Exploring nurses' experiences of supporting a cancer patient in their search for meaning.

This article presents the findings from an interpretive phenomenology study looking at nurses' experiences of supporting cancer patients in their search for meaning. Eleven nurses were interviewed from a Medical Oncology Unit and a Bone Marrow Transplant Unit in a central London teaching hospital. Having analysed the interviews, six major themes were identified: the value of experience, understanding the search for meaning, the value of time, the relationships involved, caring and the skills used by nurses, and the difficulties nurses' experienced and the support they needed to continue this role. Like many aspects of nursing care that are intangible in nature, this aspect of care was seen as important and valuable to the nurses in the clinical environments of cancer care. The findings do not represent a definitive approach to this aspect of care, but offer an insight into nurses' experiences. In order to continue this aspect of cancer care, the findings suggest that nurses need support.     

Care of women with breast cancer on a surgical ward: nurses' opinions of the need for support for women,relatives and themselves

BACKGROUND: In Sweden women with newly diagnosed breast cancer are admitted to surgical wards in order to undergo surgery and receive postoperative care. On these wards, nursing staff take care of women both with newly diagnosed breast cancer and those with cancer in advanced stages. Nurses have to meet the varying needs of patients and their relatives. AIM: To describe nurses' opinions of the need for care and support for women and their relatives in connection with surgery for breast cancer, as well as their own need for support on a surgical ward. METHODS: Thirty-one nurses from a surgical ward participated in semi-structured interviews. The interviews were tape-recorded and transcribed verbatim. Thereafter a step-by-step, qualitative content analysis was carried out. RESULTS: The nurses described the need to talk and receive information as being the most important among women and their relatives, as well as among themselves. Only a few nurses mentioned the need for physical care among the women. Contact with relatives was described as being almost nonexistent. There was a discrepancy between what nurses described as important needs and how these needs were provided for. CONCLUSION: This study shows that what the nurses described as being the most important needs, and the way how these needs were provided for, was more often seen from a theoretical point of view with few examples of self-experienced situations in the daily care. Needs among women and their relatives seemed to be not fully known to nurses and therefore, possibly, were not met. Nurses themselves had a pronounced need for support, which was sometimes unsatisfactorily met.     

Perspectives from family caregivers receiving home nursing support: findings from a qualitative study of home care patients with heart failure

Many heart failure (HF) patients depend on a family caregiver and many families need additional home care nursing support. This qualitative study identified perspectives of being a HF caregiver for families receiving home care nursing. Eleven caregivers of homebound HF patients were interviewed on what helps them the most, their own health, obstacles in caregiving, and greatest needs overall. Eight themes emerged and will be discussed in this article. The findings articulate the positive influence nurses can have on HF families to guide future practice and research.     

Power imbalance between nurses and patients: a potential inhibitor of partnership in care

The Patient's Charter identifies the need for nurses to respect patients' rights to influence their care, and contemporary nursing practice advocates that nurses work in partnership with patients. Hence nurses are encouraged to share their power and facilitate empowerment in their patients by giving them information and support. However, the literature indicates that nurses are not very successful in making patients feel empowered to make informed decisions. This study, conducted in 1998, provides some answers as to why this may be the case. The aim of the study was to explore and describe nurses' and patients' views regarding partnership in care in hospital. Using the grounded theory approach, participants were drawn from four hospitals in Western Australia. A purposive sample of 33 nurses and 32 patients were interviewed in-depth. Participant observation was also conducted and field notes were written. The interviews were transcribed verbatim and analysed using the constant comparative method. The findings showed that nurses viewed involving patients in care as requiring them to give patients information and to share their decision-making powers with them. With the exception of a few, the majority of nurses were unwilling to share their decision-making powers. This created a situation of power imbalance with subsequent little patient input. Factors identified included nurses' beliefs that they "know best", the view that patients lacked medical knowledge and the perceived need for nurses to hold onto their power and maintain control. If nurses and patients are to work as partners, it is important that nurses make every effort to equalize the power imbalance. One way to do this is for nurses to share and give information to patients readily and to be open in their communication with them.     

From their own voices: the lived experience of African American registered nurses.

This phenomenological study described the lived experience of African American registered nurses providing nursing care to individuals, families, and communities in southeast Louisiana. Data were collected from 13 African American registered nurses using semistructured interviews and a focus group. Analysis of the phenomenological data revealed two essential themes, (a) connecting with the patient and (b) proving yourself; and four incidental themes, (a) a fulfilling dream, (b) being invisible and voiceless, (c) surviving and persevering, and (d) mentoring and role modeling. The findings revealed that the general perception among participants was that they were not fully accepted as equal professionals by their Caucasian nurse colleagues, other health care providers, and sometimes patients. The findings of the study indicate the immediate need to address and resolve the issues of diversity within the nursing profession. Nursing will also have to reform its system and practices to embrace and support diversity.     

