Nurses’ experiences of caring for preterm infants in pain: A meta-ethnography

ObjectivePreterm infants are subjected to numerous painful procedures during their neonatal intensive care unit (NICU) hospitalization. Despite advancements in pain alleviation, nurses remain challenged to provide timely and effective pain management for preterm infants. Greater understanding of the lived experience of nurses caring for preterm infants in pain could provide novel insights to improve pain management for this vulnerable population. The aim of this meta-ethnography was to synthesize and interpret qualitative findings of nurses’ experiences of taking care of preterm infants in pain.MethodsAn extensive literature search in PubMed, CINAHL, PsycINFO, Scopus, BIOSIS and ProQuest Dissertation and Theses Database was conducted, including studies within the past 10 years. Two nursing researchers conducted data extraction and analysis independently. Inclusion criteria were applied to search for qualitative studies of nurse participants who worked in the NICU taking care of preterm infants. Studies published in a language other than English, articles that did not include qualitative data and qualitative data that could not be extracted from the findings or did not discuss nurses’ experiences were excluded. Critical Appraisal Skills Programme was used for literature quality evaluation.ResultsEight studies remained after further screening according to inclusion and exclusion criteria. These eight studies were conducted from 2013 to 2018 and totally enrolled 205 nurses from Iran, Canada, the United States, Finland, Sweden, Switzerland, and Australia. Five themes emerged on the nurses’ perspectives of taking care of preterm infants in pain: 1) They sense the neonatal pain; 2) Adverse consequences of unrelieved pain; 3) Barriers of managing pain; 4) Concerns of available approaches for pain relief; 5) Failure to work with parents.ConclusionsThis meta-ethnography identified nurses’ understanding of pain in preterm infants that can be assessed, and they acknowledged that unrelieved pain could cause developmental deficits in infants. The barriers are lack of training and support on pain assessment and intervention in preterm infants. Optimizing workload and environment, developing age-specified pain assessment and intervention, receiving emotional support and training, and building up a rapport with parents are urgent needs for nurses to provide better care to infants having pain.     

Nurses’ lived experiences of professional autonomy in Iran

ObjectivesNurses' autonomy is a complex and multi-dimensional concept that has often been overlooked. Although many studies have addressed patients' autonomy, there has been no assessment of nurses' experience of professional autonomy. The present study aimed to assess nurses’ lived experiences of professional autonomy in Shiraz, Iran.MethodsThe present qualitative study was conducted in Shiraz (Iran) from January 2016 to February 2018. The target population was selected among nursing professionals employed by various hospitals affiliated to Shiraz University of Medical Sciences, Shiraz, Iran. The experiences of the participants were assessed through 14 in-depth semi-structured interviews. The response of the participants was analyzed using Van Manen's 6-step approach for interpretive phenomenology.ResultsBased on the analysis of the interviews, 4 themes, 11 categories, and 13 sub-categories were extracted. The themes were: Advocacy for patients and nurses, independence in the workplace, Involvement in professional decision-making, and Professional accountability.ConclusionDue to the intense interaction between nurses and patients, a better quality of care will be achieved if the professional autonomy of nurses is ensured. Healthcare authorities and hospital managers should provide the framework and permit the nurses to practically exercise full independence in the workplace.     

Health care providers communicate less well with patients with chronic low back pain – A study of encounters at a back pain clinic in Denmark

We aimed to study the quality of communication between health care providers and patients with low back pain with emphasis on information giving in a back pain clinic, including if characteristics of patients could be associated with communication quality. We videotaped 79 encounters in which 21 providers informed patients about the results of magnetic resonance imaging of the back. Background information about the patients was collected by questionnaires and interview after the encounter. Videotapes were analysed with the Four Habits Coding Scheme (4HCS) in which higher scores mean better communication. There were strong negative correlations between 4HCS scores and the duration of back pain, and patient age. The results were significant for all professional subgroups (doctors, physiotherapists, chiropractors). Communication quality in encounters with back pain patients is worse, the longer the patient has suffered pain. Poor communication quality also seems to be associated with patients being older.     

Problem-solving in physiotherapy – physiotherapists’ talk about encounters with patients with non-specific low back pain

Purpose: To investigate how physiotherapists talk about the choice of intervention for patients with NSLBP, particularly how professionals manage clinical encounters that may be experienced as challenging. Method: Discourse analysis was performed of four focus groups’ talk. Twenty-one experienced physiotherapists working in primary health care in southern Sweden participated. Results: Four focal themes appeared: Responsibility for health and health-related problems; Normalization – what counts as a normal back pain problem in relation to living an ordinary life; Change process – how to lead one’s life; and Individualization of the intervention in relation to the individual patient but also from the physiotherapists’ point of view. The themes shape an over-arching pattern of Problem-solving – which concerned both the professional task and the back pain problem, and was related to varying case complexity. This may have implications for the intervention the individual patient will be offered and on outcome. Conclusions: Physiotherapists’ attitudes and approaches seem to entail components of professional and personal values which may influence patients’ access to health care, with a risk for unequal assessment and intervention as a consequence. We argue that enhanced physiotherapist-patient collaboration, including patient-led problem-investigation, is a prerequisite for improved outcome in terms of patient satisfaction, and for physiotherapy development. Future investigations of patients’ roles in specific face-to-face encounters are needed.

Implications for Rehabilitation

• Varying attitudes among professionals regarding responsibility for health and health-related problems may influence patients’ access to rehabilitation, with a risk for unequal assessment and intervention as a consequence.

• Professionals’ use of personal approaches indicates that interventions may be based on professional instead of patient preferences, with consequences on patient satisfaction and outcome.

• Enhanced professional-patient collaboration which thoroughly includes patient preferences seems to be a prerequisite for improved clinical outcome in terms of patient satisfaction, and for professional development.

     

Nurses’ knowledge within the context of pain management

A small-scale study determined the level of pain management knowledge of general surgical and orthopaedic nurses in three designated wards. Qualified nurses completed a questionnaire. For the surgical nurses, a set of five tutorials encompassed all aspects of pain management. The orthopaedic nurses were given no extra education. Twenty-six out of a possible 55 surgical ward nurses attended one or more of the tutorials. A repeat of the first questionnaire was given to all nurses who had attended tutorials and to the orthopaedic nurses who had completed the first questionnaire. The response was poor and inconclusive as to whether the education for surgical nurses had made a difference to their knowledge of drugs and their uses. The questionnaires from the orthopaedic nurses showed a positive shift within some of the questions.     

Nurses’ needs when collaborating with other healthcare professionals in palliative dementia care

Adequate interprofessional collaboration is essential to provide high quality palliative dementia care across different settings. Within interprofessional collaboration, nurses are the frontline healthcare professionals (HCPs), who interact closely with people with dementia, their loved ones, and other HCPs. A survey was conducted to explore the needs of nurses regarding interprofessional collaboration in home care (HC) organisations, nursing homes (NHs) and during NH admissions. The survey identified the perceived quality of and preferred needs regarding interprofessional collaboration. In total, 384 participants (53.9% home care nurses) completed the survey. The most frequently reported collaboration needs in HC organisations and NH were optimal communication content e.g. information transfer and short communication lines (being able to easily contact other disciplines), and coordination e.g. one contact person, and clear task division and responsibilities). During NH admissions, it was important to create transparency about agreements concerning end-of-life wishes, optimize nurse-to-nurse handover during NH admissions (through performing visits prior to admissions, and receiving practical information on how to guide relatives), and improve coordination (e.g. one contact person). In conclusion, the key collaboration needs were organising central coordination, establishing optimal communication, and creating transparency on end-of-life care agreements.