Oncology patients' and oncology nurses' perceptions of nurse caring behaviours

Previous research on patients' and nurses' perceptions of nurse caring behaviours has documented significant differences in the ranking of important behaviours. However, these samples have included a variety of medical-surgical patients and nurses and different types of institutional settings, all of which may have affected the results. The present study sought to determine if patients and nurses from one subspecialty area and one institution would have more concordant perceptions of caring. Forty-four oncology patients and 49 oncology nurses completed the Respondents Perceptions of Caring Behaviour Scale (RPCBS). Results showed that overall mean patient rankings were highly correlated with mean nurse rankings (Spearman's correlations coefficient 0.94, P<0.0001). The Wilcoxon two-sample rank sum test was used to test the difference in rank of the 20 items between the patients and nurses. There was a significant difference in rank in only six of the 20 items. These data suggest that oncology patients and nurses have more concordant perceptions of caring than previously investigated groups. Implications for practice and further research are discussed.     

A longitudinal study into the perceptions of caring and nursing among student nurses

A longitudinal study of a cohort of student nurses was undertaken in order to investigate whether changes in perceptions of nursing and caring take place and how perceptions of nursing and caring are related. The Caring Dimensions Inventory (CDI) and the Nursing Dimensions Inventory (NDI) were employed for data collection at entry to nurse education and after 12 months. There were significant changes in the scores of a range of items in both inventories which suggested that student nurses lose some of their idealism about nursing and caring after 12 months in nurse education. While the overall ranking of items in the inventories was very similar, it was possible to distinguish between the inventories at entry to training and to observe a change, particularly in the CDI, over time by means of Mokken scaling. Nursing and caring would appear to become more synonymous to the student nurses after 12 months in nurse education. Factors scores, for factors identified in the CDI in a previous study, were used to investigate whether these scores changed at 12 months into nurse education compared with entry. No significant changes were detected.     

Student nurses' experiences of caring for infectious patients in source isolation. A hermeneutic phenomenological study

Aim. To illuminate issues central to general student nurses’ experiences of caring for isolated patients within the hospital environment, which may assist facilitators of learning to prepare students for caring roles. Background. Because of the development of hospital‐resistant micro‐organisms, caring for patients in source isolation is a frequent occurrence for supernumerary students on the general nursing programme. Despite this, students’ perceptions of caring for this client group remain under researched. Design and methods. Through methods grounded in hermeneutic phenomenology, eight students in the second year of the three‐year undergraduate programme in general nursing were interviewed using an un‐structured, open‐ended and face‐to‐face interview approach. Data analysis was approached through thematic analysis. Results. Four themes emerged: The organization: caring in context, Barriers and breaking the barriers, Theory and practice, Only a student. The imposed physical, psychological, social and emotional barriers of isolation dramatically alter the caring experience. Balancing the care of isolated patients to meet their individual needs while preventing the spread of infection has significance for students. Applying infection control theory to the care of patients in source isolation is vital for students’ personal and professional development. Perceptions of supernumerary status influence students’ experiences of caring for these patients. Relevance to clinical practice. Designating equipment for the sole use of isolated patients assists students in maintaining infection control standards. Balancing the art and science of caring for patients in source isolation is important to reduce barriers to the student–patient relationship and to promote delivery of holistic care. Staff nurses should consider using available opportunities to impart recommended isolation practices to students thereby linking the theory of infection control to patient care. Providing structured, continuing education for all grades of staff would acknowledge the interdependence of all healthcare workers in controlling hospital‐acquired infection.     

Providers' and consumers' perspective of nurses' caring behaviours

The primary purpose of this article is to discuss the development and testing of a scale designed to examine nurses' caring behaviours. A pilot study was conducted with a convenience sample (n = 81) of 42 nurses (providers) and 39 patients (consumers). The setting was two community hospitals in the New England Region. The respondents were able to assign a rank of the items (nurses' caring behaviours) with a spread of mean values from 3.5 to 16.7. There was agreement on the most caring behaviour, 'The nurses treat me as an individual', on the behaviour in the middle range of caring, 'The nurses comfort me by their silent presence', and on the least caring behaviour, 'The nurses did not talk about how my illness might affect my life'. The Wilcoxon two-sample rank-sum test was used to test the difference in rank of the 20 items between the providers and the consumers. There was a significant difference between the providers and the consumers in the ranking of nine of the 20 items. The consumers valued behaviours that recognized their individual perspective as well as that of their family and behaviours that helped them anticipate and prepare for change. The providers placed a greater emphasis on the behaviours that were more geared towards the comforting aspects of care by encouraging patients to express and vent their feelings. These findings allow clinicians to be sensitized to their caring behaviours by increasing their realization of how behaviours are perceived by patients. The instrument needs minor revision and then further testing is indicated.     

