South Asian patients' lived experience of acute care in an English hospital: a phenomenological study

Studies on utilization of hospital services by South Asian patients in the United Kingdom have consistently demonstrated levels of dissatisfaction with care in relation to meeting religious and cultural needs, although there are few studies on minority ethnic patients' utilization of acute hospital services. This study aimed to describe and interpret from the consumer's view the 'lived experience' of acute hospital care from the perspectives of South Asian patients and their family carers. The purposive sample of 10 patients and six carers consisted of 13 females and three males (five Hindus, six Muslims and five Sikhs) who were interviewed at home 2 to 3 weeks after discharge from hospital. Data were gathered through semi-structured interviews that were tape recorded and transcribed. A phenomenological approach was used, and data were analysed using the principles of Heideggerian hermeneutics. Five themes were identified, ranging from feelings of satisfaction with care, unhappy about the service, fitting-in strategies and post-discharge coping mechanisms. Patients seemed to want to cause as little disruption as possible to the ward environment and tried to fit in to what they refer to as an 'English place'. The findings, although not generalizable, offer important insights into how South Asian patients survive their journey through their hospital stay and have implications for the provision of nursing care for minority ethnic patients.     

Patients' lived experiences of excisional breast biopsy: a phenomenological study

Aims. The purpose of this study was to explore the lived experience of patients undergoing an excisional breast biopsy. Background. It has been determined that women who feel a lump or a lesion in their breast delay seeking medical treatment because it could be cancer and they might need a mastectomy and/or the cancer may not be treatable. After women go to a health‐care facility and are told that they need to have a biopsy to make a clear diagnosis they want to have the biopsy performed as soon as possible. Method. A phenomenological approach from a Heideggerian hermeneutical perspective was used. Participants were 20 patients who had an excisional breast biopsy in the day surgery of a university research and training hospital general surgery division under general anaesthesia between the dates of 1 December 2004–30 June 2005 and who returned one week later for monitoring, who were over 18 years old and who volunteered to participate in the research. Data were collected using in‐depth interviewing and analysed using the principles of Heideggerian hermeneutics. Results. Three themes were identified: need for information, fear, spiritual needs. Conclusion. It was determined that patients undergoing excisional breast biopsy had significant information and spiritual needs and experienced a fear of having cancer, losing their breasts and dying in surgery. Relevance to clinical practice. Although there are many studies about breast cancer and day surgery patients’ experiences in the literature, no studies were found about patients’ experiences with day surgery excisional breast biopsy procedures. The results provide a possible framework for patient care.     

Meanings of giving touch in the care of older patients: becoming a valuable person and professional

Touch is central to nursing and health care workers frequently touch their patients, consciously or unconsciously in their interactions with them. Most literature has studied touch from a patient perspective, thus inquiry about professionals' experiences are rare. The aim of this study was to illuminate meanings of giving touch in nursing care of older patients. To understand the meaning of lived experiences of giving touch in care of older patients, interviews with 12 health care professionals in northern Sweden were analysed using a phenomenological-hermeneutic approach influenced by the philosophy of Ricoeur. The findings show that giving touch in the care of older patients is a transforming experience, where one suddenly perceives oneself as both a valuable person and professional who no longer powerlessly confronts patients' haunted and disrupted bodies, but who, by means of touch, has gained power to ease this suffering. The experience also transforms the way one regards older patients. Instead of seeing a severely demanding patient suffering from dementia and/or pain, one is able to see the person behind the disease as a human being, like oneself. A relationship described as calm, friendly and humane is created between caregiver and patient when giving touch, a relationship that transcends the moment of touch and influences one's way of caring. This understanding is presented using the theoretical framework of the philosophy of Marcel. Giving touch has the power to shed new light on health care professionals' experiences of caring for older patients suffering from dementia and/or pain, giving them the power to be a valuable person and professional.     

Older patients' experience of dressing changes on venous leg ulcers: more than just a docile patient

Aim and objective. The aim of this paper was to describe the lived experiences of older patients with venous leg ulcers, during dressing changes as out patients with a focus of their concerns about care interventions. Research on wound care management has focused on treatment of venous leg ulcer, wound assessments and the choice of dressing material. Few studies have focused on the patients’ experience of dressing changes. Design. Fifteen older people with verified venous leg ulcers were recruited in a metropolitan area of Sweden. Data were collected with research interviews in the form of dialogue. Method. Data were analysed with an interpretative phenomenological method developed by Benner. Results. Twelve women and three men participated. The themes were: ‘being cared for with a skilful touch’, ‘feelings of belonging, continuity and affinity’, and ‘being suppressed into a state where one loses control, leading to feelings of discomfort’. The participants’ experiences varied. Some were satisfied and felt that there was a mutual understanding between caregivers and patients, while others were dissatisfied and felt objectified. Understanding the patients as human beings and considering illness as lived experience helped the care providers to perform skilful wound care, in an atmosphere of mutual understanding. Conclusion. The patients suffering from venous leg ulcers wanted to feel worthy of wound treatment and to meet skilful, confident and gentle nurses in a sharing atmosphere. Nurses must be perceptive to the individual's bodily experience of the leg ulcer. Relevance to clinical practice. Wound care requires a multidimensional clinical approach that involves not only medical and technical care strategies of dressings and bandages, but also aspects that concern the situated‐based illness experience that persons suffering from leg ulcers may face.     

