Registered nurses' experiences of interaction with patients with mental health challenges in medical wards in Johannesburg

poggenpoel m. , myburgh c.p.h. & morare m.n. (2011) Journal of Nursing Management 19, 950–958 Registered nurses’ experiences of interaction with patients with mental health challenges in medical wards in Johannesburg Aim The aims of this research were to explore and describe registered nurses’ experiences of interacting with patients with mental health challenges in the medical wards of a public hospital in Johannesburg. Background Nurses are the major providers of hospital care and have become an important resource in the delivery of mental health care to patients with mental health challenges. However, the attitude and ability of many nurses in providing this care have been shown to be poor. Method In-depth phenomenological interviews were conducted with eight female registered nurses working in four medical wards where they interact with patients with mental health challenges. Results From the findings it is clear that registered nurses experienced frustration, unhappiness, fear and perception of danger when interacting with patients with mental health challenges in their wards. This could be attributed to a lack of knowledge and skills in mental health. Conclusion Registered nurses have negative experiences with interaction with patients with mental health challenges in medical wards because of a lack of knowledge and skills in mental health. Implications for nursing management Ward managers can facilitate the psychological empowerment of registered nurses.     

The patient-centred interview: the key to biopsychosocial diagnosis and treatment

The article reports on some ideas and experiences gained from a holistic approach to working with patients and introduces a viewpoint that includes opinions on how postmodernism, the biopsychosocial model and a patient-centred interviewing style can change traditional, biomedical-oriented medicine. During the past 10 years, we have been instructing medical students in the use of this patient-centred interviewing model and have trained experienced general practitioners (GPs) in adopting it in 2-year family-oriented continuing medical education courses. We believe that doctors and other health care providers, particularly in primary care settings, need a comprehensive concept of human health and illness, and that skill in patient-centred interviewing is the product of a deep learning process. In conclusion, we have learned that a successful patient-centred interview helps the GP to better understand the patient and helps to explain the data that the patient presents. Patient-centred orientation and interviewing also change the communication between doctor and patient in a direction which supports the patient's and his/her family members' own resources in the healing process.     

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.     

Second victim phenomenon: Is ‘just culture’ a reality? An integrative review

BackgroundDespite rigorous and multiple attempts to establish a culture of patient safety and a goal to decrease incidence of patient deaths in the health care, estimations of preventable mortality due to medical errors varied widely from 44,000 to 250,000 in hospital settings. This magnitude of medical errors establishes patient safety as being at the forefront of public concerns, healthcare practice and research. In addition to the potential negative impact on patients and the healthcare system, medical errors evoke intense psychological responses in health care providers' responses that threaten their personal and professional selves, and their ability to deliver high quality patient care. Studies show half of all hospital providers will suffer from second victim phenomena at least once in their careers. Health care institutions have begun a paradigm shift from blame to fairness, referred to as ‘just culture’. ‘Just culture’ better ensures that a balanced, responsible approach for both providers who err and healthcare organizations in which they practice, and shifts the focus to designing improved systems in the workplace.ObjectivesThe aim of this review was to identify: how medical errors affect health care professionals, as second victims; and how health care organizations can make ‘just culture’ a reality.DesignAn integrative review was performed using a methodical three-step search on the concept of second victims' perceptions and responses, as well as ‘just culture’ of health care institutions.ResultsA total of 42 research studies were identified involving health care professionals: 10 qualitative studies; eight mixed-method studies; and 24 quantitative studies. Second victims' perceptions of the current ‘just culture’ included: 1) fear of repercussions of reporting medical errors as a barrier; 2) supportive safety leadership is central to reducing fear of error reporting; 3) improved education on adverse event reporting, developing positive feedback when adverse events are reported, and the development of non-punitive error guidelines for health care professionals are needed; and 4) the need for development of standard operating procedures for health care facility peer-support teams.ConclusionsSecond victims' perceptions of organizational and peer support are a part of ‘just culture’. Enhanced support for second victims may improve the quality of health care, strengthen the emotional support of the health care professionals, and build relationships between health care institutions and staff. Although some programs are in place in health care institutions to support ‘just culture’ and second victims, more comprehensive programs are needed.     

