Patients' needs in hospital: nurses' and patients' views

Carer needs on an organic inpatient unit

Purpose

The purpose of this paper is to further understand the needs of carers when a relative with dementia is admitted to an organic impatient ward.

Design/methodology/approach

A constructivist grounded theory approach was employed to generate a substantive theory to understand the needs of carers and how staff perceive carer needs when a relative is admitted to a dementia ward. Five relatives and six members of staff were interviewed using purposive and theoretical sampling. Interview transcripts were analysed using initial, focused and theoretical coding using constant comparative methods to develop the end theory.

Findings

The grounded theory concluded that carers have three categories of needs: “The Safe and Cared for Relative”, “The Informed Carer and “The Understanding, Responsive and Available Service”. Underpinning the needs are the relationships between carers, their relative and staff. Three barriers were identified which can impact on these needs being effectively met. These identified barriers were: Loss, Time and Ineffective Communication.

Originality/value

The grounded theory demonstrates that carers needs fundamentally relate to their relatives being safe and cared for and being included and informed during the admission. Relationships can be ruptured when a barrier prevents the needs from being effectively met. Recommendations are made to aim to reduce the impact of the barriers and to aid staff in developing their understanding of the carer experience.

The Nature of Trauma Pain and Its Association with Catastrophizing and Sleep

BACKGROUND

Nearly 2.8 million people are hospitalized in the USA annually for traumatic injuries, which include orthopedic and internal organ injuries. Early post-injury pain is predictive of poor outcomes, including inability to eventually return to work, and long-term psychological distress. The goal of the present study was to improve our scientific understanding of trauma-related pain by examining (1) the nature and frequency of inpatient trauma pain and (2) the associations between inpatient trauma pain, education, opioid analgesic equivalent use, pain catastrophizing, and sleep quality.

METHOD

The study included 120 patients hospitalized at a major level I regional trauma center for the care of (1) closed long bone or calcaneus fractures and/or (2) an intraabdominal injury caused by blunt force trauma and requiring surgical repair (i.e., laparotomy). Medical records were reviewed to obtain demographic information and information about opioid use during hospitalization. In addition, participants were administered measures of average pain intensity, pain catastrophizing, and sleep quality.

RESULTS

Education, opioid analgesic equivalents, catastrophizing, and poor sleep quality together accounted for 28% of the variance of average pain intensity over a 24-h period (p < .001), with each variable making a significant independent association.

CONCLUSION

Two of the factors associated with pain intensity in the study sample-catastrophizing and sleep quality-are modifiable. It is therefore possible that interventions that target these variables in patients who are hospitalized for trauma could potentially result in better long-term outcomes, including a reduced risk for developing chronic pain. Research to evaluate this possibility is warranted.

The Psychosocial Experiences and Needs of Children Undergoing Surgery and Their Parents: A Systematic Review

INTRODUCTION

Surgery in children can be difficult for patients and parents. We aimed to summarize pediatric patients' and parents' psychosocial experiences and needs in surgery.

METHOD

We used the Ovid search engine and screened 877 abstracts across three databases to extract data on pediatric patients' and parents' surgical experiences.

RESULTS

Our search yielded 11 eligible studies representing 1,307 children undergoing surgery and their parents. Children's adverse experiences included psychological and behavioral changes before, during, and after surgery (e.g., anxiety, eating disturbances). Parents commonly experienced psychological distress. Children's needs related to medical and health care services, whereas parents had high information needs.

DISCUSSION

Children's adverse experiences can negatively affect medical outcomes. Children's experiences are inextricably linked to their parents' and can become negatively affected by their parents' adverse experiences. Patients and parents with previous hospitalizations and surgeries had worse surgical experiences, highlighting further research in the context of chronic illness.

Care necessities: the view of the patient and nursing team

Objectives:

To compare care necessities as perceived by the patient and nursing team and to investigate the sociodemographic factors associated with these perceptions.

Method:

A comparative study was conducted in units and hospitalized patients of a hospital institution in the state of São Paulo. The participants comprised 100 health professionals (50 nurses and 50 nursing technicians and auxiliaries) and 50 patients. A questionnaire was constructed and validated regarding care needs and was completed by the participants.

Results:

Considering cut-off value kappa ≥ 0.61, or that is, good and very good intervals, the greatest agreement between the perception of the patients and the nursing team was in the areas of: Care and Communication, both with 92.6% agreement; followed by Basic Care with 74.1%. The lowest value was found in the field of Care Planning and Organization, 64.3%.

