Nurses' experiences of caring for the relatives of patients in ICU

To date there have been no published qualitative studies looking solely at the experiences of nurses caring for the relatives of patients who are critically ill. This small-scale phenomenological study explores such experiences. Three intensive care units in North West England were included; the nine participants were D grade or above, with a minimum of three months' ICU experience. Each nurse attended a tape-recorded, unstructured interview to discuss caring for relatives. A thematic analysis of the nurses' comments was then performed. Although many of the nurses understood the benefits of performing the care-giver role to families, some nurses felt inadequately prepared. There were also issues about whether they felt supported by colleagues in undertaking this role.     

Nurses'' experiences of caring for culturally and linguistically diverse families when their child dies

Nurses experience the care of a dying child and their family as a challenging but distressing event. In a paediatric intensive care unit (PICU), Melbourne, Australia, nurses expressed a concern that they may not be providing the most appropriate care when a cultural disparity exists between nurses and families experiencing the death of their child. A critically informed study was undertaken with six PICU nurses to explore their experiences of caring for a culturally and linguistically diverse family whose child had died. Three consecutive focus group interviews were conducted with the nurses to identify issues in this area of their nursing practice and to contemplate how their practice might be changed. The focus of this paper is on one particular finding of the study about the nurses' use of controlling practices to ensure families conformed to the established routines and values of the PICU staff.     

Meeting the needs of minority ethnic patients

BACKGROUND: Certain aspects of nursing care related to minority ethnic patients are being highlighted in the literature, but there is little exploration of nurses' experiences of caring for people from specific minority ethnic groups. AIM: This paper reports an investigation into the experiences of Registered Nurses caring for hospitalized Pakistani patients in the United Kingdom. METHOD: A qualitative study, with a sample of 30 Registered Nurses using semi-structured interviews. The sample was self-selecting from a large health care organization in the north of England, covering adult acute, critical and rehabilitation care settings. RESULTS: Interviewees had difficulty in explaining the meaning of culture and spirituality and their relationship to nursing practice. They also had limited understanding of the Pakistani community, and deficits were identified in meeting the challenges offered by this community. Inadequate implementation of 'holism', poor preparation to meet the needs of an ethnically diverse society and the presence of racism in practice settings emerged as explanations for the deficits participants identified between their expectations and the reality in care settings. CONCLUSION: Although 'holism' is a relevant concept for enhancing nursing practice, its meaning needs to be further debated in order to avoid a tokenistic approach to its implementation in the care of patients from minority ethnic communities.     

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.     

Parent-nurse interactions: care of hospitalized children

BACKGROUND: An essential component of quality nursing care is nurses' ability to work with parents in the hospital care of their children. However, changes in the health care environment have presented nurses with many new challenges, including meeting family-centred care expectations. AIM OF THE PAPER: To report a research study examining the experiences of parents who interacted with nurses in a hospital setting regarding the care of their children. METHODS: A qualitative approach was employed for this study. In-depth audiotaped interviews were conducted with eight parents representing seven families. Data collection was completed over a 7-month period in 2001. FINDINGS: Parents characterized their experiences with nurses caring for their children as interactions, and identified the elements of establishing rapport and sharing children's care as key to a positive perception of the interactions. These elements were influenced by parental expectations of nurses. Changes in nurses' approach were reported by parents as the children's conditions changed. CONCLUSION: Nurses were able to work with families in the hospital care of their children in ways that parents perceived as positive. However, in parents' views, their interactions with nurses did not constitute collaborative relationships. A deeper understanding of these interactions may provoke new thinking about how to promote an agency's philosophy, and how nurses enact this philosophy in practice.     

Close relatives in intensive care from the perspective of critical care nurses

Aim. The aim was to describe critical care nurses’ experiences of close relatives within intensive care. Background. There is a lack of research describing critical care nurses' experiences of the significance of close relatives in intensive care. Knowledge in this area will support critical care nurses to develop good nursing care for the critically ill person and their close relatives. Design and method. The design of the study was qualitative. Data collection was carried out through focus group discussions with 24 critical care nurses in four focus groups during spring 2004. The data were subjected to qualitative thematic content analysis. Results. The focus groups discussions showed that the presence of close relatives was taken for granted by critical care nurses and it was frustrating if the critically ill person did not have any. Information from close relatives made it possible for critical care nurses to create individual care for the critically ill person. They supported close relatives by giving them information, being near and trying to establish good relations with them. Close relatives were important. Critical care nurses lacked forums for reflection and discussion about the care given. Relevance to clinical practice. This study indicates that close relatives are a prerequisite for critical care nurses to give good nursing care to meet the needs of the critically ill person. A communication based on mutual understanding is necessary if critical care nurses are to be able to support close relatives. Dealing constantly with situations that were ethically difficult without any chance to reflect was an obstacle for critical care nurses to improve their work with close relatives.     

