Associations between nurse–patient interaction and loneliness among cognitively intact nursing home residents – a questionnaire survey

Nursing home (NH) residents risk loneliness because of many losses. Nurse–patient interaction includes core aspects contributing to thriving and well-being among long-term NH residents. We performed a cross-sectional observation study of 188 residents 65 years and older from 27 NHs with ≥3 months’ residence. All had informed consent competence recognized by the responsible doctor and nurse and could converse. We asked “Do you sometimes feel lonely?” and used the Nurse–Patient Interaction Scale (NPIS) in face-to-face interviews. We identified associations between nurse–patient interaction and loneliness and investigated the prevalence of loneliness. Eighty-eight (47%) respondents reported loneliness often or sometimes and 100 (53%) rarely or never. Adjusted for sex and age, 10 of the 14 NPIS items were significantly correlated with loneliness. Loneliness is common among cognitively intact NH residents. Nurse–patient interaction associates with residents’ loneliness and might be important in alleviating loneliness.     

Nurse-patient interaction: a review of the literature

Aims. The aims of this paper are to review a theoretical model useful for developing nursing knowledge related to nurse–patient interaction, review the literature on nurse–patient interaction, and discuss areas for further research. Theoretical model. Goffman's theory of face work. Results. Nurse–patient interaction is a central element of clinical nursing practice. This paper shows how Goffman's model can be used as a theoretical framework for understanding nurse–patient communication. Relevance to clinical practice. Issues such as power, the social and cultural context, and interpersonal competence are shown to be important in the quality of nurse–patient interactions and nurses need to take cognizance of these factors in their interactions with patients.     

The impact of self‐transcendence on physical health status promotion in multiple sclerosis patients attending peer support groups

This study aimed to investigate the effect of self‐transcendence on the physical health of multiple sclerosis (MS) patients attending peer support groups. This study was a quasi‐experimental before‐and‐after design including 33 MS patients in three groups: 10 men in the men‐only group, 11 women in the women‐only group, and 12 men and women in the mixed group. Participants were required to attend eight weekly sessions of 2 h each. Instruments included the physical health section of the Multiple Sclerosis Quality of Life Inventory and Reed's Self‐Transcendence Scale. Peer support group attendance was found to have a significant positive effect on the physical health and self‐transcendence of MS patients when comparing average scores before and after attendance. Regression analysis showed that improvement in self‐transcendence predicted improvement in physical health. Results show the positive effects of peer support groups on self‐transcendence and physical health in MS patients, and suggest that improvement in well‐being can be gained by promoting self‐transcendence and physical health.     

Factors influencing nurse–patient interaction in the acute psychiatric setting: An exploratory investigation

Nurse–patient interaction in acute psychiatric in-patient facilities has been the subject of much discussion in the literature and remains a contentious issue. How and why nurses interact with patients in the acute care setting requires definition within the current dynamic environment of mental health service provision. Factors which impact on the manner in which nurses care for patients also require investigation. This article presents the findings of a collaborative research study that investigates factors that influence nurse–patient interaction in the acute psychiatric setting. Ten nurses on the study ward were given opportunity, through semi-structured interviews, to outline and describe the factors perceived to influence nurse–patient interaction. Factors identified as influencing interaction included the ward environment, something always comes up, nurses’ attributes, patient factors, instrumental support and focus of nursing. Issues which emerged from the study provide managers and clinical nurses with an opportunity for generating new possibilities for nurse–patient interaction. However, these issues must be addressed in a sensitive way that takes into account the complex and dynamic nature of acute care settings.     

Patient‐tailored self‐management intervention for older adults with hypertension in a nursing home

Aims and objectives. This study was to evaluate the effects of a patient‐tailored self‐management intervention on (1) blood pressure control and (2) self‐care behaviour, exercise self‐efficacy and medication adherence among Korean older hypertensive patients in a nursing home. Background. Little is known about whether a patient‐tailored self‐management for nursing home residents with hypertension is likely to advance the care of this growing population worldwide. Design. A non‐equivalent comparison group design. Methods. Forty‐seven patients (23 and 24 in the intervention and comparison groups, respectively) participated in the study. No one withdrew during the eight‐week study period. Hypertensive patients in the intervention group received health education and tailored individual counselling for eight weeks to enhance the self‐management. Results. The mean age of patients was 77·4 years. Patients were on hypertensive medications for 11·8 years; only 36 of them took medications without assistance. The baseline comparisons of the patients with and without 8‐week intervention did not differ for clinical and demographic variables and outcome measures. Blood pressure decreased when comparing the baseline to eight weeks later from baseline; moreover, blood pressure was significantly reduced only in patients who received the intervention. Self‐care behaviour and exercise self‐efficacy significantly increased over time only in those who were in the intervention group. However, no significant difference was observed in medication adherence between the two groups. Conclusions. Patient‐tailored self‐management intervention was a practical approach for decreasing blood pressure and increasing self‐care behaviour in older hypertensive patients in a nursing home. Further studies are needed to validate these findings using a larger sample with long‐term follow‐up. Relevance to clinical practice. A patient‐tailored intervention is feasible not only to empower nursing home residents with hypertension for their care, but also to offer a qualified training and guidelines to nursing home staffs, expanding their professional competence in clinical practice.     

