Transition to comfort-focused care: Moral agency of acute care nurses

2020 ◽  
pp. 096973302095212
Author(s):  
Mary Ann Meeker ◽  
Dianne White
Keyword(s):  
Nursing Education ◽  
Registered Nurses ◽  
Acute Care ◽  
Moral Agency ◽  
Human Subjects ◽  
Care Providers ◽  
Structured Interviews ◽  
Acute Care Nurses ◽  
Building Relationships ◽  
Protection Of Human Subjects

Background: Moving into the last phase of life comprises a developmental transition with specific needs and risks. Facilitating transitions is an important component of the work of nurses. When curative interventions are no longer helpful, nurses enact key roles in caring for patients and families. Aim: The aim of this study was to examine the experiences of registered nurses in acute care settings as they worked with patients and families to facilitate transition to comfort-focused care. Research design: Sampling, data collection, and data analysis were guided by constructivist grounded theory, chosen because of its strength in identifying and explicating social processes. Participants and context: A purposeful sample of 26 registered nurses working in acute care hospitals in one community in the northeastern United States participated in this study through semi-structured interviews. Ethical considerations: The study received approval from the university’s Institutional Review Board for the Protection of Human Subjects. Participants provided informed consent. Findings: Nurses facilitated transition to comfort-focused care by enacting their moral commitments to patients and families. They focused on building relationships, honoring patient self-determination, and maintaining respect for personhood. In this context, they discerned a need for transition, opened a discussion, and used diverse strategies to facilitate achieving consensus on the part of patients, family members, and care providers. Regardless of how the process unfolded, nurses offered support throughout. Discussion: Achievement of consensus by all stakeholders is critical in the transition to comfort-focused care. This study deepens our understanding of how nurses as moral agents utilize specific strategies to assist progress toward consensus. It also offers an example of recognizing the moral agency of nurses through listening to their voices. Conclusion: Increased understanding of effective nursing strategies for facilitating transition to comfort-focused care is essential for developing needed evidence for excellent care and strengthening end-of-life nursing education.

scholarly journals Registered nurses’ role experiences of caring for older stroke patients: a qualitative study

BMC Nursing ◽  
2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Wei Cheng ◽  
Jiong Tu ◽  
Xiaoyan Shen
Keyword(s):  
Nursing Education ◽  
Older People ◽  
Registered Nurses ◽  
Elderly Care ◽  
The Elderly ◽  
Working Environment ◽  
Structured Interviews ◽  
Stroke Patients ◽  
Care Needs ◽  
Nursing Clinical Practice

Abstract Background With China’s population ageing rapidly, stroke is becoming one of the major public health problems. Nurses are indispensable for caring for older patients with acute and convalescent stroke, and their working experiences are directly linked to the quality of care provided. The study aims to investigate registered nurses’ experiences of caring for older stroke patients. Methods A qualitative descriptive design was adopted. Data were collected via semi-structured interviews with 26 registered nurses about their lived experiences of caring for older stroke patients. Thematic analysis was used to analyze the data. Results Two main themes were identified. First, the nurses identified an obvious gap between their ideal role in elderly care and their actual practice. The unsatisfactory reality was linked to the practical difficulties they encountered in their working environment. Second, the nurses expressed conflicting feelings about caring for older stroke patients, displaying a sense of accomplishment, indifference, annoyance, and sympathy. Caring for older stroke patients also affects nurses psychologically and physically. The nurses were clear about their own roles and tried their best to meet the elderly people’s needs, yet they lack time and knowledge about caring for older stroke patients. The factors influencing their working experiences extend beyond the personal domain and are linked to the wider working environment. Conclusions Sustaining the nursing workforce and improving their working experiences are essential to meet the care needs of older people. Understanding nurses’ lived working experiences is the first step. At the individual level, nurse mangers should promote empathy, relieve anxiety about aging, and improve the job satisfaction and morale of nurses. At the institutional level, policymakers should make efforts to improve the nursing clinical practice environment, increase the geriatric nursing education and training, achieve a proper skill mix of the health workforce, and overall attract, prepare and sustain nurses regarding caring for older people in a rapidly aging society.