AIDS: what are nurses' concerns?

The purpose of this research was to study nurses' knowledge about and attitudes toward caring for patients with acquired immunodeficiency syndrome (AIDS) and the relationship of these factors with demographic and professional characteristics. Data were gathered by questionnaires mailed to a random sample of Registered Nurses in Erie County, NY. Results indicated that many of the nurses surveyed are fearful of contracting AIDS and do not have confidence in their ability to meet the intense physical and psychological needs of patients with this illness. Further, the data suggest that caring for individuals with AIDS may be complicated by the fact that a large proportion of these patients are homosexuals who are terminally ill. The findings lead to the conclusion that targeted intervention strategies are necessary to prepare nurses to met the emerging needs of the escalating AIDS epidemic and to help assure that quality of care will be maximized.     

Professional nursing support for culturally diverse family members of critically ill adults

Family members' perceptions of professional support expected of critical care nurses were examined for differences related to cultural affiliation using the "Professional Support Questionnaire for Critical Care Nurses Working with Family Members" (PSQ). The PSQ was administered face-to-face to family members waiting to visit a critically ill relative admitted to the intensive care unit. ANOVA and post hoc tests were computed to compare 90 family members' expectations for professional nursing support during a relative's critical illness across three cultural groups-African American, Hispanic, and White. There were significant differences in family members' responses on certain PSQ items across cultural groups. Despite these differences, family members' expectations of professional support from critical care nurses were generally universal-suggesting equitable care, dignity, and respect should be universal values. There is a need for critical care nurses to develop interventions that respect some cultural uniqueness as well as address the universal needs of family members coping with the ICU admission of a critically ill family member.     

Client-centred empowering partnering in nursing

AIM: This paper explores nurses' experiences 1 year after an organization's commitment to providing a client-centred and client-empowering partnering approach to care. BACKGROUND: Historically, nurses' approach to providing care in all nursing contexts has been one of doing for clients, and previous studies have focused more on in-hospital care than on home care. However, the isolation inherent in in-home nursing and nurses' limited professional autonomy and power associated with physician control over patients in home care have been reported, as has their difficulty in finding the meaning and satisfaction of human connectedness and mutuality in nurse-client relationships. Overall, research to date does not inform us about how nurses might make a change toward a more client-centred and client-empowering approach to nursing. METHODS: An interpretive phenomenological design was used to elicit in-depth understanding about Registered Nurses' experiences of providing care using this innovative empowerment model. A purposefully selected sample of eight Registered Nurses participated in in-depth interviews. Data were generated during 2002. Hermeneutic analysis was used to elicit themes and patterns emerging from the data. FINDINGS: Caring, client-centredness and the context of in-home care were important in implementing the new partnering approach. Barriers encountered at system, organizational and personal levels distracted nurses from fully comprehending and enacting the approach. After a year, they had begun to contemplate potential strategies for partnering with clients, but had not yet explored the power of their professional autonomy. CONCLUSION: Nurses are inclined to practise within the expert model of service delivery. They need to work through issues of professional autonomy and rise to the challenge of exercising their autonomy within the current healthcare context if they are to attend more consistently to client-centred empowering partnering. The home care setting offers an excellent environment for achieving these aims.     

