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AnteayerJournal of Clinical Nursing

Family‐oriented care and health‐related quality of life for women with gynaecological cancer: A cross‐sectional mixed‐method study

Abstract

Aims

This study aims to describe the experiences of women with gynaecological cancer regarding family-oriented care (FOC) and how they rated their health-related quality of life (HRQoL) using a 15D instrument (15D©).

Design

A cross-sectional mixed-method study.

Methods

The data were collected by electronic surveys of two Finnish cancer associations from gynaecological cancer patients (n = 53). The qualitative data were analysed using thematic analysis. The HRQoL answers were analysed statistically using IBM SPSS Statistics (Version 27).

Results

The results emphasized that FOC is not yet part of the care process. Furthermore, comprehensive encounters are lacking, and the experience of being a woman is forgotten during the care process. The results of the HRQoL analysis suggest that distress and the discomfort and symptoms of cancer patients are perceived as significant factors affecting their quality of life during different phases of treatment. Family status also has an impact on perceived quality of life, whereby those living alone gave worse ratings for the depression and vitality dimensions.

Conclusion

In part, the quantitative and qualitative data supported each other, but the descriptions provided a more comprehensive view of issues that affect women in a more multidimensional way, such as sexual health issues. More research on the effectiveness of FOC is needed to develop the capacity for effective healthcare.

Implications for the Profession and/or Patient Care

This study was able to identify important areas for improvement in clinical practice from the perspective of patients and their families.

Reporting Method

This study was prepared and reported according to the STROBE checklist.

Patient or Public Contribution

No patient or public contribution.

Identifying the contributors to nursing caring success stories

Abstract

Aims

To (a) seek examples of nursing caring success stories and (b) identify the common contributors to these successes. By focusing on the successes of nursing care rather than critically examining failures, this research seeks to provide examples of proven and feasible approaches and processes for improving care.

Design

This study used a narrative inquiry design.

Methods

Data were collected through group interviews. Four interviews were conducted with a total of 20 nurse participants working in inpatient settings in South Australian hospitals. A thematic analysis approach was used to analyse the data.

Results

Two dominant themes concerning the contributors to caring success were identified. These contributors were (1) the provision of holistic care and (2) the influence of the caring community, which includes family members and other patients. The findings also indicated that the definition of caring success according to nurses is not aligned with organisational performance indicators but is more closely represented by caring values.

Conclusion

Success, according to nurses, is not exclusively defined by patient outcomes but includes the approach to, and process of, care delivery.

Implications for the Profession and/or Patient Care

Nurses value the caring process while working in an environment that primarily values clinical and systems-level outcomes. Nurses want patients and their families, allied health professionals and hospital executives to be involved and invested in the process of care.

Impact

This study addressed a gap in the current literature to identify commonalities in nursing success stories, the contributors informing these successes and how these contributors can facilitate improved patient care. Understanding nursing definitions of caring success provides an opportunity to expand upon current accepted industry definitions and perspectives such as key performance indicators.

Reporting Method

Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist.

Patient or Public Contribution

No direct patient or public contribution.

Effectiveness of interventions to enhance shared decision‐making in wound care: A systematic review

Abstract

Aims

To explore the effectiveness of interventions to enhance patient participation in shared decision-making in wound care and tissue viability.

Background

Caring for people living with a wound is complex due to interaction between wound healing, symptoms, psychological wellbeing and treatment effectiveness. To respond to this complexity, there has been recent emphasis on the importance of delivering patient centred wound care and shared decision-making to personalise health care. However, little is known about the effectiveness of existing interventions to support shared decision-making in wound care.

Design

Systematic review of interventional studies to enhance shared decision-making in wound care or tissue viability. This was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines 2020.

Methods

Interventional primary research studies published in English up to January 2023 were included. Screening, data extraction and quality appraisal were undertaken independently by two authors.

Data Sources

Medline, EMBASE, Cochrane Central Register of Controlled Trails (trials database), CINAHL, British Nursing Index (BNI), WorldCat (thesis database), Scopus and registries of ongoing studies (ISRCTN registry and clinicaltrials.gov).

Results

1063 abstracts were screened, and eight full-text studies included. Findings indicate, interventions to support shared decision-making are positively received. Goal or need setting components may assist knowledge transfer between patient and clinician, and could lower short term decisional conflict. However, generally findings within this study had very low certainty due to the inconsistencies in outcomes reported, and the variation and complexity of single and multiple interventions used.

Conclusions

Future research on shared decision-making interventions in wound care should include the involvement of stakeholders and programme theory to underpin the interventions developed to consider the complexity of interventions.

Implications for the profession and patient care

Patients setting out their needs or goals and exploring patient questions are important and should be considered in clinical care.

