A qualitative exploration of nursing students’ perceptions of the homeless and their care experiences

The health care needs of the homeless are more complex than those of the population at large. The purpose of this qualitative study was to explore undergraduate nursing students’ perceptions of the homeless. Thematic content analysis of responses from 19 undergraduate nursing students yielded four themes describing student experiences with the homeless, their perceptions of homelessness and the health care of the homeless, and their suggestions for best teaching strategies. Students in this study had varying amounts of experience with and knowledge of the homeless. While our participants strongly believed that homeless people deserved compassionate, equitable nursing care, many of their statements suggested an implicit bias toward the homeless. This suggests that student nurses need more comprehensive education concerning the homeless and the health care needs of this vulnerable population. Few interventions aimed at educating student nurses about homelessness and changing their attitudes to mitigate bias are based on research, particularly research conducted from the perspective of the homeless, and few explore the impact of civil interactions on health outcomes. The findings of this study may assist nurse educators in developing education interventions to improve students’ knowledge of homelessness.     

What is important for patient centred care? A qualitative study about the perceptions of patients with cancer

Background: This article deals with one of the themes from interviews in a larger qualitative study about cancer patients' perceptions of good caring. It is widely recognized today that patient centred care is important. Patients' values and perceptions must be acknowledged in order to make care evidence based and to meet the demands of quality improvement processes. Aim: The aim was to get insight in patients with cancers' perceptions of the importance of being respected as partners and share control of decisions about interventions and management of their health problems and the reasons behind their wishes. Method: Giorgio's scientific approach to phenomenology was used. Twenty cancer inpatients with various cancer diagnoses at different stages and with different prognoses were interviewed. The sampling was purposive. Ethical issues: Permission to carry out the research was given by a Regional Committee of Research Ethics in Western Norway and the data collection followed the guidelines of the Data Inspectorate of Norway. Main findings: The units of meaning identified could be clustered into three themes with significance for patient centred care from patients' perspectives: (1) empowerment (being respected, listened to, given honest information, being valued); (2) shared decision making about the treatment of the disease (discussing the treatment, but letting the doctor decide in the end); and (3) partnership in nursing care. Conclusion: Health care professionals can practise patient centred care by treating patients with respect, giving honest information, making them feel valued as persons and by inviting them to take part in all decisions about their daily life and care. However, cancer patients' desire to make decisions about their treatments must not be taken for granted. Doctors must find out the extent to which each patient wants to participate and then give the necessary information.     

Correlates of hospitalized patients' perceptions of service quality

The purpose of this study was to examine hospital patients' perceptions of service quality in relation to four independent variables: (a) nurses' perceptions of human resource practices, (b) nurses' perceptions of autonomy in practice, (c) patient satisfaction with nursing care, and (d) patients' perceptions of organizational climate for service. The sample consisted of 102 nurse–patient dyads in an acute care hospital. Patients responded to the Modified Health Care Service Performance Instrument, the revised LaMonica–Oberst Patient Satisfaction Scale, and the Organizational Climate for Service Semantic Differential. Nurses responded to the Employee Turnover Diagnostic and the Dempster Practice Behaviors Scale. Two of the four correlational hypotheses were supported. Patient satisfaction with nursing care and patients' perceptions of organizational climate for service were each positively related to patients' perceptions of service quality. A multivariate regression hypothesis was not supported. Failure to support two theoretically based correlational hypotheses may be related to methodological problems experienced with dyadic research. © 1998 John Wiley & Sons, Inc. Res Nurs Health 21: 339–349, 1998     

Self-Management Support and Communication from Nurse Care Managers Compared with Primary Care Physicians: A Focus Group Study of Patients with Chronic Musculoskeletal Pain

Pain is a critical health problem, with over half of Americans suffering from chronic or recurrent pain. Many patients also experience comorbid depression. Although numerous self-management interventions have been implemented in an effort to improve pain outcomes, little attention has been devoted to the role of the provider of these services, typically a nurse care manager (NCM). Given the robust literature pointing to a link between physician-patient communication and patient outcomes, NCM-patient communication merits closer examination. This paper reports chronic pain patients' perceptions of the communication with NCMs in a pain self-management trial and patients' perceptions of the communication they experienced in primary care. Eighteen patients suffering from chronic musculoskeletal pain and depression participated in four focus groups designed to ascertain their perceptions of the intervention. A key emergent theme from these focus groups was the contrast in patients' perceptions of the communication with their primary care physicians versus with the NCMs. Patients reported feeling supported, encouraged, and listened to by their NCMs, whereas they tended to be dissatisfied with their primary care physicians, citing issues such as lack of continuity of care, poor listening skills, and under- or overprescribing of medication. The results of this study underscore the importance of the NCM, particularly for patients with chronic conditions such as pain.     