Conclusion:

In a general manner, there was an agreement between the care needs from the view of the patients themselves and the nursing team.

Objetivos:

Comparar como as necessidades de cuidados são percebidas pelo paciente e equipe de enfermagem e investigar os fatores sociodemográficos associados a estas percepções.

Método:

Estudo comparativo realizado em unidades e internação de uma instituição hospitalar do interior do Estado de São Paulo. Os participantes foram 100 profissionais (50 enfermeiros e 50 técnicos e auxiliares de enfermagem) e 50 pacientes. Construiu-se e validou-se um questionário sobre necessidades de cuidados preenchido pelos participantes.

Resultados:

Considerando-se valor de corte kappa ≥ 0,61, ou seja, intervalos bom e muito bom, houve maior alinhamento entre a percepção dos pacientes e equipe de enfermagem nos domínios O Ambiente do Cuidado e Comunicação, ambos com 92,6% de concordância; seguido de Cuidados Básicos, com 74,1%. O menor valor foi encontrado no domínio Planejamento e Organização do Cuidado, 64,3%.

Conclusão:

De maneira geral, observou-se alinhamento no atendimento das necessidades de cuidados no olhar do próprio paciente e da equipe de enfermagem.

The meaning of patient-nurse interaction for older women in healthcare settings: A Qualitative Descriptive Study

AIMS AND OBJECTIVES

The purpose of this study was to explore the meaning of patient-nurse interaction for older women receiving care in healthcare settings.

BACKGROUND

Older women are often overlooked or misunderstood by the nurses caring for them. Some research exists on nurses' perception of their interaction with patients, yet few studies have described the meaning of such interaction from the patients' perspective.

METHODS

This was a pilot study using qualitative description as a methodology. Data were filtered through a lens of critical feminist theory to interpret interactions taking place in healthcare settings that are often characterised by paternalism. Seven women between the ages of 66 and 81 were interviewed using a semi-structured guide.

RESULTS

Participants had a distinctive perspective on the experience of caring. Their expressions include stories of being cared for themselves by nurses as well as historical recalls of being the one-caring for family members. In these combined stories, the contrast between the nurses who held caring in primacy and those who were distinctly uncaring sheds light on the importance of cultivating a moral ideal of caring and respect for personhood.

CONCLUSION

A population of older women who potentially face disabling conditions must rely on direct, meaningful, interaction with nurses to successfully navigate the healthcare system. The findings suggest that these women did not have consistent access to such interaction.

IMPLICATIONS FOR PRACTICE

The gathering and interpretation of new narratives about patient-nurse interaction for older women could lead to a deeper understanding of power and civility as it impacts a caring relationship. Further research using a theoretical lens of critical feminism has implications for improving healthcare delivery for older women worldwide.

Experience of nursing support from the perspective of patients with cancer in mainland China

This study was conducted to understand patients' experiences of nursing support, to identify gaps between patients' expected needs and the nursing support they received, and to explore reasons for such disparity. A qualitative study with a phenomenological approach was used. A purposive sample of 22 patients with different types of cancer was recruited and interviewed using semistructured guidelines. The data were analyzed using phenomenological analytic methods. Several needs regarding nursing support were expressed, including informational, psychological, clinical, care coordination and communication needs, and there were some unmet or partially-met needs. Reasons for the disparities covered both patient- and nurse-related factors, including patients' lack of awareness regarding how to acquire professional assistance and reluctance to express their needs, and nurses' lack of active communication with patients, inability to provide specific support, and limited resources for coordination. The expectations of nursing support did not always correspond with the actual delivery of nursing care. A tailored intervention is warranted to meet patients' expectations, which might contribute to quality-of-care improvements.

In-hospital informal caregivers' needs as perceived by themselves and by the nursing staff in Northern Greece: A descriptive study

Background

Informal care is common in many countries, especially in Greece, where families provide care in hospitals. Health education and informational needs are important factors for family members which are often underestimated by nursing staff. The aim of this study was to compare the perceptions of the nurses and the in-hospital informal caregivers about the in-hospital informal caregivers' knowledge and informational needs, as well as the factors that influence these perceptions.

Methods

This was a non-experimental descriptive study conducted in three general hospitals in Greece. The sample consisted of 320 nurses and 370 in-hospital informal caregivers who completed questionnaires. Descriptive statistics were analyzed using t-tests; group comparisons were conducted using ANOVA.

