A qualitative content analysis of nurse-patient communication in Iranian nursing

Fakhr‐Movahedi A., Salsali M., Negharandeh R. & Rahnavard Z. (2011) A qualitative content analysis of nurse–patient communication in Iranian nursing. International Nursing Review 58 , 171–180 Background: Communication is the source of patients' health promotion, and nurses cannot do their duties without communicating with patients. Nurses with good communication skills have a great role in alleviating the stressful identity of hospitalization for both patients and their families. Aim: To explore cultural and contextual factors influencing nurse–patient communication according to lived experiences of Iranian nurses and patients. Methods: The participants in this qualitative study consisted of eight bachelor's degree nurses and nine patients hospitalized in surgical and medical wards of a referral teaching hospital in Tehran, Iran. Data were gathered through unstructured and semi‐structured interviews as well as observations. The data were analysed using a content analysis approach. Findings: The data analysis revealed the following theme that encompassed nurse–patient communication in Iranian nursing: ‘a patient‐centred attitude in the shadow of mechanistic structure’. This theme consisted of three categories: (1) communication as the essence of nursing care, (2) reactive communication and (3) difficulties of nurse–patient communication. Conclusion: In spite of the nurses' and patients' belief in the importance of communication, in practice each party's role in communication leaves much to be desired. This is because of some structural and socio‐cultural factors that hinder effective communication. More attention should be paid by policy makers to remove factors that hinder the nurse–patient communication process.     

Capacity for care: meta‐ethnography of acute care nurses' experiences of the nurse‐patient relationship

Aims

To synthesize evidence and knowledge from published research about nurses' experiences of nurse‐patient relationships with adult patients in general, acute inpatient hospital settings.

Background

While primary research on nurses' experiences has been reported, it has not been previously synthesized.

Design

Meta‐ethnography.

Data sources

Published literature from Australia, Europe, and North America, written in English between January 1999–October 2009 was identified from databases: CINAHL, Medline, British Nursing Index and PsycINFO.

Review methods

Qualitative studies describing nurses' experiences of the nurse‐patient relationship in acute hospital settings were reviewed and synthesized using the meta‐ethnographic method.

Results

Sixteen primary studies (18 papers) were appraised as high quality and met the inclusion criteria. The findings show that while nurses aspire to develop therapeutic relationships with patients, the organizational setting at a unit level is strongly associated with nurses' capacity to build and sustain these relationships. The organizational conditions of critical care settings appear best suited to forming therapeutic relationships, while nurses working on general wards are more likely to report moral distress resulting from delivering unsatisfactory care. General ward nurses can then withdraw from attempting to emotionally engage with patients.

Conclusion

The findings of this meta‐ethnography draw together the evidence from several qualitative studies and articulate how the organizational setting at a unit level can strongly influence nurses' capacity to build and sustain therapeutic relationships with patients. Service improvements need to focus on how to optimize the organizational conditions that support nurses in their relational work with patients.     

Cancer patients' perceptions of quality‐of‐care attributes—Associations with age,perceived health status,gender and education

Aims and objectives

The aim of this study was to explore the associations between patients' gender, education, health status in relation to assessments of patient‐centred quality and individuality in care and trust in nurses for those <65 (working age) and ≥65 years (older people).

Background

Patients' assessments of the quality of care they receive are essential for the development of the provision of patient care and services. Previous studies have revealed age of the patient is associated with their assessment of care quality attributes.

Design

The study employed a cross‐sectional, multicultural comparative survey design.

Methods

The data were collected using questionnaires among hospitalised cancer patients (N = 876, n = 599, 68%) in four European countries: Greece, Cyprus, Sweden and Finland. The data were divided into two subgroups based on age (cut point 65 years) and were analysed statistically.

Results

Cancer patients' age, gender and level of education were not related to their assessments of care quality attributes: person‐centred care quality, individuality in care and trust in nurses. Subgroup analysis of the older adults and those of working age showed clear associations with patients' assessments of quality‐of‐care attributes and perceived health status. The lower the perceived health status, the lower the assessment of care quality attributes.