The lived experience of the diabetes nurse specialist regular check-ups, as narrated by patients with type 2 diabetes

Aim. The aim was to elucidate the lived experience of regular diabetes nurse specialist check‐ups among patients with type 2 diabetes. Background. Diabetes care with diabetes nurse‐led clinics in primary care has been established in Sweden since the 1980s. Information about patients’ lived experience of these regular check‐ups is important in the further development of diabetes nursing in primary care. Methods. Narrative interviews were conducted with 10 women and 10 men with type 2 diabetes regarding their lived experience in everyday life and the regular check‐ups by the diabetes nurse specialist. A phenomenological‐hermeneutic method inspired by Ricoeur was used in the analysis. Results. Patients’– with type 2 diabetes – lived experience of regular check‐ups showed an overall positive influence on the patients’ way of living with the disease by underpinning and developing their understanding and management of daily life. This influence was interpreted as an interlinked chain comprising the following elements; being confirmed, being guided within the disease process, becoming confident and independent and being relieved. Every link contained a positive influence from being dependent‐independent, autonomous and a feeling of freedom in patients striving for an everyday life with a disease under control. Relevance to clinical practice. The development of diabetes‐nurse‐led clinics from the perspective of the patient must consider the patient's individual need for support and continuity with the diabetes nurse specialist. Consultations with collaborative partnership and specific expertise that is easy to access implied autonomous disease self‐management in terms of patients’ own control of the disease over time. In view of the increasing number of patients with diabetes, this could positively impact the availability of diabetes nursing care.     

Emergency department nurse's attitudes towards patients who self‐harm: A meta‐analysis

Self‐harm is a major challenge to public health. Emergency department (ED) nurses treat significant proportions of patients with self‐harm injuries, and positive therapeutic patient–nurse interactions are imperative to the physical and psychological outcome of this vulnerable patient group. Research, both nationally and internationally, suggests that treating those with self‐harm injuries is emotionally challenging, and ambivalence, powerlessness, and ineffectiveness are commonly manifested in negative attitudes towards these patients. Following the PRISMA guidelines, this systematic review with meta‐analyses examined the attitudes of ED nurses towards patients who self‐harm, based on currently available evidence. The following databases were searched: CINAHL complete; Medline complete; PsycARTICLES; PsycINFO; The Allied and Complementary Medicine Database; Health Source: Nursing/Academic Edition; PsycEXTRA; and Psychology and Behavioural Sciences Collection. Clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant reports to identify additional studies, were also searched. Five studies were included in the meta‐analysis. The Self‐Harm Antipathy Scale (SHAS) was used as an outcome in two studies appropriate for meta‐analysis. The Attitudes Towards Deliberate Self‐Harm Questionnaire (ADSHQ) scale was used as an outcome in three studies appropriate for meta‐analysis. Results demonstrated limited empathy and negativity towards patients who self‐harm, indicating a requirement for education and supervision of ED staff, where the SHAS or the ADSHQ can be used to monitor attitude change. Self‐harm educational content for ED staff should include areas of knowledge building including explanations and causes of self‐harm; range, forms, and functions of self‐harm; staff responses to self‐harm; assessment, management, and interventions; professional practice issues.     

Self‐neglect consultation rates and comorbidities in primary care

The aims of this study were, through secondary data analysis, to establish consultation rates for self‐neglect by 100 000 of the Scottish population and by deprivation and to identify the main comorbidities associated with self‐neglect. Data from a national dataset recording consultations in general practices where a self‐neglect diagnoses was made were analysed. Rates of self‐neglect in patients who consulted a Practice Nurse or General Medical Practitioners vary over time. Self‐neglect is more common in the 75 years and over group but is found across the age spectrum. It is more common in males and is linked to higher levels of deprivation. Self‐neglect is recorded as a diagnosis relatively infrequently in general practice. A wide range of comorbid conditions are found coexisting with self‐neglect. Nurse interventions generally focus on comorbidities and not self‐neglect. Self‐neglect does present in primary care. Nurses need to be aware of its varied presentations. Practice Nurse interventions suggest we need to develop self‐management interventions rather than respond to associated comorbid conditions.     