Registration

The review protocol was prospectively registered (PROSPERO database: CRD42023389820).

No Patient or Public Contribution

Not applicable as this is a systematic review.

Living with schizophrenia and type 2 diabetes and the implication for diabetes self‐care: A qualitative study

Abstract

Aim

To achieve an in-depth understanding of the challenges associated with diabetes management when having both schizophrenia and type 2 diabetes, while also identifying the needs for improved diabetes self-care.

Design

The study employed a qualitative explorative design utilizing a phenomenological-hermeneutic inspired approach, involving field observations and individual semistructured interviews.

Methods

Data were collected during 2020–2021 through 17 field observations of outpatient consultations and 13 individual semistructured interviews. Data, including field notes and verbatim transcribed interviews, underwent analysis following Ricoeur's interpretive philosophy, encompassing three levels: naïve reading, structural analysis and critical interpretation and discussion. This study adheres to the COREQ guidelines for qualitative research.

Results

Three key themes emerged: ‘Diabetes when life is noisy’, ‘Sacrifices and compromises in life’ and ‘The double silence’. Everyday life is significantly affected when having both schizophrenia and T2D. The mental health state dominates in relation to diabetes self-care and individuals experience challenges balancing between the two conditions. However, there exists a general acknowledgement for diabetes and its long-term complications as a serious medical condition demanding careful attention and treatment.

Conclusion

Self-managing two such complex conditions can be overwhelming and make it difficult for the individual to differentiate symptoms and prioritize diabetes care. Moreover, the existing fragmentation within healthcare systems poses communication challenges, resulting in disjointed patient pathways.

Implications for patient care

The study emphasizes the need for a holistic re that addresses the physical, emotional and social challenges. There is also a need for increased awareness and education among informal caregivers and healthcare professionals to foster better understanding and support.

The effect of long‐term COVID‐19 on aetiological factors related to nocturia

Abstract

Aims and Objectives

This study was conducted to examine the possible aetiology of nocturia in patients with long-term COVID-19.

Background

Physical and neuropsychiatric symptoms, an increase in overactive bladder symptoms, especially from urinary system complaints, has been reported in patients with COVID-19, 10–14 weeks after the illness.

Design

A descriptive design.

Methods

The study consisted of 70 patients who had experienced COVID-19, had nocturia, and were followed in the State Hospital between April and July 2022. Data were collected using a patient information form, the ‘TANGO’ nocturia screening tool, and the Visual Analog Scale. This study was created in accordance with the STROBE Statement Checklist.

Results

When the nocturia effects of long-term COVID-19 were examined it was determined that the urinary tract was the ‘priority’ aetiological condition. It was observed that there was a significant difference between the aetiological factor groups in terms of the mean age of the patients and the number of nocturia (p < .05). According to post-hoc analysis, the mean age of patients with a dominant cardio-metabolic factor was found to be significantly younger (p < .05). In addition, when comparing the number of nocturia according to the aetiological factors of the patients, it was observed that the number of nocturia was significantly frequent in the patients with a dominant sleep factor (p < .05).

Conclusions

It was found that the urinary tract aetiological factor was dominant in patients with long-term COVID-19 and nocturia, patients with a dominant cardiovascular aetiological factor were younger, and that the number of nocturia was higher in patients with a dominant sleep factor.

Relevance to Clinical Practice

Identification of the early signs and symptoms and underlying causes of nocturia in individuals with post-COVID-19 syndrome will enable nurses and health professionals to guide the early identification of different underlying problems, as well as the implementation of approaches to treat and eliminate nocturia.

Patient or Public Contribution

The patients contributed to the study by agreeing to participate in the evaluation of nocturia complaints after COVID-19 infection.

Experiences of improvement of everyday life following a rehabilitation programme for people with long‐term cognitive effects of COVID‐19: Qualitative study

Abstract

Aim and Objectives

To explore challenges in everyday life for people with long-term cognitive effects of COVID-19 and whether a rehabilitation programme contributed to the remedy thereof.

Background

Healthcare systems around the world need knowledge about acute COVID-19 treatment, long-term effects exerting an impact on peoples' everyday lives, and how to remedy these.

Design

This is a qualitative study with a phenomenological approach.

Methods

Twelve people with long-term cognitive effects of COVID-19 participated in a multidisciplinary rehabilitation programme. Individual semi-structured interviews were made. Data were analysed thematically.

Results

Three themes and eight sub-themes emerged with respect to everyday life challenges and experiences of the rehabilitation programme. The themes were (1) Personal insight and knowledge, (2) Changed daily routines at home and (3) Coping with working life.

