Critical care nurses’ experiences of working during the first phase of the COVID-19 pandemic – Applying the Person-centred Practice Framework

AimThe aim of the study was to deductively study person-centred care, based on critical care nurses’ experiences during the first phase of the CoViD-19 pandemic.DesignThe study used a qualitative design.MethodData collection was conducted as individual interviews and was analysed with qualitative content analysis with a deductive approach.ParticipantsSix critical care nurses working in a special CoViD-19 intensive care unit during the first phase of the pandemic participated.FindingsThe findings are presented within the four domains of person-centred practice: the prerequisites, the care environment, person-centred processes and person-centred outcomes. While the ambition and knowledge about how to work in accordance with person-centred practice were high, there were several obstacles to perform it.ConclusionWe need to prepare ahead of time so that nurses have optimal organisational prerequisites to be able to work in accordance with person-centred practice, also during pandemics and other crisis, which means to be able to give nursing care in accordance with the ill person’s needs and resources.     

Can mental healthcare for Muslim patients be person-centred without consideration of religious identity? A concurrent analysis

BackgroundMuslims constitute the largest, fastest growing religious minority in the UK. Globally, nurses are legally, morally and ethically obliged to provide non-discriminatory, person-centred, culturally sensitive care. This obligation includes supporting people with their religious needs where appropriate, but there is evidence this is not always happening, particularly for Muslims in mental health care.AimsThis paper reviewed primary research to address the question: Can mental healthcare for Muslims be person-centred without consideration of religious identity?MethodsNarrative synthesis and concurrent analysis. Searches were conducted post 2000 in MEDLINE, CINAHL, SAGE, PsychINFO and ASA with terms: ‘Muslim’, ‘Islam* ’, ‘mental health’, ‘nurs* ’, ‘person-cent* ’, ‘religio* ’. Narrative data were analysed for commonalities and themes.FindingsSeven studies of sufficient quality were analysed. Unconscious religious bias was the overarching theme linking the findings that healthcare staff felt ill-prepared and lacked necessary knowledge and experience to work with diverse patient groups. Unconscious racial bias contributed to limited cultural/ religious competence in treatment and care.ConclusionReligious identity is core for Muslim patients, so this group may not be receiving the person-centred care they deserve. Nurses need cultural and religious competence to deliver person-centred, holistic care to diverse patient populations, yet the importance of religious practice can be overlooked by staff, with harmful consequences for patient’s mental and spiritual welfare. This paper introduces a welcome pack that could help staff support the religious observance of those Muslim patients/service-users wishing to practice their faith during their stay in health services.     

Communicative barriers and resources in nursing homes from the enrolled nurses’ perspective: A qualitative interview study

Background and objectivesManaging communicative disability is a pervasive issue in long-term care facilities. The aim of this study was to explore how enrolled nurses experience their everyday interactions with residents in nursing homes, particularly focusing on interactions with residents with communicative disability.DesignA qualitative exploratory design including content analysis was used.Participants and settingEight individuals working at six nursing homes in western Sweden were interviewed.MethodThe interviews were semi-structured with questions about the participants’ experiences in communicating with residents, feelings associated with interactions involving residents with communicative disability, meaning ascribed to interactions, and factors influencing interactions. The interviews were analysed using content analysis.ResultsA dynamic interplay between interpersonal relations, daily interactions and the managing of communicative disability was revealed. The enrolled nurses had good knowledge of supportive strategies and an awareness of the importance of the development of personal relationships with residents in order to facilitate interaction. However, factors in the environment presented barriers to communication.Conclusions/implicationsThe organisation and physical environment of nursing homes prevent the enrolled nurses from taking full advantage of the communicative resources they have in interaction with residents with communicative disability, hence affecting staff–resident relationships and the delivery of person-centred care.     

Person-centred interactions between nurses and patients during medication activities in an acute hospital setting: Qualitative observation and interview study

Background

There is increasing emphasis on person-centred care within the literature and the health care context. It is suggested that a person-centred approach to medication activities has the potential to improve patient experiences and outcomes.

Objectives

This study set out to examine how nurses and patients interact with each other during medication activities in an acute care environment with an underlying philosophy of person-centred care.

Design

A qualitative approach was used comprising naturalistic observation and semi-structured interviews.

Setting

The study setting was an acute care ward with a collaboratively developed philosophy of person-centre care, in an Australian metropolitan hospital.

Participants

Eleven nurses of varying levels of experience were recruited to participate in observations and interviews. Nurses were eligible to participate if they were employed on the study ward in a role that incorporated direct patient care, including medication activities. A stratified sampling technique ensured that nurses with a range of years of clinical experience were represented. Patients who were being cared for by participating nurses during the observation period were recruited to participate unless they met the following exclusion criteria: those less than 18 years of age, non-English speaking patients, and those who were unable to give informed consent. Twenty-five patients were observed and 16 of those agreed to be interviewed.

