Nursing staff’s description of a good encounter in nursing homes

In search of a caring relationship - Nursing students' notions of interactions in the nurse-patient relationship

The aim of the study is to explore how nursing students talks about their notions on interactions in the relationship between nurse and patient. Empirical data has been obtained from 22 students in their first semester of the Swedish undergraduate nursing programme, applying thematic, individual interviews and using qualitative content analyses. The most significant finding is that although the students had none or limited pre-understanding of caring and the interaction between nurse and patient they were aware of the pre-supposes for establishing such an interplay, articulated in a desire to find out how to build an authentic and trustful caring relationship. Empirical data also show that the students, in the stage of beginners, were trying to identify and relate to basic concepts within caring science. The restricted understanding could then be understood as a matter of the students not being able to express more than they had words for. The results provide new insights into the interactions in the nurse-patient relationship, seen from the perspective of beginner students. These insights could be useful, for lecturers and clinical supervisors, who play a paramount role in the development of each student's acquisition of theoretical and practical knowledge.

'They get the opportunity to say what is important for them': exploring staff's early perceptions of the implementation of a new communicative approach to patients with aphasia

PURPOSE

This study explored the perceptions of staff members regarding the implementation of a new communicative approach at a multidisciplinary neurorehabilitation centre in Denmark. Communication partner training according to Supported Conversation for Adults with Aphasia (SCA^TM) was combined with augmentative strategies from the KomHIT programme to increase the influence of patients with aphasia on their own rehabilitation process.

METHODS

A qualitative approach was used involving two semi-structured group interviews with multidisciplinary staff in two wards. Three staff members from each ward participated. The recorded interviews were transcribed, and a thematic analysis of the data was conducted.

RESULTS

Three main themes emerged from the analysis. Participants reported increased influence of patients with aphasia on their own rehabilitation process, as well as an increased focus on communication with patients with aphasia. Challenges included time restrictions and dilemmas in goal setting.

CONCLUSIONS

Increasing staff knowledge of communication support and augmentative strategies seemed to improve the influence of patients with aphasia on their own rehabilitation process. Because the results were based on interviews with a small number of staff, they cannot be generalized and require further investigation that should also include interviews with the patients themselves and their families.IMPLICATIONS FOR REHABILITATIONThe combination of partner training with augmentative strategies may increase staff understanding of all individuals' rights to have their communicative needs met.The combination of partner training with augmentative strategies may support the influence of persons with aphasia on their own rehabilitation.Goal setting discrepancies between staff and patients with aphasia can be brought to light by more successful communication.The implementation of a new communicative approach can be challenged by a number of factors, e.g., time restrictions.The implementation process needs to be supported by actions on a higher organisational level.

Development and psychometric testing of the Gerontological Nursing Competence (GeroNursingCom) instrument

AIM

To develop and psychometrically test an instrument - GeroNursingCom - that measures gerontological nursing competence of nursing students.

DESIGN

An instrument development guided by COSMIN guidelines.

METHOD

The development and testing of the GeroNursingCom instrument proceeded according to four distinct phases: (a) establishing a theoretical background; (b) testing face and content validity; (c) examining structural validity; and (d) testing internal consistency. The items of instrument were based on a theoretical framework developed from a comprehensive literature review and focus group interviews with experts (N = 27) in spring 2018. Content validity was assessed by nine experts in gerontological nursing, while face validity was tested in a pilot study including 36 nursing students. Structural validity was examined with exploratory factor analysis with 267 nursing students from nine universities of applied sciences. The internal consistency was established with Cronbach's alpha. The data were collected in spring and autumn 2019. The data analysis was conducted with multivariate statistical methods.

RESULTS

The GeroNursingCom development and testing process yielded an instrument that includes 53 items across 11 factors: (a) appreciative encounters and interactions with older people; (b) medication for older people; (c) nutrition for older people; (d) safe living environment for older people; (e) supporting the functioning of older people; (f) end-of-life care; (g) developing one's competencies; (h) supporting an older person's mental well-being; (i) supporting an older person's sexuality; (j) guiding self-care among older people; and (k) responding to challenging situations. The instrument was able to explain 66.15% of the total observed variance, while Cronbach's alpha values for individual items varied from 0.75-0.89.

CONCLUSION

TheGeroNursingCom instrument can be used to measure gerontological nursing competence among nursing students to improve gerontological nursing education and/or geriatric care.

IMPACT

Graduating nursing students must develop versatile competencies to face the multiple needs of older patients and curriculums need to be further developed to ensure students are prepared for gerontological nursing.

Appreciative inquiry in a Norwegian nursing home: a unifying and maturing process to forward new knowledge and new practice

PURPOSE

Appreciative inquiry (AI) studies have proven to be useful in developing nursing knowledge and changing nursing practice. However, few AI studies have examined the meaning of participation over time among collaborating healthcare providers. Our aim was to explore and illuminate healthcare providers' participation over time in a Norwegian nursing home to develop new knowledge and practice, focusing on sensory gardens.

METHOD

Twenty healthcare providers participated in the 3 year AI study. Data were collected in fieldwork, interviews, and interventions. Saldañas' longitudinal analysis was applied.

RESULTS

The collaboration between the researcher and participants created insight of a relational room, which was named "the room of closeness". Participants' search for new arenas to apply the meaning of the room of closeness was found when focusing on the sensory garden. Their desire for joint development created a bottom-up perspective, the hallmark of successful AI.

CONCLUSION

Knowledge of participants' experiences may contribute to developing AI as a useful and transferable method, especially regarding co-creating participation, and may have implications for research and society. AI's strength-based approach may, however, lead to the neglect of data that are associated with problems, and complicate the assessment of success. Further research is therefore needed to develop AI.

