Barriers in providing psychosocial support for patients with cancer

There is sound evidence to support the notion that the provision of effective psychosocial care improves the outcomes of patients with cancer. Central to the implementation of this care is that health professionals have the necessary communication and assessment skills. This study aimed to identify key issues related to providing effective psychosocial care for adult patients admitted with hematological cancer, as perceived by registered nurses with 3 or more years of clinical experience. An exploratory qualitative design was used for this study. Two focus group interviews were conducted with 15 experienced cancer nurses. The provision of psychosocial care for patients with cancer is a dynamic process that has a professional and personal impact on the nurse. The 5 analytic themes to emerge from the data were as follows: When is it a good time to talk? Building relationships; Being drawn into the emotional world; Providing support throughout the patient's journey; and Breakdown in communication processes. The findings from this study indicate an urgent need to develop a framework to provide nurses with both skill development and ongoing support in order to improve nurses' ability to integrate psychosocial aspects of care and optimize patient outcomes.     

The impact of cancer and chemotherapy: Perceptual similarities and differences between cancer patients, nurses and physicians

BACKGROUND: An essential condition to provide optimal care to cancer patients is a thorough understanding of the worries and needs of these patients. PURPOSE: To assess and compare perceptions about the impact of cancer and chemotherapy of health-care providers and patients. METHODS: Breast cancer survivors (N=80), oncology nurses (N=41) and physicians (N=49) with oncology experience completed a psychophysical scaling method with items tapping both the physical and psychosocial effects of cancer and chemotherapy. RESULTS: The following five issues ranked highest among patients: fear of metastases, fatigue, consciousness of one's own vulnerability, hair loss and nausea. Whereas there was a strong correspondence between the ratings of nurses and physicians, both groups grossly overestimated and underestimated various issues. For example, the effects on relationships with partners and children were greatly overestimated by nurses, while physicians underestimated hair loss the most. CONCLUSIONS: There was a considerable discrepancy on various issues between perceptions of patients and medical professionals. CLINICAL IMPLICATION: The observed lack of correspondence between patients and health-care providers may result in inappropriate provision of attention and health care. Methods have to be developed to assess easily the main needs and worries of individual patients, which is an essential condition to be able to provide optimal care.     

Improving Client Outcomes Through Differentiated Practice: A Rural Nursing Center Model

The TriCounty Community Health Center (the Center) was created in 1994 with federal grant monies to increase access and to provide outreach and primary health care services for rural residents. The Center employs a differentiated practice model of nursing care in which all nurses use the nursing process targeted to client systems that match the nurse's level of educational preparation and competence. The model allows nurses to intervene with various client systems, including the individual, family, aggregate, and community. Program outcomes for the Center suggest that using a differentiated nursing practice model for outreach and primary care services appears to have a positive impact on the health of individuals, families, and aggregates in rural settings, using the Omaha Classification System as a framework for evaluation.     

Palliative care nursing in rural and urban community settings: a comparative analysis

Nurses have key roles in the coordination and delivery of community-based palliative care. The purpose of this study was to examine the differences between rural and urban community nurses' delivery of palliative care services. A survey was distributed to 277 nurses employed by a community agency in Ontario, Canada, and a 60% response rate was obtained. Nurses reported spending 27% of their time providing palliative care. Rural and urban nurses had similar roles in palliative care but rural nurses spent more time travelling and were more confident in their ability to provide palliative care. Both groups of nurses reported moderate job satisfaction and moderate satisfaction with the level of interdisciplinary collaboration in their practice. Several barriers to and facilitators of optimal palliative care provision were identified. The study results provide information about the needs of nurses that practise in these settings and may provide a basis for the development of strategies to address these needs.     

Relationships between formalized preceptor orientation and student outcomes

Competently prepared nurses are expected to provide clinical care and advocate for client care. Preceptors are an important aspect of the solution for assisting student nurses to bridge the gaps between classroom and practice. Findings from this literature review found that formal orientation, employer support, and relationships with educational settings enhance preceptor roles. While the literature supplies many opinions and ‘how to’ papers, the body of research that has investigated relationships between preceptor characteristics, preceptor orientation, and student outcomes is still limited.     

