Harmonizing hope: A grounded theory study of the experience of hope of registered nurses who provide palliative care in community settings

2011 ◽  
Vol 9 (3) ◽  
pp. 281-294 ◽  
Author(s):  
Kelly Penz ◽  
Wendy Duggleby
Keyword(s):  
Palliative Care ◽  
Grounded Theory ◽  
Registered Nurses ◽  
Care Delivery ◽  
Quality Care ◽  
Work Life ◽  
Main Concern ◽  
Theory Approach ◽  
Community Settings ◽  
Life Challenges

AbstractObjective:The purpose of this study was to explore the hope experience of registered nurses (RNs) who provide palliative care services in community settings. The specific aims of the study were to (1) describe their hope experience, (2) develop a reflexive understanding of the processes of their hope, and (3) construct a substantive theory of hope of palliative care RNs.Methods:Using constructivist grounded theory methodology, purposeful theoretical sampling was used to enroll 14 practicing community palliative care RNs in the study. Twenty-seven open-ended telephone interviews were conducted and nine daily journal entries on hope were copied. Interviews and journals were transcribed verbatim and analyzed using Charmaz's grounded theory approach.Results:Participants described their hope as a positive state of being involving a perseverant and realistic understanding of future possibilities. Their hope sustained and motivated them, and helped them to strive to provide high-quality care. The main concern for participants was keeping their hope when faced with work life challenges and contrasting viewpoints (i.e., when their hopes differed from the hopes of others around them). They dealt with this through harmonizing their hope by the processes of “looking both ways,” “connecting with others,” “seeing the bigger picture,” and “trying to make a difference.” Their experience of hope was defined within the social context of their work and lives.Significance of results:The results of this study suggest that hope is very important to palliative care RNs, in that it helps them to persevere and sustains them when faced with work life challenges in their practice. This study also highlights the need for continued research in this area as there appears to be a lack of evidence on the meaning of hope for healthcare professionals, and, in particular, understanding hope in the context of palliative and end-of-life care delivery.

Health system characteristics of quality care delivery: A comparative case study examination of palliative care for cancer patients in four regions in Ontario, Canada

2011 ◽  
Vol 26 (4) ◽  
pp. 322-335 ◽  
Author(s):  
Jonathan Sussman ◽  
Lisa Barbera ◽  
Daryl Bainbridge ◽  
Doris Howell ◽  
Jinghao Yang ◽  
...  
Keyword(s):  
Palliative Care ◽  
Health System ◽  
Acute Care ◽  
Pattern Analysis ◽  
Care Delivery ◽  
Quality Care ◽  
Structural Features ◽  
Comparative Case Study ◽  
Care Utilization

Background: A number of palliative care delivery models have been proposed to address the structural and process gaps in this care. However, the specific elements required to form competent systems are often vaguely described. Aim: The purpose of this study was to explore whether a set of modifiable health system factors could be identified that are associated with population palliative care outcomes, including less acute care use and more home deaths. Design: A comparative case study evaluation was conducted of ‘palliative care’ in four health regions in Ontario, Canada. Regions were selected as exemplars of high and low acute care utilization patterns, representing both urban and rural settings. A theory-based approach to data collection was taken using the System Competency Model, comprised of structural features known to be essential indicators of palliative care system performance. Key informants in each region completed study instruments. Data were summarized using qualitative techniques and an exploratory factor pattern analysis was completed. Results: 43 participants (10+ from each region) were recruited, representing clinical and administrative perspectives. Pattern analysis revealed six factors that discriminated between regions: overall palliative care planning and needs assessment; a common chart; standardized patient assessments; 24/7 palliative care team access; advanced practice nursing presence; and designated roles for the provision of palliative care services. Conclusions: The four palliative care regional ‘systems’ examined using our model were found to be in different stages of development. This research further informs health system planners on important features to incorporate into evolving palliative care systems.

