Individual interviews with elderly in a rural area: expectations for medical care services

INTRODUCTION: As intensive health care users, the elderly contribute significantly to rising health care cost in Japan. This research sought to elucidate the decision making processes elderly use when seeking medical care and their expectations of medical facilities and physicians. METHODS: We conducted qualitative individual interviews with rural elderly, over 65 years old, who had access to private physician offices, community, regional, and university hospitals. Interview questions elicited participants' experiences in seeking medical care; their most memorable experiences in hospitals; and their expectations for medical services. After the individual interviews, we surveyed the participants to verify the results. RESULTS: A total of 19 individuals participated in these interviews. These 19 individuals and an additional five individuals who met eligibility criteria were surveyed by mail after the interviews and verified the results. The participants identified "a feeling of intimacy" and "receiving kind-hearted treatment" as the most important attributes of medical facilities. Other important factors included: accommodating patients' preferences; being close to home; earning the patient trust; and having a well organized infrastructure. Comparatively important element were: "technology and skill", "opinion and reputation of third person", "length in the latency", "continued medical treatment by the same doctor", "actual feeling of improvement", "introduction to a higher order medical facility", "multiple medical departments", and "medical judgement by multiple doctors". These factors fall into three categories: emotional expectations; expectations of the health system; and convenience in daily life. The survey data confirmed these findings. DISCUSSION: These results suggested that elderly expect "supportive" and "accommodating" health care services in which the medical activity does not cause problems for daily life. However, these vague expectations for the medical system need translated into practical steps. Still, it is important for health care providers to consider these expectations and the relationships among them. These findings corroborate the results of a previous investigation that used focus group interviews.     

巴林特小组对军队医院聘用制护士工作压力的应用效果

目的 在了解军队医院聘用制护士工作压力的基础上,探索巴林特小组对国内护士工作压力的应用效果.方法 采用方便抽样方法,分别对军队两所三甲医院的210名、188名聘用制护士进行工作压力调查.选取有自主意愿、工作压力得分中度以上的前10名护士作为干预对象,以医院为单位各成一组,开展为期6次的巴林特小组训练.结果 两所医院护士工作压力程度接近,压力水平较高;综合医院组对象干预前后在 "护理工作"维度得分上差异非常显著(P＜0.001);"时间与工作量、环境与设备、管理与人际关系"3个维度得分均差异显著(P＜0.005);专科医院组对象干预前后在 "护理工作、环境与设备、患者护理、管理与人际关系"4个维度得分上差异非常显著(P＜0.001);"时间与工作量"维度得分差异显著(P＜0.005);两组对象合并后干预前后在"护理工作、时间与工作量、环境与设备、患者护理、管理与人际关系"5个维度得分上差异非常显著(P＜0.001).结论 管理者应对临床护士的工作压力引起重视;巴林特小组能够有效减轻护士工作压力;对象要有选择性,并要调动其积极性;选用高素质的小组主持人;巴林特小组技术的长期效果需要深入研究.     

Trust in older persons: A quantitative analysis of alignment in triads of older persons,informal carers and home care nurses

Self‐management by older persons could be influenced by the level of trust found in triads of informal carers, formal care providers and care recipient, the older person. Little research has been done on care providers’ trust in older persons. This study aims to explore the level of trust that informal carers and home care nurses have in older persons, the extent of alignment in triads and the relationship between trust in older persons and self‐management. We conducted a cross‐sectional survey study in the Netherlands, sampling 133 older persons, 64 informal carers and 72 nurses, which resulted in 39 triads. Alignment level was analysed through Intraclass Correlation Coefficient 1 scores and absolute and mean difference scores. Correlation analysis and one‐way analysis of variance measured the relationship between trust and self‐management. The results show that triads contain both alignment and misalignment. Misalignment occurs mostly when informal carers and nurses have little trust in the older person while this person views their own behaviour towards their caregivers positively. Care providers’ trust levels relate significantly to their perception of the person's ability to self‐manage, but not to the person's self‐rated ability. This could be explained by care providers not communicating their intrinsic trust in the older person to them. Trust building could be enhanced by organising discussions of mutual expectations of trust and both formal and informal care providers could benefit from compassionate assessment training, to learn how to openly express their trust in the older person.     