Community psychiatric nurses and the care co-ordinator role: squeezed to provide 'limited nursing'

AIM: This paper reports a study illuminating the factors that either facilitate or constrain the ability of community psychiatric nurses, in their role as care co-ordinators, to meet service users' and carers' needs. BACKGROUND: The Care Programme Approach is the key policy underpinning community-focused mental health services in England, but has been unevenly implemented and is associated with increased inpatient bed use. The care co-ordinator role is central to the Care Programme Approach and is most often held by community psychiatric nurses, but there has been little research into how this role is performed or how it affects the work of community psychiatric nurses and their ability to meet the needs of service users. METHODS: A multiple case study of seven sectorised community mental health teams was employed over 2 years using predominantly qualitative methods including participant observation, semi-structured interviews and document review. The data were collected in one National Health Service trust in south England between 1999 and 2001. FINDINGS: Additional duties and responsibilities specifically associated with the care co-ordinator role and multidisciplinary working, combined with heavy workloads, produced 'limited nursing', whereby community psychiatric nurses were unable to provide evidence-based psychosocial interventions that are recognized to reduce relapse amongst people with severe mental illness. CONCLUSIONS: The role of the Care Programme Approach care co-ordinator was not designed to support the provision of psychosocial interventions. Consequently, community psychiatric nurses in the co-ordinator role are faced with competing demands and are unable to provide the range of structured, evidence-based interventions required. This may partially account for the increased inpatient bed use associated with the Care Programme Approach.     

Palliative care nursing in rural Western Australia

This article presents the findings of a study of rural palliative care nurses in Western Australia. The number of rural centres in Western Australia offering palliative care services is increasing; however, at present there is little empirical data available about the roles of the nurses involved. This study was undertaken to begin to correct this deficit. The study examined basic social processes associated with the role of rural palliative care nurses, and identifies issues that affect the nurses' professional practice. A modified grounded theory approach was used to form a conceptual framework that describes rural palliative care nursing. Theoretical sampling techniques were used to identify the six palliative care nurses working in rural Western Australia who participated in the study. Data were generated using in-depth interview and participant observation techniques. Constant comparative analysis of the data was employed to allow concepts to emerge from the data. The central theme that developed is the all-consuming nature of the rural palliative care nurse's role. Three subthemes relating to multiple roles, expectations of nurses, and coping strategies are also discussed. This research explored issues that rural palliative care nurses feel are relevant to their professional practice, and it describes the basic social processes inherent in the rural palliative care nurse's role. Recommendations for nursing research, education, administration and clinical practice are presented.     

When a client develops an attraction: successful resolution versus boundary violation

Psychiatric mental health nursing in correctional institutes is an exciting field, presenting the correctional nurse with a number of challenges. A challenge of particular significance is that encountered when a client develops an attraction to a nurse. Nursing education traditionally has not equipped nurses with the theoretical knowledge or experience to address this phenomenon in clinical practice. Consequently, attractions may not be successfully resolved, resulting in boundary violations that leave the correctional nurse feeling battered. Although attraction in the therapeutic relationship is a well-documented phenomenon in the psychosocial literature, nursing has not addressed this issue sufficiently. Only when the precipitating factors are defined clearly from a sociocultural context, which includes the profession and the correctional environment, can interventions for implementation be identified. The socialization of nurses, how nursing conceptualizes professionalism, gender issues, the atmosphere of the correctional environment and the potential for dual relationships that stem from the multiple roles of the nurse, are factors that the author contends contribute to a lack of boundary setting and maintenance in the nurse-client therapeutic relationship. Consequently, this results in difficulties in assisting a client to resolve attraction successfully.     