scholarly journals PRIORITIZATION OF QUALITY CARE CRITERIA TO DELIVER QUALITY SERVICE USING DEMATEL

2015 ◽  
Vol 11 (2) ◽  
Author(s):  
Raja Rub Nawaz ◽  
Keyword(s):  
Decision Making ◽  
Graphical Representation ◽  
Care Delivery ◽  
Quality Care ◽  
Healthcare Services ◽  
Theory Approach ◽  
Quality Service ◽  
Course Of Action ◽  
Importance Ratings ◽  
Multiple Variables

Purpose:-Hospitals are very vital as an element in Quality Care delivery and their evaluation in these terms on perpetual basis are much needed as these organizations contribute in improving health outcomes for general people. Hospitals, especially privately owned, are also run like businesses these days to remain competitive in the respective arena. The environment and situation faced by many hospitals are often complicated and which definitely requires insightful solutions to steer the direction of these businesses. This study was focused on the application of group decision-making tool, DEMATEL as one of the valid methods in Multi-Criteria Decision Making (MCDM). Methodology:- The study was exploratory in nature and efforts were made to justify by highlighting the criteria prioritization procedure to be undertaken by any healthcare organization. A slight deviation from the standard four-steps of DEMATEL, a course of action was created in the shape of an eight-step procedure to exhibit a practical approach rather than mathematical theory approach. In order to make it more empirical in nature, a five-stage research framework was also devised and acted upon with the help of three separate questionnaires. Avedis Donabedian’s (1988) Quality Care framework was followed and multiple variables were devised, importance ratings were collected from patients on these devised variables and after reduction of variables in to manageable latent factors, called criteria in the study, DEMATEL method was applied to depict the prioritization of Quality Care criteria for the delivery of quality service via digraph. Findings:-The graphical representation through digraph showed that criteria were vertically divided in two halves as C1, C5, and C4 are shown as criteria influencing the lower half criteria C3, C6, and C2. The horizontal span of digraph reflected the importance of criteria prioritized and showed C1 criterion as the most important and C2 criterion with the least importance. Implications:-The prioritization of the criteria along with their cause and effect distribution gave an insight into the constitution framework of localized healthcare services of Karachi, Pakistan

The grounded theory of “trust building”

2017 ◽  
Vol 26 (3) ◽  
pp. 753-766 ◽  
Author(s):  
Monir Ramezani ◽  
Fazlollah Ahmadi ◽  
Eesa Mohammadi ◽  
Anoshirvan Kazemnejad
Keyword(s):  
Grounded Theory ◽  
Nursing Students ◽  
Spiritual Care ◽  
Care Delivery ◽  
Staff Nurses ◽  
Trust Building ◽  
Positive Thinking ◽  
Theory Approach ◽  
Grounded Theory Approach ◽  
Study Setting

Background: Despite the growing importance of spiritual care, the delivery of spiritual care is still an area of disagreement among healthcare providers. Objective: To develop a grounded theory about spiritual care delivery based on Iranian nurses’ perceptions and experiences. A grounded theory approach: A qualitative study using the grounded theory approach. Participants and research context: Data were collected through holding 27 interviews with 25 participants (17 staff nurses, 3 physicians, 3 patients, 1 family member, and 1 nurse assistant). The study setting was the Imam Khomeini Hospital Complex. Sampling was started purposively and continued theoretically. Data analysis was performed by the method proposed by Strauss and Corbin. Ethical consideration: The study was approved by the Ethics Committee of Tarbiat Modares University and the agreement of the administrators of the study setting was got before starting the study. Results: The core category of the study was “Trust building” which reflected the nature of spiritual care delivery by nurses. Trust building was the result of eight main categories or strategies including creating a positive mentality at hospital admission, understanding patients in care circumstances, having a caring presence, adhering to care ethics, developing meaningful relationships, promoting positive thinking and energy, establishing effective communication with patients, and attempting to create a safe therapeutic environment. Poor interprofessional coordination negatively affected this process while living toward developing greater cognizance of divinity and adhering to the principles of professional ethics facilitated it. The outcome of the process was to gain a sense of partial psychological security. Conclusion: The “Trust building” theory can be used as a guide for describing and expanding nurses’ roles in spiritual care delivery, developing care documentation systems and clinical guidelines, and planning educational programs for nursing students and staff nurses.