Implementation of discharge planning in the care of hospitalized older adults. Focus on involvement of home care providers at hospitals

OBJECTIVES: The present study was conducted to assess current implementation of discharge planning in the care of hospitalized older adults, and to examine the association between implementation and involvement of home care providers at hospitals. METHODS: The subjects were 434 hospitals with 100 beds or more for general patients, nationwide. We conducted a questionnaire survey by mail of hospital staff responsible for the discharge planning, and assessed to what extent home care providers were associated with the implementation of discharge planning in the hospitals. The subjects were divided into two groups: an association group (138 hospitals) in which home care providers were associated with implementation in the hospitals, and a not-association group (296 hospitals). We compared the proportions of implementation of discharge planning between the two groups, and calculated odds-ratios. In the analysis, we controlled for affiliated institution and home care services. RESULTS: The association group showed significantly higher proportions of implementation for 13 items in a total 24 items for discharge planning than the not-association group (range of odds-ratio: 2.430-5.497). The three highest odds ratios were observed for "Arrangement and guidance for home care by outreach prior to discharge" [OR= 5.497, 95% confidence interval (CI): 2.604-11.602], "Adjusting relationship between patient and family" (OR=4.871, 95%CI: 1.323-17.930) and "Refining medical and nursing care so as to be sustainable at home" (OR = 4.740, 95%CI: 1.825-12.311). CONCLUSIONS: The present study showed that hospitals with involvement of home care providers had higher proportions of implementation of discharge planning for hospitalized older adults concerning "Arrangement and guidance for home care by outreach prior to discharge", "Adjusting relationship between patient and family", "Refining medical and nursing care so as to be sustainable at home" and so on. Further study should examine the effect of discharge planning on length of stay, rate of readmission, patient and family member's satisfaction controlling for patient characteristics and hospital's role in the community.     

Reconciling concepts of space and person‐centred care of the older person with cognitive impairment in the acute care setting

Although a large body of literature exists propounding the importance of space in aged care and care of the older person with dementia, there is, however, only limited exploration of the ‘acute care space’ as a particular type of space with archetypal constraints that maybe unfavourable to older people with cognitive impairment and nurses wanting to provide care that is person‐centred. In this article, we explore concepts of space and examine the implications of these for the delivery of care to older people who are cognitively impaired. Our exploration is grounded in theorisations of space offered by key geographers and phenomenologists, but also draws on how space has been constructed within the nursing literature that refers specifically to acute care. We argue that space, once created, can be created and that nursing has a significant role to play in the process of its recreation in the pursuit of care that is person‐centred. We conclude by introducing an alternative logic of space aimed at promoting the creation of more salutogenic spaces that invokes a sense of sanctuary, safeness, and inclusion, all of which are essential if the care provided to the older person with cognitive impairment is apposite to their needs. The concept of ‘person‐centred space’ helps to crystallize the relationship between space and person‐centred care and implies more intentional manipulation of space that is more conducive to caring and healing. Significantly, it marks a return to Nightingale's wisdom, that is, to put the person in the best possible conditions for nature to act upon them.     

Traditional religion and terminal care in the Ryukyus, southern Japan]

The public health significance of traditional religions in terminal care was studied in the Ryukyu Archipelago. The traditional religious view of life, in which death at home is ideal, is still maintained: while inhabitants seek modern medical care in facilities outside of the island, they are transported back to die in their homes when their condition becomes critical. Most of the general hospitals, special nursing homes for the aged, and psychiatric hospitals of Okinawa allow bereaved families to perform "Nujifa", a traditional religious ritual for transferring soul of the dead from the death to their own home, that functions as a significant factor in relieving grief. In many of the special nursing homes for aged, not a few aged women practiced activities uniquely associated with traditional religion on strongly reflecting the fact that endemic religion is deeply embedded in their thinking. Although acculturation is in rapid progress in the Ryukyu Archipelago, such endemic religion still has a significant effect on the people. Therefore these religious factors should be considered in the terminal medical care of these people.     

Multiple relationships of nursing care: the emergence of care "of the us"

The aim of this qualitative study was to comprehend the relationships of the care of the self, of care of the other, and of care "of the us" in the different dimensions of care, through an educational/reflexive/interpretative process with nursing professionals in a University Hospital, using the complexity perspective. The data were collected through workshops and submitted to content analysis. The following categories emerged: reflecting upon the meaning of care of the self, care of the other, and "of the us" for the "I - human being", and for the "I - nursing professional"; and reflecting and (re)constructing the meanings of the relationships of care for the self, care for the other, and care "for the us". The care "for the us" is an emerging theme, in construction, and impels a concern for the collective, as well as remits to the comprehension of the multiple and unending phenomenon of constant movement among the beings and between them and their environment, modifying, altering, and causing to be altered the networks of existent relationships.     