Results

The results of the study generated insights into the nature of interactions between nurses and patients where person-centred care is the underlying philosophy of care. Three major themes emerged from the findings: provision of individualised care, patient participation and contextual barriers to providing person-centred care. While the participating nurses valued a person-centred approach and perceived that they were conducting medication activities in a person-centred way, some nurse-patient interactions during medication activities were centred on routines rather than individualised patient assessment and management. These interactions were based on nurses’ perceptions of what was important for the patient and did not provide opportunities for patient participation. Two main contextual barriers in relation to a person-centred approach to medication activities were identified as multidisciplinary communication and time constraints.

Conclusions

While some nurse-patient interactions during medication activities were consistent with the principles of person-centred care, the study results highlighted factors that influence the nature of these interactions, and identified opportunities to improve nursing practice. To ensure person-centred care is applied to medication activities, nurses should undertake ongoing assessment of patients’ needs in relation to their medications and encourage opportunities for increased patient participation.     

Evaluation of an art in health care elective module – A nurse education initiative

BackgroundInternational literature suggests that nurse educators perceive a value in the arts and literature as a teaching strategy in helping nurses express a personal philosophy of nursing, teaching spirituality and non-verbal communication.Purpose of studyThe purpose of this study was to evaluate nursing students experiences of undertaking an interdisciplinary ‘Art in Health’ elective.Study designThe formative evaluation approach was based on the reflective practice model that encourages students (n = 60) to evaluate their own learning experience.Findings88% of nursing students valued the experience of learning with students from other disciplines or colleges. 63% commented on how they enjoyed the creative aspect of studio work and the element of diversity in brought to nursing. 63% indicated that the module gave them a greater insight into the presence of art in health care contexts and felt that they gained a deeper understanding of how art can help people in hospital.ConclusionThe module presents an innovative model of interdisciplinary curriculum development which appears to facilitate students in viewing patients from a more holistic perspective. As an education experience this module appears to have the potential to help students develop skills in working collaboratively with other health care and non health care disciplines.     

Person-centred care among intensive care unit nurses: A cross-sectional study

ObjectivePractising person-centred care is crucial for nurses in the intensive care unit, as patients have high physical and psychological care needs. We aimed to identify the predictors of person-centred care among nurses working in intensive care settings.MethodsIn this cross-sectional study, 188 intensive care unit nurses at four tertiary hospitals in two cities of South Korea were included. They completed self-reported questionnaires on emotional intelligence, compassion satisfaction, secondary traumatic stress, burnout, and person-centred care. Emotional intelligence was measured using the Korean version of the Wong and Law’s emotional intelligence scale. Compassion satisfaction, secondary traumatic stress, and burnout were measured by the Professional Quality of Life questionnaire (version 5). Person-centred care was measured using the person-centred critical care nursing scale.ResultsMultiple regression identified compassion satisfaction (β = 0.49, p <.001) as the most powerful predictor of person-centred care, followed by emotional intelligence (β = 0.21, p =.004) and intensive care unit career length (β = 0.17, p =.021). These three variables accounted for 31.0 % of the variance in person-centred care.ConclusionsThis study highlights the importance of career length, emotional intelligence, and compassion satisfaction in the promotion of person-centred care among intensive care unit nurses. Nursing management should contemplate specific measures to reduce turnover among experienced intensive care unit nurses and to enhance the factors that promote person-centred care, such as compassion satisfaction and emotional intelligence.     

What is Person-Centred Care? A Qualitative Inquiry into Oncology Staff and Patient and Family Experience of Person-Centred Care

IntroductionTo investigate the understanding and practice of person-centred care by health care professionals and support staff at a cancer centre and to learn how patients and family members understand and experience person-centred care.MethodsThe study was conducted in two phases. Phase 1 used large wall mounted posters and marking pens in public areas of the cancer centre to gather comments from staff, volunteers, students, patients, family members, and visitors to answer the question, “What does person-centred care mean to you?” Phase 2 used a six-question, open-ended, paper-based questionnaire for staff and patients. A manual coding technique was used to derive themes from both posters and questionnaires.ResultsWe derived 97 themes from the posters and 134 themes from 44 returned questionnaires (survey response rate of 37%). When the themes were combined and reprioritized, we learned that person-centred care is: (1) care that is caring, compassionate, and empathetic; (2) person or patient is the centre of focus; (3) care is unique to the individual's needs; and (4) person or patient is a part of their care. Furthermore, all staff should provide person-centred care.ConclusionsOur findings describe what our staff, patients, and family members believe person-centred care is, and how it should be delivered. Based on this research study, we recommend promoting additional dialogue and continuing education opportunities for health care professionals and other front-line staff who will assist them to complete the statement, “I demonstrate person-centred care by…” to their own satisfaction in the future.     

