Patients' satisfaction with the care given by district nurses at home and at primary health care centres

The main purpose of this study was to investigate patients' satisfaction with the care given by the district nurses at home and at the primary health care centres in one area of Greater Stockholm. The questionnaire entitled 'Quality of Care from the Patient's Perspective' (QPP) was used. A total of 168 adult, home-care (HC) and 264 outpatient clinic (OC) patients answered this questionnaire. Maximum median scores were reported for most items designed to measure the four following dimensions: 'medical-technical' competence of the district nurses; 'physical-technical' conditions of the care organization; 'identity orientation' in the attitudes and actions of the district nurses and the 'socio-cultural' atmosphere of the care organization; and the perceived accessibility of nursing care. Some areas were identified as being in need of improvement, for example, pain alleviation, safety of the patients' home environment, the possibility of the patients participating in the decision-making process, the feeling that the care is not based on the patients' desires and needs, and the possibility of always meeting the same district nurse. Differences between HC and OC patients and between sub-groups were found regarding demographic characteristics and self-rated, physical health and psychological well-being. HC and OC patients with poor, self-rated, physical health were identified as being likely to be dissatisfied with the care.     

The Rehabilitation Nurse in the Home Care Setting: Care of the Client with HIV or AIDS

People with HIV or AIDS who are experiencing pain, fatigue, sexual dysfunction, bowel and bladder dysfunction, and self-care deficits are being cared for by rehabilitation nurses in the home setting. The home care rehabilitation nurse provides instruction and care to clients, their families, and caregivers regarding physical manifestations of the disease and issues such as the importance of involving the client in household activities and activities of daily living. In addition to working with an interdisciplinary team to meet clients' needs, home care rehabilitation nurses work and consult with the generalist nursing staff to offer recommendations about rehabilitation nursing care for clients with HIV or AIDS.     

Nurses’ perceptions on the skills,knowledge, and attributes required to provide healthcare to people experiencing homelessness in Australia: A qualitative study

BackgroundPeople experiencing homelessness have unmet healthcare needs often related to chronic health conditions and injury. Nurses are often the first and only point of contact for people experiencing homelessness accessing healthcare. However, education that prepares them to meet the needs of this vulnerable population is limited.AimTo qualitatively explore nurses’ perceptions on the skills, knowledge, and attributes required to provide healthcare to people experiencing homelessness in Australia that could underpin an educational pathway.DesignSemi-structured interviews with registered nurses and nurse practitioners.MethodsParticipants of a national survey were invited to undertake an interview. Interview data were analysed thematically and reported here in accordance with the Consolidated Criteria for Reporting Qualitative Research guidelines.FindingsThe registered nurses (n = 11) and nurse practitioners (n = 6) had varying levels of experience providing care for homeless Australians. Overarching themes that arose from the registered nurse and nurse practitioner participants included equitable access to care, knowledge around homelessness, contribution of nursing, and nurses’ role. However, nurse practitioners had a greater sense of agency and empowerment to enact care, while registered nurses perceived being underprepared and overwhelmed by the unmet needs of people experiencing homelessness.ConclusionsThe findings suggest that nursing practice holds opportunities to improve access and care provision for people experiencing homelessness. Capitalising on these opportunities requires that nurses are educationally prepared with the skills, knowledge, and attributes to meet the needs of this vulnerable population without necessarily becoming nurse practitioners. These findings will be used to underpin the development of an educational pathway for nurses to enhance their response to homeless populations.     

The educational experiences and needs of patients with an internal cardiac defibrillator: An interpretive phenomenological study

