Oncology patients' and oncology nurses' perceptions of nurse caring behaviours

Previous research on patients' and nurses' perceptions of nurse caring behaviours has documented significant differences in the ranking of important behaviours. However, these samples have included a variety of medical-surgical patients and nurses and different types of institutional settings, all of which may have affected the results. The present study sought to determine if patients and nurses from one subspecialty area and one institution would have more concordant perceptions of caring. Forty-four oncology patients and 49 oncology nurses completed the Respondents Perceptions of Caring Behaviour Scale (RPCBS). Results showed that overall mean patient rankings were highly correlated with mean nurse rankings (Spearman's correlations coefficient 0.94, P<0.0001). The Wilcoxon two-sample rank sum test was used to test the difference in rank of the 20 items between the patients and nurses. There was a significant difference in rank in only six of the 20 items. These data suggest that oncology patients and nurses have more concordant perceptions of caring than previously investigated groups. Implications for practice and further research are discussed.     

Nurse caring behaviours

The purpose of this research paper is to examine caring behaviours and how they relate to nurses practice from the psychiatric and general nurses' views. Whether this caring is influenced by the nurses' age, gender or qualification is also examined. The convenience sample used were nurses ( n =118) of all grades and experience in a general hospital and in a psychiatric hospital. The Care-Q instrument was used. The response rate was 66%. Statistical analysis included rankings of sub-scale and individual items and the chi-square test of association. The results show that nurses ranked physically based caring behaviours higher than affective behaviours. They emphasized monitoring and comforting behaviours but paid less attention to anticipatory behaviours. Gender appeared to have the greatest influence on what caring behaviours were valued. Male nurses were less likely than female nurses to be accessible, forming trusting relationships or performing comforting behaviours. The results challenge both nurses and nurse educators to examine caring behaviours in nursing practice.     

Suicidal patients as experienced by psychiatric nurses in inpatient care

Psychiatric nurses have a major influence on the lives of patients with suicidal behaviour in inpatient care. Despite this, there is a lack of knowledge about how nurses experience patients with suicidal behaviour in a deeper sense. The aim of this study was to investigate how psychiatric nurses experience patients with suicidal behaviour within an inpatient psychiatric context. Semi-structured interviews were carried out with 11 psychiatric nurses, each of whom had more than 5 years of experience caring for patients with suicidal behaviour. Data were analysed using qualitative latent content analysis. Two main themes emerged from the data analysis. These are 'labelled' and 'suffering'. In the nurses' natural attitude, they saw patients as being labelled with different conditions and/or behaviours based on objective signs. These were categorized into different groups or identities such as psychiatric diagnosis, mask wearer, screened-off, or the social, relapsing or determined patient. On reflection, however, the nurses described the patients' suffering in terms related to feelings of hopelessness, meaninglessness, and being out of control. The nurses' experiences of the patients as suffering were based on their subjective reflective experience of the patients. The study gives support to the conclusion that two main logic systems are represented in the care of patients with suicidal behaviour: technical practical and nursing perspectives. In order to ensure that these two logic systems combine, it is necessary for the psychiatric care organization to intervene to support the nurses in reflecting on their everyday work.     

Patient-centred care and nurses' health: the role of nurses' caring orientation

Title.  Patient-centred care and nurses' health: the role of nurses' caring orientation.
Aim.  This paper is a report of a study of the moderating effect of caring orientation on the relationship of patient-centred care to nurses' physical and mental health.
Background.  Providing effective patient-centred care is well-accepted as an important contributor to a host of patients' health outcomes. Based on two theoretical perspectives – person–environment fit and emotional labour – I suggest that providing patient-centred care per se does not potentially harm nurses' health; the cause is the fit (or non-fit) of a nurse's caring orientation and the displayed patient-centred care behaviours.
Method.  Data were collected in 2007 with a random sample of 325 registered nurses working in the Israeli public healthcare sector in in-patient units. Caring orientation, health and control variables were measured via validated questionnaires. Patient-centred care behaviours were assessed by structured observations.
Results.  The mental health of nurses who exhibited high caring orientation combined with high patient-centred care, or that of nurses who exhibited low caring orientation combined with low patient-centred care, was statistically significantly higher in comparison with the mental health of nurses who exhibited incongruent (low/high or high/low) caring orientation and patient-centred care behaviours. For nurses' physical health, the findings revealed that providing patient-centred care was associated with worsened health, and possessing a caring orientation was associated with better health.
Conclusions.  The findings support the hypotheses that were derived from person–environment fit and emotional labour only with regard to mental health. Separate theory needs to be developed on how to maintain nurses' physical health.     

