Determinants of quality of life for older people living with a disability in the community

Title.  Determinants of quality of life for older people living with a disability in the community.
Aim.  This paper is a report of a study conducted to identify the determinants of quality of life for older people with a disability living in the community and to construct a model to explain these.
Background.  There is no consensus in the literature as to the meaning of quality of life. Few studies have focused on the determinants of quality of life for people with a disability.
Methods.  A grounded theory study was conducted between 2005 and 2006, using semi-structured interviews to collect data. The constant comparative technique was used to analyse data. The sample comprised 122 older people with one of six disabilities: stroke ( n  = 20), arthritis (20), depression (20), vision and hearing deficits (20), learning disability (24) or dementia (18) who were living in the community.
Findings.  A model of the factors that determine quality of life of older people with a disability was developed. 'Living well' was conceptualized as the core category. The potential to 'live well' was influenced by foundation, mediating and facilitating/constraining factors. Quality of life of older people with a disability was revealed as a complex mix of these factors.
Conclusion.  Quality of life cannot be fully understood unless the totality of factors that have an impact on and shape perceptions are taken into account. The model implies that good support from nurses, a focus on a person's abilities and access to information and connectedness to others can make a difference and may help people cope in a better way.     

Living with a long-term urinary catheter: older people's experiences

Title. Living with a long‐term urinary catheter: older people’s experiences. Aim. This paper is a report of a study of the experiences of older people living with a long‐term urinary catheter and the development of a substantive theory grounded in their realities. Background. Understanding the user perspective is a prerequisite for involving older people in a collaborative relationship with healthcare professionals which is built around their needs and wishes. Older people’s views and experiences of the complexity of living with a long‐term catheter have not been widely researched. An enhanced understanding of catheter users’ perspectives and an awareness of their needs can be used to improve care. Method. A grounded theory approach was adopted and 20 in‐depth interviews were carried out in England in 2005 and 2006 with 13 older people living at home with long‐term urinary catheters. Findings. The core category ‘all about acceptance’ described older people’s adjustment to living with a long‐term urinary catheter; the two categories ‘at ease’ and ‘uneasy’ reflect the extremes of contentment experienced. Three interlinking categories of ‘trying to understand’, ‘judging catheter performance’ and ‘being aware of the catheter’ shaped older people’s relationships with their catheters and this was mediated by their ‘interaction with others’. The consequences for older people fluctuated along a continuum from ‘engaging actively’ to experiencing ‘downbeat sentiments’. Conclusion. To assist older people to adjust to living with a catheter, healthcare professionals must be sensitive to their life situations and individual needs rather than focusing predominantly on catheter performance and complications.     

Managerial support of community mental health nurses

AIMS: This paper is a report of a study to describe the support behaviours practised by managers of community mental health nurses (CMHNs) who provide homecare for people with mental illness, and to identify factors related to those behaviours. BACKGROUND: Homecare of mentally ill clients can prevent hospital readmission, provide rehabilitation, and include support for medication adherence, personal relationships, mental health, activities of daily living, as well as supporting informal caregivers. However, this work is stressful for CMHNs, who can themselves develop mental health problems and suffer burnout. Therefore support for these nurses is essential. METHOD: Semi-structured interviews were conducted with 10 nurse managers in 2004. A constant comparative data collection and analysis process was used, and a core category identified. FINDINGS: Four categories of managerial support behaviour were identified: (1) 'modifying client-nurse relationships'; (2) 'ensuring community mental health nurse safety'; (3) 'providing emotional support'; (4) 'providing opportunities for skill development'. 'To continue homecare for clients in need' emerged as a core category, representing the ultimate purpose of managerial support behaviours. Moreover, the timing of managerial support behaviours was influenced by the quality and length of the client-nurse relationship. CONCLUSION: The managerial support behaviours reported in the present study may be useful in other cultural contexts. Further research is needed to evaluate their effectiveness for CMHNs in other settings in Japan and other countries.     

