Supporting cancer patients with palliative care needs: district nurses' role perceptions

The aim of this study was to examine UK district nurses' perceptions of their role in supporting palliative care cancer patients. Patients with cancer are living longer with the disease. District nurses are the largest UK workforce caring for people with cancer at home, the preferred place of care. Meeting patients' supportive and palliative care needs is complex. Little is known about district nurses' supportive role in the early phase of palliative care. Semistructured interviews were conducted with 34 district nurses. Data were analyzed thematically, with assistance from Atlas/ti. A dominant theme emerging from the interviews was ambiguity in the district nurses' supportive role in early palliative care. District nurses discussed the importance of making contact early on to support cancer patients and their families but had difficulty articulating this "support." Ambiguity, lack of confidence, and perceived skill deficits presented district nurses with dilemmas that were difficult to resolve. District nurses have great potential for meeting cancer patients' supportive and palliative care needs, a potential not currently realized. Education alone is unlikely to improve practice without an understanding of the tensions faced by district nurses in their work. Recognizing and addressing dilemmas in the everyday work of district nurses is central to moving practice forward.     

A comparison between patients' experiences of how their caring needs have been met and the nurses' patient classification--an explorative study

AIM: To examine whether patient classification carried out in accordance with the Oulu Patient Classification (OPC) method can measure the patient's caring needs in a reliable manner as seen from the patient's perspective. BACKGROUND: On the basis of earlier research it can be established that there are differences between nurses' and patients' assessments of patients' caring needs. Research on patients' assessments of perceived caring needs and the care they receive in connection with patient classification does not seem to have interested researchers in caring science. METHODS: The reliability from the patient's perspective is gauged by comparing the patient's perceived caring needs with the nurse's patient classification during a 24-h bed-day. Data was collected during a semi-structured interview with a total of 73 patients. Documentary analysis was carried out on the basis of patient classifications by 30 ward nurses. FINDINGS: On the basis of the degree of correspondence between nursing care intensity experienced by the patients and the nurses' patient classification it was decided whether the patients' caring needs had been met. The results indicate, however, that patient classification as a gauging method has a built-in reductive function regarding the patient's need for care and nursing care intensity. CONCLUSIONS: Nevertheless the OPC offers possibilities from a patient perspective of providing an overall picture of the patient's nursing care intensity and can therefore serve as a reliable basis for decisions concerning staff planning.     

The patient's perceived caring needs as a message of suffering

The patient's perceived caring needs as a message of suffering ¶The aim of the study was to arrive at a deeper understanding of the patient's experience of caring needs, that is, of problems, needs and desires, by investigating and explaining how these will be expressed and shaped in the caring relation and to illuminate its implications for caring. The target population consisted of 38 patients in a medical ward and 37 patients in a surgical ward in a central hospital in Western Finland. The patients were interviewed in the wards and asked about perceived caring needs. By means of a hermeneutical process of interpretation a pattern emerged which was interpreted as pictures of themselves and of the nurses. These types of patients fell into three groups: the satisfied, the complaining and satisfied, and the complaining and dissatisfied patients. The types of nurses were divided into the competent and friendly, the competent and contact-creating and the competent and courageous. The patients' caring needs can be interpreted and understood from the standpoint of their experience of suffering, but also in relation to their experience of pleasure and comfort. The most conspicuous caring needs were experiencing confidence in the competence of the nurses, comfort, guidance, dialogue and closeness, which the patients expressed as problems, needs and desires. The patients' caring needs can contain new possibilities of growth and development. The nurse can relieve patients' suffering by promoting their experience of comfort. If the nurses' view of the limits of reality are extended to comprise the existential/spiritual dimension of human beings as well, new possibilities will emerge of interpreting and understanding patients' caring needs as a message of suffering.     