Results

The score of the questionnaire for health education and informational needs was significantly greater for informal caregivers (57.1 ± 6.9 and 26.6 ± 2.8) than for nurses (53.4 ± 5.7 and 22.4 ± 3.1) (p < 0.001). For the nursing staff, the factors that influence the informational needs of patients' caregivers were level of education and working experience, while for the caregivers the level of education was independently associated with the score for the health education needs. Finally, age, marital status, and level of education of informal caregivers' were independently associated with informational needs.

Conclusions

The in-hospital informal caregivers perceived that they have more educational and informational needs than the nurses did. The findings of this study also show that the nursing staff has to identify the needs of in-hospital informal caregivers in order to be able to meet these needs.

A qualitative content analysis of nurse-patient communication in Iranian nursing

BACKGROUND

Communication is the source of patients' health promotion, and nurses cannot do their duties without communicating with patients. Nurses with good communication skills have a great role in alleviating the stressful identity of hospitalization for both patients and their families.

AIM

To explore cultural and contextual factors influencing nurse-patient communication according to lived experiences of Iranian nurses and patients.

METHODS

The participants in this qualitative study consisted of eight bachelor's degree nurses and nine patients hospitalized in surgical and medical wards of a referral teaching hospital in Tehran, Iran. Data were gathered through unstructured and semi-structured interviews as well as observations. The data were analysed using a content analysis approach.

FINDINGS

The data analysis revealed the following theme that encompassed nurse-patient communication in Iranian nursing: 'a patient-centred attitude in the shadow of mechanistic structure'. This theme consisted of three categories: (1) communication as the essence of nursing care, (2) reactive communication and (3) difficulties of nurse-patient communication.

CONCLUSION

In spite of the nurses' and patients' belief in the importance of communication, in practice each party's role in communication leaves much to be desired. This is because of some structural and socio-cultural factors that hinder effective communication. More attention should be paid by policy makers to remove factors that hinder the nurse-patient communication process.

Clients' and workers' perceptions on clients' functional ability and need for help: home care in municipalities

The aim of the study was to compare clients' and named home care (HC) workers' perceptions of clients' functional ability (FA) and need for help and to analyse which client- and municipality-related factors are associated with perceptions of client's FA. The total of 686 Finnish HC clients was interviewed in 2001. Further, the questionnaire was sent to 686 HC workers. FA was assessed by activities of daily living (ADL), which included both basic/physical (PADL) and instrumental (IADL) activities. The association between client's FA and municipality-related variables was analysed by using hierarchical logistic regression models. The findings indicated that clients' and HC-workers' perceptions about what the clients were able to do were similar in the PADL functions, but perceptions differed when it comes to the IADL functions for mobility and in climbing stairs. A smaller proportion of clients compared with HC workers assessed themselves to be in need of help in all ADL functions. Use of home help and bathing services increased the probability of belonging to the 'poor' FA class while living alone and small size of municipality decreased the probability. The study indicates that although clients and workers assessed client's FA fairly similarly, there were major differences in perceptions concerning clients' needs for help in ADL functions. Clients' and workers' shared view of need for help forms a basis for high-quality care. Therefore, the perception of both the clients and workers must be taken into account when planning care and services. There was also variation in clients' FA between municipalities, although only the size of municipality had some association with the variation. The probability that clients with a lower FA are cared for in HC is higher if the clients live in large- rather than small-sized municipalities. This may reflect a better mix of services and resources in large-sized municipalities.

On paternalism, autonomy and best interests: Telling the (competent) aged-care resident what they want to know

This paper has been derived from a review of literature from a recent qualitative study that explored the meaning of truth-telling within the care provider-aged resident dyad in high-level (nursing home) care of elderly people. In the literature reviewed here, paternalism (as benevolent decision-making in another's best interests) is critically analysed. Autonomy is then described and its function in promoting health is underscored. Furthermore, this paper specifically challenges nurses to consider their capacity to really know another's best interests--particularly in the nursing home. Finally, a very simple recommendation is proposed for determining and managing the (competent) aged-care resident's informational disclosure preferences: ask them.

Patients' and nurses' perceptions of nursing problems in an acute care setting

AIM

This paper reports a study to determine the degree of agreement or disagreement between nurses and patients in their perceptions of the presence, severity, and importance of nursing problems.

