A gap between the intention of the Swedish law and interactions between nurses and children of patients in the field of palliative oncology – The perspective of nurses

The Family Talk Intervention Among Families Affected by Severe Illness: Hospital Social Workers' Experiences of Facilitators and Barriers to its Use in Clinical Practice

Hospital social workers (HSW) play an important role in health care, providing psychosocial support to families affected by severe illness, and having palliative care needs involving dependent children. However, there are few evidence-based family interventions for HSWs to apply when supporting these families. The Family Talk intervention (FTI), a psychosocial family-based intervention, was therefore evaluated in an effectiveness-implementation study. Within the study, HSWs were educated and trained in the use of FTI in clinical practice. This study examined HSWs' experiences of barriers and facilitating factors during their initial use of FTI in clinical practice. Altogether, 10 semi-structured focus groups were held with HSWs (n = 38) employed in cancer care and specialized palliative home care for adults, pediatric hospital care, and a children's hospice. Data were analyzed using content analysis. HSWs considered FTI to be a suitable psychosocial intervention for families affected by severe illness with dependent children. However, the way in which the care was organized acted either as a barrier or facilitator to the use of FTI, such as the HSWs' integration in the team and their possibility to organize their own work. The HSWs' work environment also impacted the use of FTI, where time and support from managers was seen as a significant facilitating factor, but which varied between the healthcare contexts. In conclusion, HSWs believed that FTI was a suitable family intervention for families involving dependent children where one family member had a severe illness. For successful initial implementation, strategies should be multi-functional, targeting the care organization and the work environment.

The influence of actors on the content and execution of a bereavement programme: a Bourdieu-inspired ethnographical field study in Sweden

Introduction

The death of a parent can have profound negative impacts on children, and a lack of adequate support can exacerbate negative life experiences.

Aim

To explore the influences of various actors on the content and execution of a bereavement programme within a Swedish context, considering relational and contextual perspectives.

Methods

An ethnographic field study involving six children, their parents, and eight volunteers. A theory-inspired thematic analysis was conducted, methodically inspired by Braun and Clarke, theoretically inspired by Bourdieu's concepts of position, power, and capital.

Results

Confidentiality obligation was an essential element in the programme, however, the premisses varied depending on actors' positions. Volunteers and researchers had different outlets to express their experiences in the program. The programme offered the children an exclusive space for talking about and sharing experiences and feelings. Simultaneously, the programme restricted the children by not allowing them to share their experiences and feelings outside the physical space. The physical settings shaped the different conditions for interactions among the actors. The sessions adopted loss-oriented approaches, where communication between volunteers and children was guided by the volunteers. However, children created strategies for additional, voiceless communication with their peers or themselves. During breaks and mingles, shared interests or spaces connected children (and adults) more than their common experience of parental bereavement.

Conclusion

The participants in the programme were significantly influenced by the structural framework of the programme, and their positions within the programme provided them with different conditions of possibility for (inter)acting. Children's daily activities and interests were both ways to cope with parental bereavement and connect them to other people.

Inclusion and Participation in a Support Programme for Bereaved Adolescents - Relational Perspectives From an Ethnographic Field Study in a Swedish Context

The death of a parent is a life-changing event, and different programmes are developed to support children. This study explored how parental bereaved adolescents were included and (inter)acted in a Swedish support programme. The conducted ethnographic field study included six adolescents, their parents, and eight volunteers. The empirical material was thematically analysed through a theoretical lens inspired by Bourdieu. Three themes emerged: 'Different strategies for adolescents' inclusion in the programme,' 'Medico-psychological understanding of grief and suffering,' and 'Reproduction of the logic of the school.' Adolescents were included in the programme through different strategies, where adults functioned as gatekeepers. The programme reproduced the school logic and was based on a medico-psychological grief/bereavement understanding. Volunteers had pedagogic authority and concomitant symbolic power, ruling adolescents to do what they must do in the meetings, silently socialising them into the medical logic. The adolescents only interacted and communicated with each other during breaks.

The 'good death' in Mainland China - A Scoping Review

Background

Since the mid 80'ies, the western palliative care philosophy has influenced the development of palliative care in mainland China. However, it has caused several challenges.