Discussion

The results suggest that the cancer itself is the strongest determinant of the care delivered, rather than any patient characteristics, such as age, education or gender. Perceived health status, in association with cancer patient assessments of care quality attributes, may be useful in the development of patient‐centred, individualised care strategies alongside a stronger focus on people instead of cancer‐care‐related processes and duties.

Conclusions

Health status was the only factor associated with cancer patients' assessments of care quality attributes. Cancer itself may be the strongest determinant of the care quality perceptions, rather than any patient characteristics.

Relevance to clinical practice

The findings of this study have implications for cancer care professionals in terms of patient assessment and care planning. The measures may be useful in assessing quality of cancer nursing care.     

To surrender in dependence of another: the relationship with the ambulance clinicians as experienced by patients

Historically, the ambulance care has focused on acute transports and medical treatment, although ambulance care has also been reported as complex, encompassing more than just medical treatment and transports. Previous studies, on ambulance clinicians, have pointed out the importance of interpersonal caring activities complementary to the medical treatment. Those activities can be understood as taking part in the relationship between patients and ambulance clinicians, earlier described as essential and a core component of care. The aim of this study was to elucidate the meaning of the relationship with the ambulance clinicians as experienced by patients. Twenty ambulance patients were interviewed in the study. The interviews were transcribed verbatim and analysed with a phenomenological hermeneutical method to grasp meanings in the patients' experiences. The regional ethical committee approved the study. In the result emerged one main theme: To surrender in dependence of another. The main theme includes four themes: Being in the hands of another, Being in a caring temporary presence, Being important while involved and Being powerless while insignificant, and the themes comprise eleven subthemes. The main theme meant to have no other option than to surrender and to put their life into the hand of another. This surrender also meant to adapt to the clinicians' views even if not shared. This is experienced as excessive care. Summarised, the patients' experiences were both positive and negative and the findings provide a complex understanding of the relationship between the patient and the ambulance clinicians. Overall, the relationship embraces the whole person without reducing the patient to be a recipient of an objectified ambulance care.     

The meaning of a consultation with the diabetes nurse specialist

Scand J Caring Sci; 2010; 24; 341–348
The meaning of a consultation with the diabetes nurse specialist Objective: The aim of this study was to elucidate the essential meaning of a consultation between diabetes nurse specialists and patients to gain a deeper understanding of the patients’ experiences. Methods: Twenty patients with type 2 diabetes were interviewed about their experience of a consultation at an annual check‐up with the diabetes nurse specialist. A phenomenological hermeneutic method was used in the analysis and interpretation of the text. Results: The patient’s experience of a consultation was interpreted as manifestation of hold on the disease control. This means a safeguard to continue daily life shown in the four themes being controlled, feeling exposed, feeling comfortable, and feeling prepared. Conclusion: The patients’ experiences of a consultation with the diabetes nurse specialist became the basis for a health maintenance process in dealing with critical health–disease aspects. Implications to practice: In a consultation, professionals have to take into account the potential emotional turbulence that disease progression can mean to a patient. Diabetes care implies patient dependence on support to avoid a potential self‐management insufficiency and call attention to professionals’ time for listening to patients’ perceptions.     

Development and testing of a patient‐centred care competency scale for hospital nurses

This study aimed to develop and test the psychometric soundness of a patient‐centred care competency (PCC) scale for hospital nurses. A cross‐sectional questionnaire survey was conducted among 594 nurses in two teaching hospitals (response rate 99.5%). Reliability and validity analyses were performed. The PCC scale consisted of 17 items divided into four subscales: respecting patients' perspectives (6 items), promoting patient involvement in care processes (5 items), providing for patient comfort (3 items) and advocating for patients (3 items). The Cronbach's alpha coefficient of the entire scale was 0.92, and those for the subscales were 0.85, 0.81, 0.84 and 0.80, respectively. Multitrait scaling analysis indicated that the four subscales had satisfactory convergent and discriminant validity. Significant correlations were found between total PCC scores and overall self‐ratings of patient‐centred care performance (r = 0.60, P < 0.001). The PCC scale was therefore determined to be a highly valid and reliable tool.     