Conversation: the fundamental nursing care from the perspective of the hospitalized patient

The study focuses conversation as care that integrates other elements of hospital nursing. It had as its objective to analyze conversation as an essential stage of the dialogue between the patient and the nursing team. Five people participated who had already been hospitalized and that were now under clinical monitoring due to learning to live with AIDS. The information was obtained by means of the "Almanac" technique of sensitivity and creativity, semi-structured interview, and by active observation. The study contributed to reinforce the relational nature of the nursing care and the position of the patient as an object of this care who expresses his/her requests and wants in the process of dialoguing between this person and the nursing staff, expressed by conversation, which is viewed as a significant factor in nursing care.     

"You have to cover up the words of the doctor": the mediation of trust in interpreted consultations in primary care

PURPOSE: This article explores issues of trust in narratives of interpreted consultations in primary health care. DESIGN/METHODOLOGY/APPROACH: The paper is based on empirical data from a qualitative study of accounts of interpreted consultations in U.K. primary care, undertaken in three north London boroughs. In a total of 69 individual interviews and two focus groups, narratives of interpreted consultations were sought from 18 service users, 17 professional interpreters, nine family member interpreters, 13 general practitioners, 15 nurses, eight receptionists, and three practice managers. The study collected and analysed these using a grounded theory approach and taking the story as the main unit of analysis. It applies a theoretical model that draws on three key concepts: Greener's taxonomy of trust based on the different "faces" of power in medical consultations; Weber's notion of bureaucratic vs traditional social roles; and Habermas' distinction between communicative and strategic action. FINDINGS: Trust was a prominent theme in almost all the narratives. The triadic nature of interpreted consultations creates six linked trust relationships (patient-interpreter, patient-clinician, interpreter-patient, interpreter-clinician, clinician-patient and clinician-interpreter). Three different types of trust are evident in these different relationships--voluntary trust (based on either kinship-like bonds and continuity of the interpersonal relationship over time, or on confidence in the institution and professional role that the individual represents), coercive trust (where one person effectively has no choice but to trust the other, as when a health problem requires expert knowledge that the patient does not have and cannot get) and hegemonic trust (where a person's propensity to trust, and awareness of alternatives, is shaped and constrained by the system so that people trust without knowing there is an alternative). These different types of trust had important implications for the nature of communication in the consultation and on patients' subsequent action. RESEARCH LIMITATIONS/IMPLICATIONS: The methodological and analytic approach, potentially, has wider applications in the study of other trust relationships in health and social care. Practical implications - Quality in the interpreted consultation cannot be judged purely in terms of accuracy of translation. The critical importance of voluntary trust for open and effective communication, and the dependence of the latter on a positive interpersonal relationship and continuity of care, should be acknowledged in the design and funding of interpreting services and in the training of both clinicians, interpreters and administrative staff. ORIGINALITY/VALUE: This is the first study in which interpreted consultations have been analysed from a perspective of critical sociology with a particular focus on trust and power relations.     

Service inputs and costs of care related to outcomes among cognitively impaired nursing home residents