The experience of being 30–45 years of age and depending on haemodialysis treatment: a phenomenological study

Scand J Caring Sci; 2010; 24; 693–699
The experience of being 30–45 years of age and depending on haemodialysis treatment: a phenomenological study The aim of this study was to describe how haemodialysis (HD) patients, between 30 and 45 years of age, experience their dependence on HD treatment. Nine patients undergoing HD treatment were interviewed. The transcribed texts were analysed according to Giorgi′s four basic principles. Being between 30 and 45 years of age and needing HD treatment meant experiencing a total lack of freedom, which was illuminated through the sub‐themes: a sense of fear, dependency on caregivers, time lost in dialysis, feelings of loneliness and the stress of being on the waiting list for a new kidney. The participants felt that being dependent on HD treatment was ‘not a real life’ and that they were experiencing a double life of sorts: the life of dialysis versus their ordinary life outside treatment. The dependency on HD treatment was also expressed as a feeling that life ‘stood still.’ The results also indicate that the participants expected to encounter competent healthcare professionals, and they emphasised the importance of providing support for younger HD patients by focusing on their ability to cope with their life situation.     

Lost in the present but confident of the past: experiences of being in a psycho-geriatric unit as narrated by persons with dementia

Aim. To illuminate meanings of being in a psycho‐geriatric unit. Background. There are known risks associated with moving persons with dementia from home to an institution, but little is known about how they experience being in psycho‐geriatric units. Method. Using open‐ended research interviews, six persons with mild to severe dementia were asked to narrate about their experiences in the hospital. The interviews were interpreted using a phenomenological hermeneutical method of analysis. Results. The comprehensive understanding of being in a psycho‐geriatric unit points towards an understanding of being lost in the present but confident of the past. The analysis showed that the participants appeared lost as they could not narrate where they were and why, but that they became confident when narrating about their previous life. The analysis also showed that being in the hospital meant sharing living space with strangers, invasions of private space and establishing new acquaintances. Being in the unit could also mean boredom and devaluation for participants. The interviews were interpreted in the light of narrative theory of identity: persons with dementia narrating about previous life experiences as to make claims of how to be interpreted by others; as persons instead of merely as ‘demented’ patients. Conclusions. Experiences of care narrated by persons with dementia present meaningful and useful information that can provide feedback to inform care practice. Relevance to clinical practice. Experiences of care from persons with dementia provide meaningful information about care and the doing and being of staff. Creating time for conversations with these persons may facilitate well‐being.     

Nursing assessment as an effective tool for the identification of delirium risk in older in‐patients: A case–control study

Aims and objectives

To evaluate the usefulness of comprehensive nursing assessment as a strategy for determining the risk of delirium in older in‐patients from a model of care needs based on variables easily measured by nurses.

Background

There are many scales of assessment and prediction of risk of delirium, but they are little known and infrequently used by professionals. Recognition of delirium by doctors and nurses continues to be limited.

Design and methods

A case–control study. A specific form of data collection was designed to include the risk factors for delirium commonly identified in the literature and the care needs evaluated from the comprehensive nursing assessment based on the Virginia Henderson model of care needs. We studied 454 in‐patient units in a basic general hospital. Data were collected from a review of the records of patients’ electronic clinical history.

Results

The areas of care that were significant in patients with delirium were dyspnoea, problems with nutrition, elimination, mobility, rest and sleep, self‐care, physical safety, communication and relationships. The specific risk factors identified as independent predictors were as follows: age, urinary incontinence, urinary catheter, alcohol abuse, previous history of dementia, being able to get out of bed/not being at rest, habitual insomnia and history of social risk.

Conclusions

Comprehensive nursing assessment is a valid and consistent strategy with a multifactorial model of delirium, which enables the personalised risk assessment necessary to define a plan of care with specific interventions for each patient to be made.

Relevance to clinical practice

The identification of the risk of delirium is particularly important in the context of prevention. In a model of care based on needs, nursing assessment is a useful component in the risk assessment of delirium and one that is necessary for developing an individualised care regime.     

A phenomenological study of early nursing experiences in Hong Kong

The experience of primary professional socialization is crucial for neophytes to learn to become a nurse. These early nursing encounters may also have long-term effects on professional development of individual nurses. However, research into the early experiences of nurses has been poorly documented. This study endeavours to reveal the early lived nursing experience amongst a group of nurses in Hong Kong. This study adopts a phenomenological approach which involves the thematic analysis of the critical incidents provided by 77 subjects. Findings revealed that incidents associated with death and dying, and clinical learning embracing interpersonal relations and professional development, were the most memorable events. Nurses were in general not equipped adequately to communicate with the dying and the grieving relatives. The subjects disclosed that positive clinical encounters confirmed their value of nursing work and motivated them to stay in the profession. Conversely, the negative experiences made them seriously consider leaving nursing. A number of implications for nursing education have been drawn from the research findings.