scholarly journals Determinants of emotional exhaustion among nursing workforce in urban Ghana: a cross-sectional study

BMC Nursing ◽  
2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Collins Atta Poku ◽  
Ernestina Donkor ◽  
Florence Naab
Keyword(s):  
Registered Nurses ◽  
Emotional Exhaustion ◽  
Care Delivery ◽  
Quality Care ◽  
Maslach Burnout Inventory ◽  
Cross Sectional Study ◽  
High Rate ◽  
Practice Environment ◽  
Sectional Study ◽  
Cross Sectional

Abstract Background The subject of emotional exhaustion organisations has become important because of the emerging trends in employment and its associated challenges. Unhealthy practice environment is a major threat in the incidence of emotional exhaustion among nurses; and any organisational culture that do not support its personnel has huge burnout costs. The study aimed at assessing rate of emotional exhaustion; determining factors that accounts for it and also ascertaining the coping strategies used by nurses to overcome it in the Ghanaian health care setting. Methods A cross-sectional study with a proportionate stratified sampling was used to draw a sample from five health facilities. A standardized questionnaire of Professional Practice Environment Scale of Nursing Work Index, Maslach Burnout Inventory and Coping Scale were used to assess variables under study. The STROBE guidelines were followed in reporting this study. Results Out of the 232 registered nurses studied, 91.1% of them reported experiencing moderate to high rate of emotional exhaustion. The practice environment of the nurses explained 39.6% of the variance in emotional exhaustion. Emotion-focused and problem-focused approaches were identified to be used by registered nurses to cope with emotional exhaustion. Conclusion When appropriate and effective intervention are employed, emotional exhaustion will be reduce and this will enrich the effectiveness of quality care delivery to patients.

scholarly journals The Process of Oncology Nurse Practitioner Patient Navigation: Triage an Essential Process

2019 ◽  
Vol 4 (2) ◽  
Keyword(s):  
Grounded Theory ◽  
Nurse Practitioners ◽  
Nurse Practitioner ◽  
Cancer Care ◽  
Patient Navigation ◽  
Care Delivery ◽  
Theory Approach ◽  
Full Time ◽  
Oncology Nurse ◽  
Grounded Theory Approach

One of the most daunting challenges faced in the health care delivery system is the complexity of cancer care, and the process of care coordination, a subcomponent of patient navigation. A study was undertaken to identify a central navigation process utilized by nurse practitioners practicing oncology. The data in this article is a component of a larger study entitled: The Process of Oncology Nurse Practitioner Patient Navigation: A Grounded Theory Approach. Utilizing a grounded theory approach N = 20 oncology nurse practitioners (ONP) were recruited. To be eligible for the study the ONP had to have a: 1) license to practice in their respective state; 2) certification to practice as an oncology nurse; 3) minimum of 5 years full time experience in oncology nursing; and 4) English speaking. The participants were recruited by: 1) word of mouth networking with peers: 2) Soliciting volunteers through public announcements at professional nursing conferences; 3) Contacting authors of oncology NP navigation articles or convention pamphlets via telephone or e-mail; 4) Posting information soliciting oncology NP volunteers on blogs or websites of professional organizations with organizational director approval; and, 5) Recruiting by snowball sampling. Telephone interviews were conducted utilizing an open-ended questionnaire. Data analysis and coding revealed the central navigation processes. The triage process was carried out in a variety of unique settings, and utilized in some instances within navigation subsystems. Key triage paths were identified along the cancer continuum; documenting the need for ONP navigators to strategically place these systems in areas along the cancer continuum, to expedite timely delivery of patient care. Literature search revealed that cancer specific triage tools are lacking. Implications for research and practice include the development of these tools for cancer care. Of critical importance is the need to identify service gaps in cancer care, and strategically place triage systems, to offset these service gaps. Practical application of the research findings in relationship to current literature is integrated for discussion.