Objective

To explore the understanding of the 'good death' among authorities, professionals, patients, and their relatives in end-of-life care settings in mainland China.

Design

Scoping review. The PRISMA-ScR checklist was used. The study is not registered.

Settings

End-of-life care settings, Mainland China.

Participants

Authorities, healthcare professionals, adult patients, and general population in mainland China.

Method

Literature searches were performed through Medline, CINAHL, PsycInfo, and Web of Sciences from 2001-2021, last search 21.4.2021. Inclusion criteria were: Empirical research studies investigating 'good death' or political documents about 'good death', perspectives from authorities, professionals, patients, and/or relatives, and studies following the Declaration of Helsinki. Exclusion criteria were: Literature reviews, languages other than English and Chinese, editorials, letters, comments, and children's death/dying.The analysis consisted of analysing the data including a descriptive numerical summary analysis and a qualitative thematic analysis.

Results

Nineteen articles and two political documents were included. The 19 studies were carried out from 2003-2020, with data collected from 1999 to 2019. The political documents were written in 2012 and 2017, respectively. The thematic analysis resulted in three themes: 'Medicalisation of death', 'Communication about death - a clash between two philosophies', and 'Dying and death were socially dependent'. The medicalisation of death meant the understanding of the 'good death' primarily focused on physical symptoms and treatments. The good death was understood as painless and symptom-free, where all symptoms could be measured and assessed. Dignity and shared decision-making were connected to the understanding of the 'good death'. However, the contents of the 'good death' varied across the different actors. The understanding of the 'good death' in mainland China was a negotiation between Chinese traditional philosophy and contemporary western medicine practice. There was a tension between openness and silence about death, which reflected the importance of death education. The understanding of the 'good death' consisted partly of a timely and practical preparation for the death and afterlife, partly of a matter of social and financial issues.

Conclusions

There seemed to be a clash between two different cultures in the understanding of a good death in Mainland China, where western philosophy seemed to rule the political medical actors while traditional Chinese philosophy seemed to rule parts of the population.

Communicating with young children who have a parent dying of a life-limiting illness: a qualitative systematic review of the experiences and impact on healthcare, social and spiritual care professionals

Background

Healthcare professionals play a key role in interacting with children who have a parent with a life-limiting illness. While playing such a role can be challenging, not much is known about how such interactions impact these professionals and affect their ability to render support.

Methods

Four databases were searched with the intention to conduct a qualitative systematic review. Articles were selected based on pre-determined inclusion and exclusion criteria. Their quality was assessed using the tool "Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields”. Findings were analysed using thematic analysis techniques outlined by Thomas and Harden as well as Sandelowski and Barroso. Review was registered with the Review Registry database.

Results

Three themes emerged – healthcare professionals’ discomfort; their assumptions and actions; and potentiating workplace factors. The discomfort had several dimensions: fear of making a situation worse, concern of not being able to cope with emotionally charged situations, and internal conflict that arose when their values clashed with family dynamics.

Conclusion

Healthcare professionals’ sense of discomfort was very pronounced. This discomfort, together with their assumptions, could impact their ability to support children. The organisation played an important role, which was reflected in the work culture, workflow and ability to collaborate with other agencies involved in supporting children. The discomfort was mitigated by having more professional experience, workplace support systems and training on communicating with children. It was apparent that the individual professional did not work alone when supporting children but alongside others within an organisation. As such, issues raised in this review will benefit from multi-faceted solutions.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12904-022-01007-1.

Children as Next of Kin in Higher Education: An Exploratory Cross-Sectional Study Among Health, Social Care, and Teacher Education Programs

INTRODUCTION

Children who are "next of kin" (ie, sick/dying/addicted/imprisoned close relatives) are at increased risk for health consequences. Health professionals in Norway are required by law to help such children, and professional educations should focus on this issue.

AIM

To assess the extent to which students attending health, social care, and teacher education felt their uni-professional education and a mandatory interprofessional learning (IPL) course had taught them about children as next of kin. To explore variations in student responses according to age and educational background.