Interacting with relatives in intensive care unit. Nurses' perceptions of a challenging task

Aims: To describe how Danish intensive care unit (ICU)‐nurses perceive personal knowledge and skills (self‐efficacy) and outcome expectations to interacting with relatives. Moreover, to explore relationships between self‐efficacy and outcome expectations and the nurses' attitude towards involving relatives in care‐related tasks and allowing relatives to be with the patient during critical situations. Background: Interacting with relatives can be a challenging task, and nurses play a leading role in integrating relatives in ICU. Little is known about how ICU‐nurses cope with this part of nursing Design: Cross‐sectional Method: Sixty‐eight ICU‐nurses responded to a self‐administered questionnaire based on Bandura's self‐efficacy theory adjusted to critical care. Results: The nurses' perceptions of personal knowledge, skills and expectations to the outcome of interacting with relatives were positive. There were disparities in nurses' level of agreement on when to involve relatives in caring activities. Generally, the nurses did not support the presence of relatives in critical situations. Nurses' outcome expectations were correlated to their attitude towards involving relatives in caring activities. No other statistically significant correlations were found between general attitude, knowledge, skills, and attitude of nurses towards involving relatives in caring activities or allowing them to be with the patient at cardiac arrest or acute intubation. Conclusion: The nurses' outcome expectations and self‐efficacy in terms of knowledge and skills interacting with relatives were high. There was considerable variation in the nurses' agreement on when to involve relatives in caring activities or allowing them to be with the patient in critical situations. The self‐efficacy theory was not supported as a result of lack of correlation between nurses' self‐efficacy and outcome expectations and their attitude towards involving relatives in ICU. Relevance to clinical practice: The study provides important knowledge to clinicians, educators and managers on how to educate and supervise ICU‐nurses to support their efforts to interact proficiently with relatives.     

Families, nurses and intensive care patients: a review of the literature

1. Nurses striving to give holistic care to provide quality care for their patients, need to recognize the importance of caring for patients' families. 2. A detailed review of the literature examining the relationships between nurses and intensive care patients' families was undertaken to examine its strengths and weaknesses as a basis for further study. 3. Studies show that although nurses are often in the best position to meet families' needs, their needs are not always met. 4. The building of good relationships with families is essential for nurses, and yet evidence shows that some nurses have difficulties in this area. 5. Good practice is identified and obstacles nurses face in forming relationships with families are explored. 6. Strategies for improving the interaction process between intensive care nurses and patients' families are systematically evaluated.     

Being an intensive care nurse related to questions of withholding or withdrawing curative treatment

Aims and objectives. The aim of the study was to acquire a deeper understanding of what it is to be an intensive care nurse in situations related to questions of withholding or withdrawing curative treatment. Background. Nurses in intensive care units regularly face critically ill patients. Some patients do not benefit from the treatment and die after days or months of apparent pain and suffering. A general trend is that withdrawal of treatment in intensive care units is increasing. Physicians are responsible for decisions concerning medical treatment, but as nurses must carry out physicians’ decisions, they are involved in the consequences. Design and methods. The research design was qualitative, based on interpretative phenomenology. The study was carried out at an adult intensive care unit in Norway. Data were collected by group interviews inspired by focus group methodology. Fourteen female intensive care nurses participated, divided into two groups. Colaizzi's model was used in the process of analysis. Results. The analysis revealed four main themes which captured the nurses’ experiences: loneliness in responsibility, alternation between optimism and pessimism, uncertainty – a constant shadow and professional pride despite little formal influence. The essence of being an intensive care nurse in the care of patients when questions were raised concerning curative treatment or not, was understood as ‘being a critical interpreter and a dedicated helper.’ Conclusions. The findings underpin the important role of intensive care nurses in providing care and treatment to patients related to questions of withholding or withdrawing curative treatment. Relevance to clinical practice. The findings also show the need for physicians, managers and intensive care nurses themselves to recognize the burdens intensive care nurses carry and to appreciate their knowledge as an important contribution in decision making.     

Clinical group supervision in an intensive care unit: a space for relief,and for sharing emotions and experiences of care

Much has been written about models, aims and the concept of clinical group supervisional, although few studies are empirical or focus on intensive care. The aim of the study was to illuminate the process and describe, using qualitative content analysis, the content of conversations carried out during the course of clinical group supervision sessions among Registered Nurses (RN) and enrolled nurses (EN) working in an intensive care unit (ICU). During the supervision sessions, ENs talked about their life-world from a caring perspective, while RNs focused on their professional development. Both ENs and RNs regarded the supervision sessions as a space for relief and for sharing emotions and caring experiences, which helped to manage complex nursing care. The findings are viewed in the light of Roach's theoretical framework describing the attributes of professional care as five Cs. Clinical group supervision is interpreted as supportive in developing interpersonal skills and a sensitive nursing practice.