The factors that influence nurses' use of physical restraint: A thematic literature review

Lane C, Harrington A. International Journal of Nursing Practice 2011; 17 : 195–204 The factors that influence nurses' use of physical restraint: A thematic literature review Difficult clinical situations in both hospitals and aged care facilities might lead to the use of physical restraint on older people. This literature reviewed aimed to identify the factors that influence nurses' use of physical restraint on people aged over 60 years. The prevalence of restraint use in aged care facilities was shown to be between 12% and 47%, with 7% to 17% for hospitalized patients. Database searches retrieved studies published after 1992 that highlighted nurses' use of physical restraint on older people in both acute and aged care settings. The analysis revealed two reasons for decisions to use physical restraint that were categorized as ‘patient safety’ and ‘nurses' workload’. It is important for nurses to understand the nursing culture that perpetuates restraint use, and to consider patient‐centred nursing as an instigator for change.     

MRSA--global threat and personal disaster: patients' experiences

ANDERSSON H., LINDHOLM C. & FOSSUM B. (2011) MRSA – global threat and personal disaster: patients' experiences. International Nursing Review 58 , 47–53 Aim: To ascertain and describe the patients' knowledge, perceptions and experiences of being methicillin‐resistant Staphylococcus aureus (MRSA) positive. Background: Antibiotic resistant bacteria are a serious global threat. MRSA can cause wound infection, pneumonia, septicaemia and mortality. This qualitative study has focused on patients' experiences of living with MRSA. Methods: Fifteen patients with MRSA‐infected wounds were interviewed. All data were transcribed verbatim and analysed according to content analysis. Findings: Information about the MRSA diagnosis often caused a shock‐like reaction. Patients' perception of being MRSA positive was stigmatizing as plague or leprosy; they felt dirty and felt that they were a severe threat to their environment. Fears of infecting someone else and being rejected were commonly expressed. The key findings emerged as a theme: Being exposed to others' shortcomings and being a threat to others' health. Three categories were identified: understanding and emotional reactions, treatment by the healthcare professionals and consequences and expectations. Gaps in both patient and staff knowledge of MRSA led to unnecessary misunderstandings, causing fear, social isolation and suffering. Conclusions: Living with MRSA can be extremely stressful for the patients. Knowledge and empathy from staff involved in their care is crucial to optimize patients' experiences. Staff education to meet patients' demand for information and prevent contamination is essential.     

Hospital and homecare nurses' experiences of involvement of patients and families in transition between hospital and municipalities: A qualitative study

Background

Involving patients and families in nursing care is essential to improve patients' health outcomes. Furthermore, families play an essential role in supporting patients by helping nurses understand the patient's everyday life. However, families also need support. Involvement of patients and families is especially important when patients are transferred between hospital and home as transitions heighten the risk of compromising quality and safety in care. However, no consensus exists on how to involve them. Consequently, this may challenge a systematic approach toward patient and family involvement.

Aim

To describe hospital and homecare nurses' experiences with involving patients and their family members in nursing care in the transition between hospital and municipalities.

Method

Focus group interviews were conducted in the Gastro unit at a large university hospital in Denmark. Participants included 10 hospital nurses from three wards at the Gastro unit and six homecare nurses from one of three municipalities in the hospital catchment area (total n = 16). Data were analysed using qualitative content analysis. The study is reported according to the Consolidated Criteria for Reporting Qualitative Research.

Findings

Our analysis revealed one overall theme – “The complexity of involvement” – based on four categories: gap between healthcare sectors increases the need for patient and family involvement, lack of time is a barrier to patient and family involvement, involvement is more than information, and involvement as a balancing act.

Conclusion

The nurses experienced patients' and families' involvement as essential, but a discrepancy was found between nurses' intentions and their actions. Aspects related to a gap between healthcare sectors and various understandings of involvement challenged the systematic involvement of patients and families in the transition between healthcare sectors. However, the nurses were highly motivated to achieve a close cross-sectoral collaboration and to show commitment towards patients and families.     

The challenge of risk prevention in home healthcare—An interview study with nurses in municipal care

Background

Safety in home healthcare has garnered increased attention as more people are receiving care for complex conditions at home. The prerequisites for providing safe care at home differ from those in hospitals. Malnutrition, falls, pressure ulcers and inappropriate medication commonly follow poor risk assessments, causing unnecessary suffering and costs. Therefore, risk prevention in home healthcare needs to be prioritised and studied more closely.