METHODS

This was a cross-sectional study. Students (n = 2811) completed questionnaires relating to IPL courses delivered in 2019 and 2020 (hybrid case-based learning). Students discussed issues relating to interprofessional collaboration targeting children, young people and their families in small IPL groups.

FINDINGS

The response rates ranged from 25.8% to 36.0%. All but 5.2% of the students agreed that it was important to learn about children as next of kin. Although 61.9% reported that their education had not taught about such children, 73.8% had gained increased insight from the IPL course (difference 35.7% 95% CI (29.0; 42.0), p < 0.001). The teacher and child welfare students had gained greater insight than the health and social care students. Significant pre- to post-course increases were found among the physiotherapy (p < 0.001), Mensendieck physiotherapy (p < 0.001), teacher education (p < 0.001), early childhood education (p < 0.001), and teacher education in art and design (p = 0.042) students.

CONCLUSION

Nearly 2/3 reported that they had not been taught about children as next of kin at their own educations, but more than 2/3 had gained greater insight from the IPL course. The health and social care students reported the least gain. Although the law has existed for a decade, the topic of children as next of kin is still omitted from most educational programs.

The enablers and barriers to children visiting their ill parent/carer in intensive care units: A scoping review

AIM

The aim of the study was to identify the enablers and/or barriers to children visiting their ill parent/carer in intensive care units by examining the visiting policies as practiced or perceived by nurses and experienced or perceived by parents and caregivers.

REVIEW METHOD

This is a scoping review following Joanna Briggs Institute Protocol Guidelines.

DATA SOURCES

An extensive literature search of Cumulative Index of Nursing and Allied Health Literature, Medical Literature Analysis and Retrieval System Online, PsychINFO, PubMed, and Excerpta Medica dataBASE databases, using key terms, was conducted between May 2019 and July 2020; studies published between 1990 and 2020 were considered for inclusion. Double screening, extraction, and coding of the data using thematic analysis and frequency counts were used.

RESULTS

Fifteen barriers, 19 facilitators, nine situationally contingent factors, and six personal judgement considerations were identified that influenced children visiting their ill parent/carer in intensive care units. Most barriers (n = 10) were related to organisational factors including restrictive policies, nurses' level of education, age, working hours, nurses' attitudes, and lack of required skills to promote emotional resilience and/or to communicate with children. Family perception factors relating to parents' perceptions, attitudes and concerns of staff/parents, and anticipated behaviours of children were also identified as both barriers and facilitators.

CONCLUSIONS

There is a lack of consistency in the application of policies and procedures to facilitate children visiting their loved ones in an intensive care unit. Without key involvement from the nurses and healthcare team, there may have been opportunities lost to optimise family-centred care practices in critical care settings.

Articulations of antimicrobial resistance in trade union financed journals for nurses in Scandinavia - A Foucauldian perspective

Antimicrobial resistance (AMR) in bacterial infections is a growing threat to humanity and a challenge to healthcare systems worldwide. Healthcare professionals have an important role in preventing AMR and the spreading of infections. This article focuses on trade union financed journals for nurses in Scandinavia studying how the journals articulate AMR to its readership. A systematic literature search over an eleven-year period was conducted, using web-based national trade union financed journals, searching for 'bacteria' and 'resistance'. A thematic analysis, inspired by Foucault's concepts of power and governmentality, was made of 131 texts to understand, which kind of practices, strategies and policies the journals frame regarding AMR. The time period studied resulted in the recognition of four separate themes: the horror scenario, the 'dangerous' other, healthcare professionals as a source of resistance development and AMR as a field of research and producer of research qualifications. The study concludes that the journals tend: to present AMR in apocalyptic terms with more research and pharmaceutical industries needed for avoidance; to point out problems in other countries, populations, and sometimes nurses' working conditions, but primarily with other professionals' behaviour; and lastly, to present the nurse as a good fairy and disciplinator of doctors.

'Don't forget the children': a qualitative study when a parent is at end of life from cancer

Purpose

Preparation for end of life is one of the greatest challenges faced by parents with cancer who have dependent children (< 18 years old), with requirement for support from professionals. The aim of this study is to explore how parents can be best supported in relation to their children, when a parent is at end of life from cancer.