BACKGROUND

Patient experiences, values and preferences are increasingly acknowledged as important factors underpinning healthcare decision-making. The ability to identify patient problems accurately is an important prerequisite for planning and implementing individualized high quality care.

METHODS

A convenience sample of patients (n = 80) and Registered Nurses (n = 30) in an acute care setting responded to a 43-item questionnaire. Findings. Nurses identified patients' problems with a sensitivity of 0.53 and a positive predictive value of 0.50. Patients identified several severe problems that were not identified by nurses, particularly problems with nutrition, sleep, pain, and emotions/spirituality. Nurses underestimated the severity in 47% of mutually-identified problems. An overall level of agreement of 44% was found on the importance of patient problems. Low levels of agreement on severity and importance were related more to individual differences than to systematic differences.

CONCLUSIONS

Nurses need to be more aware that patients and nurses often hold disparate views of the priorities in nursing care. To plan individualized nursing care effectively, nurses need to elicit and use individual patients' preferences more systematically in care planning.

Nurses’ assessments and patients’ perceptions: development of the night nursing care instrument (NNCI), measuring nursing care at night

BACKGROUND

Nursing care provided at night has a different purpose and objective to that provided during the day. A review of the literature does not reveal any scientifically tested research instruments for evaluating and comparing the nurse's assessment of nursing care with the patient's perception at night.

AIMS AND OBJECTIVES

The aim of this study was to develop and test an instrument for evaluating nursing care and to compare nurses' assessments with patients' perceptions of nursing care provided at night.

DESIGN

The study was carried out in two phases; the first had an explorative design and the second an evaluative and comparative design. The Night Nursing Care Instrument (NNCI) included two questionnaires; one for nurses and one for patients. These questionnaires were developed from a nursing framework and covered the following three areas: 'nursing interventions', 'medical interventions' and 'evaluation'.

METHODS

Nurses (n = 40) on night duty on a medical ward at a central hospital in southern Sweden were consecutively selected, to participate in the study. The patients (n = 80) were selected by means of convenience sampling. In order to achieve construct validity, factor analysis of each individual area was carried out. Reliability in terms of internal consistency was tested by Cronbach's alpha.

RESULTS

The overall NNCI had acceptable reliability and validity. There was no statistically significant difference between nurses' assessments and patients' perceptions in any of the three areas of 'nursing interventions', 'medical interventions' or 'evaluation'. The patients rated night nursing care as satisfactory for the majority of the items.

RELEVANCE TO CLINICAL PRACTICE

These findings demonstrate that it is possible to create a short instrument with acceptable reliability and validity, which is easy to use in clinical practice. The results also show that night nurses need to improve their ability to assess patients' needs during the night to increase the quality of night nursing care.

Sleep quality in hospitalized patients

AIMS AND OBJECTIVES

The objective of this study was to evaluate and compare sleep quality of the hospitalized patients and matched healthy controls.

BACKGROUND

Although the functions of sleep are not clearly understood, it is generally accepted that it is necessary for the maintenance of good health. Hospitalized patients' sleep may not be refreshing or restorative. The reasons for this can be categorized into three groups: environmental, physiological and psychological.

DESIGN AND METHODS

This research was conducted at the Cumhuriyet University Hospital in Turkey. One hundred and fifty hospitalized patients (psychiatry = 50; orthopaedic + general surgery + cardiovascular surgery + urology = 50; internal medicine + chest diseases + infectious diseases + physical therapy and rehabilitation = 50) and 50 healthy controls constituted the sample. The researchers administered to the patient and control groups Sociodemographic Information Form and the Pittsburgh Sleep Quality Index. We compared sociodemographic and illness variables with sleep characteristics. The following statistical analyses were used in order to evaluate the data: variance analysis, Tukey HSD test, Student's t-test, Kruskall-Wallis test.

RESULTS

We found that patients in psychiatric ward experienced worse sleep quality than the other patients, worse in female patients than male patients, and worse sleep characteristics in patients than controls.

CONCLUSIONS

Health professionals must be educated about sleep and must provide intervention when needed. Relevance to clinical practice. The enhancing of sleep quality accelerates to the recovery from illness.

Nursing care at night: an evaluation using the Night Nursing Care Instrument

INTRODUCTION

Night nurses carry overall nursing responsibility for approximately half the time that patients spend in hospital. However, there is a paucity of literature that focuses on nursing care provided at night.