‘There was no preamble’: Comparing the Transition from Hospital to Home in Different Care Settings

2020 ◽  
pp. 1-11
Author(s):  
Marianne Saragosa ◽  
Lianne Jeffs ◽  
Shoshana Hahn-Goldberg ◽  
Howard Abrams ◽  
Christine Soong ◽  
...  
Keyword(s):  
Acute Care ◽  
Health Care Providers ◽  
Transitional Care ◽  
Informal Caregivers ◽  
Care Providers ◽  
Outpatient Services ◽  
Structured Interviews ◽  
Individualized Approach ◽  
Transition Points ◽  
Hospital To Home

ABSTRACT Our qualitative descriptive study compared how older patients and their informal caregivers experienced the care transition from acute care or rehabilitation to home. We recruited patients 65 years of age or older, or their informal caregivers, from in-patient units within acute care hospitals and rehabilitation facilities to participate in semi-structured interviews. We identified emergent themes via thematic analysis. In all, 16 patients and four patient caregivers participated. Across all care settings, caregivers were integral in facilitating the transition as well as experiencing variable discharge preparation, health care providers’ optimizing transitions, and missed care and medication discrepancies at transition points. Orthopedic and rehabilitation patients more commonly voiced prior transition experiences in discharge preparation, including having to unexpectedly coordinate and wait for outpatient services. Differing responses between acute care and orthopedic settings suggest that transitional care practices and policies favor an individualized approach that considers patients’ previous experiences, needs, and care expectations.

Involving Parents and Children in Community-Engaged Research

2018 ◽  
pp. 206-226
Author(s):  
Erin Talati Paquette ◽  
Lainie Friedman Ross
Keyword(s):  
Stakeholder Engagement ◽  
Moral Agency ◽  
Conflicts Of Interest ◽  
Human Subjects ◽  
Research Process ◽  
Privacy Concerns ◽  
Community Engaged Research ◽  
Parents And Children ◽  
Patient Groups ◽  
Protection Of Human Subjects

Stakeholder engagement in research is increasingly relied upon for its potential to increase the relevance of research, improve transparency of the research process, and translate evidence into practice. Engaging communities in research provides research teams with unique views into the needs, interests, and skills of public stakeholders including healthy volunteers, advocacy groups, patient groups, and their families and/or caregivers. This chapter considers key ethical considerations for researchers contemplating community-engaged research, including how to think about protection of human subjects and privacy, concerns regarding conflicts of interest and group harms, and compensation in community-engaged research. These concerns are heightened and further complicated in community-engaged pediatric research because of the additional vulnerabilities of children. In the pediatric setting, the scope of child participation, consent, and compensation deserve special attention, with respect to and for the evolving but not yet fully developed moral agency of children.

Acceptance of the HPV Vaccine in a Multiethnic Sample of Latinx Mothers

2021 ◽  
Vol 31 (3) ◽  
pp. 472-483
Author(s):  
Ana Cristina Lindsay ◽  
Madelyne J. Valdez ◽  
Denisse Delgado ◽  
Emily Restrepo ◽  
Yessica M. Guzmán ◽  
...  
Keyword(s):  
Health Care Providers ◽  
Thematic Analysis ◽  
Hpv Vaccine ◽  
Female Adolescents ◽  
Future Research ◽  
Care Providers ◽  
Foreign Born ◽  
Structured Interviews ◽  
Direct Benefits ◽  
Multiethnic Sample

This descriptive qualitative study explored Latinx mothers’ acceptance of the human papillomavirus (HPV) vaccine for their adolescent children. Data were collected through individual, semi-structured interviews and analyzed using a hybrid method of thematic analysis that incorporated deductive and inductive approaches. Twenty-two ( n = 22), mostly foreign-born, Latinx mothers of male and female adolescents participated in the study. Three main themes and nine subthemes emerged from the analyses. Findings identified the need for increased efforts to raise awareness and knowledge among Latinx mothers of the direct benefits of the HPV vaccine for sons, including stressing prevention of HPV-associated cancers in males. Findings also underscore the need for improved health care providers’ communication and recommendation of the HPV vaccine for Latinx adolescent males. Future research should intervene upon the study’s findings to address barriers that remain and affect Latinx mothers’ acceptance and uptake of the HPV vaccine for their children, in particular their sons.