BACKGROUND: There are over 17 000 nursing homes in the United States. Within these, special care units (SCUs) provide a separate residential and/or activity locus for residents, and are expected to provide more staff time and more specialized staff assignments. This paper addresses a fundamental issue relating to the nature, quality and quantity of resident care inputs: what impacts of SCUs are associated with added service inputs, and thus with personnel costs, recognizing that personnel account for the majority of costs associated with nursing home care? AIMS OF THE STUDY: The aim of this aspect of the study was to determine the extent to which additions of staff would result in a diminution of deviant behaviors among residents of special care and of traditional care units. METHOD: The data were collected from a random sample of ten downstate nursing homes located in New York State. Using rigorous sampling procedures, random samples of 40 residents were drawn from each of the facilities, equally divided between special care unit and traditional care unit residents. Thus, the sampling design involved two levels of clustering: subjects were clustered within units and units were clustered within facilities. The observational behaviour measure was taken from the INCARE (institutional version of the Comprehensive Assessment and Referral Evaluation). The behavioral observation measure contains 23 items such as "disruptive of others", "picks/pulls clothing", "repetitive movements", "repetitive questioning"and "wandering". Each item is rated as to frequency of occurrence; ratings are collected on three occasions, and averaged. Outcome and covariate data (e.g., behavior and cognition) were collected by trained research staff who visited each site for three to four weeks of intensive data collection, accomplished through direct resident interviews, staff interviews and questionnaires and chart data abstraction. The clinical staff time data were collected using the InfoAide system, whereby each care provider used a portable barcode scanner to record the type of care given, the recipient and the duration of care. A random effects model using the SAS mixed procedure was applied to the data; adhering to this model, some effects were fixed and some random. The random effects were comprised of the subject (intercept or subject starting point at baseline) and the unit; used here was restricted maximum likelihood (REML) with the EM algorithm. RESULTS: There was a significant reduction of behavior disorder associated with more provision of aide time in SCUs as contrasted with non-SCUs. The greater the service provided, the greater the slope, i.e., the greater the reduction. That is, while SCU residents showed improvements in behavior accompanying increases in aide time, no such change was observed among non-SCU residents. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: The significant effect of SCU + time + aide-minutes indicates that more aide time on SCUs was associated with improvement in behavior. It appears that the important ingredient in relation to the reduction of behavior disorder is not membership in an SCU per se, but the provision of more aide time within SCUs. Those SCUs that provide more aide time have a better behavior outcome. Thus, these findings point to additional paths for exploration, i.e., future research needs to focus on elements of SCUs such as the available amounts of program and staff resources rather than on SCU status alone.     

Adequacy of prenatal care and birthweight: a systematic review

This was a systematic literature review on publications in which prenatal care was investigated as a predictive factor for birthweight. The MEDLINE, Cochrane Library, and SciELO databases were searched using a combination of the following uniterms: "prenatal care", "antenatal care", "quality", "adequacy", "birthweight", and "low birthweight". Twenty-five studies were found: seventeen had a cross-sectional design, in addition to four cohort studies, three case-control studies, and one randomized trial. The adequacy indicators related to utilization (quantitative measures) and content of prenatal care (process or qualitative indicators). Most authors employed quantitative indicators, mainly the Kessner Index and the Adequacy of Prenatal Care Utilization Index. Qualitative criteria were used in only two studies. Most of the cross-sectional studies found a protective effect of prenatal care against low birthweight, whereas results of studies with other designs were conflicting. This review's findings highlight that the impact of prenatal care on birthweight is not unequivocal, mainly due to the effect of self-selection bias. Randomized trials are needed to elucidate such a relationship.     

Palliative care: community nurses' perceptions of quality

OBJECTIVES: To identify community nurses' perceptions of quality care provision for patients requiring palliative care. DESIGN: Semi-structured interviews were conducted with community nurses working within the district nursing service. An adaptation of Flanagan's critical incident technique was employed to elicit factors associated with high or poor quality palliative care. Interviews were tape recorded and transcribed. Data were analysed using thematic content analysis, recurrent themes being agreed by the research team. SETTING: One community healthcare trust. SUBJECTS: 62 members of the district nursing team (grades B-H). RESULTS: Respondents recounted the context in which high quality palliative care could be provided, the actions required, and the indicators that suggested the desired level of care had been achieved. Key factors identified were: the early referral of patients to the district nursing service, family circumstances, the availability of time, the accessibility of services and equipment, and the relationship with other healthcare professionals and informal carers. There was a general view that a positive outcome had been achieved when patients retained control over their circumstances and died a peaceful death, in the place of their choice, supported by their family. CONCLUSIONS: Community nurses were able to articulate clearly the essential components of high quality care. Whilst these factors do not represent a comprehensive list, they are put forward as a useful starting point for standard setting and subsequent audit.     

The art of Leonardo Da Vinci as a resource to science and the ideal of nursing care

Theoretical reflection whose goal is to demonstrate the art a nursing team is required to show in order to perform a technical procedure for transfer of solutions from a normal vial to a microdrops vial, based on Leonardo Da Vinci's theoretical referential, inspired by his work called "Vitruvian Man", so that body harmony is kept. The authors emphasize its relationship to nursing care, viewing it from its broadest sense, and its own motto--"Science, Art and Ideal".     