AIM

The aim of this study was to evaluate nursing care provided at night from the perspective of both nurses and patients.

METHODS

The study, which had an evaluative and a comparative design, was carried out using the Night Nursing Care Instrument at a hospital in southern Sweden. Nurses (n = 178) on night duty were consecutively selected, while the patients (n = 356) were selected by convenience sampling.

RESULTS

The results showed a statistically significant difference between nurses' assessments and patients' perceptions of the nursing care provided at night in nursing interventions (P < 0.0001). In the areas of medical interventions and evaluation, no statistically significant differences were found between nurses and patients. For eight of 11 items, patients reported that they were satisfied (> or =80%) with the nursing care provided at night.

CONCLUSIONS

These findings suggest that night nurses need to improve their ability to assess patients' needs for nursing care at night. A first step in this direction is for them to become aware of how patients perceive night nursing. As a second step, nurses need to increase their knowledge of which nursing actions promote patients' rest at night.

Managing personal integrity: the process of hospitalization for elders

BACKGROUND

Although, in the United States of America (USA), 40% of people aged 75 years old and older are hospitalized each year, the literature does not provide insight into their perspectives on hospitalization.

AIM

The study was designed to illuminate the experience and behaviours of hospitalized elders, discover the meaning of that experience for them, and develop a substantive theory that could explain the social processes in which elders engaged while hospitalized.

METHOD

Interviews and participant observation data were used to develop a grounded theory. Participants had to be at least 75 years old, speak English, have been admitted to the hospital for medical (non-surgical) reasons, and be able to give informed consent. The elder, a family member, and a registered nurse caring for the elder were interviewed. Two-hour periods of observation were conducted throughout the elder's hospital stay. Computer-assisted data analysis included open, axial and theoretical coding. Techniques to improve the trustworthiness of the research included persistent observation, participant checking, a peer research support group and an audit conducted by an expert gerontology nurse researcher.

FINDINGS

Hospitalization was characterized as a process beginning when an alteration in health is identified and continuing through to the process of adjusting to returning home. Personal integrity was found to be a dynamic, intrinsic quality of the self, composed of health, dignity and autonomy. During hospitalization, elders used strategies to manage their personal integrity. At first, elders focused on strategies relating to health and then moved on to dignity and, finally, autonomy.

CONCLUSION

Hospitalized elders choose how they will interact with health care providers and the actions they will take to manage their health, dignity and autonomy. The findings have implications for developing nursing care and for further research.

Patient-centered Needs Assessment

Determining an individual's unique perspective of an illness experience remains a challenge for clinicians, administrators, and researchers. A range of concepts and psychometric measures have been developed and evaluated to capture this information. These include patient satisfaction, quality of life, and utility measures. Needs assessment as a tool for evaluating perceptions of health status and determining patient satisfaction and treatment plans has been explored in oncology. Studies have demonstrated that a high proportion of patients have unmet needs in relation to activities of daily living, information sources, and comfort. Heart failure (HF), a condition with significant individual and societal burden, mirrors the illness of experience of cancer, as individuals process issues related to prognosis, treatment regimens, and decreased functional status. A needs-based assessment of health status, expectations, and perceptions is patient-centered and has the capacity to not only evaluate current health status but also plan and project care plans. Needs assessment is a dynamic construct rather than a point in time consistent with other assessment modalities, such as quality of life. Multidimensional needs assessment allows for planning and projection of needs, not only on an individual but also a population basis. Implicit in the exploration of needs is an expectation of level of care to be provided, from both the provider and recipient of care. In many instances a misalignment may exist between services and resources available to the individual. This article seeks to provide a theoretical justification for the development of a needs assessment instrument for patients with HF and to discuss the rationale of this method of assessment to create better alignment and resources with patients needs and expectations.

Referrals from home care to emergency hospital care: basis for decisions

The Swedish government implemented a reform, the Adel reform, in the care of older citizens in 1992, so that the communities where older people live became responsible for their care and housing. Nurses were appointed to make sure that older people were given accurate care and to act as supervisors for nurses' aides. In this study, 10 Registered Nurses from community home care services and four consultant head physicians in primary care were interviewed in order to illuminate what they thought influenced nurses' decisions to refer patients for emergency treatment and what support they requested to facilitate the decision. Content analysis showed the necessity of feeling secure in one's role as a community nurse. The categories that developed were: own competence, knowledge about the patient and a supportive working environment. The main theme was To feel safe in one's role - a basis for decision-making. High demands were put on the nurses' competence and their burden of responsibility became too great. This influenced decision-making negatively, if nurses felt that they were lacking in their own personal competence. Training in documentation for the nurses was required, as well as the need for organizations to provide staff with sufficient time for accurate documentation. A greater input of nursing and medical care was required to make it possible for patients to be cared for at home if they so wished. Respondents described considerable deficiencies in their working environment and in co-workers' competence, and nurses' professional roles within the community were not made clear. If these problems were remedied, this would improve working conditions, increase understanding, and reduce feelings of uncertainty among decision-makers.

