Parents' perceptions of chronic illness trajectories.

The notion of a small, generic set of chronic illness trajectories that can be independent of specific medical diagnoses, though controversial, has some theoretical, clinical, and qualitative research support. The purpose of this study was to quantitatively describe trajectories among parents of children with a chronic condition. It was hypothesized that factor analysis would confirm 3 trajectories similar to those in the qualitative literature and that parents' perceptions of their child's trajectory would differ significantly from medically based perceptions. A total of 140 parents provided data on their perceptions of the past, present, and future course of the condition of their repeatedly hospitalized child. Fourteen time-related items from the Coping Health Inventory for Parents Questionnaire on Resources and Stress and the Parenting Stress Index were analyzed. Pre- and post-hospitalization factor analyses extracted the same 8 items to construct 3 trajectories: Life Threatening; Declining; and Stable, Optimistic. The views of approximately one third of the parents differed from medically based classifications. Type of nursing care had no bearing on the perceptions of the parents.     

Patients' and nurses' perceptions of quality nursing activities

Nurses and patients come from varying backgrounds and have different life experiences. Their perceptions regarding what comprises quality nursing care may differ. The objective of this article was to determine whether there is a difference in the perceived importance of nursing activities from the point of view of patients and nurses. If differing perceptions were found, the goal would then be to increase nursing awareness of these differences. A convenience sample of 30 nurses and 30 patients on a medical-surgical unit were surveyed about nursing care using a 41-item questionnaire. Data obtained were divided into four classes of nursing activities: psychosocial, physical, safety, and indirect. There was a significant difference in the perceived importance of nursing activities by nurses and patients in the psychosocial and safety categories. Nursing activities that may not be recognized as such by patients, or which are not seen as important to quality care, should be clarified for patients. Clarification may also be useful in helping patients to understand the professional nursing role. In addition, this insight may heighten patient satisfaction with caregiving.     

Patients' perceptions of barriers for participation in nursing care

Scand J Caring Sci; 2011; 25; 575–582
Patients’ perceptions of barriers for participation in nursing care Background: In many Western countries as in Sweden, patients have legal right to participate in own care individually adjusted to each patient’s wishes and abilities. There are still few empirical studies of patients’ perceptions of barriers for participation. Accordingly, there is a need to identify what may prevent patients from playing an active role in own nursing care. Such knowledge is highly valuable for the nursing profession when it comes to implementation of individual patient participation. Aim and objective: To explore barriers for patient participation in nursing care with a special focus on adult patients with experience of inpatient physical care. Methodological design and justification: Data were collected through 6 focus groups with 26 Swedish informants recruited from physical inpatient care as well as discharged patients from such a setting. A content analysis with qualitative approach of the tape‐recorded interview material was made. Ethical issues and approval: The ethics of scientific work was adhered to. Each study participant gave informed consent after verbal and written information. The Ethics Committee of Göteborg University approved the study. Results: The barriers for patient participation were identified as four categories: Facing own inability, meeting lack of empathy, meeting a paternalistic attitude and sensing structural barriers, and their 10 underlying subcategories. Conclusions: Our study contributes knowledge and understanding of patients’ experiences of barriers for participation. The findings point to remaining structures and nurse attitudes that are of disadvantage for patients’ participation. The findings may increase the understanding of patient participation and may serve as an incentive in practice and nursing education to meet and eliminate these barriers, in quality assurance of care, work organization and further research.     

Assisted living nursing practice: health literacy and chronic illness management

Functional illiteracy is an inability to read sufficient to function in society. In the high-tech, information-dependent environment of postindustrial society, being illiterate is being at risk. Health literacy is the ability to access, understand, and use basic information about health conditions and services that is necessary to make informed decisions. Older adults (>/=65 years of age) have lower health literacy than all other age groups. Limited health literacy is associated with greater use of emergency department visits, increased rates of hospitalization, and failure to take important diagnostic tests. To maintain independence and self-determination, assisted living (AL) residents need to be able to understand a new or changed diagnosis, as well as oral and written instructions, especially with regard to their medication management. This article discusses health literacy, "plain language," and assessment and interventions to maintain health literacy.     

Ambiguous chronic illness in women: community health nursing concern

The purpose of this study was to explore how women with ambiguous chronic illness, such as celiac disease and interstitial cystitis, cope with the difficulty of being diagnosed and the subsequent realities of daily life. A convenience sample of 15 women with chronic ambiguous illness in 4 geographic areas was interviewed via qualitative methods. Data were analyzed using conceptual coding and constant comparative methods. These categories were identified: persistence in obtaining a correct diagnosis, trivialization and stigmatization, embarrassment, being an inconvenience, and ways of coping. Women were misdiagnosed for years (R = 2 to 11) and felt dismissed as being depressed or hysterical. Yet, they emphasized that persistence in obtaining a correct diagnosis is essential even though it may mean suffering embarrassment and inconvenience. Suggestions for community health nurses to improve the lives of women with ambiguous chronic illness are offered.     