Aim

To describe nurses' experiences of performing risk prevention in municipal home healthcare.

Methods

Qualitative inductive approach, using semi-structured interviews with 10 registered nurses in a municipality in southern Sweden. Data underwent qualitative content analysis.

Findings

The analysis resulted in three main categories and one overarching theme describing nurses' experiences of risk prevention in home healthcare. Getting everyone onboard comprises the categories: Managing safety while respecting the patient's self-determination, which covers patient participation, the strategic importance of respecting different views of risks and information and the fact that healthcare workers are guests in the patient's home. Finding ways to make it work touches upon the relational aspect, including next-of-kin and promoting a common understanding to prevent risks. Being squeezed between resources and requirements refers to ethical dilemmas, teamwork, leadership and organisational prerequisites.

Conclusion

Patient habits, living conditions and limited awareness of risks is a challenge in risk prevention in home healthcare, where patient participation plays a pivotal role. Risk prevention in home healthcare needs to be initiated at an early stage of disease and ageing and should be seen as a process where early health-promoting interventions can prevent the development and accumulation of risks over time. Long-term cross-organisational collaborations and patients' physical, mental and psychosocial conditions also need to be taken into account.     

Barriers to diabetes control from Syrian women's perspectives

Aim: Diabetes constitutes a major public health problem and is a leading cause of morbidity and mortality. The purpose of this study was to explore the barriers to diabetes control of middle‐aged Syrian women with type 2 diabetes. Methods: A qualitative approach was adopted using conventional content analysis of semi‐structured interviews carried out with 12 women with type 2 diabetes in the diabetic center in Lattakia (Syria) between March 2010 and December 2010. The participants were recruited by the purposeful sampling method. Results: Three main themes emerged from the data analysis: (i) a poor patient–healthcare provider relationship; (ii) inadequate education; (iii) and psychosocial problems. The first theme had two subthemes: (i) relationship with doctors; and (ii) relationship with nurses. The second theme was without subthemes. The third theme consisted of six subthemes: (i) work and family responsibilities; (ii) motherhood role; (iii) lack of social support; (iv) anxiety; (v) depression; and (vi) low self‐efficacy. Conclusion: The findings support that effective relationships can be enhanced through active listening and by opening a free channel for the flow of ideas and information between patients and healthcare providers. Additionally, providers have an important role to play in learning to identify and manage the psychosocial problems that arise in living with diabetes, so that their patients can be supported in overcoming barriers to managing their diabetes more effectively.     

Nurses' perceptions of systems and hierarchies shaping their responses to child abuse and neglect

Nurses have an important role in preventing and responding to child abuse and neglect. This paper reports on nurses' perceptions of how organisational systems and hierarchies shaped their capacity to respond to child abuse and neglect. This is one of four key themes identified through an inductive analysis of data from a broader qualitative study that explored nurses' perceptions and experiences of keeping children safe. The study was guided by social constructionist theory, and data were collected through in‐depth interviews with nurses working with children in Australia (n = 21). Key findings showed that nurses experienced many challenges to responding to child abuse, including difficulties sharing information, fear of making mistakes and inflexible systems of care. This was underpinned by an organisational ‘rule‐centred’ culture of following policies at the expense of maintaining an explicit focus on children's needs. These findings demonstrate first the importance of creative and flexible thinking from individual professionals, so policies are enacted with a clear child focus. Second, they highlight the need for leadership to enact organisational and systemic cultural change that maintains a genuinely child‐centred approach.     

Finnish nurses' perceptions of care of older patients

The aim of the study was to explore how far the perceptions of care of nurses in Finland take into account the preferences of the older patient and the patient's family members and to evaluate related background factors. The data were collected by questionnaire with nurses (n = 167) working in a geriatric hospital. The questionnaire contained items about shared decision‐making, attitudes to nursing patients, assessment of patients' functional ability and need for care, goal‐setting, evaluation of outcomes and discharge planning. This study showed that taking into account the preferences of the patient and the patient's family members regarding the patient's care was challenging for the nurses in practice. About one‐third of the nurses reported making the decisions on a patient's care themselves and not respecting patient autonomy in situations where patients are not able to assess their own situation. In addition, the nurses reported asking for the views of patients less frequently than those of family members when assessing and setting patient care goals. In practice, nurses need to be aware of this, during the transition from routine‐centred care to patient‐centred care.     

