Nurses' perceptions of unaccompanied hospitalized children

The purpose of this study was to acknowledge and interpret the stories and perceptions of pediatric nurses who care for children left unaccompanied during their hospitalization. This was a phenomenological qualitative study conducted via interviews using open-ended questions. The study was conducted in a large Midwestern pediatric hospital that has both urban and suburban settings. Twelve nurses voluntarily completed the interviews. Recruitment was accomplished though a group e-mail that was sent to all registered nurses at the hospital complex. Nurses made assumptions about families particularly when the family did not communicate the reason for their absence. Unaccompanied children received equal nursing care but often received more attention than children whose families were present. Care for unaccompanied hospitalized children presents more challenges to nurses and may not be optimal for children. Nurses should examine their feelings and judgments about non-attendant families. Staffing levels should take into account whether the child has a guardian at the bedside.     

La visita infantil a la unidad de cuidados intensivos pediátricos desde la experiencia de las enfermeras

BackgroundFamily process disruption is one of the main consequences of the hospitalization of a critically ill child in a Paediatric Intensive Care Unit (PICU). Children's visits to PICU may help improve family coping. However, this is not a standard practice and nurses’ experiences in facilitating children's visits to units where it is encouraged is unknown.AimTo explore nurses’ experience related to promoting the visits of siblings to PICU.MethodsAn interpretative phenomenological study was carried out through in-depth interviews in two PICUs belonging to third level public hospitals in Madrid. Twelve nurses with more than two years of experience in PICU were interviewed. They all were working in PICU during the study. Furthermore, a PICU psychologist with an experience of four years was interviewed and this was considered shadowed data. Data analysis followed a thematic discourse analysis.ResultsNurses’ experience of facilitating children's visits to PICU can be condensed into four themes: emerging demand for visits, progressive preparation, decision-making through common consensus and creating intimate spaces.ConclusionsThe experience of nurses in facilitating visits is mainly in response to the demand of families going through prolonged hospitalisation or end-of-life situations. The role of the nurse is one of accompaniment, recognising the major role of parents in the preparation of children and in developing the visit. Nurses feel insecure and lack resources for emotional support and demand action protocols to guide intervention and decision making.     

Consultation with children in hospital: children, parents' and nurses' perspectives

Aims and objectives. To explore children's, parents’ and nurses’ views on participation in care in the healthcare setting. Background. Children have a right to be consulted and involved in their care. Design. The grounded theory method was used and data were collected through in‐depth interviews, questionnaires and observation. Sample consisted of 11 children, 10 parents and 12 nurses from four paediatric wards in two hospitals in England. Results. Parents felt that children should be involved in the decision‐making process thereby enhancing and promoting children's self‐esteem and positive self‐regard, which would consequently enhance their overall welfare. Likewise, children expressed the need for consultation and information so that they could understand their illness; be involved in their care, and prepare themselves for procedures. However, children's own opinions and views were underused and they had varying experiences of being consulted about their care and treatment. Nurses appeared to hold varying and discrepant views on the involvement of children in decisions and for some nurses, the child's involvement seemed to be dependent on the child's cognitive maturity and being defined as a rational subject. Conclusion. Health professionals’ communication behaviour may reflect recognition of children's cognitive abilities rather than their competence to understand. The fact that children's nurses appeared to make decisions about involving children in decision making in the absence of a reliable framework was a significant finding and highlights a real problem in the current climate. Relevance to clinical practice. Nurses faced with workforce pressures may encounter considerable challenges to facilitating children's involvement in decisions about their care. Hence it is imperative that nurses’ examine the basis of their decisions and use more explicit criteria for determining children's involvement.     

“A stressful and frightening experience”? Children's nurses' perceived readiness to care for children with cancer following pre-registration nurse education: A qualitative study

BackgroundIn the UK children with cancer are cared for by children's nurses in a variety of settings, specialist and non-specialist. Whilst post-registration specialist education is available to some nurses, many nurses rely solely on pre-registration education to competently care for these children. This study explores whether nurses perceive that this adequately prepares them.ObjectivesTo explore the extent to which qualified nurses perceive that pre-registration nurse education prepares them to care for children with cancer; to consider the implications for children's nursing pre-registration curricula.DesignA small-scale qualitative study was undertaken using an interpretivist approach.MethodsSemi-structured interviews were conducted with six qualified children's nurses in two clinical areas - a specialist children's cancer inpatient ward, and a general children's ward where inpatients included children with cancer.ResultsFindings are discussed in relation to three emergent themes: Learning in Theory and Practice, Care of the Child and Family, and Resilience. Participants attached significance to the quantity and quality of practice experience. They reflected on barriers to specific and transferable theoretical learning and stressed the importance of integrating theory and practice. Understanding of family-centred care formed a significant part of their preparation. Preconceptions, communication with families and the emotional impact of this speciality were stressful. Improved pre-registration preparation may have developed participants' resilience.ConclusionThe complexities of caring for children with cancer and their families require well-prepared nurses. Participants' perceptions of preparedness were influenced by aspects of pre-registration education. Their experiences suggest that curricula should be practice-focused and include a range of placements. Specialist theoretical content must be integrated with practice and transferability of knowledge and skills made explicit. Reflection and problem-based learning may foster coping mechanisms and resilience that will equip them to care for children with cancer.     