Patient-centred care and nurses' health: the role of nurses' caring orientation

Title.  Patient-centred care and nurses' health: the role of nurses' caring orientation.
Aim.  This paper is a report of a study of the moderating effect of caring orientation on the relationship of patient-centred care to nurses' physical and mental health.
Background.  Providing effective patient-centred care is well-accepted as an important contributor to a host of patients' health outcomes. Based on two theoretical perspectives – person–environment fit and emotional labour – I suggest that providing patient-centred care per se does not potentially harm nurses' health; the cause is the fit (or non-fit) of a nurse's caring orientation and the displayed patient-centred care behaviours.
Method.  Data were collected in 2007 with a random sample of 325 registered nurses working in the Israeli public healthcare sector in in-patient units. Caring orientation, health and control variables were measured via validated questionnaires. Patient-centred care behaviours were assessed by structured observations.
Results.  The mental health of nurses who exhibited high caring orientation combined with high patient-centred care, or that of nurses who exhibited low caring orientation combined with low patient-centred care, was statistically significantly higher in comparison with the mental health of nurses who exhibited incongruent (low/high or high/low) caring orientation and patient-centred care behaviours. For nurses' physical health, the findings revealed that providing patient-centred care was associated with worsened health, and possessing a caring orientation was associated with better health.
Conclusions.  The findings support the hypotheses that were derived from person–environment fit and emotional labour only with regard to mental health. Separate theory needs to be developed on how to maintain nurses' physical health.     

Patients' and nurses' experiences of the caring relationship in hospital: an aware striving for trust

The phenomenon, caring relationship, has been widely studied in earlier research. Nevertheless, empirical studies in hospital, concerning patients and nurses experiences of the actual phenomenon caring relationship are rare. The aim was to illuminate patients with long-term illness and nurses' experiences of the caring relationship. The data were collected from 13 interviews, seven patients and six nurses, which were then analysed using an interpretive phenomenological method. This study shows patients' and nurses' view of the phenomenon. The findings concerning patients' view were identified in themes --'Maintaining dignity' with subthemes: using one's own competence and being cared for by the team as well as 'A feeling of vulnerability' with subthemes: being cared for in a strained situation and being exposed, inquiring personal caring relationship. The findings concerning nurses' view were identified in the following themes: 'A purposeful striving' with subthemes: using one's own competence and being aware of limitations as well as 'An arduous compassion' with subthemes: giving care in a strained situation and being aware of what is needed. These findings show that patients and nurses were aware in their striving for trust through forming a caring relationship. Their striving was not enough to result in trust. The findings in this study are understood as patients need a personal caring relationship which enables the possibility of trust.     

A critical incident study of nurses' responses to the spiritual needs of their patients

AIMS OF STUDY: The aims of the study were to carry out a critical incident study to: (1) Describe what nurses consider to be spiritual needs; (2) Explore how nurses respond to the spiritual needs of their patients; (3) Typify nurses' involvement in spiritual dimensions of care; (4) Describe the effect of nurses' intervention related to spiritual care. BACKGROUND: In the caring professions a focus on individuals as bio-psychological-spiritual beings is gaining recognition and this notion is based on the premise that there should be a balance of mind, body and spirit for the maintenance of health in a person (Stoll 1979). Emerging research highlights the importance of spiritual care in nursing and suggests that there is scope for improving this dimension of care in order to improve the quality of life for many patients. However, there is very little evidence about how nurses respond to the spiritual needs of their patients. Therefore the purpose of this study was to map by critical incident techniques how nurses construct and respond to patients' spiritual needs in a variety of clinical settings. METHODS: Critical incidents were obtained from 115 nurses. The data from these incidents were subjected to content analysis and categories were developed and described. The emerging categories were subjected to peer reviews to ensure reliability and validity of findings. FINDINGS: The findings suggest that there is confusion over the notion of spirituality and the nurse's role related to spiritual care. A variety of approaches to spiritual care emerged in this study from the critical incidents derived from nurse respondents. These were categorized as 'personal', 'procedural', 'culturalisit' or 'evangelical'. There was an overwhelming consensus that patients' faith and trust in nurses produces a positive effect on patients and families, and nurses themselves derived satisfaction from the experience of giving spiritual care. In this respect, spiritual care interventions promote a sense of well-being in nurses as well as being a valuable part of total patient care. CONCLUSION: The study concluded that there is scope for developing an ideal model of spiritual care using the critical incident data from this study.     