我国康复护士培养现状与建议

综述了我国康复护理的现状及康复护士的作用。目前康复护理的培训对象多是具有注册护士资格证书和一定临床经验的护士,在大专院校尚未进行康复护士的培养。通过对教育培养目标、教学模式的分析,认为在大专院校进行康复护理人才培养是可行的。     

Patient participation in clinical decision-making in nursing: A comparative study of nurses' and patients' perceptions

Aims and objectives. The aim of this study was to compare the degree of concordance between patients and Registered Nurses’ perceptions of the patients’ preferences for participation in clinical decision‐making in nursing care. A further aim was to compare patients’ experienced participation with their preferred participatory role. Background. Patient participation in clinical decision‐making is valuable and has an effect on quality of care. However, there is limited knowledge about patient preferences for participation and how nurses perceive their patients’ preferences. Methods. A comparative design was adopted with a convenient sample of 80 nurse–patient dyads. A modified version of the Control Preference Scale was used in conjunction with a questionnaire developed to elicit the experienced participation of the patient. Results. A majority of the Registered Nurses perceived that their patients preferred a higher degree of participation in decision‐making than did the patients. Differences in patient preferences were found in relation to age and social status but not to gender. Patients often experienced having a different role than what was initially preferred, e.g. a more passive role concerning needs related to communication, breathing and pain and a more active role related to activity and emotions/roles. Conclusions. Registered Nurses are not always aware of their patients’ perspective and tend to overestimate patients’ willingness to assume an active role. Registered Nurses do not successfully involve patients in clinical decision‐making in nursing care according to their own perceptions and not even to the patients’ more moderate preferences of participation. Relevance to clinical practice. A thorough assessment of the individual's preferences for participation in decision‐making seems to be the most appropriate approach to ascertain patient's involvement to the preferred level of participation. The categorization of patients as preferring a passive role, collaborative role or active role is seen as valuable information for Registered Nurses to tailor nursing care.     

Action research as a catalyst for change: Empowered nurses facilitating patient participation in rehabilitation

Based on action research as a practitioner‐involving approach, this article communicates the findings of a two‐year study on implementing patient participation as an empowering learning process for both patients and rehabilitation nurses. At a rehabilitation facility for patients who have sustained spinal cord injuries, eight nurses were engaged throughout the process aiming at improving patient participation. The current practice was explored to understand possibilities and obstacles to patient participation. Observations, interviews and logbooks, creative workshops and reflective meetings led to the development and testing of four new rehabilitation initiatives aimed at enhancing patient participation. This study suggests that skills of critical reflection from action research toolbox shed light on both the notion of patient participation and caring in nursing rehabilitation. By actively involving nurses in research, the knowledge development stems from practice and the solutions therefore became practice‐oriented. In addition, the personal and professional development experienced by the involved nurses points to a secondary gain in the form of an analytical and reflective approach to complex issues in relation to patient participation, rehabilitation in general and the individual nurses' sense of professional pride.     

Re-establishing dignity: nurses' experiences of caring for older hospital patients

In western countries, the older population is increasing and with age follows a risk of un-health. Every fifth hospital patient is above 65 years of age. As a consequence, nursing care to older patients is a significant but tacit nursing issue. The aim of this study was to explore Danish clinical nurses' experiences of caring for older hospital patients. The study was based on Benner and Wrubel's phenomenological notion that caring as a special kind of involvement, a grasp of a situation in terms of its meaning, is primary in nursing. A qualitative secondary analysis of data from an interview study with 29 nurses and nurse assistants was performed following Van Manen's hermeneutic phenomenology. Findings show that caring mainly concerns 're-establishing dignity' especially through 'seeing the patient as a unique person', 'assisting in getting rid of the bed' and 'supporting patient appearance'. The study documents that caring for older people is about creating small everyday circumstances in which patient dignity can flourish. Shortcomings of a secondary analysis are discussed and suggestions for future research, such as how older hospital patients experience caring and dignity in relation to nursing care received, are suggested.     