Elderly peoples' experience of nursing care after a stroke: from a gender perspective

Title.  Elderly peoples' experience of nursing care after a stroke: from a gender perspective.
Aim.  This paper is a report of a study conducted to explore, from a gender perspective, older people's experiences of nursing care after a stroke.
Background.  Little attention has been given to gender differences in nursing care. The majority of people who have a stroke are older. Improving knowledge of the gender perspectives of older men and women regarding nursing care after stroke is crucial.
Method.  This was a qualitative study based on interviews with five women and five men between 66 and 75 years of age, who had received nursing care at a ward for stroke rehabilitation. The data were collected in 2006. Qualitative content analysis of the interviews was carried out.
Findings.  A main theme and five categories, all common to both men and women, were identified. The main theme, to promote recovery of the body, encompassed the categories. There were, however, gender differences in how the nursing care received was experienced. The ways patients experienced nursing care seemed to be linked with their lives as women and men before they had the stroke. Their perceptions are linked with their lives as women and men before they had their stroke. Both men and women will reclaim former abilities but what they perceive to be the goals of nursing care and rehabilitation may differ.
Conclusion.  Nurses need to increase their awareness and knowledge concerning the similarities and gender differences in the experiences and needs of older people, both men and women.     

Older people and laxative use: literature review and pilot study report

This study explored older adults' perceptions of constipation, and the measures taken if they believed themselves to be afflicted by this condition. The paper provides an overview of the current literature surrounding laxative use, followed by a discussion of the pilot study and its findings. The objectives of the pilot study were to establish older people's definitions of the term 'constipation'; identify prescribed laxatives, over-the-counter laxatives, and home remedies used by older people to manage constipation; produce a detailed account of when these products are used; identify the older person's belief system underpinning their concepts of constipation, and their consequent use of laxative products; and produce information which will inform nursing practice, with a particular focus on nurses in community practice. People who identified themselves as being constipated were interviewed on a one to one basis. Participants shared their stories of loneliness, social isolation and anxiety related to constipation and the need to use laxatives on a daily basis, and described persistent unpleasant and often painful physical symptoms such as bloating, urges, excessive flatus, nausea and cramps, commonly associated with laxative ingestion. Nurses are challenged to work with older people within a 'wellness' framework, helping clients to maintain their bowel function, rather than fall back on short-term options, which provide only brief relief of symptoms, while ignoring the underlying causes.     

Being reborn: the recovery process of postpartum depression in Taiwanese women

AIM: This paper reports a qualitative study describing the process of recovery from postpartum depression in Taiwanese women. METHODS: We carried out a study using grounded theory with a purposive sample of 23 postnatally depressed women in 2001-2002. The Beck Depression Inventory was used to screen for severe depression. Women with scores higher than 16 at 6 weeks after childbirth were categorized as having postpartum depression. Only two out of the 23 mothers were being treated for depression at the time. The data were analysed by constant comparative method. FINDINGS: 'Being reborn' was the core concept that emerged from the data on the mothers' experience of going through postnatal depression, which was a process of descent into near-death insanity and eventual rebirth. Such postnatally depressed mothers often underwent four stages of coping with the loss of self or loss of former identity and attachment to their new lives as mothers. The four stages were: (1) shattered role identity, (2) feeling trapped and breaking down, (3) struggling for self-integrity and (4) regaining vitality. CONCLUSION: The experience of postpartum depression should be examined within the social and cultural contexts in which it occurs. These Taiwanese data can be used to develop culturally-sensitive health care. The nursing role is primarily that of reflective listening to help the women adjust to the process of being reborn--an internal process of painful growth represented by motherhood and striving to protect the real self in order to maintain emotional health while negotiating a developmental transition. Preventive interventions might include providing guidance for parenting, counselling of individual mothers, and facilitating the development of support groups.     

Anticipatory vigilance: A grounded theory study of minimising risk within the perioperative setting

Aims and objectives

To explore and explain how nurses minimise risk in the perioperative setting.