重视癌症患者支持性照顾需求提高患者生存质量

目的调查癌症患者支持性照顾需求及未满足情况,提出相应建议措施,为提高肿瘤患者服务质量提供参考。方法采用便利抽样法选取研究患者,用癌症患者支持性照顾需求问卷开展横断面调查,运用Epidata软件录入数据,运用SPSS 24.0软件进行统计分析。结果患者支持性照顾需求得分由高到低依次是心理需求、健康信息需求、照顾支持需求、生理需求、性需求;支持性照顾需求未满足率由高到低依次是心理需求（63.28%）、生理需求是（60.88%）、性需求（56.80%）、健康信息需求（45.66%）、照顾与支持需求（44.22%     

Adolescents' perceptions of inpatient postpartum nursing care

The authors used a transcendental phenomenological approach to describe adolescent mothers' satisfactory and unsatisfactory inpatient postpartum nursing care experiences. They analyzed data from 14 in-depth interviews and found that adolescent mothers' satisfaction is dependent on their perceptions of the nurse's ability to place them "at ease." Nursing care qualities that contributed to satisfactory experiences included nurses' sharing information about themselves, being calm, demonstrating confidence in mothers, speaking to adolescent and adult mothers in the same way, and anticipating unstated needs. Nursing care was perceived to be unsatisfactory when it was too serious, limited to the job required, or different from care to adult mothers, or when nurses failed to recognize individual needs. In extreme cases, unsatisfactory experiences hindered development of an effective nurse-client relationship. These findings illustrate the value of qualitative inquiry for understanding patients' satisfaction with care, can be used for self-reflection, and have implications for nursing education programs.     

Without reciprocal recognition there is not quality of care

Understanding the classic doctor-patient relationship has entered a crisis in medicine today. Communication difficulties, underestimation of empathy, or bringing economic criteria are leading to care styles that facilitate the objectification of patients, contempt for doctors, and indifference of both to collective measures of health. Basic principles of this relationship such as quality, justice, patient autonomy and beneficence may appear weak content. We intend to apply the concept of "reciprocal recognition" from philosophy to "recharge" content different aspects of the clinical relationship: a look "inside", dealing with the identity of the protagonists seek to promote it by using reciprocal recognition of both patient and the professional. In one aspect "external", focusing on the quality of care, a key objective of the clinical relationship. With reciprocal recognition, issues of justice and equity are reinforced through public health, building an identity of citizens with rights.     

Differences in subject needs between nursing home residents' and residential care professional's perspectives

OBJECTIVE: Considerable attention has been directed toward the quality of nursing home care, with a more recent focus on residents' perspectives concerning bio-psychosocial needs. Several researchers have reported professional and patients' perspectives to be consistently different regarding biopsychosocial needs. The objective of this study was to examine such differences. METHODS: A cross-sectional survey was conducted, with interviews of nursing home residents and a self-administered questionnaire for residential care professions. The data were obtained from 85 matched pairs in 6 nursing homes. The measures for subjective needs of the residents had three dimensions (physical, psychological, and social) covering 8 sub-categories. Analyses of the data offered good evidence of reliability (internal consistency) and content validity. RESULTS: In an agreement statistic analysis using Cohen's kappa, the residents' and care professional perspectives significantly differed regarding subject needs. In another analysis using t-tests, measures for subject needs derived from residential care professionals were consistently greater than those with nursing home residents. This tendency was generally consistent across sub-categories by ADL levels. However, the ranking order for the 7 sub-categories for subject needs was very similar with both raters. CONCLUSION: Assessing nursing home residents' subject needs represents an important and essential component of quality of care. However, needs assessment by the residential care profession is still its infancy and includes failure to consider the residents' perspective. The future research challenge is to find reasons for the gap in subjective thinking between the groups. In addition, researchers can perform a critical function on behalf of nursing home residents when they suggest improvements to the methodology for assessing residential care professionals views on residents' needs.     

Nursing care according to women in abortion situations

This qualitative study aimed to understand how women having an abortion experience the nursing care they receive. The statements of 13 hospitalized women were analyzed through content analysis. The central category "Nursing care experienced in situations of abortion" was constituted from 4 subcategories: care centered in physical needs; fear of judgment in abortion situations; legal aspects defining care; the need for support in abortion situations. These women identified nursing care as based on physical aspects, without contemplating their individuality and specificities. Results indicated the need to create an environment that stimulates listening, helping these women to elaborate their feelings and allowing professionals to behave closer to these women's reality, in order to reduce their own desires and conflicts and contemplate the integrality of care.