Teaching spirituality in nursing: a literature review

Nurse educationalists have a poor record in preparing nurses adequately for providing spiritual care. Contemporary nursing philosophy embracing holism demands that nurses learn the appropriate skills to enable them to provide care in all domains, including the spiritual. Three questions are explored within this review: what is spirituality?; what should pre-registration nursing students be taught concerning spirituality?; and how can spirituality in nursing be taught? Although sources of literature stemmed from the West, a predominantly Judeo-Christian culture, this is balanced by reference to a synopsis of world religions provided by a number of texts. Research studies included in the review consider nurses' concepts of spirituality, nurses' awareness of spiritual aspects of care, assessment of patients' spiritual needs, and caring and coping strategies for nurses and patients. Some have demonstrated the need for educational input to better prepare nurses for spiritual care but none identify how this might be effectively achieved.     

Perceptions of privacy in the care of elderly people in five European countries

The focus of this article is on elderly patients' and nursing staff perceptions of privacy in the care of elderly patients/residents in five European countries. Privacy includes physical, social and informational elements. The results show that perceptions of privacy were strongest in the UK (Scotland) and weakest in Greece. Country comparisons revealed statistically significant differences between the perceptions of elderly patients and also between those of nurses working in the same ward or long-term care facility. Perceptions of privacy by patients and their nursing staff were quite similar in Finland, Germany and the UK. In contrast, in Greece and Spain these perceptions were different: nurses believed that they took account of their patients' privacy needs more often than the patients themselves felt this was the case. Among Spanish and UK patients, an association was found between lower levels of independence and comparatively less positive perceptions of privacy. No associations were established between nurses' perceptions and their demographic factors. This is the third of a set of five articles published together in this issue of Nursing Ethics in which the results of this comparative research project are presented.     

A summative evaluation of clinical competence: students' and nurses' perceptions of inpatients' individual physical and emotional needs

The ability to assess individual patients' physical and emotional needs was used as one foundation for evaluation of clinical competence for Swedish student nurses. Each of the randomly sampled 48 student nurses and their corresponding supervisors (48 nurses) assessed the perceived needs of a patient they both knew well by separately answering a questionnaire concerning basic physical and emotional needs. Simultaneously the selected patients (n = 48) were interviewed about their perceived needs. Student nurses' and nurses' assessments were compared with the individual patient's opinion. Both the students' and the nurses' assessments showed close similarities with the patients' own estimations, although certain under- and overestimations for both physical and emotional needs were found, with a predominance of overestimation of emotional needs. Student nurses and nurses also showed uncertainty in some of their assessments, mainly concerning emotional needs. Their assessments were closer than student nurses/patients or nurses/patients, and also closer for physical than for emotional needs. The conformity in student nurses' and their supervisors' assessments might be understood as the supervisors' influence as role models. Attention should be paid both in nursing education and in clinical practice to the need for individualization of patient care.     

Recording the content of the caring process

In the present study, a theoretical basis for the content of caring and nursing documentation is described. The goal was to find out to what extent documentation based on the theory might reveal the patients' experience and views of their care. Documenting according to Eriksson's (1997, 2001) caring science theory was tried out in an intervention study. The content of nursing care records was evaluated before the intervention and after completing it. After the intervention the nurses' experiences of the theory-based recording were collected by means of questionnaires. According to the evaluation performed after the intervention, the content of the documentation had improved on several wards. The nurses paid more attention to the patients' views than before when documenting care in the way introduced in the study. According to the results nurses need strong support from their managers in order to successfully be able to implement a theoretical basis of documentation of care.     