Conclusion

Participants experienced long-term effects of COVID-19 as cognitive challenges, fatigue and headaches, which affected their everyday lives, that is inability to overcome daily tasks at home and at work, maintaining family roles and relations with relatives. The rehabilitation programme contributed to a vocabulary and insights related to the long-term effects of COVID-19 and the experience of being a different person. The programme contributed to changes in daily routines, organising breaks in everyday life and explaining challenges to family/relatives and the way in which they affected daily routines and their role in the family. In addition, the programme supported several of the participants in finding the right workload and working hours.

Relevance to Clinical Practice

We recommend multidisciplinary rehabilitation programmes inspired by cognitive remediation of long-term COVID-19 cognitive effects. Municipalities and organisations could collaborate in the development and completion of such programmes, possibly comprising both virtual and physical elements. This could facilitate access and reduce costs.

Patient or Public Contribution

Patients contributed to the conduct of the study by participating in the data collection via interviews.

Clinical Trial Registration Number

Data collection and processing of data are approved by the Region of Southern Denmark (journal number: 20/46585).

The effect of fear of contagion/being contagious on depression, anxiety and stress levels of university students during the COVID‐19 pandemic

Abstract

Background

University students are generally quite active in social life. It is thought that their fear of contagion/being contagious will affect their depression, anxiety and stress levels due to the removal of restrictions and the increase in individual responsibilities. This study aims to determine the effect of fear of contagion/being contagious on depression, anxiety and stress levels of university students during the COVID-19 pandemic.

Methods

This study, descriptive and cross-sectional. Quantitative data were collected using the Demographic Information Form, the Fear of Contagion/Transmission Scale and the Depression-Anxiety-Stress Scale. The sample included 3500 participants. Descriptive statistics were used for the presentation of the results. The STROBE checklist for cross-sectional studies was used in this study.

Results

This study revealed that the depression, anxiety and stress levels of university students were above normal, and these results were mostly associated with females, those with a chronic disease and high fear of contagion/being contagious.

Conclusion

The findings of this study may be useful for precautionary plans to support the psychological health of university students after the COVID-19 pandemic and in the fight against possible new pandemics. Considering the findings of our study, educational programs should be planned for youth in general and university students in particular to deal with depression, anxiety, stress and fears.

Relevance to Clinical Practice

The depression, anxiety and stress levels of university students were above normal. As the fear of contamination and contagion increases, the level of depression, anxiety and stress increases. Those with chronic diseases have high levels of depression, anxiety and stress.

Patient or Public Contribution

Research data were collected through an online questionnaire. Data collection tools were prepared on Google Forms, and then, links were shared with student groups over social media. Students shared the link on their social platforms, allowing it to reach wider audiences.

Exploration of the advanced preparation nurse‐mother role in care of children with chronic disease: A narrative inquiry

Abstract

Aim

To explore the lived experience of advanced preparation nurses (APNs) who are mothers (APN-mothers) as they seek care in the Emergency Department for a child with a chronic disease.

Design

Qualitative, Narrative Inquiry.

Methods

Narrative Inquiry was used to examine critical self-reflections of four (n = 4) APN-mothers. Directed by a question guide, participants engaged in the Narrative Reflective Process through metaphoric and artistic means.

Results

Participants identified salient challenges associated with their experiences. Narrative threads that emerged include feelings around being discovered, unfair expectations by healthcare providers, feelings of guilt and the tension from competing roles: APN and mother.

Conclusion

APN-mothers represent a unique population with enhanced knowledge, skills and judgement; however, they indicate that there is insufficient communication and interprofessional collaboration between parents and Emergency Department staff. Further research is needed to foster and improve therapeutic relationships between APN-mothers and healthcare providers.

Implications for the Profession and/or Patient Care

Findings can inform the development of family centred care guidelines for healthcare professional parents and their children.

Impact

This study explores the experiences of an understudied population. This research will impact APN-mothers, healthcare professionals in the Emergency Department as well as nursing students and researchers.

Reporting Method

EQUATOR guidelines and SRQR reporting method used.

Patient or Public Contribution

APN-mothers, caregivers and support persons of children with chronic disease enacted investigator-participant roles and were involved in each step of the study process. In addition, some patients (participants' children with chronic diseases) were included in data collected.

Mobilisation during mechanical ventilation: A qualitative study exploring the practice of conscious patients, nurses and physiotherapists in intensive care unit

Abstract

Aim

To explore the practice of mobilisation of conscious and mechanically ventilated patients and the interaction between patients, nurses and physiotherapists.

Background

Long-term consequences of critical illness can be reduced by mobilisation starting in Intensive Care Units, but implementation in clinical practice is presently sparse.

Design

A qualitative study with a phenomenological-hermeneutic approach.