Factors which influence how nurses communicate with cancer patients

Communication is one of the most important aspects of cancer nursing. Evidence suggests nurses experience communication difficulties and frequently block patients from divulging their worries or concerns. This paper focuses on a study which aimed to determine: (a) the extent to which nurses facilitate or block patients and awareness of their verbal behaviours; (b) whether there is a relationship between nurses' verbal behaviours and levels of anxiety, social support, work support and attitude to death; and (c) nurses' difficulties in caring for cancer patients. The study was conducted in a specialist and non-specialist hospital. Fifty-four registered nurses completed three audio-taped histories (one with a new cancer patient, a patient with a recurrence and a patient for pallative care), a self-administered questionnaire and a semi-structured audio-taped interview. The data were analysed using SPSSX. The findings indicate an overall poor level of facilitative communication, with a patient's recurrence causing most difficulties. There is evidence to suggest the way nurses communicate may depend on the environment created by the ward sister, the nurses' religious beliefs and attitude to death rather than specific education in communication skills.     

Registered Nurses' work experiences: personal accounts integrated with professional identity

BACKGROUND: The work context is important for the development of Registered Nurses' skills and identity as professionals, but the work context and organization can also hinder their professional development. AIM: This paper reports a study whose purpose was to understand the meaning of Registered Nurses' narratives of their work experience 5 years after graduation. RESEARCH METHOD: Data were collected in 2001 from interviews with 16 Registered Nurses 5 years after graduation and analysed using a phenomenological hermeneutic method, influenced by the philosophy of Paul Ricoeur. RESULTS: Analyses of the narratives resulted in three themes: 'The meaning of caring and protection of patients', 'The meaning of work organization in nurses' work' and 'The implied meaning of using one's individual attributes in one's professional role'. Since the number of nurses participating in the study is small, it is important to re-contextualize the results when transferring them to other contexts. CONCLUSIONS: There is a complex interrelationship between the health care organization, individual attributes of nurses (including self-esteem) and patient care. Provision of adequate resources and support for nurses' professional and personal development is needed to ensure high quality patient care, and these are political issues.     

Nurses'' behavioural intentions towards self-poisoning patients: a theory of reasoned action, comparison of attitudes and subjective norms as predictive variables

BACKGROUND: The incidence of self-poisoning is on the increase. Most patients who self-poison are dealt with initially in the general hospital. Therefore, the type and quality of care self-poisoning patients receive will depend, in part, on how they are viewed by nursing staff within the general hospital setting. A knowledge and understanding of the attitudes held by nurses towards self-poisoning patients is therefore important to those involved in the planning and delivery of care towards this client group. Previous studies have examined health care professionals' attitudes towards people who self-poison. Usually, however, these have not focused specifically on nurses' attitudes, and they have ignored the relationship between the attitudes expressed by staff and their intentions to engage in subsequent caring behaviour of one sort or another. It is hence unclear how the findings of such studies are relevant or applicable to nursing policy and practice. AIMS: The present study aims to address these limitations using a methodology informed by the theory of reasoned action. The study aims to separate out the distinctive roles played by nurses' own attitudes, and the social pressures represented by other people's attitudes, in determining the types of caring behaviour in which nurses intend to engage when dealing with self-poisoning patients. DESIGN/METHODS: The study adopts a questionnaire-based approach incorporating two specially designed vignettes. RESULTS: The results show that nurses' own attitudes, and what they believe about the attitudes of others, predict their behavioural intentions towards self-poisoning patients. The study also shows that nurses with a more positive orientation towards self-poisoning patients differ in behavioural and normative beliefs from nurses who have a less positive orientation. CONCLUSIONS: The implications for future attempts to explore the relationship between nurses' attitudes and subsequent caring behaviour are considered, along with implications for nursing policy and practice.     

Development of an administrative ethical behaviour scale

The aim of this study was to develop an Administrative Ethical Behaviour Scale (AEBS) and to determine whether nurses found their head nurses' behaviours ethical and to reveal head nurses' ethical and unethical administrative behaviour. It was conducted on 264 nurses working in five state hospitals in Trabzon, Turkey. Content validity index of the scale was 0.87, item-to-total correlations ranged from 0.50 to 0.81 and Chronbach Alpha was 0.98. The scale included five subscales, i.e. truthfulness and honesty, liabilities and supremacy of laws, rights and freedom, good human relationships and humanism, justice and equality. Overall, head nurses' behaviour was considered ethical by nurses; however, their behaviour in terms of justice and equality, good human relationships and humanism was not found ethical. Positions, satisfaction with head nurses' behaviour and frequency of contact with them affect nurses' opinions.     