Methods

This is an interpretive qualitative study, using 79 semi-structured interviews with parents at end of life (n3), bereaved parents (n21), health and social care professionals (HSCPs) (n32) and funeral directors (n23). Data were analysed thematically and triangulated.

Results

Parents are central to preparing their children for the death of a parent. Striving for everyday ordinariness, maximising social networks, maintaining hope and making preparations for the future are helpful for families when a parent is at end of life. Most HSCPs were unaware of the challenges faced by parents at end of life, and psychosocial support was often left outside the caring realm. As a result, funeral directors noted complexities faced by the families after the death. Results are discussed under four themes: (1) communication with the children as a process, (2) coping throughout the unfolding end of life experience, (3) tension and complexities at end of life and (4) preparing for the future.

Conclusions

Parents should be reassured that by involving the children early in the end of life experience when the ill-parent is ‘well enough’ to parent enables them to be actively involved in supporting their child through one of the greatest life changing event. A number of recommendations are discussed for professionals.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00520-021-06341-3.

Children's experiences of information, advice and support from healthcare professionals when their parent has a cancer disease - experiences from an oncological outpatient department

PURPOSE

This study was carried out in order to evaluate children's experiences after taking part in the pilot clinical intervention "See Me" aimed at supporting children as relatives.

METHOD

A qualitative explorative design with interviews was chosen, with analyses using an inductive approach. Interviews were conducted with 19 children (9 aged 7-12 years and 10 aged 13-18 years). The younger children were asked to draw a picture of a person in hospital, using the Child Drawing: hospital (CD:H) instrument to measure the child's level of anxiety. The older children completed the Caring Professional Scale (CPS) as a measure of the caring approach in their encounter with the nurse.

RESULTS

The interviews with the children show that: they felt expected and welcomed at the hospital; they needed knowledge about their parent's situation; they needed information and participation based on their individual situation; and they needed the nurse to offer them information and support. The results from the pictures showed that one child had above-average levels of anxiety. The older children reported that the nurses were Competent Practitioners, but to a lesser degree that they were Compassionate Healers.

CONCLUSIONS

The results of this pilot study indicate that the structure of "See Me" could be used as a starting point to ensure that children as relatives receive information, advice, and support. Further the results indicate that both CD:H and CPS could be used to evaluated children's experiences of support when a parent has a long-term illness.

Recognition of Insufficient Competence-Nurses' Experiences in Direct Involvement With Adolescent Children of Cancer Patients

BACKGROUND

A parent's cancer may have disruptive impact on his/her adolescent children. Currently, nurses have been regarded as central actors in direct involvement with patients' minor children. Development of an extended nursing role has become a pertinent issue.

OBJECTIVE

Adolescents' needs tend to be overlooked by nurses because of inexperience with this population. The aim of this study was to explore nurses' experiences of direct involvement with these adolescents, to get a deeper understanding about this phenomenon.

METHODS

Using a constructivist grounded theory approach, 12 interviews were conducted among Norwegian nurses within the cancer care context. The category insufficient competence was explored through analyzing participants' experiences of direct involvements with adolescents.

RESULTS

The recognition of insufficient competence became visible as nurses experienced being involved with a population about whom they held inadequate and limited knowledge. Adolescents were perceived as unpredictable and rejecting nurses' approaches. Consequently, nurses feared involvement and experienced failing on their assignments. After completing more or less failed attempts to establish good relationships with adolescents, the nurses request for more knowledge and experience in order to support this group.

CONCLUSIONS

Nurses are recognizing insufficient competence in direct involvement with adolescents, which calls for extended competence. Because nurses are not the only responsible actors performing in this field, building competence requires a broadened attention at both an individual and organizational level, across several healthcare disciplines, as well as through user participation.

IMPLICATIONS FOR PRACTICE

Competence building should be considered in light of organizational frameworks, collective learning possibilities across disciplines, and opportunities for involving adolescents/young adults as user participants.

Going against patients' will? A qualitative study of how palliative health-care professionals handle competing considerations when children are excluded from parental illness and death

PURPOSE

The Norwegian Health Personnel Act (HPA §10a) obliges health professionals to contribute to meeting minor children's need for information about their parents' illness and prognosis. Previous research has shown that many parents withhold information about illness and anticipated death from their children. This study explored main considerations for palliative health-care professionals in these situations, and how they negotiate conflicting considerations of confidentiality and child involvement.