Methods

Participant observations in three Intensive Care Units involved twelve conscious mechanically ventilated patients, thirty-one nurses and four physiotherapists. Additionally seven semi-structured patient interviews, respectively at the ward and after discharge and two focus group interviews with healthcare professionals were conducted. The data analysis was inspired by Ricoeur's interpretation theory. The study adhered to the COREQ checklist.

Findings

Healthcare professionals performed a balance of support and guidance to promote mobilisation practice. The complexity of ICU mobilisation required a flexible mobility plan. Furthermore, interaction with feedback and humour was found to be ‘a leverage’ for patient's motivation to partake in mobilisation.

The practice of mobilisation found patients striving to cope and healthcare professionals promoting a ‘balanced standing by’ and negotiating the flexible mobility plan to support mobilisation.

Conclusion

The study revealed a need to clarify interprofessional communication to align expectations towards mobilisation of conscious and mechanically ventilated patients.

Relevance to Clinical Practice

The study demonstrated the important role of healthcare professionals to perform a stepwise and ‘balanced standing by’ in adequately supporting and challenging the mobilisation of mechanically ventilated patients. Furthermore, a synergy can arise when nurses and physiotherapists use supplementary feedback and humour, and cooperate based on a flexible situation-specific mobility plan in intensive care.

Needs assessment in patients with inflammatory bowel disease in the encounter and communication with healthcare professionals: A fieldwork study

Abstract

Aim

To explore how patients with Inflammatory bowel disease experienced encounters with healthcare professionals in two gastrointestinal outpatient clinics to demonstrate what matters in the communication between patients and healthcare professionals.

Design

This fieldwork study is part of a larger study developing an application for patients with inflammatory bowel disease in a framework inspired by Participatory Design. Participatory design consists of three phases and this study focused on the first phase, needs assessment. A phenomenological hermeneutic approach and qualitative methods were applied to obtain an understanding of patients' needs.

Methods

Three weeks of participant observations and three focus groups with 14 subjects were conducted at two university hospitals in Denmark. Field notes and interview transcripts were analysed using condensation of meaning and interpreted based on interactional nursing practice theory. The reporting method adhered to the EQUATOR guideline: COREQ.

Results

Four themes emerged: Easy and dependable access to healthcare professionals. Predictability of follow-up appointments. Importance of privacy during patient exams and Quality of time spent with healthcare professionals.

Conclusion

Easy, dependable access, privacy, presence and predictability of follow-up appointments were important to patients with Inflammatory Bowel Disease.

Implications for the profession and patient care

In communication with patients with inflammatory bowel disease, healthcare professionals must be aware of privacy and the importance of predictable follow-up agreements. They must be aware that presence and easy, reliable access positively affect patients' self-care skills.

Patient contribution

This study is part of a larger project based on Participatory design involving patients and healthcare professionals in the development of technology to support communication.

Exploring the terminological validity of ‘chronic pain’ nursing diagnosis: A retrospective descriptive study using nursing diaries

Abstract

Aim

The aim of this study is to generate empirical evidence, drawing from clinical records, with the goal of elevating the level of evidence supporting the nursing diagnosis (ND) of ‘chronic pain’.

Background

Chronic pain is a prevalent condition that affects all age groups. Patients often feel disbelieved about their pain perception, leading to adverse psychological effects, difficulty accessing healthcare and poor rehabilitation outcomes.

Design

Retrospective descriptive study. Standards for Reporting Diagnostic Accuracy Studies guidelines were followed in this study.

Methods

Data were extracted from Electronic Health Records (EHR) of patients admitted to the University Hospital of Perugia, Italy, between March 2016 and December 2022. The study sample comprised individuals without a specific medical diagnosis or high-risk population. Out of 1,048,565 EHR, 43,341 clinical-nursing diaries with the keyword ‘pain’ were identified, from which 283 clinical-nursing notes were selected based on a keyword-based retrieval technique and diagnostic definition for further analysis.

Results

Our study findings support the diagnostic descriptors of the ‘chronic pain’ ND in clinical-nursing diaries. We observed the presence of 9 out of 11 defining characteristics, 7 out of 10 related factors, 4 out of 8 at-risk populations and 11 out of 17 associated conditions.

Conclusions

The study validated diagnostic criteria for chronic pain and proposed ‘haematological pathology’ as a new associated condition. The findings were presented to the Diagnosis Development Committee of NANDA-International for further review. However, limitations of the study prompted the need for further analysis using natural language processing and artificial neural network techniques. As a result, a new research direction using artificial intelligence (AI) tools was initiated.

Relevance to Clinical Practice

The study validates diagnostic descriptors for chronic pain and proposes future directions in semantic analysis and AI tools, aiming to enhance clinical practice and decision-making in nursing care.

Patient or Public Contribution

No patient or public contribution.

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