Patients' perceptions of nursing practice. A rationale for a qualitative research approach.

The discipline of nursing is, in Sweden, in the early stages of discovering and expanding specific knowledge embedded in nursing practice. This is a challenging as well as a problematic venture. It is important to evaluate nursing practice within the specific cultural context before applying terminology and meaning of concepts used. The purpose of this paper is to present a basis for the study of perceptions of nursing practice as experienced by the patient himself in a specific cultural context. The historical context, the terminology commonly used, and relevant research in this domain of inquiry is critically examined as a means of determining appropriate research methods for further study in the domain of nursing practice.     

A nursing practice model for chronic illness.

As the 21st century approaches, one very important issue for nursing is the increased prevalence of chronic conditions such as arthritis. Self-management is one way that individuals can cope with the uncertainty and many changes chronic illness brings. The purpose of this article is to describe a nursing model that addresses the need for enhanced self-management skills and the rehabilitation nurse's role in this process. The model is based on the concept of intentional action and uses Orem's (1995) self-care deficit nursing theory as its conceptual structure. The expected outcomes of care for clients are effective self-management skills and subsequently improved health status and quality of life. The model will be useful in the design of rehabilitation nursing research as well as in the planning of care for individuals with chronic illness.     

Patients' and nurses' perceptions of the quality of nursing care in Kuwait

Using an exploratory research method and a purposive sample of 259 subjects (109 of whom were nurses and 148 patients), data were collected using an instrument consisting of the elements of the nursing process. Four hypotheses were tested, using the analysis of covariance and the t -test The result of hypothesis I showed that there was no statistically significant difference in the perception of the quality of nursing care between the patients in the medical and surgical units of the five study hospitals. Hypothesis 2 indicated that there was no significant difference between nurses in the medical-surgical units in the areas of assessment, planning and implementation. However, a significant difference was found for accountability and responsibility. Further analysis using a t -test showed a significant difference between nurses in the medical and surgical units in the areas of accountability and responsibility. The data for hypothesis 3 and 4 yielded no significant difference in the perceptions of quality care by nurses according to work experience and by patients in all hospitals regardless of the patients' age and sex.     

Patients' and nurses' perceptions of nursing problems in an acute care setting

AIM: This paper reports a study to determine the degree of agreement or disagreement between nurses and patients in their perceptions of the presence, severity, and importance of nursing problems. BACKGROUND: Patient experiences, values and preferences are increasingly acknowledged as important factors underpinning healthcare decision-making. The ability to identify patient problems accurately is an important prerequisite for planning and implementing individualized high quality care. METHODS: A convenience sample of patients (n = 80) and Registered Nurses (n = 30) in an acute care setting responded to a 43-item questionnaire. Findings. Nurses identified patients' problems with a sensitivity of 0.53 and a positive predictive value of 0.50. Patients identified several severe problems that were not identified by nurses, particularly problems with nutrition, sleep, pain, and emotions/spirituality. Nurses underestimated the severity in 47% of mutually-identified problems. An overall level of agreement of 44% was found on the importance of patient problems. Low levels of agreement on severity and importance were related more to individual differences than to systematic differences. CONCLUSIONS: Nurses need to be more aware that patients and nurses often hold disparate views of the priorities in nursing care. To plan individualized nursing care effectively, nurses need to elicit and use individual patients' preferences more systematically in care planning.     

Adaptation to chronic illness. Analysis of nursing research

The review of reported nursing research on chronic illness has many implications for nursing practice. Results of these studies may be implemented in many of the interventions provided for chronically ill patients. There needs to be collaboration between the researcher and practitioner to share knowledge of interventions that promote adaptation to chronic illness, and to investigate new and innovative therapies. Another contribution to nursing practice is the psychosocial variables that affect adaptation of chronically ill patients. Depending on the health problem and practice setting, nurses need to identify which variable may increase the effectiveness of their interventions and how they can best promote adaptation. Particularly noticeable was the absence of studies on the prevention of chronic illness. Although there is documented evidence of the relationship between stress and illness, and predictions that future environments will be even more stressful, a needed area for nursing research is prevention of chronic health problems. Areas such as stress management, health promotion, relaxation training, and behavior modification are timely subjects for nurses to research for prevention of these problems. There are merits to studying a particular chronic health problem in depth and in studying the commonalities among several chronic illnesses. With knowledge of both the physical and psychosocial, nurses are in an ideal position to contribute to the knowledge base of human responses to chronic illnesses.     

Patients' perceptions of bedside handover

Gone are the days when a nurse would discuss a patient's progress in a matter of fact way behind their back when handing over their care to a colleague. Handover has now moved from the office to the bedside to maximise patient involvement and continuity of care. Catherine Greaves reveals how patients perceive this practice.