Oral sequelae of chemotherapy: an important teaching opportunity for oncology health care providers and their patients

 The object of this work was to conduct a rapid assessment of a teaching hospital's promotion of optimal oral health among its chemotherapy patients. A pilot study was undertaken, which included focus interviews with oncology clinic staff, a review of the fellowship training curriculum, and unobtrusive observations in the clinic setting. Charts were also audited for oncology patients who were probable chemotherapy candidates. A review of the data offered no evidence that oral health care was routinely addressed in a preventive context prior to the initiation of chemotherapy. Promotion of oral health care will help reduce the risk of oral sequelae of chemotherapy for patients and the subsequent impact of the oral sequelae on patients' chemotherapeutic regimen, thereby improving patients' chances of survival and improving their quality of life. Other teaching hospitals may wish to conduct a similar rapid assessment to determine whether they too could improve patient care and professional education in this area by incorporating pre-chemotherapy oral health evaluation and treatment into routine care for cancer patients. Published online: 18 November 1999     

Migraine and chronic daily headache management: a qualitative study of patients' perceptions

AIM: The aim of the study was to gain insight into the patients' perceptions of migraine and chronic daily headache (CDH) management. METHODS: Thirteen, semi-structured and individual interviews with seven migraine and five CDH patients were carried out and analysed in QSR NUD*IST5, using a grounded theory methodology. RESULTS: The participants described using five areas of management: 1) health care use; 2) medication use; 3) alternative therapies; 4) social support; and 5) lifestyle and self-help. The participants described their expectations, preferences, worries and (dis)satisfaction in relation to these five areas of management. The participants adapted headache management to suit their needs and preferences, making migraine and CDH management highly individual and giving the headache patient a central role within their own care. CONCLUSION: Health care is changing towards a greater involvement of the patients in their own care. Therefore, it is important to increase understanding of the patients' perspective of chronic diseases, including migraine and CDH. The results from this study inform health care professionals of the range of their patients' needs and preferences. This knowledge can be used to shape clinical practice, to develop patient education programmes and to further research efforts into issues that are important to the headache patient.     

Nursing documentation: non-physical dimensions of end-of-life care in acute wards

AIM: to explore discrepancies between nurses' knowledge and their documentation of issues of psychosocial, spiritual and cultural aspects of palliative care, evidenced clearly in recent nursing research into end-of-life care in an acute care, teaching hospital. DESIGN: the study involved a retrospective patient case-note audit of an opportunistic sample of 20 patients deceased recently and interviews of the two nurses most involved in the care of each patient (n=40). FINDINGS: this research indicates that nurses in acute care settings often recognize, sometimes explore, but infrequently document psychosocial, spiritual and cultural aspects of care. CONCLUSION: there is a strong need for: (1) education about both the impact of non-physical dimensions of patients' lives and the effective documentation of these dimensions; and (2) up-grading of documentation tools to better facilitate documentation of non-physical aspects of palliative care.     

The practice of health education in acute care setting in Hong Kong: an exploratory study of the contribution of registered nurses.

A multiple case study design was used to explore the practice of health education in acute care settings in Hong Kong. Two case studies, a medical ward and a surgical ward, were selected to reflected to reflect the real setting in which nurses carry out health education in acute care. Data collection methods involved the use of non-participant observation and semi-structured interviews. Seven nurses and eight patients were interviewed to explore their understanding of health education concepts, the use made in the wards of health education and the factors influencing such practice in the acute settings. Individual and cross-case analysis showed that respondents' understanding of the concept of health education was limited to patient information-giving. Although the importance of health education in acute patient care was acknowledged, the degree to which health education featured in nurses' practice was minimal. Many available opportunities for health education were missed and factors such as nurses' busy-ness and the associated lack of time and staff were identified as influencing health education practice in these acute care settings. Implications for practice and future studies were discussed in the light of these findings.     

A survey of interprofessional education in communication skills in health care programmes in the UK

There is considerable evidence to indicate that patient satisfaction is directly related to the communication skills of health care providers. However, communication is an area in which health care practitioners often fail to meet patients' needs. Interprofessional education (IPE) is advocated as one way of improving health care communication for the consequent development of interprofessional care. However, poorly planned and delivered IPE can reinforce professional differences, so it is imperative that its introduction is based upon sound evidence of local need, opportunity and resources. A multidisciplinary and cross university project was designed to identify opportunities for, and best practice in, IPE in communication skills amongst undergraduate health care practitioners within one Workforce Development Directorate (WDD) in England. Methods included a comprehensive literature review of relevant educational initiatives, together with telephone and e-mail interviews with key informants in higher education institutions (HEIs) across the UK. This paper reports the findings from the interviews. Based upon these findings, a series of recommendations are made for the planning, implementation, and evaluation of IPE in communication skills, which should be taken into account by local curriculum planning groups.     