Background

Perioperative nurses care for patients who are having surgery or other invasive explorative procedures. Perioperative care is increasingly focused on how to improve patient safety. Safety and risk management is a global priority for health services in reducing risk. Many studies have explored safety within the healthcare settings. However, little is known about how nurses minimise risk in the perioperative setting.

Design

Classic grounded theory.

Methods

Ethical approval was granted for all aspects of the study. Thirty‐seven nurses working in 11 different perioperative settings in Ireland were interviewed and 33 hr of nonparticipant observation was undertaken. Concurrent data collection and analysis was undertaken using theoretical sampling. Constant comparative method, coding and memoing and were used to analyse the data.

Results

Participants’ main concern was how to minimise risk. Participants resolved this through engaging in anticipatory vigilance (core category). This strategy consisted of orchestrating, routinising and momentary adapting.

Conclusion

Understanding the strategies of anticipatory vigilance extends and provides an in‐depth explanation of how nurses’ behaviour ensures that risk is minimised in a complex high‐risk perioperative setting. This is the first theory situated in the perioperative area for nurses.

Relevance to clinical practice

This theory provides a guide and understanding for nurses working in the perioperative setting on how to minimise risk. It makes perioperative nursing visible enabling positive patient outcomes. This research suggests the need for training and education in maintaining safety and minimising risk in the perioperative setting.     

A theory for the nursing care of patients at risk of suicide

AIM: This paper presents a nursing care theory developed to guide the care given to people with suicidal ideas and those with a previous suicide attempt. BACKGROUND: Suicide is a major public health problem. According to the World Health Organization, international suicide rates range from highs of more than 20 per 100,000 people in Hungary (1997 figures), to fewer than 10 per 100,000 in the United Kingdom (2002 figures). In 2002, the number of completed suicides in Taiwan increased by nearly 10% over the previous year, and the Taiwanese Government has set targets to reduce this rate. Psychiatric nurses play a vital role in helping reduce the suicide rate through prevention, education and by providing care that promotes the healing of patients who attempt suicide. METHODS: A grounded theory approach was used. Fifteen patients who had either suicidal ideas or had attempted suicide and 15 psychiatric nurses working on acute wards were interviewed and observed using an observer-as-participant strategy. Data were collected through field notes and by tape-recorded interviews during 2003, and analysed using open, axial and selective coding and the qualitative software program QRS NUD*IST. FINDINGS: The core category that emerged from the data collected was the provision of 'safe and compassionate care via the channel of the therapeutic relationship'. Other key categories linked to and embraced within this core category were: providing holistic assessments; providing protection; providing basic care; and promoting healing through advanced care. CONCLUSION: The theory generated from the findings could be used by nurses as a guide as they initiate and maintain therapeutic relationships with patients who are at risk of suicide. The theory could advance the quality of care provided by nurses. In addition, it holds potential for instilling hope in patients who have lost their ability to cope with life events and perhaps life itself.     

Patient participation on a ward for frail older people

AIMS: The paper reports a study whose aims were to explore the meaning of participation for older people in hospital and their health care workers and ways in which staff can enhance patient participation in their care. BACKGROUND: Participation in care is a concept that is central to nursing practice. However, little is known about patient and staff views of participation and how it takes place in practice. METHODS: Action research was used, and data were collected by means of focus groups and in-depth interviews. Three focus groups and 24 interviews were undertaken with staff, and 19 interviews were undertaken with patients. The main action undertaken with staff aimed at raising their awareness of participation. In addition small changes in practice were introduced, such as the use of a patient biographical booklet. FINDINGS: The findings suggest that participation is a dynamic process that is integral to the work of nurses and carers. The process is enacted through the themes of facilitation, partnership, understanding the person, and emotional work. CONCLUSION: The study demonstrates how nurses can become increasingly aware of the potential for facilitation and creation of opportunities for participation. It is crucial that practitioners working with older people develop a deeper understanding of participation and are also empowered to act in ways that fit with the needs of this specific client group.