Validation of CARE‐Q in residential aged‐care: rating of importance of caring behaviours from an e‐cohort sub‐study

Aim and objective. To validate the Caring Assessment Report Evaluation Q‐sort questionnaire in the residential aged‐care setting. Based on this determination, to conclude with what degree of confidence the questionnaire can be used to determine the ranking of the importance of caring behaviours amongst aged‐care nurses and residents in residential aged‐care. Background. Perceptions of caring may be context specific. Caring in residential aged‐care may stand in contrast to the sense of caring understood and practiced in other settings. Design. Self‐administered survey. Methods. Residents from three not‐for‐profit aged‐care facilities, across both high‐care (nursing‐home) and low‐care (hostel care) were surveyed relying on the Caring Assessment Report Evaluation Q‐sort questionnaire. A sub‐sample of registered and enrolled nurses working in residential aged‐care and registered with the Nurses & Midwives e‐cohort study completed the same survey. Results. Although the Caring Assessment Report Evaluation Q‐sort questionnaire showed good internal consistency for the sample of nurses, the results for the residents were more erratic. Both groups displayed large ranges for the inter‐item correlations. The results of the Mann–Whitney U‐test indicated that the nurses rated the Comforts, Anticipates and Trusting relationship as significantly more important than the residents. Both groups rated the Explains and facilitates subscale as least important. All subscales, however, received median scores greater than, or equal to, six (seven‐point, Likert scale) indicating that all were considered important overall. Conclusion. Based on poor Cronbach's alpha coefficients, negative inter‐item correlations and qualitative observations, without further development within the residential aged‐care facility the free response format version of the Caring Assessment Report Evaluation Q‐sort may not be an appropriate measure to use with residential aged‐care residents. More research needs to be conducted into how residents and nurses are interpreting the items in the Caring Assessment Report Evaluation Q‐sort. Relevance to clinical practice. There will always remain a need for nurses to enact behaviours that are meaningful to residents (and patients generally).     

Incongruence between nurses' and patients' understandings and expectations of rehabilitation

Aims and objectives. To explore nurses’ understandings and expectations of rehabilitation and nurses’ perceptions of patients’ understandings and expectations of rehabilitation. Background. Within the context of a broadening appreciation of the benefits of rehabilitation, interest in the nature of rehabilitation is growing. Some believe that rehabilitation services do not adequately meet the needs of patients. Others are interested in the readiness of patients to participate in rehabilitation. Design. Qualitative. Method. Grounded theory using data collected during interviews with nurses in five inpatient rehabilitation units and during observation of the nurses’ everyday practice. Findings. According to nurses working in inpatient rehabilitation units, there is a marked incongruence between nurses’ understandings and expectations of rehabilitation and what they perceive patients to understand and expect. Conclusion. Given these different understandings, an important nursing role is the education of patients about the nature of rehabilitation and how to optimise their rehabilitation. Relevance to clinical practice. Before patients are transferred to rehabilitation, the purpose and nature of rehabilitation, in particular the roles of patients and nurses, needs to be explained to them. The understandings of rehabilitation that nurses in this study possessed provide a framework for the design of education materials and orientation programmes that inform patients (and their families) about rehabilitation. In addition, reinforcement of the differences between acute care and rehabilitation will assist patients new to rehabilitation to understand the central role that they themselves can play in their recovery.     

A model of professional nurse caring: nursing students' experience

Research into caring from the perspective of nursing students is poorly documented. This paper presents a study which described the construct of caring as experienced by students in pre-registration programmes at two universities in New South Wales, Australia. Qualitative data were collected using a questionnaire and semi-structured interviews. From the analysis of the data a model of professional nurse caring from the student's perspective was created. In this model, compassion, as the core of caring is actualized in the students' nursing of patients by communicating, providing comfort, being competent, being committed, having conscience, being confident and being courageous. Communication is not only an actualization of this caring but constitutes an important medium for the expression of caring actions.