Nursing care of older people: a personal construct theory perspective

This paper outlines the use of the repertory grid technique, with nurses caring for elderly residents, and residents of a nursing home. The method focuses on the individuality of each person's attempt at making sense of her/his caring world. Previous papers have focused on a discussion of the repertory grid technique as a research method and tool for psychiatric nurses, an overview of studies using this technique with nurses and social workers, and applications of personal construct theory (from which the technique is derived) to nursing research. A paper by Rawlinson described content analysis of the role constructs elicited from the nurses. In this study, content analysis of caring constructs elicited by nurses and residents was also undertaken, and the results are presented. Additionally, principal component analysis of the repertory grids was carried out, and three examples are presented. This combined analysis provides an in-depth insight into nurses' perceptions of caring for others; perceptions which guide their caring behaviours. This information can be used by individual nurses to review their caring practice.     

A Chinese version of the Caring Assessment Report Evaluation Q-sort scale for measuring patients' perception on nurses' caring behaviours: Reliability and validity assessment

A reliable and valid instrument for understanding patients' perceptions of nurses' caring behaviour as well as assessing the quality of nursing care is necessary. The purpose of this study was to assess the reliability and validity of a Chinese version of the Caring Assessment Report Evaluation Q-sort (CARE-Q) Scale for the measurement of patients' perceptions of nurses' caring behaviours. The study sample comprised 250 patients from a medical centre in central Taiwan. Content validity, construct validity, internal consistency and stability reliability were assessed. The Content Validity Index of the Chinese version of CARE-Q was 0.90. Cronbach's alpha indicated good internal consistency reliability. Stability reliabilities for the six subscales ranged from 0.83 to 0.92. The results reveal that the Chinese version of the CARE-Q scale for the measurement of patients' perceptions on nurses' caring behaviours indicates high reliability (internal consistency and stability) and good content validity.     

The relationship between nurses' personality and stress levels reported when caring for interpersonally difficult patients.

The aim of this study was to investigate the self-reported stress in a group of nurses caring for patients with interpersonally difficult behaviours at four Melbourne hospitals. An examination was undertaken of the role played by the personality construct known as Lifestyle, in nurses' cognitive appraisal of interpersonal stressors. One hundred and ten nurses completed the Basic Adlerian Scales for Interpersonal Success, Adult Version (BASIS-A) personality inventory and the Difficult Patient Questionnaire (DPQ) and a subgroup of 40 nurses were subsequently interviewed. The interviews were analysed with the Alexis lexical thematic content analysis computer program using the Harvard III Psychosociological Dictionary. The results revealed no significant correlations between stress and the nurses' demographic or professional backgrounds. However, very specific and significant correlations between certain personality profiles and stress levels were detected. Lexical thematic content analysis indicated that nurses who reported high stress differed significantly from those reporting low stress in the psychological processes they used when caring for interpersonally difficult patients. These findings suggest that the personality construct of Lifestyle plays an important role in regard to the stress response of these nurses. The implications of the findings include the possibility of structuring interventions based on Individual Psychology that may assist nurses to better deal with interpersonal conflict in patient care, and hence to reduce their own stress levels.     

Cautious caregivers: gender stereotypes and the sexualization of men nurses' touch

AIM: The aim of this research was to explore the experience of men nurses and the ways in which gender relations structure different work experiences for women and men in the same profession. BACKGROUND: Men are now entering the nursing profession in record numbers and challenging the notion that men are inappropriate in caregiver roles or incapable of providing compassionate and sensitive care. A limitation of the current state of knowledge regarding caring and men nurses is that it is primarily focused on men nursing students, not practising nurses. Little is known about men nurses' practices of caring and how such practices reflect the gendered nature of nursing and nurses' caring work. METHODS: The theme of men nurses as cautious caregivers emerged from data that were collected in two rounds of semi-structured interviews with eight men nurses practising in Nova Scotia, Canada. Thematic analysis, informed by feminist theory and masculinity theory, was used as the method for analysing the data. FINDINGS: For men nurses, the stereotype of men as sexual aggressors is compounded by the stereotype that men nurses are gay. These stereotypes sexualize men nurses' touch and create complex and contradictory situations of acceptance, rejection and suspicion of men as nurturers and caregivers. They also situate men nurses in highly stigmatized roles in which they are subject to accusations of inappropriate behaviour. For men nurses, this situation is lived as a heightened sense of vulnerability and the continual need to be cautious while touching and caring for patients. Ultimately, this situation impacts on the ability of men nurses to do the caring work they came into nursing to do.     