METHOD

This qualitative exploratory study involved semi-structured interviews with 11 palliative health-care professionals. Hermeneutics informed the data analysis.

RESULTS

The health professionals' main considerations were sustaining patients' hope and building trust in the professional-patient relationship. Both concerns were grounded in respect for patient autonomy. The health professionals negotiated patient autonomy and child involvement in different ways, defined in the present analysis on a continuum ranging from granting full patient autonomy to going directly against patients' will.

CONCLUSIONS

The professional-patient relationship is the primary consideration in the health care context, and decision making on the degree of children's involvement happens in a dialogical process between health professionals and patients. Close professional-patient relationships might increase the emotional impacts on health professionals, who consequently might give greater relative weight to patients' will. We propose that procedures for initiating collaboration with professionals in the child's everyday life context help health professionals involving the child without threatening trust.

Children's Views Are Not Taken Into Account in Accordance With Article 12 of the United Nations Convention on the Rights of the Child in the Family Talk Intervention When a Parent Is Cared for in Palliative Care

Having a parent with a life-threatening illness is challenging throughout the illness trajectory, and for some also in bereavement. Article 12 of the United Nations Convention on the Rights of the Child states a child's right to express their opinion and have it respected in processes that affect them. The aims of this paper were to explore the child's active participation in a family support programme, the Family Talk Intervention, in accordance with Article 12, when having a parent cared for in palliative care. Twenty families with 50 children participated. Fieldnotes were taken during the programme and later analysed with interpretive descriptions. The study shows that all children were listened to, but only a quarter reached the minimum point required in Article 12, where their views were taken into account. The Family Talk Intervention in palliative care would benefit from implementing a child-centred approach in order for all children to be active participants.

Nurses' refusals of patient involvement in their own palliative care

BACKGROUND

Ideas of patient involvement are related to notions of self-determination and autonomy, which are not always in alignment with complex interactions and communication in clinical practice.

AIM

To illuminate and discuss patient involvement in routine clinical care situations in nursing practice from an ethical perspective.

METHOD

A case study based on an anthropological field study among patients with advanced cancer in Denmark.

ETHICAL CONSIDERATIONS

Followed the principles of the Helsinki Declaration.

FINDINGS

Two cases illustrated situations where nurses refused patient involvement in their own case.

DISCUSSION

Focus on two ethical issues, namely 'including patients' experiences in palliative nursing care' and 'relational distribution of power and knowledge', inspired primarily by Hannah Arendt's concept of thoughtlessness and a Foucauldian perspective on the medical clinic and power. The article discusses how patients' palliative care needs and preferences, knowledge and statements become part of the less significant background of nursing practice, when nurses have a predefined agenda for acting with and involvement of patients. Both structurally conditioned 'thoughtlessness' of the nurses and distribution of power and knowledge between patients and nurses condition nurses to set the agenda and assess when and at what level it is relevant to take up patients' invitations to involve them in their own case.

CONCLUSION

The medical and institutional logic of the healthcare service sets the framework for the exchange between professional and patient, which has an embedded risk that 'thoughtlessness' appears among nurses. The consequences of neglecting the spontaneous nature of human action and refusing the invitations of the patients to be involved in their life situation call for ethical and practical reflection among nurses. The conditions for interaction with humans as unpredictable and variable challenge nurses' ways of being ethically attentive to ensure that patients receive good palliative care, despite the structurally conditioned logic of healthcare.

Becoming a good nurse - Socialisation of newly employed nurses into the oncological clinic

AIM AND OBJECTIVES

To explore newly employed nurses' socialisation in the process of introduction into an oncological clinic from the perspectives of unit managers and newly employed nurses.

BACKGROUND

There are managerial challenges in retaining nurses at workplaces. The way in which nurses are socialised into their work is important for their job satisfaction and retainment.

METHOD

Qualitative, semi-structured interviews with seven nurses and two unit managers, and written introductory material. Thematic analyses were made, inspired by Goffman's concepts of social interaction, back stage, front stage and roles. SRQR checklist was used.