BackgroundInternal cardiac defibrillators (ICD) are the treatment option for primary and secondary prevention of sudden cardiac arrest and potential death. The majority of research to date has focused on the psychological and physical outcomes affecting patients, such as fear, anxiety, depression, and changes in quality of life post ICD insertion. There is, however, limited research exploring the adequacy of their educational preparation by nurses and other health care professionals.AimThe aim of this study was to understand the educational experiences and needs of adult patients with ICDs within a metropolitan tertiary hospital in Queensland.MethodsAn interpretive phenomenological approach was chosen to explore the everyday educational experiences and needs of patients with an ICD or Subcutaneous Internal Cardiac Defibrillator (S-ICD). Semi-structured interviews were conducted with a purposive sample of ten participants until data saturation was reached. Thematic analysis was used to analyse the data.FindingsFive themes emerged and these were ‘understanding the information needs of patients’; ‘psychological aspects’; ‘fearful of the ICD shock’; ‘physical concerns’; and ‘importance of family inclusion’.DiscussionThe study’s findings revealed that patients with ICD/S-ICDs had unmet educational needs that are important for nurses to understand and address. These specifically related to education and the relevance to each individual’s particular needs. These included addressing their anxiety levels explaining changes to everyday activities and including family in the education sessions. Discharge care via telemonitoring may be useful for follow-up care for this unique and vulnerable patient group.ConclusionInterpretive phenomenology was used to understand the experiences and needs of people living with an ICD/S-ICD. This study has provided knowledge about the patient’s desire for clarity of information relevant to their individual needs. The research found that patients with ICD/S-ICDs did not perceive the education that they received regarding the device to be adequate, nor did it address their specific needs. The research highlighted that nurses caring for patients undergoing ICD/S-ICD insertion need to provide education that is both patient and family specific, and that it continues for at least two months post-hospital discharge.     

Listening to the voices of patients with cancer, their advocates and their nurses: A hermeneutic-phenomenological study of quality nursing care

This article presents the findings from a hermeneutic-phenomenological study looking at the meanings of "quality nursing care" through the experiences of patients with cancer, their advocates and their nurses. Twenty-five patients were interviewed from which fifteen also participated in two focus groups. Six patients' advocates participated in a focus group and twenty nurses were individually interviewed. The informants came from the three major hospitals in Cyprus which provide in-patient cancer care. Patients' advocates came from the two major cancer associations in Cyprus. Having analysed the data, seven major themes were identified: receiving care in easily accessible cancer care services, being cared for by nurses who effectively communicate with them and their families and provide emotional support, being empowered by nurses through information giving, being cared for by clinically competent nurses, nurses addressing their religious and spiritual needs, being cared for in a nursing environment which promotes shared decision-making, and patients being with and involving the family in the care. These findings stress the need to integrate these aspects in the care of patients with cancer. In doing so, nurses will need support and adequate training in order to acquire the relevant skills towards better caring for the patients.     

Nursing older dying patients: findings from an ethnographic study of death and dying in elderly care wards

Nursing older dying patients: findings from an ethnographic study of death and dying in elderly care wards Background and aim. The aim of the study was to explore the experiences of dying patients and nurses working in three elderly care wards focusing on the management of care for dying patients. The majority of patients who die in hospital are over the age of 65 and evidence suggests that three fifths are over the age of 75. Older patients pose tremendous problems and challenges to nurses and doctors regarding the provision of good terminal care, particularly in relation to developing effective communication. METHOD: An ethnographic research design was chosen. The research sample consisted of 74 patients, 29 nurses and 8 physicians. The principle data collection methods were participant observation and semi-structured interviews. All respondents were interviewed following a period of observation on each of the ward areas. The data obtained from participant observation were then used to structure the interview questions. The purpose of asking questions about meanings associated with observational material was to evaluate the extent to which convergence or divergence of the data was taking place. FINDINGS: The findings demonstrate that the care of older dying patients was defined by a lack of 'emotional engagement' with the patient and the institutionalized nondisclosure of information about death and dying. The study raises issues concerning the lack of effective communication about terminal diagnosis and the strategies used by nurses and doctors for disclosing information about death and dying. The findings suggest that although nurses provide individual care to dying patients, much of this was aimed at meeting patients' physical needs. Nurses reported psychosocial aspects including spiritual and emotional care to be important, although there was little evidence of them being orientated towards this in practice. CONCLUSION: The indicative conclusions from this study suggest that terminal care for some elderly patients remains hampered by a reluctance of nurses and doctors to be more open in their communication about death. It would appear that hospital culture and the mores, beliefs and ideologies that emanate from the biomedical model, significantly shape the experiences of older dying patients.     