Assessing the educational needs of post-myocardial infarction patients

Nurses involved in cardiac rehabilitation have a responsibility and an opportunity to promote positive changes in lifestyle through patient education programs. Assessing patients' needs and setting goals with the patient are essential for attainment of the maximum benefit from the educational program. The problem of dwindling resources and pressures to control health care costs have complicated the delivery of this care in some institutions. The educational strategy chosen by the nurse will depend on the resources available. Nevertheless, whichever strategy is chosen, the nurse, by virtue of his or her role in the health care delivery system and specialized knowledge, can still significantly impact on the successful goal attainment of goals for increasing numbers of post-myocardial infarction patients.     

应用临床护理路径对准分子激光原位角膜磨镶术患者的健康教育

目的 探讨应用临床护理路径对准分子激光原位角膜磨镶术患者的健康教育.方法 通过制定临床护理路径,将研究对象按门诊编号单双号将102例患者分成2组,对照组50例患者接受常规性健康教育,实验组52例患者采用临床护理路径实施健康教育,对比2组患者对健康教育知识掌握情况及对护理质量的满意度.结果 实验组患者对护理质量满意度比对照组明显提高,健康教育知识达标率显著高于对照组.结论 采用临床护理路径进行健康教育,可提高准分子激光原位角膜磨镶术患者健康知识掌握程度,使患者自觉采取健康行为,积极配合医疗护理,提高患者满意度.     

“An Evil Heritage”: Interview Study of Pain and Autosomal Dominant Polycystic Kidney Disease

Pain is a common problem for patients with autosomal dominant polycystic kidney disease (ADPKD). Knowledge about patients' experience of the pain, pain management, and pain's effect on everyday life is, however, limited. In clinical practice there is a need to improve the care of these patients. To be able to do so, information about how the disease and its pain affect the patients is required. This study explores patients' experience of living with ADPKD and its pain. The findings are based on in-depth semistructured interviews. The participants were 22 patients with ADPKD. The data were transcribed and analyzed by using phenomenology. Findings showed that the patients experienced limitations in their everyday life due to inexplicable and unpredictable pain and fatigue. Also, pain management was experienced as suboptimal and pain was seldom discussed at health care appointments. Emotional distress concerning the hereditary nature of the disease was also present. Health care providers need to increase their focus on pain and pain management to reduce the disease's intrusion in patients' everyday life. Also, patients and people in the patients' immediate surroundings need to be given information and education about the disease and its pain as well as the opportunity to talk about their worries concerning heredity. By implementing the findings of the present study when meeting a patient with ADPKD, improved patient satisfaction and health-related quality of life could be accomplished.     

The cardiac surgical patient's expectations and experiences of nursing care in the intensive care unit.

There is an abundance of research investigating patient satisfaction. However, few studies have addressed patient satisfaction by comparing patients' expectations of nursing care with the care they actually received. This qualitative study explores both cardiac surgical patients' preconceptions and expectations of nursing care in the intensive care unit (ICU) and their actual experience of nursing care while in the unit. Data were collected using a semistructured interview technique. Interviews took place prior to admission and following discharge from ICU, and were taped and transcribed. Using thematic analysis, major and minor themes emerged from the data. The preoperative interviews revealed that participants had clear expectations of the nurse's role in ICU. They expected the nurse who cared for them to be capable, intelligent, experienced and technically adept. Further, they wanted a nurse who would be vigilant and provide them with personalised care. Participants understood they would be vulnerable and looked to the nurse to help them through this period. Post-operative interviews revealed that when participants perceived vigilance or experienced personalised care from the nurses they felt reassured and secure. However, patients also described feelings of anxiety, apprehension, fear and other unexpected experiences, notably confusion and hallucinations. Recommendations suggest that modification to pre-operative patient education programs could lead to a reduction in anxiety in the post-operative period. They also highlight the importance, to the patients, of nurse caring activities. In addition, the findings suggest a need for staff education that addresses patient anxiety and post-operative psychological disturbances.     