Abuse in health care: a concept analysis

Scand J Caring Sci; 2012; 26; 123–132 Abuse in health care: a concept analysis Aims and objectives: To analyse the concept of abuse in health care. This analysis also covers how abuse in health care is different from the related concepts of medical error, patient satisfaction and personal identity threat. Background: Abuse in health care is an emerging concept in need of a clear analysis and definition. At the same time, boundaries to the related concepts are not demarcated. Design: Concept analysis as developed by Walker and Avant. Method: The databases Cumulative Index to Nursing and Allied Health Literature, Medline, and Google Scholar were used to obtain articles published between 1997 and 2009. A total of eleven articles are referred to on abuse in health care, four on medical error, six on patient satisfaction and three on personal identity threat. Results: Abuse in health care is defined by patients’ subjective experiences of encounters with the health care system, characterized by devoid of care, where patients suffer and feel they lose their value as human beings. The events are most often unintended. We also found differences with the aforementioned related concepts: medical error does not share the patients’ perspective, and patient satisfaction does not offer room for patients’ abusive experiences. The concept of personal identity threat shares all attributes with abuse in health care, but it lacks an antecedent that signifies the social structures underlying the phenomenon. Conclusions: Abuse in health care covers a phenomenon that has severe consequences but is invisible if seen from a medical error or patient satisfaction perspective.     

The significance of fellow patients for the patient with cancer: what can nurses do?

Based on two qualitative studies, this article describes the significance of fellow patients in cancer wards, and the relevance for health personnel involved in patient-patient relationships is discussed. Using grounded theory, in-depth interviews were conducted in the first study with 21 adult cancer patients and in a follow-up study with 8 patients and 27 health care providers. The findings indicate that the significance of fellow patients for the patient with cancer can be described in terms of three different dimensions: attitudes toward own illness, interpersonal relationships, and environmental factors. Although contact with fellow patients most often seems to engender positive experiences, some negative experiences are reported also. The suggestions in this article for practical implications are meant to help nurses and other health care providers to promote positive and prevent negative consequences in patient-patient relationships in hospitals.     

Perceived factors influencing hospital-based primary care clinic referrals to community health medical nutrition therapy: An exploratory study

Primary care clinics provide an array of diagnostic and clinical services that assist patients in preventing the onset or managing acute and chronic conditions. Some chronic conditions such as high blood pressure, high cholesterol, and type 2 diabetes require primary care professionals to seek additional medical intervention from registered dieticians. This study explored beliefs, attitudes, and practices of medical and administrative professionals in primary care clinics encountering patients who are potential candidates for ongoing nutrition education or counselling. Five focus groups with primary care providers and clinical staff (n = 24) were conducted to identify perceived intra-organisational factors influencing initiation of community health medical nutrition therapy (MNT) referrals. Lack of clarity regarding community health dieticians’ role in chronic disease management was the primary finding for the absence of MNT referrals. Insurance-imposed constraints, perceived patient readiness to change, and service inaccessibility were revealed as barriers that influence referrals to both community health and specialty care dieticians. This study underscores the importance of identifying organisational and interpersonal barriers that influence the initiation of community health MNT referrals. Understanding these barriers can create stronger interprofessional collaboration between primary care providers and community health dieticians.     

Collaborating with medicine? Perceptions of Australian naturopaths on integrating within the conventional medical system

Complementary and alternative medicine (CAM) is an increasingly prevalent part of contemporary health care. Whilst there have been some attempts to understand the dynamics of CAM integration in the health care system from the perspective of conventional care providers and patients, little research has examined the view of CAM practitioners. This study aims to identify the experiences of integration within a conventional healthcare system as perceived by naturopaths. Qualitative semi-structured interviews were conducted using a purposeful sample of 20 practising naturopaths in South East Queensland, Australia to discuss their experiences and perceptions of integrating with conventional medical providers. Analysis of the interviews revealed five broad challenges for the integration of CAM according to naturopaths: competing paradigms between CAM and conventional medicine; co-option of CAM by conventional medical practitioners; the preservation of separate CAM and conventional medical worlds by patients and providers due to lack of formalised relations; negative feedback and biases created through selective or limited experience or information with CAM; and indifferent, reactive and one-sided interaction between CAM and conventional medical providers. Naturopaths support the integration of health services and attempt to provide safe and appropriate care to their patients through collaborative approaches to practice. The challenges identified by naturopaths associated with integration of CAM with conventional providers may impact the quality of care of patients who choose to integrate CAM and conventional approaches to health. Given the significant role of naturopaths in contemporary health-care systems, these challenges require further research and policy attention.     

