Nursing students' beliefs about families in nursing care

Caring for families is a growing part of nurses' professional work in various health care settings and consequently an important issue for nursing education. One way to determine the readiness for nursing students to meet families is to reveal their beliefs about families. Beliefs can be uncovered through interpretation of conversations, as beliefs are embedded in our stories. The aim of this study was to explore nursing students' beliefs about families in nursing care. Nine nursing students, three from each year of a three-year programme, were interviewed individually. The interviews were tape-recorded and transcribed verbatim. First, a manifest content analysis was performed followed by a latent content analysis in order to reveal underpinning beliefs. The results demonstrate beliefs about families and nurses and their relationship, for example, if family members are close to each other and when the patient is cared for in his/her own home, it reduces suffering for the whole family, and if nurses create a trusting relationship and atmosphere, it fosters the families' well-being. Although the beliefs uncovered are seen as facilitative ones, educational efforts are essential to implement family nursing both theoretically and practically in curricula throughout the nursing education.     

The experience of nursing an AIDS patient whose secret was divulged to his family

This article concerns an Acquired Immunodeficiency Syndrome (AIDS) patient who had contracted the disease through casual sex. The secret of the nature of his disease was accidentally divulged to his family and friends by his care provider. The patient was rejected by his family and friends. The nursing experience of caring for the physical and psychological symptoms of the patient was reported. The author collected data through observation, physical assessment, interview, and telephone communication from January 20, 2005 to January 31, 2005. Because of the disease and his alienation from family and friends, the patient felt a lack of trust for his care provider, as well as anxiety, fear, a sense of guilt, self-recrimination, sadness and low self-esteem. The psychological symptoms were aggravated by the divulgence to family and friends of the fact that his disease was AIDS. The nursing problems were studied. The Watson theory of care was applied carefully. The patient was cared for with empathy and a positive attitude. A relationship of trust was established and the objective of quality care was accomplished. The nursing experience of caring for AIDS patients is unique. The privacy of the patient must be respected.     

An experience providing home care to a victim of cerebral vascular accident and purple urine bag syndrome

This article presents the case of a victim of cerebral vascular accident with long duration of urinary catheterization, who developed a purple urine bag syndrome (PUBS) because of deficiency of knowledge and skills in home care and lack of communication and support among family members. In this case, the main caregivers also experienced psychophysical fatigue and fear, which diminished family coping ability. During the period of nursing care, from March 10 to August 15, 2006, we carried out 10 home care visits and eight telephone consultations. Exiting urinary tract infection, constipation, and compromised coping and ineffective family were identified as the three main nursing care issues. As we successfully instilled trust and developed a positive relationship with the patient, we provided continuous and comprehensive nursing care to resolve the PUBS issue her which was causing her anxiety, and her constipation, as well as stabilizing her family function. Consequently, through this care experience involving a sick elderly patient, we promoted the function of nursing home care. From this case intervention, we found that health education should be closely followed up in order to maintain its effectiveness. Insufficient communication skills, however, were identified through meetings with the patient's family. We suggested related family communication skills and practices should be included in clinical nursing training courses to enhance skills in dealing with family issues and life quality among patients and their families.     

What to do when the end is near: ethical issues in home health care nursing

As managed care shortens the length of hospital stays, home settings for the practice of nursing will become increasingly important. In spite of community health nursing's long tradition of family-centered care delivered in the home, many discussions of the nurse/patient relationship in the medical ethics literature assume the hospital setting for the practice of nursing and seem to neglect the impact of family and significant others for the nurse/patient relationship. Through a case-based analysis, this article highlights the special ethical and legal issues encountered in caring for patients who are dying at home. This analysis demonstrates that traditional frameworks for the nurse/patient relationship are inadequate for capturing the richness of the relationship the home health care nurse has with both patient and family. By developing a new framework for the nurse/patient/family relationship that (a) recognizes the patient's decision-making authority and autonomy, (b) allows the exercise of the nurse's moral rights, and (c) recognizes the patient's relationships to significant others, the authors attempt to resolve some challenging legal and ethical questions concerning who should be allowed to decide what to do when the end is near. The discussion details the implications of this framework for nursing assessment in the home care setting.     