scholarly journals Care-seeking and managing diabetes in rural Bangladesh: a mixed methods study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hannah Maria Jennings ◽  
Joanna Morrison ◽  
Kohenour Akter ◽  
Hassan Haghparast-Bidgoli ◽  
Carina King ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Health Care Providers ◽  
Low Income ◽  
Diabetes Management ◽  
Local Health ◽  
Care Seeking ◽  
Care Providers ◽  
Structured Interviews ◽  
Rural Bangladesh

Abstract Background Type 2 diabetes mellitus poses a major health challenge worldwide and in low-income countries such as Bangladesh, however little is known about the care-seeking of people with diabetes. We sought to understand the factors that affect care-seeking and diabetes management in rural Bangladesh in order to make recommendations as to how care could be better delivered. Methods Survey data from a community-based random sample of 12,047 adults aged 30 years and above identified 292 individuals with a self-reported prior diagnosis of diabetes. Data on health seeking practices regarding testing, medical advice, medication and use of non-allopathic medicine were gathered from these 292 individuals. Qualitative semi-structured interviews and focus group discussions with people with diabetes and semi-structured interviews with health workers explored care-seeking behaviour, management of diabetes and perceptions on quality of care. We explore quality of care using the WHO model with the following domains: safe, effective, patient-centred, timely, equitable and efficient. Results People with diabetes who are aware of their diabetic status do seek care but access, particularly to specialist diabetes services, is hindered by costs, time, crowded conditions and distance. Locally available services, while more accessible, lack infrastructure and expertise. Women are less likely to be diagnosed with diabetes and attend specialist services. Furthermore costs of care and dissatisfaction with health care providers affect medication adherence. Conclusion People with diabetes often make a trade-off between seeking locally available accessible care and specialised care which is more difficult to access. It is vital that health services respond to the needs of patients by building the capacity of local health providers and consider practical ways of supporting diabetes care. Trial registration ISRCTN41083256. Registered on 30/03/2016.

Breastfeeding Experiences of Baccalaureate Nursing Students: A Qualitative Study

2020 ◽  
pp. 089033442097998
Author(s):  
Cheryl Langford ◽  
Marcella Gowan ◽  
Monica Haj
Keyword(s):  
Nursing Students ◽  
Health Care Providers ◽  
Baccalaureate Nursing ◽  
Community Support ◽  
Baccalaureate Nursing Students ◽  
Care Providers ◽  
Structured Interviews ◽  
Breastfeeding Support ◽  
Cross Sectional

Background Students returning to school who are breastfeeding face unique challenges. There is limited literature on breastfeeding university students. Several researchers have studied breastfeeding employees in the workplace. Institutions of higher education closely mimic the employment environment. Breastfeeding college students who express their milk while at school share similar challenges to employed mothers. A baccalaureate nursing program is rigorous and little is known about the challenges facing breastfeeding student nurses returning to classes. Research aim To explore the breastfeeding experience of baccalaureate nursing students. Methods Our study was a cross-sectional descriptive qualitative design. Purposive sampling was used to enroll participants ( N = 12). In depth, semi-structured interviews were conducted. Qualitative thematic analysis was used to analyze the data both manually and using Dedoose QDA software. Results An overarching theme of pervasive conflict between the role of the breastfeeding mother and the role of the student nurse surfaced. Three interrelated organizing themes also emerged; challenging, vulnerability, and resilience. Time constraints, self-care versus role demands, and structural accommodations contributed to the challenges. Only one participant indicated a knowledge of her breastfeeding rights. All of the participants expressed gratitude for faculty and community support, regardless of conflicts. Conclusion Breastfeeding participants were both vulnerable and resilient. Faculty may improve experiences through providing specific areas of support. A breastfeeding support policy outlining student rights and faculty responsibilities is needed to educate, guide, and enforce protections. Health care providers may enhance breastfeeding students’ experiences through anticipatory guidance, education, and continued support.