RESULTS

Unit managers created the framework for socialising newly employed nurses through written introductory guidelines and assignments of supervisors as mainstream role models. Newly employed nurses were socialised gradually through mirroring their supervisors in their role as nurse. Front stage, patients often functioned as objects for newly employed nurses' training. Back stage, patients often functioned as communication objects for all professionals. Newly employed nurses, who also demand roles such as transformer, boss, coordinator, prompter and friend, were socialised into the role of assistant to the doctor. Medical rounds functioned as a socialisator in this process.

CONCLUSION

The allocated supervisors were role models in socialising newly employed nurses into an oncological clinic and its culture. Nurses were socialised into an understanding of care as a biomedical orientation, in which medicine had a higher value than care in the existing knowledge hierarchy at the oncological clinic. This might have implications for who applies for and stays in the job.

RELEVANCE TO CLINICAL PRACTICE

Increased awareness of the importance of socialisation of nurses into the clinic during the introduction process. Re-thinking nurses' independent functions and patient perspectives in introduction of newly employed nurses to maintain and develop nursing as an independent profession.

A gap between the philosophy and the practice of palliative healthcare: sociological perspectives on the practice of nurses in specialised palliative homecare

Palliative care philosophy is based on a holistic approach to patients, but research shows that possibilities for living up to this philosophy seem limited by historical and administrative structures. From the nurse perspective, this article aims to explore nursing practice in specialised palliative homecare, and how it is influenced by organisational and cultural structures. Qualitative, semi-structured interviews with nine nurses were conducted, inspired by Bourdieu. The findings showed that nurses consolidate the doxa of medicine, including medical-professional values that configure a control-oriented, positivistic approach, supported by the organising policy for clinical practice. Hierarchically, nurses were positioned under doctors: medical rounds functioned as a structuring structure for their working day. They acted as medical assistants, and the prevailing medical logic seemed to make it difficult for nurses to meet their own humanistic ideals. Only short time slots allowed nurses to prioritise psychosocial needs of patients and relatives. Point-of-actions had high priority, added financial resources and ensured that budgets were allocated. Weekly visits made it possible for nurses to measure, control and govern patients' drugs and symptoms which was a necessity for their function as medical assistants. The findings challenge nurses to take on an ethical point of view, partly to ensure that patients and their families receive good palliative care focusing on more than medical issues and logic, and partly to strengthen the nurses' profession in the palliative field and help them implement palliative care philosophy in practice.

The Divorced Family-Focused Care Model: A Nursing Model to Enhance Child and Family Mental Health and Well-Being of Doubly Bereaved Children Following Parental Divorce and Subsequent Parental Cancer and Death

The experience of parental death concomitant with parental divorce occurs for 46% of Danish children and 50% of American children who lose a parent to death. This experience of loss and double bereavement compounds increased risk of mental health problems. The aim of this study was to explore nursing interventions for double bereaved children that promoted their well-being. A phenomenological-hermeneutic approach was used to conduct 20 interviews with nurses in family cancer care. Ricoeur's theoretical framework was followed with naïve reading, structural analysis, and critical interpretation, resulting in the formulation of a new model of nursing care for these children: the Divorced Family-Focused Care Model. Four themes were apparent: (a) collection of information about family structure, (b) assessment of support needs, (c) initiation of well-being support, and (d) coordination and follow-up focused on the child's well-being. The new intervention model has implications for health care education and implementation of health care policies.

Professionals’ involvement of relatives – only good intentions?

Purpose

The purpose of this paper is to explore how, and under what conditions, professionals involve relatives in clinical practice.

Design/methodology/approach

Two cases were constructed from two studies in Denmark, theoretically inspired by Bourdieu’s concepts of doxa and position and analyzed with focus on the involvement of relatives from the perspective of professionals.