The needs and experiences of long term ventilated children and their families

To effectively plan and deliver complex multidisciplinary healthcare packages for long term ventilated children and their families, health professionals need to understand their needs and experiences. A search for published research in this issue revealed eight small-scale studies that reported similar themes: the prolonged stay in paediatric intensive care, discharge planning, life at home and dual role: parent and nurse. Two studies explored children's views which included not having control and not being able to live a normal life. Although there have been improvements, these children and their families still have significant unmet needs, particularly when they must remain in the unsuitable environment of the intensive care unit.     

Chronic pain and distress among elderly in the community: comparison of patients' experiences with enrolled nurses' assessments

AIM: This study compared elderly patients' reported experiences of pain and distress with enrolled nurses' assessments and related potential differences to patient and enrolled nurse characteristics. BACKGROUND: Many elderly suffer from chronic pain but few studies have focused on this group of patients. METHODS: Data were collected through personal interviews with 38 patients and questionnaires completed by 38 enrolled nurses. FINDINGS: Enrolled nurses underestimated patients' experiences of physical pain, physical discomfort, breathing problems, resignation, and dependency. Pain and distress were overestimated by enrolled nurses who had lower scores on three of the five personality scales used. In contrast, enrolled nurses who had higher scores on these personality scales tended to underestimate the patients' pain and distress. CONCLUSIONS: There is a need to develop staff training programmes in order to optimize the care for elderly patients with chronic pain in the community.     

Caring for the patient with fibromyalgia: the rehabilitation nurse's role.

Fibromyalgia (FM) is a chronic, potentially disabling, cluster of symptoms that manifests as pain for 3 months or more and pain with pressure on 11 of 18 tender points throughout the body. Because there is no known cause, and therefore, no cure, treatment focuses on the control or relief of symptoms. Many patients are referred to rehabilitation settings for physical or exercise therapy. While exercise is helpful in the control of the pain, stiffness, fatigue, sleep disorders, and mood changes, a holistic approach to treatment is more effective. Rehabilitation nurses provide major support for patients with FM. Validation of the patients' experiences is essential for achieving quality of life. Many patients have a history of being undertreated because of a lack of credibility and invisibility of the illness. This article provides background information about FM, summarizes the FM trajectory, reviews approaches to management, and discusses the role of rehabilitation nurses in a holistic approach to care of clients with FM.     

Nurses' and patients' perceptions of expert palliative nursing care

AIM: This paper reports a study of the perceptions of patients and nurses of palliative care and, in particular, the concept of the expert palliative nurse. BACKGROUND: Palliative care is a growing specialty and is practised globally. There is, however, limited information on patients' views about palliative care. While the idea of expertise in nursing is not new, few studies have explored the concept of the expert nurse in palliative care. Some evidence exists on palliative nurses' perceptions of their care, that it is supportive and involves maintaining therapeutic relationships with patients. Facing a terminal illness has been identified as a stressful and fearful experience that affects all aspects of life. It has also been revealed that dying patients may have unmet care needs, mainly in the areas of pain and symptom control, emotional support, and spending time alone. METHODS: A phenomenological study was carried out, using in-depth interviews and thematic content analysis. A convenience sample of 22 Registered Nurses and 22 dying patients was interviewed in 1996-1997. FINDINGS: Dying patients had a desire to maintain independence and remain in control. Palliative care nurses experienced both effective and ineffective interpersonal communication, the building of therapeutic relationships with dying patients and attempting to control patients' pain and distressing symptoms. Patients and nurses agreed that the two most important characteristics of an expert palliative nurse were interpersonal skills and qualities such as kindness, warmth, compassion and genuineness. CONCLUSION: Although the study was conducted in the United Kingdom, the findings have relevance for palliative care practice globally in terms of dependence, issues of patient choice, nurses being interpersonally skilled and building therapeutic relationships with patients.     