scholarly journals A Multiple Stakeholder Perspective for Evaluating Community-Based Dementia Care

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 60-61
Author(s):  
Johan Suen
Keyword(s):  
Dementia Care ◽  
Structural Constraints ◽  
Care Provision ◽  
Care Providers ◽  
Structured Interviews ◽  
Community Based ◽  
Relational Factors ◽  
Care Relationships ◽  
The Individual ◽  
The Impact

Abstract For holistic interventions and research on dementia, it is fundamental to understand care experiences from the perspectives of carers, care recipients, and care professionals. While research on care dyads and triads have highlighted the effects of communication and interactional aspects on care relationships, there is a lack of knowledge on how individual-contextual and relational factors shape the provision and receipt of care in terms of decision-making processes, resource allocation, and expectations of care outcomes. Thus, this paper sheds light on (i) how carers negotiate care provision with other important life domains such as employment, household/family roles and conflicts, as well as their own health problems, life goals, values, and aspirations for ageing; (ii) how older adults with dementia perceive support and those who provide it; (iii) the structural constraints faced by care professionals in delivering a team-based mode of dementia care; and, taken together, (iv) how community-based dementia care is impeded by barriers at the individual, relational, and institutional levels. Findings were derived from semi-structured interviews and observational data from fieldwork conducted with 20 persons with dementia (median age = 82), 20 of their carers (median age = 60), and 4 professional care providers. All respondents were clients and staff of a multidisciplinary and community-based dementia care system in Singapore. Our analysis indicates the impact of dementia care is strongly mediated by the interplay between institutional/familial contexts of care provision and the various ‘orientations’ to cognitive impairment and seeking support, which we characterised as ‘denial/acceptance’, ‘obligated’, ‘overprotective’, and ‘precariously vulnerable’.

scholarly journals “What is the actual goal of the pathway?”: examining emergency department physician and nurse perspectives on the implementation of a pediatric concussion pathway using the theoretical domains framework

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Anh Ly ◽  
Roger Zemek ◽  
Bruce Wright ◽  
Jennifer Zwicker ◽  
Kathryn Schneider ◽  
...  
Keyword(s):  
Emergency Department ◽  
Health Care Providers ◽  
Clinical Pathways ◽  
Theoretical Domains Framework ◽  
Local Context ◽  
Emergency Department Physician ◽  
Evidence Based ◽  
Care Providers ◽  
Structured Interviews ◽  
Pediatric Concussion

Abstract Background Multiple evidence-based clinical practice guidelines (CPGs) exist to guide the management of concussion in children, but few have been translated into clinical pathways (CP), which operationalize guidelines into accessible and actionable algorithms that can be more readily implemented by health care providers. This study aimed to identify the clinical behaviours, attitudinal factors, and environmental contexts that potentially influence the implementation of a clinical pathway for pediatric concussion. Methods Semi-structured interviews were conducted from October 2017 to January 2018 with 42 emergency department clinicians (17 physicians, 25 nurses) at five urban emergency departments in Alberta, Canada. A Theoretical Domains Framework (TDF)-informed interview guide contained open-ended questions intended to gather feedback on the proposed pathway developed for the study, as well as factors that could potentially influence its implementation. Results The original 14 domains of the TDF were collapsed into 6 clusters based on significant overlap between domains in the issues discussed by clinicians: 1) knowledge, skills, and practice; 2) professional roles and identity; 3) attitudes, beliefs, and motivations; 4) goals and priorities; 5) local context and resources; and 6) engagement and collaboration. The 6 clusters identified in the interviews each reflect 2–4 predominant topics that can be condensed into six overarching themes regarding clinicians’ views on the implementation of a concussion CP: 1) standardization in the midst of evolving research; 2) clarifying and communicating goals; 3) knowledge dissemination and alignment of information; 4) a team-oriented approach; 5) site engagement; and 6) streamlining clinical processes. Conclusion Application of a comprehensive, evidence-based, and theory-driven framework in conjunction with an inductive thematic analysis approach enabled six themes to emerge as to how to successfullly implement a concussion CP.

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