Care of women with breast cancer on a surgical ward: nurses' opinions of the need for support for women, relatives and themselves

BACKGROUND

In Sweden women with newly diagnosed breast cancer are admitted to surgical wards in order to undergo surgery and receive postoperative care. On these wards, nursing staff take care of women both with newly diagnosed breast cancer and those with cancer in advanced stages. Nurses have to meet the varying needs of patients and their relatives.

AIM

To describe nurses' opinions of the need for care and support for women and their relatives in connection with surgery for breast cancer, as well as their own need for support on a surgical ward.

METHODS

Thirty-one nurses from a surgical ward participated in semi-structured interviews. The interviews were tape-recorded and transcribed verbatim. Thereafter a step-by-step, qualitative content analysis was carried out.

RESULTS

The nurses described the need to talk and receive information as being the most important among women and their relatives, as well as among themselves. Only a few nurses mentioned the need for physical care among the women. Contact with relatives was described as being almost nonexistent. There was a discrepancy between what nurses described as important needs and how these needs were provided for.

CONCLUSION

This study shows that what the nurses described as being the most important needs, and the way how these needs were provided for, was more often seen from a theoretical point of view with few examples of self-experienced situations in the daily care. Needs among women and their relatives seemed to be not fully known to nurses and therefore, possibly, were not met. Nurses themselves had a pronounced need for support, which was sometimes unsatisfactorily met.

A comparison of patient needs as ranked by patients and nurses

A group of patients (n=69) were asked to arrange the three most important of 10 groups of needs, identified by patients in a previous study, in order of priority from one to three. A group of nurses (n=89) were asked to arrange same groups of needs in order of priority from one to three according to how they believed patients would rank them. No significant differences were found between patients cared for at medical and at surgical wards or between nurses working at different departments. However, differences were found between the rankings of patients and nurses.

Quality of sleep and its daily relationship to pain intensity in hospitalized adult burn patients

Sleep disturbances are frequently reported in victims following burn injuries. This prospective study was designed to assess sleep quality and to examine its daily relationship to pain intensity within the first week of hospitalization. Twenty-eight non-ventilated patients were interviewed during 5 consecutive mornings (number of observations=140) to collect information about perceived quality of sleep (visual analogue scale, number of hours, number of awakenings, presence of nightmares). Pain intensity was assessed at rest (nighttime, morning, during the day) and following therapeutic procedures using a 0-10 numeric scale. Seventy-five percent of patients reported sleep disturbances at some point during the study although, in most patients, sleep quality was not consistently poor. Pooled cross-section regression analyses showed significant temporal relationships between quality of sleep and pain intensity such that a night of poor sleep was followed by a significantly more painful day. Pain during the day was not found to be a significant predictor of poor sleep on the following night. These results support previous findings that perceived quality of sleep following burn injury is poor. Moreover, they show a daily relationship between quality of sleep and acute burn pain in which poor sleep is linked to higher pain intensity during the day.

Perceptions of caring among patients with cancer and their staff. Differences and disagreements

The current dyadic study investigated (a) patient and staff perceptions of the importance of caring behaviors, patient health, quality of life, and greatest health-related concern; (b) patient anxiety and depression (Hospital Anxiety and Depression Scale); and (c) staff views of patient perceptions of the importance of caring behaviors. The study included 21 matched patient-staff dyads. Three questionnaire versions of the Caring Assessment Instrument were used to tap patient (CARE-P) and staff (CARE-S) perceptions, and staff views of patient perceptions (CARE-SP). There were no correlations between patient and staff perceptions of the importance of caring behaviors, patient health, quality of life, or greatest health-related concern. However, staff views of patient perceptions about the importance of caring behaviors were strongly correlated with their own perceptions. Staff ratings of the importance of caring behaviors were not related to patient anxiety, depression, health, and/or quality of life. Patient depression was negatively correlated with three CARE-Q subscales. The results indicate that staff are not successful in judging the importance of caring behaviors, health, quality of life, and greatest health-related concern for individual patients. The major implication is that staff must be open to patient perceptions of what caring behaviors are important, and must validate their own perceptions of patient needs and concerns.