Hospital nurses' work environment, quality of care provided and career plans

HINNO S., PARTANEN P. & VEHVILÄINEN‐JULKUNEN K. (2011) Hospital nurses' work environment, quality of care provided and career plans. International Nursing Review 58 , 255–262 Background: In several European countries, the availability of qualified nurses is insufficient to meet current healthcare requirements. Nurses are highly dissatisfied with the rising demands of the healthcare environment and increasingly considering leaving their jobs. Aim: The study aims to investigate the relationships between the characteristics of hospital nurses' work environment and the quality of care provided, and furthermore to examine Dutch nurses' career plans. Methods: A cross‐sectional, questionnaire survey of registered nurses (n = 334) working in the academic and district hospitals was conducted in 2005/2006. Previously validated questionnaires translated into the participants' language were used. Factor and regression analysis were used for data analysis. Results: Overall, nurses rated their work environment rather favourably. Five work environment characteristics were identified: support for professional development, adequate staffing, nursing competence, supportive management and teamwork. Significant relationships were found between nurses' perceptions of their work environment characteristics and quality of care provided and nurses' career plans. When work environment characteristics were evaluated to be better, nurse‐assessed quality of care also increased and intentions to leave current job decreased linearly. Conclusions: Study findings suggest that nurses' perceptions of their work environment are important for nurse outcomes in hospital settings. Further research is needed to explore the predictive ability of the work environment for nurse, patient and organizational outcomes in hospitals.     

Assault experiences: Lessons learned from mental health nurses in Taiwan

Mental health nurse are frequently subjected to patients' violent and aggressive behaviour. These assault experiences have given rise to mental health nurses' physical and psychological trauma, and negatively impact the quality of patient care. The purpose of the present qualitative study was to understand mental health nurses' experiences of being assaulted, the influences on their patient care, and their perspectives of the effectiveness of in‐service, violence‐prevention education. Ten mental health nurses from two different inpatient mental health facilities were interviewed using a semistructured interview guide. Thematic analysis of interview data found six themes: (i) violence is unpredictable; (ii) violence is normal; (iii) lasting psychological trauma; (iv) limited support from peers and the administrator; (v) violence prevention requires team cooperation; and (vi) doubting the effectiveness of in‐service education on violence prevention. Psychiatric ward administrators should assess nurses' learning and skill needs to determine whether these needs are met by existing in‐service training programmes. A culture of safety should also be promoted by building a warm and supportive ward climate for both staff and patients, which would include team cooperation and support for colleagues who suffer a violent incident.     

Health consumers' experiences in Australian critical care units: postgraduate nurse education implications

Aim: To explore critical care patients and families experiences and seek their input into nurses' postgraduate educational preparation and practice. Background: There is an inconsistency in the expected standard of practice to ‘qualify’ Australian critical care nurses. There has also been a lack of health consumer input in the development of postgraduate course curriculum and content. Method: Following institutional ethics committee approval, purposive sampling was used to select participants for focus groups and individual interviews who had experienced intensive care or coronary care. Findings: Seventeen participants provided data which created two main thematic categories; the role of the critical care nurse and; minimum practice standards for postgraduate critical care course graduates. Both physical patient care and socio‐emotional support of patients and family were identified as important for the critical care nurse role. The level of socio‐emotional support provided by nurses was reported to be inconsistent. Components of socio‐emotional support included communication, people skills, facilitating family presence and advocacy. These components were reflected in participants' concepts of minimum practice standards for postgraduate critical care course graduates; talking and listening skills, relating to and dealing with stressed people, individualizing care and patient and family advocacy. Conclusion: Health consumers' views emphasize that socio‐emotional skills and behaviours need to be explicitly described in postgraduate critical care nursing course curricula and instruments developed to consistently assess these core competencies.