Nursing is different than medicine: ethical difficulties in the process of care in surgical units

AIM: This paper describes a study of the kinds of ethical difficulties nurses face in the process of care in surgical units. BACKGROUND: Nurses face ethically difficult situations in trying to find the most appropriate actions to take for patients. Differences of opinion with doctors about the treatment and care of patients and conflicts between nurses' value systems and those in the organization where they are employed are described as sources of ethical difficulty. Nurses experience moral distress when institutional constraints restrict them from carrying out appropriate moral actions. METHODS: Ten female nurses working in surgical units at one university hospital in Norway were interviewed as part of a comprehensive investigation into the narratives of nurses and doctors about being in ethically difficult situations. The transcribed interview texts were subjected to a phenomenological-hermeneutic interpretation. The study was conducted during 2004. FINDINGS: The main ethically difficult care situations described by the nurses concerned being open and honest, trusting patients' complaints, and creating limits to their involvement. Differences in opinion with doctors about the treatments, the absence of doctors in the unit and limited interest in holistic treatment and care resulted in nurses not receiving the medical orders they needed. A heavy workload, lack of time and staffing problems resulted in difficult ethical prioritizations and reduced standards of care. Shared rooms and beds in the corridors made it difficult to preserve patients' rights to privacy and confidentiality. CONCLUSION: Interventions and investments are needed to improve the work environment of nurses, especially modifying the job constraints of the work environment. The moral responsibility for upholding the quality of care in surgical services and hospital performance should be more equally distributed between nurses, doctors and hospital managers. Discussions and collaboration between and within healthcare disciplines and managers should be initiated to establish shared moral understanding of the standards of care in hospitals.     

Senior nursing students' and professional nurses' perceptions of effective caring behaviors: a comparative study.

Care forms the basic core of nursing actions. Traditionally nurses have described the acts of administering to patients as care behaviors. Many nurses find it difficult to define these caring behaviors. It is important that nurses have insight into the specific behaviors that patients perceive to be most important. Several studies have examined and compared nurses' and patients' perceptions of effective care behaviors. The literature supports an incongruence of what nurses perceive and what patients perceive as effective. This study identifies and compares student nurses' and professional nurses' perceptions of effective caring behaviors. The Caring Assessment Report Evaluation Q-sort (CARE-Q) was used to obtain the data. The participants included senior baccalaureate nursing students (n = 30) at Thomas Jefferson University, College of Allied Health Sciences, and professional nurses (n = 30) with 1 or more years experience. The significance of the difference between the groups was tested using the Mann Whitney U test. Results indicate agreement between the students and the nurses in all categories except trusting relationship (p = .06). The ages within the groups varied from 21 to 47 years. The difference in ages between the nurses and the students is significant (p = .0002). Findings provide a better understanding of student nurse perceptions of caring behaviors and provide implications for further research for nurse educators.     

Nurses' views on situations related to privacy in providing home care for persons with long-term mental illness: an exploratory study

The main aim of this exploratory study was to explore the views of nurses and mental health care workers on situations related to patient privacy in the home care of persons with long-term mental illness in Sweden. A specifically designed questionnaire was developed from theoretical constructs obtained in a qualitative study and distributed to 1,139 respondents. Data from 660 district nurses, psychiatric nurses, and mental health care workers revealed significant differences in perceptions by age, gender, and professional groups. For example, psychiatric nurses and mental health care workers indicated to a greater extent than district nurses feelings that relate to intrusion on patient privacy. Respondents who were 41 years or younger also indicated to a greater extent than those who were older that they felt home care was an intrusion on patient privacy. Moreover, men indicated to a greater extent than women feelings of insecurity in their professional role. Further investigation is needed, especially into how nurses deal with situations that intrude on patient privacy and how nursing intervention impacts on the patients' own sense of privacy.     