Learning that cannot come from a book: An evaluation of an undergraduate alcohol and other drugs subject co-produced with experts by experience

Alcohol and other drugs (AOD) use is a significant public health issue and is associated with high mortality and morbidity rates. Despite this, people who use drugs are often reluctant to seek care due to the lack of trauma-informed treatment and harm reduction treatment options, as well as experiences of stigma and discrimination in health services. Arguably, AOD education that is co-produced with people who use alcohol and drugs can enhance future health professionals' ability to practice in ways that support the needs of this population. This paper reports on a qualitative co-evaluation of a co-produced undergraduate nursing AOD subject. The AOD subject was co-planned, co-designed, co-delivered, and co-evaluated with experts by experience, who have a lived experience of substance dependence and work as advocates and peer workers. Following the delivery of the subject in 2021 and 2022, focus groups were undertaken with 12 nursing students. Focus group data indicate that the co-produced subject supported participants to understand and appreciate how stigma impacts on nursing care and how to recognize and undertake ‘good’ nursing care that was oriented to the needs of service users. Student participants noted that being co-taught by people who use drugs was particularly powerful for shifting their nursing perspectives on AOD use and nursing care and took learning beyond what could be understood from a book. Findings indicate that co-produced AOD education can shift nursing students' perceptions of AOD use by providing access to tacit knowledge and embodied equitable and collaborative relationships with people who use drugs.     

“Sleepless Nights and Sore Operation Site”: Patients' Experiences of Nursing Pain Management After Surgery in Jordan

Internationally, it is agreed that pain management is a central component of nursing care. Although much has been written about pain prevalence among patients after surgery, research is scant on patients' experiences of nursing pain management and factors involved. This study explores patients' experiences of nursing pain management in Jordan and identifies contributing factors. A qualitative research design was used. Data were collected through focus group discussions (n = 4). A total of 31 patients were purposively selected. Two main themes emerged. The first theme was living in pain and comprised two categories: from sleep disturbances to the fear of addiction and from dependence to uncertainty. The second theme was about barriers that affect nursing pain management. Patients' experiences of nursing pain management were not up to their expectations; their needs were largely ignored and were dealt with in a mechanistic way. Barriers precipitating this situation were referred to in this study as the three “nots,” including not being well-informed, not being believed, and not being privileged. The study concluded that patients' experiences of nursing pain management are a complex world that goes beyond medically orientated care. Nurses, therefore, are urged to look beyond standardized assessment tools and use patients' experiences and voices as valuable evidence contributing to more effective pain management. Unless this occurs in their daily encounters with patients, another decade will pass with little change in the practice of pain management.     

Chinese values, health and nursing

PURPOSE: To describe the roots of Chinese values, beliefs and the concept of health, and to illustrate how these ways have influenced the development of health care and nursing among Chinese in the Republic of China (ROC) and the People's Republic of China (PRC). Scope. Based on the literature and direct observation in the PRC and ROC, this is an introduction to Chinese philosophies, religion, basic beliefs, and values with a special meaning for health and nursing. Chinese philosophies and religion include Confucian principles, Taoism, theory of "Yin" and "Yang", and Buddhism. Beliefs and values include the way of education, practice of acupuncture, herbal treatments and diet therapy. How people value traditional Chinese medicine in combination with western science, and the future direction of nursing and nursing inquiry are also briefly addressed. CONCLUSION: Chinese philosophies and religions strongly influence the Chinese way of living and thinking about health and health care. Nurses must combine information about culture with clinical assessment of the patient to provide cultural sensitive care. A better way may be to combine both western and Chinese values into the Chinese health care system by negotiating between the traditional values while at the same time, respecting an individual's choice. The foundation of China's philosophical and aesthetic tradition, in combination with western science is important to the future advancement of nursing research that will be beneficial to the Republics, Asia, and the world.     