Patient self-medication--a change in hospital practice

Aims and objectives. The purpose of this study was to evaluate the effectiveness of a self‐medication programme (SMP) for inpatients of the Nursing Convalescent Unit, a 26‐bed unit with medical and surgical patients. Background. Self‐medication is an important part of self‐management of chronic illness. Self‐medication is a way of allowing patients to give themselves their medications in hospital after receiving education instead of the usual practice of medications administered by a Registered Nurse (RN). Design. The pilot study was undertaken over a six‐month period to examine the relationship between a programme of self‐medication and patient knowledge and adherence to medication regimens, number of medication errors, efficiency in relation to the number of nursing hours associated with the SMP, patient and nursing satisfaction. Methods. A total of 220 patients participated in the study. The SMP included three levels of patient self‐administration of medications: level one, medications administered by a RN; level two, self‐medication directly supervised by a RN and level three, self‐medication indirectly supervised by a RN. Outcome measures included staff and patient satisfaction, number of medication errors, time taken by nurses to undertake activities related to the SMP and the number of patients who achieved levels two and three. Results. Study findings showed that 45% of patients remained on level one, 26% achieved level two and 29% achieved level three. There were no patient initiated medication errors during the study period. Efficiencies were identified in staff workload associated with patient discharge procedures. Overall, nurses perceived that the SMP increased their knowledge of medications and contributed to effective patient education. Conclusions. In selected patients, the SMP was an effective aid for improving adherence to medication regimens. Relevance to clinical practice. Collaboration between nurses, medical staff, pharmacists, patients and carers is integral to the success of in hospital SMP.     

Self‐efficacy as a unifying construct in nursing‐social work collaboration with vulnerable populations

WASHINGTON OGM and MOXLEY DP. Nursing Inquiry 2013; 20 : 42–50
Self‐efficacy as a unifying construct in nursing‐social work collaboration with vulnerable populations The authors consider self‐efficacy practice as an organizing construct guiding nursing–social work action research in partnership with older homeless and formerly homeless African‐American women. The authors, both academics who together have worked with members of this vulnerable population for a decade and a half, report on their unifying action research perspective immersed in self‐efficacy theory. We examine how our adaptations of Bandura’s classic four sources of self‐efficacy form a distinctive intervention practice designed to help older African‐American women emerge from homelessness. We amplify the incorporation of the four sources (vicarious experience and exposure to powerful role models, emotional arousal and accompanying catharsis, verbal persuasion, and role performance) into a grand strategy useful in working collaboratively with members of vulnerable populations, so they can achieve outcomes that improve their functional health, well‐being and ultimately their quality of life.     

Nurse burnout: Personal and environmental factors as predictors

The aim of this study is to investigate the level of burnout of clinical nurses and to examine the influence of personal and environmental factors on nurse burnout. A total of 717 full‐time nurses from six hospitals in Tianjin, China, completed five questionnaires: a demographic questionnaire, the Maslach Burnout Inventory, the General Self‐Efficacy Scale, the Practice Environment Scale of the Nursing Work Index and the Nurse Job Stressor Scale. The participants had moderate levels of emotional exhaustion (mean score 23.95 ± 11.11) and depersonalization (mean score 7.90 ± 6.58) and a high level of reduced personal accomplishment (mean score 27.51 ± 10.96). Both personal and environmental factors were correlated with nurse burnout; however, personal factors played bigger roles in predicting personal accomplishment, whereas environmental factors played bigger roles in predicting emotional exhaustion and depersonalization. In order to reduce nurse job burnout effectively, administrators should pay more attention to the improvement of nurses' self‐efficacy and professional nursing practice environment and the reduction of stressors.     

Patient–patient interaction – caring and sharing

Aim: The aim of this study is to provide an understanding of the significance of hospitalized patients’ interpersonal interaction with fellow patients in an infectious disease ward in a large Danish hospital. Method: A qualitative approach was selected using participant observation and semi‐structured qualitative interviews. Six female participants at the age of 32–81 years with different types of infectious diseases accepted to participate in interviews. The analysis was carried out using Kvales’ three levels of qualitative data analysis. Data were catalogued into two main categories with several subcategories representing significance of patients’ interaction with fellow patients. Results: The qualitative analysis resulted in two main categories: (i) Caring for fellow patients and (ii) Sharing illness information with fellow patients. Each of the main categories was elucidated through several subcategories. Our findings clearly showed that interpersonal interaction with fellow patients was of utmost importance when it came to care and support and when they needed information about their illness. Typically, the interpersonal interaction was experienced as giving and referred to in positive terms, but occasionally, the opposite was experienced too. Less typically, the patients experienced interaction with fellow patients as a burden and referred to it in negative terms. Conclusions: Patients’ interaction resembled care as well as self‐care. Patient–patient interaction was an important part of the social support system during hospitalization.     

Nurse competence between three generational nurse cohorts: A cross‐sectional study

Research indicates significant differences between nurse cohorts in many work‐related factors. This study compared nurse competence between three generational cohorts comprising the current nursing workforce. The Nurse Competence Scale was used to collect data for this cross‐sectional study from 2052 nurses in a university hospital in Finland. Data were analysed statistically. Significant differences were found between nurse cohorts in their competence. The length of work experience had a significant impact on the development of competence. The oldest cohort, with the longest work experience, had the highest competence scores (70.1 on a visual analogue scale), and the youngest had the lowest (59.0). All cohorts were most competent in patient‐related nursing tasks, in maintenance of professional competence and in ethical care. Nurses were weakest in the development of nursing practice and the use of evidence‐based knowledge. Targeted interventions in teaching–coaching for different nurse generations are needed to ensure the maintenance of nurse competence and high‐quality patient care.