Negotiating relational practice patterns in palliative home care

Providing palliative care in the home presents a variety of challenges for nurses and other care providers. As part of a focused ethnographic study examining client/caregiver/care-provider relationships within the socio-cultural context of home-based palliative care, this paper describes the provision of palliative care to Canadian seniors with advanced cancer from the perspective of nurses. Data were collected through in-depth interviews (n=19) with three palliative care nurses and participant observations in four households over a six-to-eight-month period. Home-based palliative care nursing was depicted in this study as a dialectical experience, revealing three relational practice patterns: making time-forfeiting time, connecting-withdrawing, and enabling-disabling. Nurses attempted to negotiate the tensions between these opposing approaches to palliative care. Study findings suggest that the sociocultural context of palliative care is not conducive to high-quality palliative care and provide several insights related to future directions for practice, policy, and research.     

Relative professional roles in antenatal care: results of a survey in Scottish rural general practice

There is evidence of variation and some ambiguity about self-perceived relative professional roles in antenatal care in the UK. There is little information about models of antenatal care provision in UK rural areas. In rural areas, in particular, women have limited choice in accessing health care professionals or alternative primary care delivery settings. In the light of a recent review of Scottish maternity services, it is important and timely to examine models of care and interprofessional working in antenatal care in rural areas. This study explores midwives' and GPs' perceptions about their relative professional roles in remote and rural general practice in Scotland. A questionnaire survey involving all 174 Scottish remote and rural general practices (using one definition of rurality) was conducted, followed by 20 interviews. At least one professional returned a completed questionnaire from 91% of rural practices. A number of areas of dissonance were noted between GPs' and midwives' perceptions of their roles in maternity care and, given the context of service provision, these may impact upon rural patients. Findings are relevant to wider debates on extending the primary care team and strengthening inter-disciplinary working, particularly in rural areas.     

A Day in the life of RURAL advanced practice nurses

Advanced practice nurses (APNs) have been a critical component of the rural health care system for many years. This study describes the impact of APNs on primary care in Wyoming, a predominantly rural and frontier state, and illustrates a typical practice day for APNs. Wyoming APNs are experienced nurses, in their late 40s on average, and are quite independent in their practices. The APNs provided a significant amount of health care, with an average of 15 client visits per day. These APNs were heavy prescribers and performed a number of office procedures. Implications for health policy are discussed.     

We cannot staff for 'what ifs': the social organization of rural nurses' safeguarding work

MACKINNON K. Nursing Inquiry 2012; 19: 259-269 We cannot staff for 'what ifs': the social organization of rural nurses' safeguarding work Rural nurses play an important role in the provision of maternity care for Canadian women. This care is an important part of how rural nurses safeguard the patients who receive care in small rural hospitals. This study utilized institutional ethnography as an approach for describing rural nursing work and for exploring how nurses' work experiences are socially organized. Rural nurses advocated for safe healthcare environments by ensuring that skilled nurses were available for every shift, day and night, at their local hospital. Rural nurses noted that this work was particularly difficult for the provision of maternity care. This article explores two threads or cues to institutional organization that were identified in our interviews and observations; namely staffing and safety standards, and the need for flexibility in staffing in small rural hospitals. Rural nurses' concerns about ensuring that skilled nurses are available in small rural hospitals do not enter into current management discourses that focus on efficiency and cost savings or find a home within current discourses of patient safety 'competencies'.     

Patient education and consumer medicine information: a study of provision by Queensland rural and remote area Registered Nurses