“Acute caring” in the emergency department

The aim of this essay was to discuss the ways in which the dynamics of interprofessional communication and collaboration among healthcare providers ultimately affect patient quality of care in the acute setting. Interprofessionalism describes a care model whereby health providers use complementary skills, knowledge and competencies to provide quality care to a group of patients. These interactions are characterized by trust, respect and an understanding of each other's skill and knowledge. At its best, the interprofessional care model has made great strides in the amelioration of patient outcomes, including reduction in negative outcomes, decreased health access needs and increased patient satisfaction. However, challenges with regard to communication and implementation have translated to a steep learning curve for healthcare providers. As such, a new-found emphasis has been placed on interprofessional education for today's healthcare students with the goal of promoting a more efficient and collaborative philosophy for tomorrow's healthcare teams.     

Experience with prognostic disclosure of families of Japanese patients with cancer

ContextPrognosis is difficult to discuss with patients who have advanced cancer and their families.ObjectivesThis study aimed to explore the experiences of families of patients with cancer in Japan in receiving prognostic disclosure, explore family perception of the way the prognosis was communicated, and investigate relevant factors of family-perceived need for improvement.MethodsA multicenter questionnaire survey was conducted with 666 bereaved family members of patients with cancer who were admitted to palliative care units in Japan.ResultsIn total, 86.3% of the families received prognostic disclosure. The overall evaluation revealed that 60.1% of the participants felt that the method of prognostic disclosure needed some, considerable, or much improvement. The parameter with the highest value explaining the necessity for improvement was the family perception that the amount of information provided by the physician was insufficient (beta = 0.39, P < 0.001). Furthermore, the family perception that they had lost hope and that health care providers failed to facilitate preparation for the patient’s death had significant direct effects on the necessity for improvement (beta = 0.21, P < 0.001; and beta = 0.18, P < 0.001, respectively). The feelings for the necessity for improvement also were affected significantly by seven communication strategies (i.e., not saying “I can do nothing for the patient any longer,” pacing explanation with the state of the patient’s and family’s preparation, saying “We will respect the patient’s wishes,” making an effort to understand the family’s distress, being knowledgeable about the most advanced treatments, assuring continuing responsibility as the physician for medical care, and respecting the family’s values).ConclusionThis model suggests that strategies for care providers to improve family perception about prognostic disclosure should include 1) providing as much prognostic information as families want; 2) supporting families’ hopes by keeping up with up-to-date treatments and by assuring the continuing responsibility for medical care; 3) facilitating the preparation for the patient’s death by providing information in consideration of the family’s preparations and values; 4) stressing what they can do instead of saying that nothing can be done for the patient; and 5) assuring the family that they will respect the patient’s wishes.     

The Lived Spiritual Experiences of Patients Transitioning Through Major Outpatient Surgery

Dramatic changes in outpatient surgery have occurred in recent years, but the basic care needs of surgical patients remain constant. Most outpatients face the same spiritual and coping issues that inpatients do, but outpatient surgery requires that patients cope with the surgery at an accelerated pace. This phenomenological study describes the meanings of the lived spiritual experiences of patients transitioning through major outpatient surgery. Analysis of interviews with participants resulted in four distinct themes: a point in time, holy other, vulnerability in the OR, and appraisals of uncertainty. Ways that health care providers can provide holistic case include developing an understanding of the patient’s overall experience, understanding the patient’s goals, and supporting the patient’s own coping mechanisms and resources. Additional research should be conducted to explore interventions related to patients’ spiritual well-being in outpatient settings.     