Transfer of nurse education to universities under a model of person-centred care: A consequence of changes in Spanish society during the democratic transition

BackgroundIn Spain the transfer of nurse education to universities was accompanied by a shift towards a model of person-centred care.AimTo explore whether the change in nurses' professional profile (from physician assistant to providers of person-centred care) was a response to changing needs in Spanish society.DesignQualitative study.MethodsTheoretical sampling and in-depth interviews using an inductive analytical approach.ResultsFour categories described the nursing profession in Spain prior to the introduction of university training: the era of medical assistants; technologisation of hospitals; personal care of the patient based on Christian values; professional socialisation differentiated by gender. Further analysis showed that these categories could be subsumed under a broader core category: the transfer of nurse education to universities as part of Spain's transition to democracy.ConclusionThe transfer of nurse education to universities was one of several changes occurring in Spanish society during the country's transition to democratic government. The redefined public health system required a highly skilled workforce, with improved employment rights being given to female health professionals, notably nurses.     

Theoretical framework construction on care complexity in Chinese hospitals: A grounded theory study

ObjectivesThis study aims to construct a theoretical framework to analyze risk factors and explore hospital nurses’ perspectives on care complexity.MethodsThe grounded theory method was adopted, and semi-structured in-depth interviews regarding the understanding of care complexity were conducted among the participants, including 31 nurses and nine doctors. In addition, data were coded and strictly analyzed in accordance with the coding strategy and requirements of grounded theory.ResultsOur study reveals three factors that are closely related to care complexity, namely, (1) patient factors, including patients’ condition, age, self-care abilities, compliance, social support systems, psychological conditions, expectations, and requirements; (2) nursing staff factors, including work experiences, education, knowledge and operational skills of caring, and communication skills; and (3) organization and equipment factors, including nursing workforce, nursing workload, support from multidisciplinary teams and ancillary departments, and the conditions of medical and hospital services.ConclusionsThis study defines care complexity on the basis of its factors. Care complexity refers to the difficulty of nursing tasks during patient care plan implementation, which are affected by patients, nurses, and other factors in nursing and multisectoral, multidisciplinary cooperation. The framework can be beneficial for nursing education and for the improvement of the quality and efficiency of clinical nursing practice.     

Us and them: Experiences of agency nurses in intensive care units

ObjectiveThis qualitative case study describes the work experiences of agency nurses from their perspective. It explores their interactions with intensive care unit managers to whom they report in their designated intensive care units and their relationships with fellow permanent nurses.MethodsA qualitative study was undertaken in three intensive care units at a public hospital in South Africa. Face-to-face interviews were used to collect data from eleven agency nurses. Thematic analysis of the data was undertaken.FindingsThe challenges of agency nursing work were haphazard clinical allocation, a lack of self-efficacy and competence, and feelings of exclusion. Positive aspects of the agency nurse experience included feedback and support from permanent nurses and intensive care unit managers and occurrences of belonging and acceptance.ConclusionThe findings of this study point to the importance of agency nurse relationships with managers and fellow permanent nurses. To ensure patient care is not compromised, managers and nurse managers have a responsibility to ensure a welcoming, inclusive and nurturing environment for all staff tasked with intensive care unit responsibilities.     

Translating change: The development of a person-centred triage training programme for emergency nurses

Within health care, there has been a change in practice from an illness-orientated service to one that is more health-focused and person-centred. The concept of person-centredness is frequently espoused by practitioners as being not only a desirable, but a necessary element of health care provision. Indeed, nationally and internationally, person-centred care has underpinned many healthcare documents and policies. Person-centred practice focuses on providing care, utilising a variety of processes that operationalise person-centred nursing and include working with patients′ beliefs and values, engagement, presence, sharing decision-making and providing for physical needs.In the field of emergency nursing, the incorporation of person-centred care and its holistic foundation may require a significant shift in practice. There is evidence to suggest that emergency nurses view their role as one, which is predominantly concerned with providing urgent physical care, rather than one, which espouses the theories of holistic healthcare. To this extent, being person-centred in the context of emergency care, requires the nurse to move beyond the traditional notions of his/her role and to embrace the more holistic aspects of patient care. The aim of this article is to critically analyse how a change in nurse-led triage training in one Irish Emergency Department facilitated an improved person-centred approach in practice.     