Patients' perceptions of the quality of psychiatric nursing care: findings from a small-scale descriptive study

• ? This study tested a development of the Critical Incident Technique (CIT) (Flanagan, 1954) in a field-study to gather incidents of high- and low-quality nursing care as perceived by 24 patients with mental-health problems in two admission wards of a psychiatric hospital. The development of the CIT used took the form of an interactive, guided interview, developed previously for the same purpose with other groups of patients and their nurses and is discussed in detail elsewhere. This paper describes the results of the study which throws light on patients' perceptions of high- and low-quality nursing care in an acute-care setting.
• ? Qualitative analysis of the interviews revealed 239 indicators of high- and low-quality psychiatric nursing care which were grouped into six main categories. Patients' responses indicated the importance attached to the therapeutic functions of the psychiatric nurse, in particular the value placed by patients on nurses being active listeners. Aspects of practice most often identified as of poor quality included nurses' failure to explain their actions, the negative impact of nurses' group behaviour on ward atmosphere, their inadequate knowledge base and the negative consequences of inadequate staffing.
• ? The CIT fulfilled its potential as an interactive method of eliciting the views of this patient group of the quality of nursing care.

     

Patient's perceptions of bedside handovers

? The bedside handover is a universal phenomenon in nearly every type of care setting. It has become the chief arena for the intershift handover in contemporary nursing practice. Published literature investigating patients' viewpoints on the location of the bedside handover is sparse. ? The overall aim of this study is to describe and provide an analysis of patients' perceptions of the bedside handover. ? A grounded theory approach to data collection and data analysis was employed to capture surgical patients' views about the bedside handover. ? The analysis tentatively suggests the existence of three categories that describe the patients' perceptions of the bedside handover. ‘Maintaining a Professional Distance’, ‘Establishing Professional Sharing’ and ‘Maintaining Patient Safety.’     

Clinical instructors' knowledge and perceptions about nursing care of older people: A pilot study

With an aging population, the majority of nurses will spend their careers working with older people. Currently, there is scant research about clinical instructors' knowledge and perceptions about nursing care of older people despite their instrumental role in preparing nurses for practice. The purpose of this study was to explore clinical instructors' knowledge and perceptions about nursing care of older people. A mixed methods approach was used. Fifteen clinical instructors and 15 nurse educators employed on specialized units for older people completed questionnaires. Independent t-tests were administered. Five of the clinical instructors also participated in semi-structured interviews, which were analyzed using thematic analysis. Findings indicated that clinical instructors had significantly lower scores on knowledge and perceptions about nursing care of older people than practice-based nurse educators. Further, clinical instructors found it difficult to integrate specialized knowledge about nursing care of older people along with other aspects of their teaching. They also reported that it was challenging to support learning about best practices for older people within the current clinical context, which was complex and fast-paced. This study reinforces the need for professional development opportunities for clinical instructors to support their instrumental role in preparing students for practice with older people.     

Perceptions and concerns about sustainable healthcare of nursing students trained in sustainability and health: A cohort study