How accurately do nurses perceive patients' needs? A comparison of general and psychiatric settings

This paper examines to what extent nurses' perceptions of patients' needs correspond to the patients' views of their own needs. A questionnaire was designed to assess patients' emotional and physical needs in general medical wards and in acute psychiatric wards. Sixty patients, 30 psychiatric and 30 general, together with their 'key' nurses, took part in the study. Results indicate that, despite there being no evidence of appreciable disagreement between the 'average' psychiatric nurse and the 'average' psychiatric patient, there is little evidence that individual nurses and their patients, whether psychiatric or general, agree. The nurses' inability to perceive patients' needs on an individual basis is consistent with other studies which suggest that nurses use stereotypes when perceiving patients' needs. Implications for nursing care are discussed.     

Palliative care for patients with cancer: district nurses' experiences

AIM: This paper reports a study exploring district nurses' experiences of providing palliative care for patients with cancer and their families. BACKGROUND: There is an increasing demand for palliative care in the community, as many patients wish to die at home. District nurses are central to providing palliative care in the community, but there is a dearth of literature on district nurses' experiences in palliative care. METHOD: A Husserlian phenomenological approach was adopted with a purposive sample of 25 female district nurses. Data were collected using unstructured, tape-recorded interviews and analysed using Colaizzi's seven stages of data analysis. FINDINGS: Four themes were identified: the communication web; the family as an element of care; challenges for the district nurse in symptom management and the personal cost of caring. CONCLUSIONS: District nurses' experiences of providing palliative care to family units was challenging but rewarding. The emotive nature of the experience cannot be under-estimated, as many district nurses were touched by the varying situations. Whilst acknowledging the need to maintain an integrated approach to care, district nurses should be identified as the key workers in the complex situation of palliative care.     

Nurses' experiences of abusive/non-abusive caring for demented patients in acute care settings

Nurses caring for patients with dementia in acute care settings often lack specialized education in geriatric nursing. The acute care settings do not have an environment made for dementia care. The staff often had a high workload, which makes the situation stressful and the nurses who take care of these patients might end up in difficult situations. The aim of this study was to describe nurses' experiences of difficulties related to caring for patients with dementia in acute care settings. Interviews were performed with 12 nurses. Qualitative thematic content analyses were carried out in several steps. The results show that the nurses experienced various difficulties in meeting patients with dementia in acute care settings. This gave rise to for example frustration. Most commonly reported was lack of time to treat these patients satisfactorily. The difficulties were mostly related to the often disorderly conduct of these patients, the ethical problems that appeared in the care of these patients, and the medical care organization. The problematic situations described sometimes led to abuse and neglect of these patients.     

Nurses as patient advocates in oncology care: activities based on literature

This article will explore oncology nurses' patient advocacy activities and compare those activities with patient advocacy activities defined in an earlier study by the authors. Data were collected from 42 English-language peer-reviewed articles published from 2000-2010. Search terms used included cancer care and advocacy and oncology nursing and advocacy. According to the findings of the reviewed articles, oncology nurses promote the interests of their patients by analyzing patients' psychosocial and physical distress and care plans, particularly at the beginning of the illness trajectory. Oncology nurses also are instructed in the literature to educate patients about cancer management prior to the first treatment and during cancer management to promote informed consent, but not to analyze patients' information or self-determination preferences. Oncology nurses do, however, advocate for their patients by presenting and raising awareness of patients' needs and preferences in regard to the healthcare system. To some degree, this advocacy can be seen as responding to patients' care and self-determination preferences. Oncology nurses' patient advocacy activities are similar to advocacy activities defined in the context of procedural pain care but are more focused on the beginning of the illness trajectory. However, care and self-determination needs, information needs, and advocacy needs of patients with cancer vary during the illness trajectory. Those needs should be analyzed and responded to systematically.