Patients' experiences of palliative care in the home: a phenomenological study of a Swedish sample

In recent times the rapid expansion of interest in palliative care has become a significant feature of health care development. Caring in the palliative way means simultaneous attention to the medical, nursing, spiritual, emotional, and social needs of the patient. The main purpose of the present study has been to obtain an understanding of patients' experiences of palliative care at home with service from district nurses. The research design is influenced by Giorgi's phenomenology. Six patients diagnosed with cancer and receiving palliative care at home were interviewed and the transcribed interviews were analyzed. Interviews were conducted in the patients' homes. The findings show that the essential meaning of the patients' experiences of palliative home care can be described as "uncertain safety." This meaning of essence is explicated by 4 themes, which are labeled "Safe but unsafe at home," "A sense of powerlessness," "Change of everyday life," and "Hope and belief in the future." The findings of the study point out the importance of well functioning teamwork and resources to facilitate patient's experiences of safety in their own homes. It should be noted that the patient and their next of kin are members of the team.     

Caring for patients with terminal delirium: palliative care unit and home care nurses' experiences

AIM: To explore palliative care unit and home care nurses' experiences of caring for patients with terminal delirium. DESIGN: A qualitative exploratory design using individual interviews. SAMPLE: Participants included five nurses working in an interdisciplinary palliative care unit located in a large Canadian city hospital, and four nurses from a palliative home care nursing team located in the same city. RESULTS: Nurses in both sites experienced multiple challenges caring for delirious patients. Additional education on delirium and collaborative teamwork were viewed as key factors in enhancing their ability to care for and support this patient and family population. Four core themes reflected the participants' perceptions and experiences: experiencing distress; the importance of presence; valuing the team; and the need to know more. CONCLUSION: Findings suggest the need for interdisciplinary educational initiatives focused on the identification and management of terminal delirium, and targeted to the specific context in which nurses practise.     

Vulnerability and security in seriously ill patients in intensive care.

The purpose of this research was to gain an understanding of the experience of being a seriously ill patient in an intensive care unit (ICU). Fourteen former patients, aged 17-71 years old, who had been in ICU 3-53 days, participated in focus group interviews 3-6 months after discharge. The focus groups met 3 times each for 1.5 hours, resulting in 13-14 hours of audiotaped discussions. The transcribed data were qualitatively analysed to identify themes representing participants' experiences. Vulnerability emerged as a central concept that captured the identified themes. The data reveal that patient vulnerability while in ICU was related to extreme physical and emotional dependency. Lack of information and depersonalizing care were associated with fear, anxiety and increased vulnerability. Lack of sleep and rest also contributed to patient fear and anxiety. Vulnerability decreased when patients were kept informed of what was occurring while in ICU, received care that was personalized to their individual needs, and when their families were present. The results of this study suggest that ICU patients' vulnerability may be decreased by the security that they experience when they are adequately informed about what is happening, and when nursing and medical care is personalized to their individual needs.     

Classification tree model identifies home-based service needs of Japanese long-term care insurance consumers

ABSTRACT Objectives: To clarify care receivers' needs and unmet needs for home help or home nursing services during daytime and/or nighttime hours, and to identify the characteristic of elders who are most likely to need home care services. Design and Sample: We used a chi‐squared automatic interaction detection technique to analyze data from 92 care management researchers, who interviewed 280 caregivers. Measures: Demographic information, assessments of the statuses and service needs of elders. Results: We found that care receivers had more unmet needs at night than during the day. Daytime home help was needed by elders who (1) lived alone or (2) lived with just one person and whose primary caregiver was not their wife. Nighttime home help was needed by those who required assistance eating, and whose primary caregiver was male. Daytime home nursing was needed by elders who (1) received medical treatment instead of day care or (2) did not receive medical treatment, but had difficulty eating. Nighttime home nursing was needed by those who had unstable illnesses and whose medical treatments continued during the night. Conclusions: Our findings may help public health nurses assess community needs in order to effectively and efficiently manage health care resources.     