AimTo describe nursing students' perceptions of sustainable health education in the nursing curriculum and their concerns about sustainable healthcare and the impact of climate change on nursing.BackgroundSustainable health education involves education on the impact of climate change on health and the impact of healthcare on the environment. The effectiveness of sustainable health education in improving attitudes, knowledge and skills in sustainable healthcare has been demonstrated. However, there is a need to study students' perceptions of this and their concerns about achieving sustainable healthcare from the use and disposal of healthcare resources.DesignA cohort study with an inductive content analysis of open-ended questions included in a survey.MethodsThe study was carried out with undergraduate nursing students throughout their four-year undergraduate academic program using scenario-based learning and augmented reality related to sustainability, climate change and health. As students were exposed to three educational interventions, they completed a survey of open-ended questions about their perceptions of their environmental sustainability training in the nursing curriculum, their concerns about the resources’ used in healthcare and their perceptions of the impact of climate change on the nursing profession.ResultsStudents identified content in the nursing degree program on climate change and health and hospital waste segregation. They also demanded more content on 'low environmental impact nursing care' when their clinical practice training increased. Students were concerned about the excessive and unnecessary use of materials in healthcare, especially in the post-pandemic period, the lack of environmental awareness of healthcare professionals and the lack of power to change the situation. They recognised the lack of proper waste segregation in healthcare settings, no recycling bins and little reuse of materials. They were also concerned about the polluting disposal of material. They perceived important impacts of climate change on nursing, such as patient care due to increased pollution-related diseases, including foetal malformations and new health care needs arising from weather conditions. Finally, students were concerned about the impact this will have on nursing care work and require 'nursing leadership in environmental awareness'.ConclusionsStudents demand more training in low environmental impact healthcare and innovative educational practices are effective in this regard. Appropriate Sustainable Healthcare Education can make future health professionals more environmentally aware and enable them to lead the shift towards climate-smart care.Tweetable abstractStudents demand more training in low environmental impact healthcare and perceive significant impacts of climate change on nursing.     

Organizational influences on patient perceptions of symptom management

We tested a theoretical model of the relationships of hospital context, nursing unit structure, and patient characteristics to patients' perceptions of the extent to which nurses met their expectations for management of troubling symptoms. In our sample of 2,720 patients randomly selected from 278 nursing units in 143 hospitals, we found that patient age was positively associated with patients' perceptions of symptom management. The proportion of registered nurses as caregivers on the unit was not a significant predictor of symptom management, but better work conditions on the unit (nurses' autonomy, participation in decision‐making, and collaboration with other disciplines [relational coordination]) significantly contributed to patients' perceptions of better symptom management. © 2009 Wiley Periodicals, Inc. Res Nurs Health 32:321–334, 2009     

Make No Assumptions: Communication Between Persons With Disabilities and Clinicians

Fundamentally improving health care quality requires providing care that respects patients' preferences, needs, and values. This goal holds special resonance for persons with disabilities, many of whom find others defining and circumscribing their lives and opportunities. Achieving patient centeredness demands open communication between patients and clinicians, unhampered by prior and often erroneous assumptions about patients' goals, aspirations, and abilities. Building on this communication, optimal care involves collaboration between patients and clinicians, each bringing his or her particular expertise to the table. Interviews with individuals with diverse disabilities revealed a common theme of faulty communication between patients and clinicians. Some shortfalls relate to basic failures to accommodate communication needs, whereas others result from clinicians' erroneous perceptions of medical aspects of persons' underlying conditions, the role of assistive technologies, and how disability affects people's daily lives. Crafting collaborative care partnerships between patients and clinicians requires transforming traditional patient-clinician relationships. Following two basic precepts immeasurably improves communication between clinicians and patients with disabilities: first, make no assumptions, and second, just ask patients about their needs and preferences.     

Relationship between nurses' perceptions of nursing assistant roles and information‐sharing behaviors: A cross‐sectional study

Information‐sharing between nurses and nursing assistants is necessary for appropriate inpatient care. Nurses who perceive nursing assistant roles highly may display positive behaviors related to information‐sharing with nursing assistants. This study aims to examine the relationship between nurses' perceptions of nursing assistant roles and the frequency of their sharing information with nursing assistants. Using a self‐administered, cross‐sectional survey questionnaire, data from 2,642 nurses in 182 hospitals were collected. Nurses' perceptions of nursing assistant roles were measured with a scale containing four factors: (i) improving patients' abilities through daily care; (ii) caring for various patients using broad perspectives; (iii) facilitating co‐ordination and co‐operation among team members; and (iv) increasing the amount of information on patients among team members. Information‐sharing behaviors included “expressing,” “asking,” “linguistic response,” and “feedback.” Multiple regression analyses for each nurse's information‐sharing behaviors were conducted. Nurses' perceptions of nursing assistant roles were positively correlated with the frequency of sharing information with nursing assistants. The degree of the correlations differed, depending on the type of information‐sharing behavior. Therefore, improving nurses' understanding of nursing assistant roles might increase their information‐sharing behaviors.