An alternative clerkship model for ambulatory training: An interdisciplinary primary care experience

The Primary Care Clerkship of George Washington University is the only required ambulatory experience in the medical school curriculum. This 6‐week clerkship for third‐year medical students blends exposure to several primary care disciplines: family practice, internal medicine, pediatrics, and geriatrics. In addition to addressing epidemiologically common conditions, the curricular goals emphasize primary care concerns such as the doctor‐patient relationship, clinical epidemiology, the natural history of disease, appropriate and cost‐effective use of resources and consultants, quality assessment, screening strategies, and critical thinking skills. Each student is assigned two primary preceptors for the entire clerkship and spends 80% of his or her time in patient care. Typically, one of each student's preceptors works in the Medical Center's faculty practice; the other is a physician in private practice or in an inner‐city clinic for the medically underserved and homeless. Students may also work with geriatricians in nursing homes and on home visits in the Washington, DC area.     

An experience providing terminal care based on Watson's theory to a cancer patient who lived alone

This article presents the case of a terminal stage cancer patient who lived alone and had a detached relationship with his family, and negative behaviors such as: depression, passivity, silence, refusal of treatment, and inability to trust others because of lack of family care during hospitalization. We cared for the patient with direct personal nursing care, using skillful physical evaluation, conversation and close observation from June 11, 2004, to July 11, 2004. Using Watson's theory, we successfully instilled trust in the patient and developed a positive relationship with him. We took care of his needs in a timely manner, used physical care to make him feel comfortable, showed concern about what he was really feeling, provided him with medical information, and helped him to manage his physiological, psychological, social, and spiritual problems. We enabled the patient to face his disease, in the hope that he would experience the end of his life peacefully under our warm and professional nursing care.     

Interacting with patients' family members during the office visit

The physician-patient relationship is part of the patient's larger social system and is influenced by the patient's family. A patient's family member can be a valuable source of health information and can collaborate in making an accurate diagnosis and planning a treatment strategy during the office visit. However, it is important for the physician to keep an appropriate balance when addressing concerns to maintain the alliance formed among physician, patient, and family member. The patient-centered medical home, a patient care concept that helps address this dynamic, often involves a robust partnership among the physician, the patient, and the patient's family. During the office visit, this partnership may be influenced by the ethnicity, cultural values, beliefs about illness, and religion of the patient and his or her family. Physicians should recognize abnormal family dynamics during the office visit and attempt to stay neutral by avoiding triangulation. The only time neutrality should be disrupted is if the physician suspects abuse or neglect. It is important that the patient has time to communicate privately with the physician at some point during the visit.     

老年痴呆患者住院期间的风险管理

痴呆病人记忆力差,生活活动能力减退,且可出现行为错乱等情况,护理中潜在很大的风险,本文通过老年病人痴呆患者的观察要点为患者提供安全、有序、优良的护理服务,预防老年性痴呆的健康教育指导等方面来加强老年痴呆患者住院期间的风险管理.     

The quality of nursing home care: do the opinions of family members change after implementation of emotion‐oriented care?

OBJECTIVE: The present study focuses on opinions on the quality of nursing home care of family members of nursing home residents with dementia. Furthermore, we examined whether family members' appreciation of the care increased as a result of the implementation of emotion-oriented care. DESIGN: Randomized clinical trial. INSTRUMENT: An 18-item questionnaire was developed. The following subjects were addressed: communication activities between staff and family members; satisfaction regarding contacts with staff; the extent to which family members can participate in care; the contact that family members experience with the person with dementia, and opinions about the way in which nursing staff treat residents. RESULTS: Most family members already had a positive opinion on the nursing home care prior to the implementation of emotion-oriented care. The most positive assessment concerned the way in which nursing staff treated residents. The lowest scores concerned communication activities between ward staff and family members. Comparison of the first and end measurements showed that in general opinions on the quality of care did not change. STUDY LIMITATIONS: A large number of incomplete questionnaires made it impossible to conduct factor analysis on the classification of the questions in various sections and therefore allowed us only to make statements at the item level. CONCLUSIONS: For the most part family members had a positive opinion on the nursing home care. In general, implementation of emotion-oriented care did not lead to a more positive assessment. Despite the generally accepted notion that involving family members in care is important, family members were regularly treated as outsiders. This demonstrates that there is room for improvement in the communication by nursing home staff with family members (e.g. more frequent contacts and information about the illness).     