Nurses' Perceptions of Patient Participation in the Postanesthesia Care Unit—A Qualitative Focus Group Study

PurposeTo explore postanesthesia care unit (PACU) nurses' experiences and perception of patient participation during PACU care.DesignQualitative focus group study based on a phenomenological hermeneutic approach.MethodsWe conducted three focus group interviews with 18 nurses from three different PACUs. Themes were created based on interpretive theory inspired by Ricoeur.FindingsFour themes and 11 subthemes were found. Patients’ clinical condition and situation, time management, ethical aspects, and the patient-nurse relationship all had a high impact on postanesthesia nursing practice and conditions for involving patients.ConclusionsPACU nurses want patients to participate in their own treatment and care in the PACU; however, nurses perceive patient participation differently. Nurses experience challenges including patients’ impaired autonomy, absence of a holistic approach, and lack of time and resources. Nurses highlight that these barriers should not become an excuse for noninvolvement.     

Patient Activation and its Predictors in Hospitalized Older Adults in Singapore

BackgroundPatient activation is critical in hospitalized older adults preparing for discharge as it enhances their ability to self-care at home. Little is known about how person-centred care and demographic predictors could influence activation in Asian patients.AimsTo explore patient activation and its predictors in hospitalized older adults in Singapore.MethodsMulti-centre cross-sectional survey of hospitalized older adults. Multivariable analysis conducted with age, gender, education, socioeconomic status, functional dependency and perception of person-centred care as potential predictors to patient activation.Results300 older adults were surveyed, 65% were at the top two levels of activation. Perception of person-centred nursing care was the strongest predictor with the largest effect on patient activation, (β=0.22, b=3.48, 95% CI:1.70–5.26, p<0.001). Other predictors were age, education, income and independence in care.ConclusionOur study highlights the importance of person-centred nursing care in raising patient activation in hospitalized older adults, enhancing their capacity to self-care.     

The Role of Interdisciplinary Faculty in Nursing Education: A National Survey

BackgroundThe role of interdisciplinary faculty in schools and colleges of nursing has evolved over time. Historically, integration of interdisciplinary faculty into nursing education was as experts in non-nursing content and to fill a gap created by the lack of doctorally prepared nurses. In the 1980s, Lenz and Morton surveyed Departments, Schools and Colleges of Nursing to explore the role of interdisciplinary faculty in nursing education.PurposeOur study adapted Lenz and Morton's work to examine new trends in faculty composition, while also considering the evolution in nursing education, including the integration of doctor of nursing practice (DNP) prepared faculty.ResultsDifferences in enrollments, programs offered, and number of faculty and faculty composition were observed between 1988 and 2017. In 1988 the most common disciplines represented were nutrition, education and psychology, while in 2017 the most common disciplines were pharmacology, statistics and biological sciences. The current study shows a decrease of 15% in interdisciplinary faculty educating nursing students, although this finding may be related to differences in sampling techniques.ConclusionsIntegration of interdisciplinary faculty has the potential to enrich nursing education by bringing in a depth of specialized knowledge from other disciplines. Further faculty role-modeling successful interdisciplinary collaboration is another way to prepare nurses for team-based patient care which is an imperative skill in today's health care arena.     

How Japanese nurses provide care: a practice based on continuously knowing the patient

AIM: Criticisms of the nursing process as a problem-solving approach have emerged recently. This study aimed to identify and describe a way of nursing based on the clinical practice of selected nurses in Japan. METHODS: Data were collected using semi-structured interviews and observations at one 300-bed Japanese hospital in 1999. The purposive sample consisted of 24 female nurses. Data analysis occurred simultaneously with data collection, and questioning and constant comparison were used for data analysis. Codes were clustered into categories and relationships among these were identified. In the final stage of the analysis, two group interviews with participants were carried out to enhance credibility. FINDINGS: This study identified a Japanese way of nursing intended to help patients explore and realize meanings and values of their experiences with illness. When nurses first contacted a patient, they quickly formed a patient image, but altered it each time they obtained new patient information. A patient image consisted of the patient's subjective world (the patient's perspective) and the holistic patient (nurses' perspectives of the patient). The nurses sometimes pursued strategies to know the patient's subjective world. The target, direction, conditions and ways of nursing care were decided based on continuously knowing the patient. The nurses related their knowledge and thoughts to the patient, and by talking with the patient promoted the patient's consideration and participation, and empowered the patient. Nurses continued attending to patients even when they could not provide specific nursing interventions. CONCLUSIONS: Knowing the patient was found to be especially important in determining nursing care. The model described in this study does not contradict the nursing process as a systematic approach to problem-solving. Rather, it has some alternatives that might be useful in providing individual care in Japan.