Findings

Support to relatives in practice is rarely included in the way that treatment and care are organized in healthcare. Professionals’ views of the involvement of relatives were characterized by the values of neoliberal ideology and medical-professional rationality, in which relatives are not regarded as a subject of care and support in clinical practice. The involvement of relatives aimed to ensure patients’ participation in randomized clinical trial and to help professionals to care for patients when the professionals were not absolutely needed. Professionals were relatively higher positioned in the clinic than relatives were, which allowed professionals to in – and exclude relatives. Neoliberal ideology and medical-professional rationality go hand in hand when it comes to patient treatment, care and the involvement of relatives; it is all about efficiency, treatment optimization and increased social control of the diagnosed patient. These neoliberal, organizational values consolidate doxa of the medical field and the positions that govern the meeting with patients’ relatives – if it takes place at all.

Originality/value

The results put into perspective how the combination of neoliberalism and medical logic work as an organizing principle in contemporary healthcare systems, and challenge a normative, humanistic view on involving patients’ relatives in the medical clinic.

Nurses' attitudes towards support for and communication about sexual health-A qualitative study from the perspectives of oncological nurses

AIM AND OBJECTIVES

To explore nurses' articulations of support and communication regarding sexual health with patients.

BACKGROUND

Sexual health is adversely effected by cancer and various oncological treatments. Patients' often have the experience that healthcare professionals do not talk about sexual health.

METHOD

Semi-structured interviews were conducted with seven nurses in Southern Sweden. Content analyses were made, inspired by Foucault's concepts of power, discipline and normalisation. SRQR checklist was used.

RESULTS

Patients' sexual health had low priority in the oncological clinic from the perspective of nurses. The medical logic directed nurses' articulations about sexual health towards a physical view, understood as sex, and sexual problems, which could be treated pharmacologically. Further, nurses articulated a sexual norm that sex belongs to young people and younger persons in permanent, monogamous and heterosexual relationships. This norm-governed nurses' inclusion and exclusion of patients in communication about sexual health. According to nurses, most patients did not mention sex, but some patients challenged the clinic's norms. Assessing sexual health problems, nurses often engaged other professions and thereby became gatekeepers for patients' options for getting help.

CONCLUSIONS

From the perspective of nurses, nurses' support and communication regarding sexual health with patients with cancer diagnosis were relatively absent and had a low priority in an oncological clinic. Overall, the nurses had the power to set the agenda about patients' sexual health in the oncological clinic. The clinical gaze became a disciplinary technique that tacitly defined by whom, in what way and how sexual health could be articulated in an oncological clinic.

RELEVANCE TO CLINICAL PRACTICE

By illuminating nurses' preconceptions, thoughts and actions in relation to cancer patients' sexual health, the results invite practitioners to reflect upon and discuss the challenges, opportunities and limitations in providing inclusive and supportive sexual health care to cancer patients.

Health and social care professionals' experiences of supporting parents and their dependent children during, and following, the death of a parent: A qualitative review and thematic synthesis

BACKGROUND:

Children need to be prepared for the death of a parent and supported afterwards. Parents seek support from health and social care professionals to prepare their children. Support is not always forthcoming.

AIM:

To systematically identify, analyse and synthesise literature reporting of the experiences of health and social care professionals when supporting parents and children during, and following, the death of a parent.

DESIGN:

A systematically constructed qualitative review and thematic synthesis. Registered on Prospero (CRD42017076345).

DATA SOURCES:

MEDLINE, CINAHL, Embase, PsycINFO, PsycARTICLES and PROSPERO, searched from January 1996 to July 2018 for qualitative studies in English, containing verbatim reporting of health and social care professionals' experiences of supporting parents and children during, and following, the death of a parent. Qualitative data were appraised using a modified Critical Appraisal Skills Programme qualitative appraisal checklist.

RESULTS:

The search yielded 15,758 articles. Of which, 15 met the inclusion criteria. A total of 13 included professionals' experiences of supporting parents and children before parental death. Two included experiences of supporting surviving parents and children afterwards. Three analytical themes identified as follows: (1) aspiring to deliver family-focussed care, (2) health and social care professionals' behaviours and emotions and (3) improving connections with parents and children. Connecting empathically with parents and children to prepare and support children entails significant emotional labour. Professionals seek to enhance their confidence to connect.

CONCLUSION:

Professionals struggle to connect empathically with parents and their children to prepare and to support children when a parent is dying and afterwards. Awareness of professionals' needs would enable provision of appropriate support for parents and children.