Fecal incontinence in elderly patients

Fecal incontinence has a severe impact on the elderly patient, as well as the caregiver, and it can be the deciding factor in placing the patient in a nursing home. However, with knowledge of the causes, comprehensive assessment of the patient and his or her situation, and appropriate treatment, the physician can often reverse or minimize the negative effects of this common problem. The authors discuss all these facets and describe normal bowel function.     

Proposal for a survey for assisting the family and caregivers of patients with spinal cord injuries

This study proposes a basis survey for assistance to the family and caregivers because we believe there is necessity of family participation on the treatment, trying to understand and share the disease or deficiency situation. We objectified to sketch the relationship degree and the people's gender that accompanied the spinal cord injured hurt medular patient in nursing consultations and to discuss the necessity of basis survey to the assistance family and to the caregiver. 101 nursing consultations were accomplished, in clinic health, to the spinal cord injured patient and his/her relative and 36 patients were totalized, from this number 26 (72.22%) were male and 10 (27.78%), were female. It was verified that the men with medular lesion, in the greater number (27-80.7 O/o), were accompanied with his relatives specially mother and wife, while the women with medular lesion, in the greater number too (7-70%) were accompanied with her relatives of diversified proximity. In reference to the basis survey that comprehend the care at house and the caregiver necessity, we can affirm its relevance, trying to context the family support identified attending the caregivers.     

Spirituality and the elderly: nursing implications with nursing home residents

Spiritual care is integral to quality nursing care for nursing home residents. Spirituality can be defined as dynamic principles developed throughout the lifespan that guide a person's view of the world; influence his or her interpretation of a higher power, hope, morals, loss, faith, love, and trust; and provide structure and meaning to everyday activities. Spiritually focused nursing interventions include silent witnessing, serving as a liaison, and active listening. Nursing interventions for spiritual care can be divided into four dynamic phases: self-comfort, assessment, intervention, and evaluation. Spiritual well-being helps residents' total well-being and inner peace.     

The application of the resiliency model to caring for the family of a head injury client

Head injury often occurs in accidents, with severe consequences affecting not only the injured individual but his/her entire family. The purpose of this paper is to describe a case of nursing care provided to the family of a head injury patient using the family resiliency model. From June 26 to July 10, 2002, one of the authors took care of the head injury patient as a primary nurse, then assessed the family in accordance with the five factors influencing the family crisis adaptation process identified in the family resiliency model. The major stressors for the family included the unknown prognosis for the patient, the lack of family income, and not knowing how to talk with the children about their father's condition. Three nursing problems were identified, as follows: the family's knowledge deficit concerning head injury treatment, compromised family coping, disruption of family life and lack of coping resources. Applying various nursing interventions (i.e. education, family conferences, and play therapy), the authors guided the family towards an understanding of the disease treatment plan and the stresses they were facing. Finally, family members were able to participate in the rehabilitation plan for the patient and to find the resources to solve the family problems. This demonstrated that the resiliency model is a good tool for assessing families in crisis and planning nursing care in order to facilitate the family's successful bonadaptation.     

End of life in intensive care: Is transfer home an alternative?

The past decade has witnessed an increased focus on improving the quality of end of life care internationally. This has resulted in the development of specific health policy work streams to support patient choice and improve standards of care and patient experience. One concept well explored in areas outside of critical care is that of home care at the end of life. This paper seeks to challenge assumptions and practices about the options for transferring the critically ill patient home at end of life. As a piece of collaborative writing from a bereaved family member and critical care nursing team, this paper explores care given to one gentleman at the end of his life. In this, his journey is detailed, the decisions made are outlined and the experience for him and his family are examined with a retrospective narrative account from his wife that is woven throughout the paper. In this paper, we are not asserting that transfer home at end of life is desirable or feasible for all critically ill patients. We are challenging practitioners to consider when and how the initiative of transferring critically ill patients home at end of life, may occur.     