Aims and objectives. The aim of the larger study was to ascertain the medication practices of registered and enrolled nurses in rural and remote areas of Queensland after the introduction of the Health (Drugs and Poisons) Regulation. This paper reports on the findings of the role of registered nurses and their confidence in the ability to provide information on medications in a way that the client understands; the frequency of the provision of information to clients prior to discharge; and the frequency of Indigenous Health Workers or interpreters for people without English as a first language. Background. Queensland employs approximately 17% of the Australian registered nurse workforce. In 1996 Queensland changed the Health (Drugs and Poisons) Regulation to allow specific registered nurses, who had undertaken approved postgraduate education and training programmes, to become endorsed for an expanded medication practice role. In particular, it allowed endorsed nurses to administer and supply (but not prescribe) drugs listed in a drug formulary to certain clients using protocols. It was not clear, however, whether the changes to the Regulation reflected the scope of practice, thereby providing adequate legal protection for the nurse. Design. During 2001–02 an exploration of the medication practices of rural and remote area nurses was conducted by the use of a cross‐sectional postal survey. Phase 1 of the study used a facility audit to ascertain facility medication practices and phase 2 of the study used a postal survey to ascertain nurses’ medication practices. Method. All nurses employed in rural and remote health facilities in Queensland were eligible to participate in the study. The nurse registering authority's (the Queensland Nursing Council) register was used to generate a non‐proportional stratified random sample. Of the 1999 questionnaires sent, there were 668 respondents. Of these, 520 were registered nurses. Results. The data indicated that there was a difference between endorsed and unendorsed registered nurses’ medication practice. In particular, it was apparent that endorsed registered nurses were more likely to believe they could explain the side‐effects of medication to clients in a way the patient understood; provided medication education to clients on discharge; and used Indigenous Health Workers or interpreters to explain medications to those clients for whom English was not a first language. However, it was apparent that <50% of all Registered Nurses were providing client medication education or using Indigenous Health Workers or interpreters. Conclusion. It is apparent that the changes to the Regulation have ensured that Registered Nurses who have undergone postgraduate education to enhance their medication practice are more likely to provide client education and consumer medication information. However, the results suggest that the majority of registered nurses in Queensland, whilst believing they have sufficient knowledge of pharmacology to provide client education, often do not provide appropriate medication advice to clients, particularly on discharge from the acute setting. Relevance to clinical practice. It is well recognized that the provision of medication education to clients has several benefits to both the client and the health care system. The lack of client medication education indicated in this study compromises patient's safety as well as their compliance with their medication regime.     

Education for differentiated role development for NP and CNS practice: one nursing program''s approach

Development of nurse care providers who best meet the public's health care needs is imperative. Some nurses believe the functions of nurse practitioners and clinical nurse specialists should be combined. However, the experience of the authors' nursing program argues otherwise. Two graduate nursing tracks, family nurse practitioner and rural health specialist, were developed to meet the health care needs of rural populations. Although the two tracks share expected competencies and areas of expertise to some extent, differences in practice are apparent in identified domains of practice and terminal competencies. Family nurse practitioner practice focuses on assessment, diagnosis, and management of health and illness conditions of individuals and families across the life span. Clinical nurse specialist practice incorporates traditional roles of client assessment, monitoring and coordination of care, outcome assessment, and client, family, and community education, with a new focus on case management strategies. These differences are important to care delivery in the managed care era.     

Occupational health hazards of hospital staff nurses. Part I: Overview and psychosocial stressors

1. In the health care environment, occupational stressors may be physical, chemical, biological, or psychosocial. 2. Psychosocial stressors include physical and mental overload, job insecurity, role ambiguity, a client population with anxiety or fear, and poorly designed work schedules. 3. Stress can be an occupational hazard because it arises from the environment, and may lead to accidents or injuries. 4. Psychosocial stressors will become increasingly important as the hospital environment demands more of nurses.     

Patient teaching in the ambulatory setting

Tremendous growth in the ambulatory setting has made patient education an integral part of health care in that setting. Numerous factors can hinder the implementation of patient education. Institutional variables include time, environment, and money. Acuity, psychosocial issues, and available resources are patient-centered variables. In order to promote effective patient education in an ambulatory setting, nurses need to be involved actively in planning and presenting material and in evaluating patient learning. In addition, nurses should be knowledgeable about the content being presented. The type of environment in which the teaching occurs and the strategies utilized in patient education facilitate the information exchange. The nurse and client must develop trusting relationships built on effective communication skills by both client and nurse. The trend toward fostering the patient as an active partner in health care can be accomplished through the teaching of communication skills as well as prevention, management, and self-care skills.