Undertaking the role of patient advocate: a longitudinal study of nursing students

Patient advocacy has been claimed as a new role for professional nurses and many codes of ethics for nurses state that they act as patient advocates. Nursing education is faced with the challenge of preparing nurses for this role. In this article we describe the results of a study that considered the tendencies of a cohort of nursing students at the Kocaeli University School of Nursing to act as advocates and to respect patients' rights, and how their capacities to do so changed (or not) as a result of their nursing education. This longitudinal study used a questionnaire consisting of 10 statements relating to patient care. It was performed both at the start (1998) and at the end (2002) of the nursing training. At the beginning of their course 77 students participated; in the study. After four years, only 55 students participated, the reason for this drop in number being unknown. The questions asked nurses if patients should have: the right to receive health care; the right to participate in the decision-making process about their treatment; the right always to be told the truth; and the right to have access to their own medical records. They were also asked: if quality of life should be a criterion for discontinuing treatment; if patients have the right to die and the right to refuse treatment; if patients should be assisted to die or helped to undergo active euthanasia; and if severely disabled newborn babies should be allowed to die. The student nurses demonstrated considerable insight into contemporary nursing issues and were ready to act as patient advocates. Professional responsibility demands that good nurses advocate strongly for patients' choices.     

Hope as experienced in women newly diagnosed with gynaecological cancer

AimThis article presents findings from a hermeneutic-phenomenological study with the aim to investigate the meaning of the lived experience of hope in women newly diagnosed with gynaecological cancer.MethodFifteen women were interviewed the day they were receiving the diagnosis at a gynaecological department of a Danish university hospital. The women, aged 24–87 (median 52 yrs), were diagnosed with ovarian, endometrial, cervical and vulvar cancer.ResultsHope was found to be connected to both diagnosis, cure, family life and life itself and closely tied to hopelessness. The newly received cancer diagnosis made the women oscillate between hope and hopelessness, between positive expectations of getting cured and frightening feelings of the disease taking over. Five major interrelated themes of hope were identified: hope of being cured, cared for and getting back to normal, hope as being active and feeling well, hope as an internal power to maintain integration, hope as significant relationships and hope as fighting against hopelessness. Thus, hope was woven together with hopelessness in a mysterious way; it took command through inner strength and courage based on a trust in being cured and of being in relationship with significant others.ConclusionThe findings of the close relationship between the shades of hope and hopelessness support the need for nurses to continue to practice hope-inspiring nursing. Nurses need to understand the complexity of hope and its close connection to hopelessness when newly diagnosed with a threatening disease as cancer; and the findings might help nurses assist patients in fighting hopelessness.     

CAMHS liaison: supporting care in general paediatric settings

Increasing numbers of children and young people with mental health problems are being cared for in general paediatric settings, presenting a challenge to nurses who do not have mental health nursing qualification and experience. A survey of nurses in a children's hospital identified their concerns and attitudes to caring for this client group. On-call nursing support was felt by almost all nurses (87 per cent, n=90) to be the most beneficial aspect of a liaison service, followed by teaching (84 per cent) and individual support with the young person/family (84 per cent). Based on the findings, a project was initiated to improve nursing liaison with CAMHS nurses providing support and advice to general children's nurses. Effective liaison between general paediatric wards and child and adolescent mental health services (CAMHS) can improve care for children and young people with diagnosed mental health problems. However, there is still a gap in addressing the need of the significant numbers of children with physical illness who also have mental health needs.     

Culturally diverse patient--nurse interactions on acute care wards

The nurse-patient interaction is central to providing nursing care. This qualitative study explores nurses' and culturally diverse patients' experiences within nurse-patient relationships in acute care wards. Eight nurses and their respective patients volunteered to join the study and were interviewed. The three themes identified in relationships between nurses and culturally diverse patients were shared tension, perceived difference and held awareness. It is concluded from the study that relationships between nurses and culturally diverse patients in acute care wards during short episodes of hospitalization are not easy for nurses and need to receive deeper consideration as to how they can be developed more effectively. It is recommended that educational support be provided to develop more effective interactions between nurses and patients with research being carried out to investigate factors that can strengthen culturally diverse patient-nurse interactions in acute care settings.     