Supporting bereaved parents: a phenomenological study of a telephone intervention programme in a paediatric oncology unit

Aims and objectives. This study sought to discover bereaved parents’ perspectives and experiences of a nurse‐led, ward‐based, telephone support programme in a children’s oncology unit. Background. Parental grief is especially intense and long‐lasting, and many parents can experience serious psychological problems. The oncology team learned that some parents felt ‘forgotten’ or ‘abandoned’ following their child’s death and addressed this concern by initiating and subsequently evaluating a telephone bereavement support programme. Design. An interpretive phenomenological investigation of the experiences of six parents who participated in the programme. Methods. Parents shared their experiences and perceptions of the programme in individual interviews. Interpretive phenomenology and thematic analysis guided the interviews’ interpretation to ascertain both the parents’ experiences of the programme and their understandings of everyday clinical terms such as ‘support’ or ‘reassurance’. Results. Parents found the programme supportive, especially valuing ongoing contact with a nurse who ‘knew them’. Telephone contact was preferred to visiting the hospital, which brought back painful memories. Calls were important elements in helping parents create meaning and memory around their deceased child. Conclusions. Regular telephone contact over an agreed period from a familiar member of the child’s treating team can create a more positive and supportive bereavement experience for parents in the year following their child’s death. The specific findings are discussed in the context of the death of a child as a crisis of meaning. Relevance to clinical practice. Clinical nurses are ideally placed to use existing close relationships to extend care and support to bereaved parents. This study shows how nurses can identify service gaps, work with interdisciplinary team colleagues to initiate appropriate actions and participate in the essential evaluation subsequently required.     

The qualitative experience of Chinese parents with children diagnosed of cancer

Aim. The present study aimed to describe the coping experiences of Chinese parents with children diagnosed as having cancer during the treatment stage. Background. Cancer is the second major cause of death among children in Hong Kong, it claims the lives of 60–70 children per year. Childhood cancer has tremendous impact on the family, especially the parents. It is, therefore, important to understand parents’ psychological functioning and coping experience. Methods. A phenomenological approach was used. Data were collected by qualitative interviews and analysed following Colaizzi's phenomenological methodology. A purposive sample of nine parents whose children were diagnosed of having childhood cancer was recruited from a regional hospital in Hong Kong. Results. Four themes emerged describing parents’ coping experiences: shock and denial, establishing the meaning or the situation, confronting the reality and establishing a new perspective. The initial reactions of the parents to the diagnosis were shock, denial and worry. However, they quickly accepted the reality and regarded their child's illness as their ‘fate’ that they had to accept. They were committed to the care of the sick child and seek informational and emotional support to cope with the situation. All of them were able to identify positive aspects from the illness experience and establish hope for the future. Chinese cultural beliefs might help the parents cope positively and avoid negative emotions. Conclusion. This study found some commonalities of coping experience in both Western and Chinese culture. It adds knowledge to the coping experience of Chinese parents at the treatment phase of their children's illness and highlighted the need for emotional and information support for parents. Relevance to clinical practice. Education programme and mutual support group would be helpful to parents. Nurses have to learn how different cultural groups and subcultural groups in the society cope to provide competent cultural care.     

The method of nursing support in hospital and patients' and family members' experiences of the effectiveness of the support

Nurses are an important source of support for patients and family members during hospitalization. It is unclear, however, what kinds of support methods are used in hospitals and how the support affects the patient and family member(s). This study describes methods of nursing support in hospital and adult patients' and their family members' experiences of this support. The data were collected in spring 2009 through essays written by and group interviews with nurses (n = 11) working at a Finnish university hospital. The data from patients (n = 9) and family members (n = 7) were collected in individual and group interviews. The material was interpreted by inductive content analysis. In their interaction with patients and family members, the hospital nurses used the methods of emotional and informational support. Patients' and family members' experiences of the effectiveness of this support were related to the establishment of a care relationship, their future outlook, mental well‐being and experiences of getting well. The evidence from this research will be useful in developing methods of nursing support for patients and family members and family‐oriented care in hospital.     