Nursing management of adults in the hospital

This chapter has provided an overview of the nursing process from the initial assessment to discharge planning in the care of the adult AIDS patient. The psychosocial aspects have not been addressed since they are discussed in the article by Govoni. The emotional support required by the patient may be as great as the physical nursing care needed. The AIDS patient may be experiencing social isolation related to discrimination, rejection or isolation by employers, society, family, friends, and even health care workers. It is important not to isolate the patient but to establish a therapeutic relationship. This may be accomplished by being professional, knowledgeable about the issues, nonjudgmental, understanding, and, lastly, sensitive to the patient's needs, fears, and concerns. Patients may be going through the stages of grieving as they try to come to terms with their prognosis. Caring for the adult AIDS patient is both complex and challenging for the nurse as the primary care provider. The nurse can help the patient to cope through the very difficult periods of the disease, even if it means to help the patient have a peaceful and dignified death.     

Caring for a family member with Alzheimer's disease: coping with caregiver burden post-nursing home placement

Most nursing home research has focused on predictors for placement, the placement decision-making process, or the effects of placement on the nursing home resident. Little research is available on family caregivers' experiences after placing their loved ones in a nursing home. The purpose of this qualitative study was to identify how family caregivers coped with the burden of post-nursing home placement of a family member with Alzheimer's disease (AD). Several factors that positively or negatively affected coping among family caregivers were identified. Family caregivers' interactions with their loved one, other nursing home residents, family and friends, nursing staff, and the nursing home-sponsored support group all contributed positively to their coping with the burden of post-nursing home placement. Factors that decreased family caregivers' coping were role disruption, guilt over placement, and uncertainty about the future.     

Interdisciplinary roles in stroke care

Care of the stroke patient presents a complex challenge to the interdisciplinary stroke team. The physical therapist, occupational therapist, and clinical social worker are important members of that team, each of whom contributes specialized knowledge and interventions in behalf of the patient. The physical therapist focuses on prevention of joint and tissue injury and retraining of lost motor skills. The occupational therapist considers the total patient in his or her environment and assists the patient in regaining or improving function in all areas of daily living. The clinical social worker concentrates on psychosocial assessment and intervention with the patient and family, aiding them in the adjustment process and planning for discharge. The nurse, in addition to playing a unique role in the delivery of nursing care to the stroke patient, is in a position to serve as coordinator of the interdisciplinary team. The nurse can facilitate the work of the physical and occupational therapists and the social worker by providing them with timely referrals, valuable assessment information and insights, and reinforcement of therapeutic activity while the patient is on the nursing unit. The keys to making the interdisciplinary team work for the maximal benefit of the patient are threefold: mutual respect and understanding among team members; ongoing coordination of efforts; and open communication between all team members, the patient, and the family. These elements are interrelated and essential if the interdisciplinary team is to be successful at meeting its ultimate goal: expert care of the total patient to achieve maximal independence.     

MDS coordinator relationships and nursing home care processes

This study describes how Minimum Data Set (MDS) coordinators' relationship patterns influence nursing home care processes. MDS coordinators interact with nursing home staff to coordinate resident assessment and care planning, but little is known about how they enact this role or influence particular care processes beyond paper compliance. Guided by complexity science and using two nursing home case studies, the authors describe MDS coordinators' relationship patterns by assessing the extent to which they used and fostered good connections, new information flow, and cognitive diversity. MDS coordinators at one site fostered new information flow, good connections, and cognitive diversity, which positively influenced assessment and care planning, whereas those at the other site did little to foster these three relationship parameters, with little influence on care processes. This study revealed that MDS coordinators are an important new source of capacity for the nursing home industry to improve quality of care.     

Caregivers' desired patterns of communication with nursing home staff- just TALKKK!

Individuals with cognitive impairment often represent a significant percentage of the residents in a nursing home nurse's care. With years of experience caring for their placed family members, caregivers of these residents are often experts in knowing the resident's needs, habits, behaviors, and moods. Caregivers often wish to convey this insider knowledge to nursing home staff. Furthermore, communication with caregivers promotes trust that personalized, safe, and effective care occurs when they are not there. Based on an interpretive study of the experiences of caregivers who place a family member with Alzheimer's disease in the nursing home, six preferred patterns of communication are presented in this article. The six patterns are represented by the acronym TALKKK (tell them; ask them; listen to them; know their family member by relating and communicating; be knowledgeable about dementia, its progression, dementia-specific care, and commonly used medications; and share that knowledge with them).