642 nurses in 182 hospitals were collected. Nurses' perceptions of nursing assistant roles were measured with a scale containing four factors: (i) improving patients' abilities through daily care; (ii) caring for various patients using broad perspectives; (iii) facilitating co‐ordination and co‐operation among team members; and (iv) increasing the amount of information on patients among team members. Information‐sharing behaviors included “expressing,” “asking,” “linguistic response,” and “feedback.” Multiple regression analyses for each nurse's information‐sharing behaviors were conducted. Nurses' perceptions of nursing assistant roles were positively correlated with the frequency of sharing information with nursing assistants. The degree of the correlations differed, depending on the type of information‐sharing behavior. Therefore, improving nurses' understanding of nursing assistant roles might increase their information‐sharing behaviors.     

Existential encounters: Nurses' descriptions of critical incidents in end-of-life cancer care

Nurses working with cancer patients in end of life care need to be prepared to encounter patients' psychosocial and spiritual distress.AimThe aim of this study was to describe nurses' experiences of existential situations when caring for patients severely affected by cancer.Methods and sampleNurses (registered and enrolled) from three urban in-patient hospices, an oncology clinic and a surgery clinic and a palliative homecare team were, prior to the start of a training program, invited to write down their experiences of a critical incident (CI), in which existential issues were featured.ResultsEighty-eight CIs were written by 83 nurses. The CIs were analyzed with qualitative content analysis. Two main themes were found: Encounters with existential pain experiences, which concerned facing death and facing losses; and Encountering experiences of hope, which concerned balancing honesty, and desire to live.ConclusionsThis study points out that health care professionals need to be aware of patients' feelings of abandonment in exposed situations such as patients' feelings of existential loneliness. That there are some patients that express a desire to die and this makes the nurses feel uncomfortable and difficult to confront these occurrences and its therefore important to listen to patients' stories, regardless of care organization, in order to gain access to patients' inner existential needs.     

Perspectives regarding what constitutes a “good death” among Thai nurses: A cross‐sectional study

Palliative care is a crucial component in improving peoples' end‐of‐life period. It is important to understand the wishes of people at the end of life and the perceptions of their healthcare providers regarding these wishes. As nurses play a key role in patient care, in this study we set out to determine nurses' perceptions regarding what constitutes a “good death”, comparing what they thought their older patients would prefer to their own preferences for their own end‐of‐life care. Questionnaires asking about various options of end‐of‐life care were distributed to nurses, and they were asked how they thought older people would respond to each of the questions and what their own preferences would be if they were terminally ill. In total, 656 participants were enrolled and they rated relief from suffering as the most important component, both for themselves and for those in their care. More than 80% of nurses agreed with all of the statements on the questionnaire. However, some of the nurses' preferences for their own end of life differed from those they expected their patients to value.     

Challenges of Nurses' Professional Behaviour Change Process

The aim of the study was to complement a project consisting of a planned modification of nurses' professional activities, which showed that nurses did not adopt a problem-solving approach to care after a specific in-service training. The aim of the study was to gain a better understanding of the ‘meanings’ that a group of nurses assigned to daily work, and how they perceived the changed situation. The main findings were that the nurses felt they had a limited degree of control over nursing care, a dependence on physicians, and consequently, used defensive strategies. The meaning assigned to nursing care was thus a series of pre-determined routines, though the nurses wished to increase the extent of interaction with patients. The study highlights the conflict between professional values and work values, as well as the gap between ‘espoused theories’ and ‘theories in use’. It is suggested that the process of change with regard to the nurses' professional behaviour, at unit level, is mediated by intrapersonal as well as by interpersonal factors such as the nurse's role and the nurse-physician relationship.