Genetic education,knowledge and experiences between nurses and physicians in primary care in Brazil: A cross‐sectional study

Recent advances in genomics and related technologies have the potential to improve health care throughout the world. In this cross‐sectional study, we examine genetics education, knowledge, and genetics‐related experiences among the nurses and physicians who provide primary care in a Brazilian city. Fifty‐four healthcare professionals from family health units participated in the study (response rate: 90%). Data were collected using a structured 36‐item questionnaire divided into five axes: sociodemographic data and academic background; genetics education; genetics knowledge; genetics‐related experiences in family practice; and knowledge regarding the National Policy for Comprehensive Care in Clinical Genetics in the Unified Health System. Although most participants (85.2%) acknowledged receiving some genetic content during their undergraduate education, the majority (77.8%) advised that they did not feel prepared to deliver genomics‐based health care in primary care. The results suggest that nurses and physicians often lack the knowledge to provide genomics‐based health care in primary care. Therefore, continuing education in genetics/genomics should be provided to primary healthcare professionals in order to enhance family practice and compliance with national policies.     

Verbal abuse of nursing and midwifery students in clinical settings in Turkey

This phenomenological study describes nursing and midwifery students' experiences with and perceptions of verbal abuse in clinical settings in Turkey. Purposive sampling and, within this technique, typical case sampling were used to capture the students' most typical experiences of verbal abuse. Four categories with 10 themes describing verbal abuse experiences emerged from interviews. The abusive behavior originated from clinical instructors, agency nurses and midwives, physicians, patients, and patients' families. Abuse included health care professionals' exhibiting condescending attitudes toward and making derogatory comments about nursing higher education, refusing to share clinical knowledge and skills with students, belittling students' approaches to patient care, and humiliating and treating students as health care professionals of lesser value. During their clinical education, students were both vulnerable to and the targets of significant verbal abuse from those in supervisory positions. The students were vulnerable to verbal abuse because they were outsiders, left alone to tend to their own learning needs, inexperienced in patient care, and unsure of their rights. Measures should be taken to eliminate verbal abuse not only because of its obvious injustice, but also because it impedes the professionalization of nursing. Faculty and students should be prepared for the possibility of verbal abuse so they can respond assertively.     

维持性血液透析病人治疗满意度的调查

目的 调查维持性血液透析病人对于治疗的满意度情况,为制定改进措施提供依据.方法 81例维持性血液透析超过3个月的病人纳入本研究.应用自设问卷进行调查,问卷包括治疗护理技术方面、健康教育和指导方面、关心和照顾方面、与其他科室的协调方面、参考病人的意见方面、整体评价等共6方面.结果 本组血液透析病人对于血透室医护人员的整体满意度达91.4%,但在健康教育和指导、参考病人意见以及和其他科室协调等方面相对满意度较低.血透病人的满意度与透析龄呈负相关(P<0.05).结论血透室医护人员要通过个体化的健康教育和康复指导,促进病人的自我管理来提高病人的满意度.     

Implementation of SIGN 44 guidelines for managing cancer pain in a community setting

This paper discusses the realistic evaluation of an evolving managed clinical network (MCN) in palliative care. The primary focus of this community-based MCN was to improve cancer patients' pain by implementing clinical guidelines. The methods of evaluation included three case studies which featured interviews with patients, relatives and health professionals involved in their care. The results of the case studies were fed back to the network executive group during focus group interviews. The case studies and focus group interviews were carried out at approximately five-monthly intervals. The model of care being implemented by health professionals was refined by the network executive group following each focus group interview. The context, mechanisms and outcomes which evolved from the evaluation contained some elements of a best practice model for controlling pain for patients with advanced cancer.     

Patients' choice of asthma and allergy treatments

BACKGROUND AND OBJECTIVES: Only a few studies have focused on a comparison between general practitioner (GP) patients' and classical homeopath (CH) patients' reasons for choosing, continuing or termination of their treatment by GPs or CHs, respectively. The existing studies are mostly based on quantitative methods and dealing with patients' reasons for choosing complementary and alternative medicine (CAM). The objective of this paper is to develop concepts to understand and compare Danish GP patients' and CH patients' initial choice of, continuing choice of, and termination of treatments for asthma and allergy. DESIGN: Data originate from an explorative study based on semistructured interviews with 18 GP patients and CH patients having asthma and allergy. The selection of the patients to the interviews was based on a questionnaire study including 88 respondents (response rate 58 patients). RESULTS: In understanding the patients' initial choice and continuing choice of treatment and termination of treatment, the concepts push-from, pull, press-into, stop, and stay factors are used. These factors are connected to the patients' experiences with conventional treatment, patients' attitudes toward and personal experiences with alternative treatment, and the patients' understanding of their asthma and allergy. The results of the study indicate that patients before seeking CHs had experienced inappropriate health care within the conventional health care system. The results of the study also indicate that if the CH patients experience inappropriate health care within homeopathic treatment, they terminate the treatment. CONCLUSIONS: The study indicates the importance of health providers' insight into GP patients' and CH patients' different reflections on adverse events, the patients' different understandings of asthma and allergy, and the different learning processes that GP patients and CH patients might be involved in while living with asthma and allergy. These are important issues for understanding patients' initial and, continuing choice of and termination of GP treatment and CH treatment, respectively.     