Exploring the impact of digital stories on empathic learning in neonatal nurse education

Within neonatal nurse education, learning to understand the compelling emotional experiences of parents following the birth of their premature baby is essential to give person-centred empathic care. A collection of digital stories informed by parents' experiences was created to use as a pedagogical tool for students and staff within the neonatal speciality. This study reports on an exploration of the value of these digital stories for the enhancement of empathic learning. Using the principles of narrative inquiry, a mixed-methods design comprising ‘point-of-view’, reflective exercises, interviews and a questionnaire distributed to nursing students and practice staff ascertained views of three digital stories. The participants evaluated the digital stories positively overall and it was clear they were an effective and innovative way to learn about emotional experiences of parents. Powerful emotional messages from parents enhanced awareness, understanding and insight into their affective experience. Within the context of narrative-based neonatal education, there is a place for digital storytelling as a pedagogical strategy informed by parent narratives, to teach students and staff about the emotional impact of the neonatal care experience. In turn, this can potentially lead to more empathic, person-centred care relating to the families of sick, vulnerable babies.     

Women's stories of their experiences as overweight patients

Title. Women’s stories of their experiences as overweight patients. Aim. This paper is a report of a study to illuminate the meaning of women’s experiences as overweight patients in their encounters with healthcare services and healthcare providers. Background. Overweight and obesity are increasingly important issues for women’s health internationally. Overweight or obese women may delay or avoid health care if care providers have previously reacted negatively to them based on weight. However, studies focusing on the meaning of women’s experiences as overweight patients and as recipients of healthcare services are lacking. Method. A hermeneutic phenomenological approach was used. Face‐to‐face interviews were conducted in the United States of America in 2007 with eight women volunteers who self‐identified as being overweight patients. The framework of van Manen’s lifeworld existentials of lived space, lived body, lived time and lived relation‐guided reflection for data analysis. Findings. The essence of women’s experiences was a battle to fit into the world of healthcare services. Four major themes were identified. ‘ Struggling to fit in ’ consisted of trying to fit into limited physical space (examination rooms, equipment), limited time, and limited satisfaction and support in relationships with healthcare providers. ‘ Being dismissed ’ consisted of demeaning and embarrassing interactions with providers. ‘ Feeling not quite human ’ involved the stigma of being different because of body size. ‘ Refusing to give up ’ consisted of persistence in seeking support and advice from professionals despite negative past experiences. Conclusion. Awareness of these findings could reform understanding of women’s experiences as overweight patients and raise the consciousness of nurses worldwide to develop sensitive communication strategies and healthcare environments that support holistic care.     

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.     

Qualitatively exploring the attributes of adaptability and resilience amongst recently graduated nurses

AimTo explore newly graduated nurse’s understandings and practices of adaptability and resilience in clinical environments.BackgroundThe everyday practice of nursing work involves managing emotional and practical everyday demands related to the role. Adaptability and resilience are two critical attributes that equip nurses for this by enabling them to manage challenges and be flexible with their practices and expectations in the face of rapidly changing and unpredictable circumstances.DesignInformed by the theoretical underpinnings of the Person-centred Practice Framework, semi-structured interviews using topic guides were conducted with nine newly graduated registered nurse participants recruited through purposive sampling. Interviews occurred between March-October 2020 with participants working across seven different healthcare settings in three Local Health Districts in NSW, Australia.ResultsAnalysis of the data generated the core themes of: 1) ‘Making sense’ explored how nurses defined resilience and adaptability; 2) ‘Surviving as the nurse’ focused on how nurses experienced adaptability and resilience as a newly qualified nurse; 3) ‘Trusting oneself’ reflected the interconnection of nurses’ developed adaptability and resilience to their clinical self-assurance; and 4) ‘Doing it again’ described how adaptability and resilience can be further supported by the university sector. Findings demonstrated that adaptability and resilience in combination are essential attributes and required for effective nursing practice post-graduation. However, both collegial and organizational support were found to be lacking in positively reinforcing these attributes in this study.ConclusionNewly graduated nurses can develop adaptability in clinical practice, so they are a more resilient future workforce. However, greater organizational leadership is required to model and strengthen these attributes for nurses. When perceptions, knowledge and experiences of adaptability and resilience are developed using person-centred approaches, they will be used in person-centred ways.Tweetable abstractNewly graduated nurses can develop adaptability in clinical practice, so they are a more resilient future workforce. However, greater organizational leadership is required to model and strengthen these attributes for nurses. When perceptions, knowledge and experiences of adaptability and resilience are developed using person-centred approaches, they will be used in person-centred ways.     