Impact of the perceived public image of nursing on nurses' work behaviour

AIM: This paper reports a study comparing nurses' perceptions of their public image with their self-image, and examining how the relationship between their perceived public image and self-image was associated with their job performance and turnover intentions. BACKGROUND: The stereotypical public image of nursing is a major concern to nurses. However, it is relatively unknown how this image affects nurses. A few studies have investigated how nurses' interpretations of their public image affect their self-image and work behaviour. METHODS: A convenience sample of 346 Australian nurses participated in a questionnaire study in 2003. The results were analysed by t-test, polynomial regression and response surface analysis. Six participants from the survey participated in a focus group to provide further interpretation of the findings. RESULTS: Nurses rated their aptitude for leadership more positively than they thought the public viewed them. In contrast, nurses rated their image as being caring less negatively than their perceived public image. Job performance was predicted by self-image relating to leadership aptitude. On the contrary, the relationship between self-image and perception of the public image as being caring predicted job performance. When nurses perceived their public image as caring less positively than their self-image, their job performance tended to improve. As for turnover intention, both self-image and perceived public images of having an aptitude for leadership and being caring were negatively related to intention to quit the job. CONCLUSION: To enhance nurses' job performance and reduce their turnover intentions, it is important to improve both the public image and self-image of nurses.     

Difficulties encountered by nurses in the care of terminally ill cancer patients in general hospitals in Japan

The aim of this study was to investigate the difficulties encountered by nurses who have cared for terminally ill cancer patients at general hospitals. To collect data, a survey by questionnaire was self-administered. The respondents were 375 nurses and the response rate was 70.2%. Factor analysis was conducted on 80 items related to the difficulties encountered by nurses who have cared for terminally ill cancer patients to allow reasonable item reduction and to explore better domains. Two items were excluded and the results revealed eight underlying domains: 'Communication with patients and families', 'Knowledge and skill of nurses', 'Treatment and informed consent (IC)', 'Personal issues', 'Collaboration as a team including patients and families', 'Environment and system', 'Collaboration among nurses', and 'Near-death issues'. Cronbach's alpha coefficients for each domain ranged from 0.77 to 0.93. The results showed that nurses working at general hospitals have experienced a high degree of difficulty overall while caring for the dying, particularly with communication with patients and families. It was concluded that this study was useful in determining the specific areas where nursing education and research should be focused.     

Differences and similarities in the perception of caring between Spanish and UK nurses

The aim of the present paper was to compare and contrast perceptions of caring in nursing between Spanish and UK nurses. There are no previous studies comparing directly the perceptions of caring across cultures in nursing. A survey method was used employing the 25-item Caring Dimensions Inventory. Data were Mokken scaled for comparison with data from a previous study and scores for common items on the 25-item Caring Dimension Inventory for Spanish and UK nurses were correlated. There were similarities and differences between Spanish and UK nurses' perceptions of caring: many similar items were incorporated into Mokken scales but the endorsement of items did not correlate. The present work demonstrates that it is possible to measure differences and similarities in perceptions of caring. The study design could be improved and such work could be valuable in cross-cultural work with nurses.     

Male identity in mental health nursing

AIM: To explore the cultural meaning associated with male mental health nurses. METHOD: An ethnographic approach was used to discover the meaning informants attach to the cultural norms, values and rules that govern their behaviour. Data were collected through participant observation and in-depth interviews with informants. RESULTS: Data were analysed using emerging domains and taxonomies regarding male nurse issues. This involved grouping terms, words and everyday reflections collected from the male mental health nurses. These lists of data (taxonomies) enabled the researcher to identify in-depth cultural themes about the attitudes, behaviours and symbolism typically associated with male nurses. CONCLUSION: A number of cultural themes emerged, including the notion of 'soft masculinity', which provided some insight into male nurses' experiences of working in a female-dominated workplace. A recurring theme was the need for male nurses to demonstrate gentleness and caring while maintaining a balanced sense of masculine identity.