Experiences of AIDS-dedicated nurses in alleviating the stress of AIDS caregiving

From the beginning of the AIDS epidemic, there have been individuals dedicated to the care of patients with AIDS. However, there has been little research regarding their perceptions and experiences of AIDS caregiving and the strategies they use to alleviate the stress and promote their willingness to care. Based on the experiences of 12 nurses at one hospital, who had chosen to work on an AIDS-dedicated unit, this exploratory study, conducted in 1998, explored the following: the physical, emotional or spiritual risks and stresses associated with AIDS caregiving; factors that provide resistance to the stresses of AIDS caregiving and promote a willingness to care; and strategies recommended by AIDS-dedicated nurses in caring for patients with AIDS. The data reveal important themes related to the physical stress of AIDS caregiving, specifically being aware of risks, but not paralysed by fear, and bombardment of the senses. The coping strategies of nurses included taking the risk in their stride, reframing the risk, and protecting oneself. The emotional stress of AIDS caregiving included witnessing suffering, experiencing unresolved grief, accepting diversity, being emotionally connected, distress from the dismantling of the AIDS unit and work demands, and declining team spirit. Coping strategies included balancing personal and professional life, releasing pain, respecting yet controlling feelings, managing demands, and asking for help. Nurses maintained their spiritual perspective. They experienced through AIDS caregiving a greater sense of shared humanity and a new perspective of life. Findings indicate that AIDS-dedicated nurses use many coping strategies. The experiences of these nurses can assist clinicians, educators and administrators in supporting nurses' caregiving and promoting the quality of care offered to patients with AIDS.     

Postoperative pain and self-management: women's experiences after cardiac surgery

Title.  Postoperative pain and self-management: women's experiences after cardiac surgery.
Aim.  This paper is a report of a study to describe women's experiences and their self-management of postoperative pain after elective cardiac surgery.
Background.  Cardiac surgery involves several pain-sensitive areas, and untreated postoperative pain may lead to chronic pain. Early discharge requires increased patient participation in pain management. Women report more postoperative pain than men after cardiac surgery.
Methods.  Semi-structured interviews were conducted in 2004–2005 with 10 women 1–2 weeks after discharge from their first elective cardiac surgery. Qualitative content analysis was used to identify recurring themes. Pain diaries were used to record postoperative pain experiences 1–2 weeks before the interviews, providing more nuances to the experiences of pain and pain management.
Findings.  Postoperative pain experiences varied from no pain to pain all the time. Worst pain intensity was recorded as moderate or more. Pain experiences depended on what women's expectations of pain after cardiac surgery. None wanted to complain about their painful experiences. The women had needed for more individualized information about self-management of pain, and had difficulties remembering the information they had received. Most did not want to use pain medication, or waited to do so until pain was unbearable.
Conclusion.  Patients need more individualized and gender-specific information before early discharge from cardiac surgery to improve self-management. More specific predischarge education on self-management using analgesics regularly might prevent pain ratings rising to a severe level after discharge home.     

Nurses' experiences in giving bad news to patients with spinal cord injuries.

Nurses, as well as patients and their families, have unique communication needs when a patient has suffered a spinal cord injury. This qualitative study used grounded theory methods to describe how nurses working on an acute spinal cord unit manage this sensitive situation. Twenty-two registered nurses participated in focus group interviews designed to elicit their experiences with patients and their needs as healthcare professionals. Five major themes emerged from analysis of the data: being the bearer of bad news, strategies used by the nurses to give bad news, the role of the patients, the role of the families, and meeting the nurses' needs. The findings indicate that nurses are placed in a position of being the bearers of bad news; it is not always possible or even desirable to avoid the situation. To maintain the patients' hope and preserve their own integrity, nurses must develop strategies to address the patients' needs.     

Avoiding restraints in patients with dementia: understanding, prevention, and management are the keys

Older adults with dementia are at higher risk than other patients for being placed in restraints, despite numerous negative physical and psychological outcomes associated with their use. Many nurses continue to believe that restraints are necessary to control behavioral symptoms and prevent falls or the disruption of life-sustaining therapies in patients with dementia. Reducing the use of restraints depends on interpreting patient behavior to identify unmet needs; regular assessment for changes in mental or physical status; individualized care focused on communication, consistency, surveillance, and appropriate environments; and a flexible team approach based on dialogue among staff members and respect for patients' needs and rights. For a free online video demonstrating the use of the practice guide, go to: (http://links.lww.com/A231).