Patients and families experiences with video telehealth in rural/remote communities in Northern Canada

Aim. To explore patients’ and families’ experiences with video telehealth consultations as a method of health care delivery in rural/ remote communities in Northern Canada. Background. Accessing health services in isolated populations where human resources and infrastructure are constrained by vast geographical landmasses poses challenges and opportunities for nurses, health care providers, patients and families. Design. A qualitative approach was adopted with a purposeful sample of 10 patients and four family members representative of nine communities. Method. Selection criteria included patients receiving telehealth visits for a minimum of a year and willing to share their experiences. Data were collected during the winter of 2006 using semi‐structured video taped interviews and analysed using a qualitative thematic content analysis. Results. Patients and families experiences of their telehealth visits centered on three key themes: lessening the burden (costs of travel, accommodations, lost wages, lost time and physical limitations), maximising supports (access to family, friends, familiar home environment, nurses and other care providers), tailoring specific e‐health systems to enhance patient and family needs. Conclusion. The benefits of telehealth extend not only to patients and families but are linked to benefits for providers as well as the health care system. Relevance to clinical practice. This study indicates that video telehealth is an effective mechanism for delivering nursing and other health services to rural/remote communities and can impact positively on the quality of health care. The integration of telehealth practice can enhance the coordination, organisation and implementation of health care services.     

The nurse navigator: Broker,boundary spanner and problem solver

BackgroundThe Queensland Health nurse navigator service is an innovative model that has recently emerged as a way of bridging gaps in care and supporting care coordination for patients with highly complex care needs. The translation of key principles into practice, and how nurse navigators operationalise their role in the care of individual patients in a highly complex health system while engaging a diverse team of health care providers, requires further understanding.AimTo explore how nurse navigators in Queensland operationalise their novel roles.MethodsThis was a qualitative study involving in-depth interviews with three nurse navigators. To explore interprofessional relationships and modes of operation, an exploratory multiple-case study design was used to produce illustrative case examples of practice.FindingsThree main modes of operation were identified and illustrated: the boundary spanner, the problem solver, and the broker. These modes of operation offer important insight into the practices and experiences of nurse navigators.DiscussionThe ‘problem solver’ demonstrates capacity to instigate system improvements, using patient advocacy as a mechanism for broader systems initiatives. The ‘boundary spanner’ exemplifies how nurse navigators can transcend traditional health system boundaries and build networks across nonhealth settings. The ‘broker’ illustrates the nurse navigator's relational role in forging partnerships with patients, across stakeholders in patient care, and across settings (and beyond the health sector).ConclusionThese case examples are demonstrative of how nurse navigators operate across a continuum, delivering holistic and individualised care.     

Satisfied patients are also vulnerable patients--narratives from an acute care ward

Aim. To illuminate the experience of being a patient and cared for in an acute care ward. Background. Patients may be the best source of information for assessing the quality of care in acute care wards. Studies often show that patients’ satisfaction with their hospital stay is interpreted by managers and care providers as a measure for quality of care. Design. Ten patients were interviewed as part of a comprehensive investigation by four researchers into the narratives of five enrolled nurses (study No. 1 – published in Nursing Ethics 2004), five Registered Nurses (study No. 2 published in Nursing Ethics 2005) and 10 patients (study No. 3) about their experiences from an acute care ward at one university hospital in Sweden. Method. A phenomenological hermeneutical method (inspired by the French philosopher Paul Ricoeur) was conducted in all three studies. Findings. The patients are very satisfied with their treatment and care. They also tell about factors that they do not consider as optimal, but which they explain as compromises, which must be accepted as a necessary part of their stay in the ward. This study demonstrates a close connection between patient satisfaction and vulnerability. Conclusions. It is important for all health care providers not to be complacent and satisfied when patients express their satisfaction with their treatment and care. This can result in losing the focus on the patients’ vulnerability and existential thoughts and reflections which are difficult for them, and which need to be addressed. Relevance to clinical practice. The findings can be seen as a challenge for the health care providers as well as the organization to provide quality of care to patients in acute care ward. When listening to the patients’ voice it makes it easier to be aware of the content of their vulnerability.     