Nurses' roles in systematic patient education sessions in psychiatric nursing

The purpose of this study is to gain understanding of nurses' expectations of their roles in systematic patient education in psychiatric inpatient care. Qualitative design was used in the study. The data were collected through interviews with nurses participating in the implementation of systematic patient education (information technology (IT) based patient education n= 14, or conventional patient education n= 16). The data were analysed using inductive content analysis. The analysis showed that nurses had different roles in both IT-based and conventional patient education. Nurses acted as learners, advisors, collaborators, teachers or limiters. The nurses tailored the role in each session according to the patients' interest and mental status. We can conclude that nurses working in psychiatric hospitals have different roles in systematic patient education and they are ready and willing to tailor their roles according to patients' individual needs. Information technology should be adopted without delay as a new treatment method in daily practice in psychiatric services. It has potential to support equality between patient and nurse in secluded environments.     

Nonmedical illness behavior: a model of patients who seek alternatives to allopathic medicine

This project investigated the process by which African-Americans in Chicago decided to access drugless, natural health care systems in conjunction with, or as alternatives to, orthodox medical care. The study focused on African-American users of the drugless, natural health care systems of chiropractic and naprapathy. The data for the study were qualitative and ethnographic, and included over 100 in-depth interviews, extensive field notes based on participant observation and related documents. The findings involved constructing a five-stage sequential model that describes the process of conversion to regular use of natural health care. The purpose of this article is to present a model of nonmedical illness behavior that can sensitize health care practitioners to the situational and contingent factors affecting patients' choices.     

Storytelling and professional learning: a phenomenographic study of students' experience of patient digital stories in nurse education

This paper reports the findings of a phenomenographic study which sought to identify the different ways in which patient digital stories influence students' professional learning. Patient digital stories are short multimedia presentations that combine personal narratives, images and music to create a unique and often emotional story of a patients' experience of health care. While these are increasingly used in professional education little is known about how and what students learn through engagement with patient digital stories. Drawing upon interviews with 20 students within a pre-registration nursing programme in the UK, the study identifies four qualitatively different ways in which students approach and make sense of patient digital stories with implications for learning and professional identity development. Through an identification of the critical aspects of this variation valuable insights are generated into the pedagogic principles likely to engender transformational learning and patient centred practice.     

Nurses' opportunistic interventions with patients in relation to smoking

AIM: This paper reports a study exploring nurses' provision of opportunistic health education on smoking for hospital patients. BACKGROUND: Smoking cessation guidelines recommend assessment of patients' smoking habits and provision of smoking cessation advice when possible, and highlight the importance of the role of nurses in health promotion and health education. In the past, nurses have been criticized for lack of knowledge, skills and confidence in relation to health education and the perception that it is additional to, rather than integrated with, nursing care. METHODS: A qualitative case study design was selected to explore the health education practice of 12 nurses working in acute wards in three general hospitals in Scotland. Data were collected in 2000 through non-participant observation, semi-structured interviews and the use of a radio-microphone to record nurse-patient interactions. The data analysis was guided by four key elements of health education practice: 'the teachable moment', 'readiness to learn', 'the provision of health information' and 'oral communication'. FINDINGS: Smoking was part of the nurses' agenda, as most recognized opportunities to introduce health education on smoking during nursing care, suggesting a tentative move towards the integration of health education with nursing care. Evidence from patients' interactions indicated ample opportunity for nurses to provide smoking-related health information. However, the content of nurses' interactions on smoking was variable, with some limited by poor communication skills and inadequate knowledge of smoking and smoking cessation. The context of the interactions was also important in understanding some of the restrictions on conversational progress. CONCLUSIONS: Nurses require the knowledge and skills to perform a health education role, and the inclusion of smoking cessation guidelines in nursing curricula would contribute to this. Where patients are in hospitals for short periods of time, opportunistic health education on smoking needs to be introduced as the basis for more specialist intervention.