Cardiac nurses' preparedness to use self-help groups as a support strategy

Self-help groups are lay, mutual support groups in which people who share some long-term existential problems in their lives meet regularly to support each other empathetically These groups can be viewed as supplementary sources of support outside patients' existing social networks As such, it is of importance to be aware of them when planning nursing care The aim of this study was to examine cardiac nurses' preparedness to use self-help groups as a support strategy A qualitative research method was used and 12 registered nurses from two coronary care units were interviewed The findings showed that nurses' knowledge of social support, self-help groups and of patients' social circumstances as well as their attitudes to their own roles as nurses were of importance in their preparedness to use self-help groups as a support strategy Lack of knowledge of social support and self-help groups affected the nurses attitudes towards lay care and was probably the reason for not using self-help groups as a support strategy Most of the nurses were well informed about their patients' social circumstances, they had an explicit family nursing approach and were not at all against further expansion of their nursing role However, there is a need for education in innovative ways of working that respond to and interact with informal support networks if nurses are to be able to contribute to empowerment of their patients     

Application of Orem's Self-Care Deficit Theory to the pediatric chronically ill population

The conditions under which children with long-term chronic health problems are cared for have changed dramatically in the past decade. These children are more often living longer and being cared for at home by their families and nursing supports. An effective tool allowing nurses to systematically assess, plan, implement, and evaluate the care needs of these children is a nursing theory. Orem's (1985) self- or dependent-care deficit theory is a useful basis from which the care of the chronically ill pediatric population can be planned. Attention is given to a caring relationship in which there is a dependent person in need of care and an individual who serves as that dependent person's agent of care. This article discusses several of the major concepts of the self- or dependent-care deficit theory and how it can be applied to guide clinical nursing practice aimed at meeting the care demands of the pediatric chronically ill population and their families.     

Palliative care in Irish nursing homes: the work of community clinical nurse specialists

AIM: to assess the current level of input from community-based clinical nurse specialists in palliative care into nursing homes in the Republic of Ireland. METHOD: a national survey was undertaken with questionnaires distributed via the National Council for the Professional Development of Nursing and Midwifery database. The total population was 114 community-based clinical nurse specialists in palliative care. FINDINGS: 63 completed questionnaires were returned achieving a 55% response rate. All respondents had undertaken work with nursing homes. The main focus of interactions with nursing homes was on pain and symptom management and this was often provided by telephone. The majority of nurses were involved exclusively in care of patients with cancer, although 40% of respondents cared for patients with non-malignant diseases. CONCLUSIONS: As populations age and more people end their lives in residential care settings, this area of care has increasing relevance. The dissemination of palliative care best practice would ensure that all patients, regardless of their diagnosis, receive the benefits of palliative care at the end of life. Clinical nurse specialists are ideally placed to provide education and support to nursing homes and other residential care settings for older people.     

Family Nursing Practice in Public Health: Finland and Utah

Abstract This exploratory study of family nursing practice in public health care was conducted in Finland and Utah. Staff nurses were interviewed in focus groups and asked to describe their practice of family nursing, the factors promoting and restraining practice, and the impact of the changes in health care delivery on practice. Thirty-six Finnish and 30 Utah nurses participated. Pressure to do more activities with fewer nurses and resources, changes in family problems, and skill level of the nurses were common themes. However, differences were evident. Finnish public health nurses used emotional support and information to help families empower themselves to use resources and to strengthen their family unit. Utah nurses focused first on individual level goals and then family cohesion and health. Nurseinitiated referrals and direct physical care were the primary intervention strategies of Utah nurses. Unlike the U.S. health care system, access for all in maternal and child health care and school health allowed Finnish nurses to develop long-term relationships with families, thus advancing family nursing practice. This study identifies several potential variables for further study particularly related to the organization of health care and nurse-family relationships.     

Engagement and detachment: understanding patients' experiences with nursing

This study aimed to understand what post-operative patients perceived was important about the nursing care they had experienced. The participants were nine women recovering from total hip replacement surgery which had been performed in a large public, acute care hospital in south Australia. Participants volunteered to be involved in the study and were interviewed pre- and post-operatively and interviews continued in their home environment following discharge. The study took place during 1995 within a 10-month time frame. Methodological guidance was sought from the phenomenology literature, with the ideas from Husserl and Heideggar providing shape for the interpretive framework. The analysis of data utilized Colaizzi's (1978) seven procedural steps. For the purposes of this paper the authors have selected to focus only on the findings of this study. Two major themes emerged from the conversations with women. Patients described nurses as being engaged or detached with their nursing care. These themes will be explicated in this paper. In the light of these dominant themes the nursing literature around engagement and detachment are examined. The implications for nursing practice are discussed.