The meaning of guilt and shame: A qualitative study of mothers who suffer from eating difficulties

The aim of this study was to illuminate and interpret guilt and shame expressed by mothers with eating difficulties (ED). The research question was: What is the meaning of guilt and shame experienced by mothers with ED? Experiences of guilt and shame in mothers with ED may be strong, yet concealed, and should be addressed when promoting women's mental health. The study design was explorative, and in‐depth interviews were conducted with eight mothers suffering from ED. The data were analysed by means of qualitative content analysis and interpreted according to a hermeneutic approach. The main theme ‘Struggling in silence with guilt and shame as a mother living with ED and trying to keep it secret’ was interpreted on two levels: emotional, ‘Feeling worried about failure and wanting to be successful’, and cognitive, ‘Having condemning thoughts about one's own sense of responsibility’. In addition, each theme contained two subthemes. Feelings and awareness of guilt and shame are strong; they vary between individuals and are intensified in mothers who suffer from ED. It is important for mental health nurses to help mothers with ED articulate such feelings in order to promote health.     

The hidden benefit: the supportive function of the nursing handover for qualified nurses caring for dying people in hospital

1. The nursing handover is a key activity for nurses working in acute hospital wards in the NHS. Little scholarly attention has been paid to the use nurses make of the information exchanged during nursing handover or how certain features of the nursing handover might impact positively or negatively on patient outcomes. 2. This paper draws on data from a phenomenological study of 28 qualified diplomate nurses. 3. During the course of non-directive semi-structured interviews, some of the participants in this study expressed the opinion that nursing handover was helpful in enabling them to work with dying people in the acute hospital medical wards in which they worked. 4. The nurses identified two important functions of the nursing handover. The first was as a forum for discussing opinions and expressing feelings. The second was as a source of information on which to base their nursing decisions and actions. 5. It is proposed that some qualified nurses need help with the emotional labour of caring for dying people and that the nursing handover can assist in emotional adaptation, so enabling the management of troubling thoughts or feelings experienced in the course of caring for someone who is dying. 6. The role of the nursing handover in providing emotional support for nurses has been little studied and is a potentially useful area of future research, especially if it can be related to patient experiences and outcomes.     

Negotiating the transition: caring for women through the experience of early miscarriage

Aim.  To explore women’s experiences of having an early miscarriage in a hospital gynaecological unit. Background.  Miscarriage is a global health issue affecting significant numbers of women and is usually considered a distressing experience. This distress is often interpreted as being characteristic of grief. Nurses and other health professionals in hospital and community settings are therefore expected to provide appropriate care to meet the physical and emotional needs of the woman. Design.  A qualitative, ethnographic study of a hospital gynaecological unit in the UK. Methods.  The primary method was 20 months of part‐time participant observation. Data were also collected through documentary analysis of key documents in the setting and formal interviews. These were with eight women who had an early miscarriage and 16 health professionals (nurses, doctors, ultrasonographers) working in the unit. Results.  Three clear phases emerged in the women’s experience of miscarriage and hospital admission; first signs and confirmation, losing the baby and the aftermath. These were interpreted as being components of a process of transition. The hospital admission emerged as vital in these early phases in which the importance of nurses and other health professionals providing sensitive, engaged care to meet the emotional and physical needs of the woman was identified. Conclusions.  The hospital setting emerged as highly influential in shaping the care that was given to women and influencing their experiences. Transition models were felt to be more appropriate than grief and bereavement models in guiding the psychological care given to women. Relevance to clinical practice.  The experience of hospital admission and the actions of nurses and other health professionals is influential in how women negotiate the transition through miscarriage.     

The meaning of caring for people with malodorous exuding ulcers

Title. The meaning of caring for people with malodorous exuding ulcers. Aim. This paper is a report of a study to illuminate the meaning of caring for people with malodorous exuding ulcers. Background. Managing ulcers is complicated and consensus on assessment and treatment difficult to reach. Nurses need knowledge and skills to provide good care. They must stay close and be exposed to contamination and suffering. They must provide care without violating patients and we need to further explore this challenge. Method. A convenience sample of ten participants was recruited. Participants had experience of caring for people with malodorous exuding ulcers and were employed in primary health or hospital care in Sweden. Narrative interviews were conducted during late 2002 to early 2005 and interpreted using a phenomenological‐hermeneutic method. Findings. Themes were formulated: ‘Facing the wound’ when nurses reveal what is meant to be concealed and perceive patients’ vulnerability; ‘Facing one’s own defencelessness’ when feeling invaded, helpless and ashamed; ‘Struggling to shield one’s own defencelessness’ was achieved by striving to be in control, striving to endure and seeking a way out. ‘Struggling to shield patients’ vulnerability’ was about alleviating patients’ additional suffering by striving to spare patients, pushing boundaries, making uncomfortable decisions and sharing togetherness. When failing to shield their own defencelessness and patients’ vulnerability, nurses run the risk of experiencing desolation. Conclusion. Physical proximity and bodily suffering affect nurses. Caring for people with ulcers calls for improved interprofessional cooperation in order to provide the best treatments and care. Further education for these nurses is needed, as well as support from managements and organizations.