Reducing Language Bias in Nursing Education: Equipping Educators

Increasing diversity in the population and development of a stronger global focus create concern about language bias. Hesitance among patients to seek medical care and poorer patient outcomes may result from language bias among health care providers.Nurse educators can reduce the use of language bias in healthcare by increasing awareness and using inclusive language with students. The creation of educational experiences that embrace diversity and inclusion promote the delivery of culturally competent care.     

Using a Six-Domain Framework to Include Biopsychosocial Information in the Standard Medical History

Problem: The traditional approach to physicians’ history taking is designed to facilitate diagnosis and treatment of biomedical conditions. However, in the 21st century, health is critically influenced by the interaction of biomedical conditions and nonbiomedical factors such as patient’s ability to manage chronic disease and the social determinants of health. Interventions to expand routine history taking to include nonbiomedical factors have not been widely adopted, possibly due to the difficultly of incorporating long checklists into routine care and the inability to achieve consensus on the relevant behavioral or social determinants of health content applicable to all patients. Intervention: In 2015–2016, we introduced medical students to a 6-domain (biomedical and psychiatric conditions, behavioral health, living environment/resources, social support, and functional status) approach to history taking and instructed them to elicit information from each domain alongside the traditional approach. Students were required to obtain information from each domain in one admitting history or one daily progress note, discuss their findings with the attending physician, and involve members of the medical team in addressing concerns and barriers in the care of that patient. Students’ history notes were reviewed for completeness and compared to those from a student control group. Students also completed a 10-question evaluation of the model. Context: The intervention was conducted during a 1-month rotation on a hospitalist general medicine service from May 2015 through August 2016. Outcome: Patient history and daily progress notes were collected from 38 fourth-year intervention students and compared to 24 control students on the same service from the previous year. Compared to control students, intervention students provided more patient information (p?≤?.001) in all nonbiomedical domains except behavioral health. Intervention students reported that the 6-domain model helped them identify clinical information that could be addressed with existing resources and prompted involvement of social workers, pharmacists, and nurses in care planning. They also indicated the framework added clinically valuable information and enhanced team-based care. Lessons Learned: A domain-based framework can be used by medical students to identify clinically relevant behavioral conditions and social determinants of health tailored to individual patients while avoiding long standardized checklists. Arguably, routine collection of behavioral and social determinants of health is a necessary first step in enhancing physicians’ awareness and skills in working with health care teams to address nonbiomedical determinants of patients’ health.     

“Life on Hold”: A Qualitative Study of Patient Experiences with Outpatient Commitment in Two Norwegian Counties

In recent decades, outpatient commitment orders have been increasingly used in the follow-up of persons with serious mental disorders. Most studies on outpatient commitment orders have focused on compliance and consumption of health care services; there is little research on the content of outpatient commitment orders from a patient perspective. The aim of this study is to examine patients’ experiences of living with outpatient commitment orders, and is based on qualitative interviews with 16 persons in two Norwegian counties. The data were analysed using a constructivist, interpretive approach to the grounded theory method. The main finding was that patients with outpatient commitment orders felt that their lives were on hold. The feeling of being seen only as patients prevented them from taking responsibility for their own lives. The medical context was perceived as an obstacle to recovery and transition to a more normal life. Patients’ daily lives were dominated by the agenda set by health care providers and many said they were subjected to control measures that resulted in a reduced quality of life. However, informants also spoke of positive experiences as outpatient commitment order patients, such as feeling safe and secure and having easy access to health care staff and services.     

Transition of Nurse Practitioner Faculty Practice and Student Clinicals to Telehealth: Response to the COVID-19 Pandemic

The COVID-19 pandemic forced the US health care system to evaluate alternative care delivery strategies to reduce the risk of coronavirus transmission to patients and health care providers. Telehealth modalities are a safe and effective alternative to face-to-face visits for primary and psychiatric care. Federal policy makers approved changes to telehealth reimbursement coverage and allowed flexibility of location for patients and providers. This article describes the transition of patient visits to telehealth by nurse practitioner faculty at an academic medical center to maintain continuity of care of underserved patient populations. This pivot facilitated resumption of clinical learning experiences for nurse practitioner students.