scholarly journals Recognition for registered nurses supporting students on clinical placement: a grounded theory study

2020 ◽  
Vol 37 (3) ◽  
Author(s):  
Carina Anderson ◽  
Lorna Moxham ◽  
Marc Broadbent
Keyword(s):  
Grounded Theory ◽  
Nursing Students ◽  
Registered Nurses ◽  
Learning Opportunities ◽  
Clinical Placement ◽  
Theory Approach ◽  
Major Category ◽  
Additional Time ◽  
Clinical Placements ◽  
Undergraduate Nursing

Objective: This study examined registered nurses’ perspectives of being supportive of nursing students and providing them with learning opportunities when on clinical placements. Background: In Australia, as part of their three-year Bachelors degree, undergraduate nursing students undertake a minimum of 800 hours of clinical placement. During these clinical placement hours, nursing students are supervised by registered nurses who are required to be supportive of the students and provide them with learning opportunities. Study design and methods: This study used a grounded theory approach. In this qualitative study there were fifteen registered nurse participants. Thirteen participants were female participants and two were male. Participants were individually interviewed. Transcripts from these in–depth interviews were analysed using constant comparative analysis. Results: The major category, an added extra, emerged from this study. An added extra is about registered nurses’ perception that having a student is an added extra to their daily duties. The major category an added extra is informed by three emergent themes. The first theme was time, the second theme was workload and the third theme was wanting recognition. Discussion: Registered nurses perceived that their workloads tend not to be taken into consideration when they have nursing students. The literature suggests that nursing students often miss out on learning opportunities when they are on clinical placement because registered nurses do not have additional time to effectively support students’ clinical learning. Conclusion: Participants in this study believed being supportive of nursing students and providing them with learning opportunities was an added extra to their daily nursing duties. Findings revealed registered nurses want to be recognised for the extra time and effort they dedicate to students’ learning.

scholarly journals Constructing Stability – A Classic Grounded Theory Of Next-Of-Kin In Palliative Cancer Care

2020 ◽  
Author(s):  
Carina Werkander Harstade ◽  
Anna Sandgren
Keyword(s):  
Palliative Care ◽  
Grounded Theory ◽  
Cancer Care ◽  
Extended Family ◽  
Main Concern ◽  
Next Of Kin ◽  
Classic Grounded Theory ◽  
Personal Finances ◽  
Keywords Cancer ◽  
Palliative Phase

Abstract Background: Being next-of-kin to someone with cancer requiring palliative care involves a complex life situation. Changes in roles and relationships might occur and the next-of-kin thereby try to adapt by being involved in the ill person’s experiences and care even though they can feel unprepared for the care they are expected to provide. Therefore, the aim of this study was to develop a classic grounded theory of next-of-kin in palliative cancer care. Method: Forty-two next-of-kin to persons with cancer in palliative phase or persons who had died from cancer were interviewed. Theoretical sampling was used during data collection. The data was analysed using classic Grounded Theory methodology to conceptualize patterns of human behaviour. Results: Constructing stability emerged as the pattern of behaviour through which next-of-kin deal with their main concern; struggling with helplessness . This helplessness includes an involuntary waiting for the inevitable. The waiting causes sadness and frustration, which in turn increases the helplessness. The theory involves; Shielding, Acknowledging the reality, Going all in, Putting up boundaries, Asking for help, and Planning for the inescapable . These strategies can be used separately or simultaneously and they can also overlap each other. There are several conditions that may impact the theory Constructing stability , which strategies are used, and what the outcomes might be. Some conditions that emerged in this theory are time, personal finances, attitudes from extended family and friends and availability of healthcare resources. Conclusions: The theory shows the complexities of being next-of-kin to someone receiving palliative care, while striving to construct stability. This theory can increase healthcare professionals’ awareness of how next-of-kin struggle with helplessness and thus generates insight into how to support them in this struggle. Keywords cancer, constructing stability, grounded theory, next-of-kin, palliative care

scholarly journals Constructing Stability – A Classic Grounded Theory of Next-of-Kin in Palliative Cancer Care