Measuring patient outcomes in palliative care: a reliability and validity study of the Support Team Assessment Schedule

This study reports the process and results of a psychometric evaluation of a clinical audit tool, the Support Team Assessment Schedule (STAS), used to measure outcomes of palliative care. The STAS was developed in London, UK to audit community palliative care services provided by a support team. The purpose of this study was to evaluate the reliability and validity of the STAS when introduced in a different setting and with different populations from those for which it had been designed. Evaluation of the STAS was completed using multidisciplinary team members, patients and families from a palliative care unit and an oncology unit of a large urban Canadian teaching hospital. The results from the reliability tests revealed a lack of consistency in the use of the tool by team members with simulated patients in clinical scenarios. The validity analysis highlighted the differences between patients, families and health care professionals' perceptions of the same clinical situation. This study provided a valuable perspective on using a previously developed clinical audit tool in different patient populations and clinical settings. Recommendations for future use of the tool are offered.

A summative evaluation of clinical competence: students' and nurses' perceptions of inpatients' individual physical and emotional needs

The ability to assess individual patients' physical and emotional needs was used as one foundation for evaluation of clinical competence for Swedish student nurses. Each of the randomly sampled 48 student nurses and their corresponding supervisors (48 nurses) assessed the perceived needs of a patient they both knew well by separately answering a questionnaire concerning basic physical and emotional needs. Simultaneously the selected patients (n = 48) were interviewed about their perceived needs. Student nurses' and nurses' assessments were compared with the individual patient's opinion. Both the students' and the nurses' assessments showed close similarities with the patients' own estimations, although certain under- and overestimations for both physical and emotional needs were found, with a predominance of overestimation of emotional needs. Student nurses and nurses also showed uncertainty in some of their assessments, mainly concerning emotional needs. Their assessments were closer than student nurses/patients or nurses/patients, and also closer for physical than for emotional needs. The conformity in student nurses' and their supervisors' assessments might be understood as the supervisors' influence as role models. Attention should be paid both in nursing education and in clinical practice to the need for individualization of patient care.

A comparison between patients' experiences of how their caring needs have been met and the nurses' patient classification--an explorative study

AIM

To examine whether patient classification carried out in accordance with the Oulu Patient Classification (OPC) method can measure the patient's caring needs in a reliable manner as seen from the patient's perspective.

BACKGROUND

On the basis of earlier research it can be established that there are differences between nurses' and patients' assessments of patients' caring needs. Research on patients' assessments of perceived caring needs and the care they receive in connection with patient classification does not seem to have interested researchers in caring science.

METHODS

The reliability from the patient's perspective is gauged by comparing the patient's perceived caring needs with the nurse's patient classification during a 24-h bed-day. Data was collected during a semi-structured interview with a total of 73 patients. Documentary analysis was carried out on the basis of patient classifications by 30 ward nurses.

FINDINGS

On the basis of the degree of correspondence between nursing care intensity experienced by the patients and the nurses' patient classification it was decided whether the patients' caring needs had been met. The results indicate, however, that patient classification as a gauging method has a built-in reductive function regarding the patient's need for care and nursing care intensity.

CONCLUSIONS

Nevertheless the OPC offers possibilities from a patient perspective of providing an overall picture of the patient's nursing care intensity and can therefore serve as a reliable basis for decisions concerning staff planning.

Nursing model of hospitalization events

PURPOSE

To provide a model of hospitalization events from a nursing perspective. Hospitalization has become an event of highly technical care coupled with intense nursing care requirements. This proposed model is needed to support clinical nursing research among hospitalized patients.

SCOPE

Hospitalization occupying space and time as a discrete event on the health-illness continuum. First developed to provide a framework for a descriptive study, the model shows the factors involved in hospitalization and provides a framework for understanding the nursing care that occurs. Selected results from descriptive research that used patients hospitalized with AIDS as subjects are reported as an example of use of the model.

CONCLUSIONS

Research about hospitalization events continues to be critical for the advancement of clinical nursing. This model is presented to provide a conceptual framework for future research.