2020 ◽  
Author(s):  
Carina Werkander Harstade ◽  
Anna Sandgren
Keyword(s):  
Palliative Care ◽  
Grounded Theory ◽  
Cancer Care ◽  
Extended Family ◽  
Main Concern ◽  
Next Of Kin ◽  
Classic Grounded Theory ◽  
Personal Finances ◽  
Theoretical Sampling ◽  
Palliative Phase

Abstract Background: Being next-of-kin to someone with cancer requiring palliative care involves a complex life situation. Changes in roles and relationships might occur and the next-of-kin thereby try to adapt by being involved in the ill person’s experiences and care even though they can feel unprepared for the care they are expected to provide. Therefore, the aim of this study was to develop a classic grounded theory of next-of-kin in palliative cancer care. Method: Forty-two next-of-kin to persons with cancer in palliative phase or persons who had died from cancer were interviewed. Theoretical sampling was used during data collection. The data was analysed using classic Grounded Theory methodology to conceptualize patterns of human behaviour. Results: Constructing stability emerged as the pattern of behaviour through which next-of-kin deal with their main concern; struggling with helplessness. This helplessness includes an involuntary waiting for the inevitable. The waiting causes sadness and frustration, which in turn increases the helplessness. The theory involves; Shielding, Acknowledging the reality, Going all in, Putting up boundaries, Asking for help, and Planning for the inescapable. These strategies can be used separately or simultaneously and they can also overlap each other. There are several conditions that may impact the theory Constructing stability, which strategies are used, and what the outcomes might be. Some conditions that emerged in this theory are time, personal finances, attitudes from extended family and friends and availability of healthcare resources. Conclusions: The theory shows the complexities of being next-of-kin to someone receiving palliative care, while striving to construct stability. This theory can increase healthcare professionals’ awareness of how next-of-kin struggle with helplessness and thus generates insight into how to support them in this struggle.

scholarly journals Pathways of nurses in Long-term care hospitals: Seeking work-life balance

2020 ◽  
Author(s):  
Samsook Kim ◽  
Ga Eon Lee ◽  
Barbara Bowers ◽  
Yeonjae Jo
Keyword(s):  
Registered Nurses ◽  
Professional Growth ◽  
Long Term Care ◽  
Work Life ◽  
Work Life Balance ◽  
Theory Approach ◽  
Term Care ◽  
Life Balance ◽  
Theoretical Sampling

Abstract Background This study explores the pathways of nurses in LTCHs and its underlying conditions in Korea. Nursing shortage in long-term care setting has been a worldwide concern. Although the factors of staying or leaving of nurses in long term care hospitals (LTCHs) have been reported, few studies have examined the trajectory and conditions of nurses staying in and leaving LTCHs. Methods A qualitative study design with a grounded theory approach was conducted. Data were collected in one to one interviews. Purposive and theoretical sampling led to the inclusion of 17 registered nurses with diverse characteristics from 14 LTCHs in a metropolitan city in South Korea. Individual, in-depth interviews were conducted. Data collection and analysis coincided. Data were analyzed using open and focused coding, constant comparison, theoretical sampling and memoing, and this enabled the construction of a substantive theory. Results Seeking work-life balance was the core category of nurses’ pathway. Consequences of nurses’ pathway were categorized into three groups: thriving, surviving, and leaving. Thriving nurses in LTCHs found meaning in their work, fostered good relationships, and saw opportunities for growth. Surviving nurses in LTCHs were enduring their jobs in LTCHs, having a work-life balance, and supportive nursing leader. Leaving group nurses wished to leave LTCHs due to lack of professional growth, unappealing work, continuing conflict, and social stigma. However, compensation, work system, and interpersonal relationships were the common moving conditions for all three groups. Conclusions This study provided the trajectory and conditions of nurses to enter, stay, move, or leave at LTCHs. Understanding the pathways for staying or leaving can be used as a strategy for successful retention of registered nurses in LTCHs.

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