Interaction between Nursing Staff and Residents with Aphasia in Long-Term Care: A Mixed Method Case Study

Introduction

Thousands of individuals with communication disorders live in long-term residential care. Nursing staff are often their primary communication partners. The positive effects of social interaction and person-centred care have been recognised but there remains a paucity of research on the content and quality of communicative interaction between long-term care staff and residents with aphasia. This mixed method study investigates the discourse in interaction between nursing staff and residents with aphasia.

Methods

A routine care activity was explored in 26 video-recordings featuring four enrolled nurses and four elderly persons with severe aphasia. Factors such as goals and roles in the activity were mapped out and a qualitative discourse analysis was performed. Based on the findings a coding scheme was constructed and the amount of time spent in different interactional foci of discourse was explored.

Results

From the qualitative findings three broad, but distinct, foci in the nurse-initiated interaction could be distinguished: (1) a focus on getting the task done with minimum interaction; (2) topics related to the task, but not necessary to get the task done; and (3) personal topics related to themes beyond the caring task. The analysis of distribution of time revealed that although most of the interaction was focused on the main care activity, between 3 and 17% of the time was spent in either task-related or non task-related interaction. The distribution varied between dyads and could not be related to the residents' severity of aphasia nor the activity as such.

Conclusions

An endeavour to interact socially with the residents with aphasia influences the nurses' foci of interaction. Contextual and personal factors of the residents and nurses need to be considered in clinical work as well as research on how communication may be supported to facilitate social interaction and person-centredness in long-term care of people with aphasia.

Making Each Other's Daily Life: Nurse Assistants' Experiences and Knowledge on Developing a Meaningful Daily Life in Nursing Homes

Background:

In a larger action research project, guidelines were generated for how a meaningful daily life could be developed for older persons. In this study, we focused on the nurse assistants’ (NAs) perspectives, as their knowledge is essential for a well-functioning team and quality of care. The aim was to learn from NAs’ experiences and knowledge about how to develop a meaningful daily life for older persons in nursing homes and the meaning NAs ascribe to their work.

Methods:

The project is based on Participatory and Appreciative Action and Reflection. Data were generated through interviews, participating observations and informal conversations with 27 NAs working in nursing homes in Sweden, and a thematic analysis was used.

Result:

NAs developed a meaningful daily life by sensing and finding the “right” way of being (Theme 1). They sense and read the older person in order to judge how the person was feeling (Theme 2). They adapt to the older person (Theme 3) and share their daily life (Theme 4). NAs use emotional involvement to develop a meaningful daily life for the older person and meaning in their own work (Theme 5), ultimately making each other’s daily lives meaningful.

Conclusion:

It was obvious that NAs based the development of a meaningful daily life on different forms of knowledge: the oreticaland practical knowledge, and practical wisdom, all of which are intertwined. These results could be used within the team to constitute a meaningful daily life for older persons in nursing homes.

District nurses' views on quality of primary healthcare encounters

Good encounters are fundamental for good and professional nursing care, and can be described as treating patients with respect and protecting their integrity and autonomy. This study describes district nurses' views on quality of healthcare encounters in primary healthcare. A purposive sample of 27 district nurses participated in five focus group interviews. The focus groups interviews were digitally recorded and transcribed verbatim. The interview texts were analysed using a thematic content analysis. The analysis resulted in four themes, including being aware of the importance and difficulties during encounters, being the patient's advocate, being attentive to the unique person and being informed when a meeting turned out poorly. The results show that district nurses believed that encounters formed the basis of their work and it was vital for them to be aware of any difficulties. District nurses found that acting in a professional manner during encounters is the most significant factor, but this type of interaction was sometimes difficult because of stress and lack of time. The district nurses considered themselves to be the patients' advocate in the healthcare system; in addition, the acts of seeing, listening, believing and treating the patient seriously were important for providing good quality care. If a poor encounter occurred between the district nurse and the patient, the district nurses found that it was necessary to arrange a meeting to properly communicate what problems arose during the interaction. The district nurses highlighted that providing an apology and explanation could improve future encounters and establish a better nurse-patient relationship. In conclusion, this study shows the importance of confirming and respecting patients' dignity as the fundamental basis for a good quality encounter in primary healthcare.

Meanings over time of working as a nurse in elderly care

Background:

Although registered nurses (RNs) play a central role in the care of older persons, their work in elderly care has historically been described as “low status” in nursing. This is especially problematic due to the global issue of RN turnover, but there is still little evidence of how to change this trend. Better understanding is needed of the reasons why RNs work in elderly care, as well as knowledge of whether these reasons have changed over time.

Aim:

The aim was to explore the meaning of working in elderly care, over time, from the perspective of RNs.

Method:

We interviewed thirteen RNs working in nursing homes, six of them in 2000 and the remaining seven in 2012, and analysed the resulting data using Interpretive Description.

Results:

The results show similarities and differences over time in the RNs’ reasoning about the meaning of their work with older persons, from a focus on obstacles to a view of opportunities.

Conclusion:

An RN’s intention to continue working in elderly care might be based on their beliefs; their view of older people, and their experiences of being able to influence the care. Managing this knowledge could be an essential factor in reversing the historical trend of RN work in elderly care being seen as low status, and the increasing turnover in such nurses. Our results could stimulate reflection on daily care and beliefs about caring for older persons.

Encounters in home-based nursing care - registered nurses' experiences

The encounter between registered nurses and persons in need of healthcare has been described as fundamental in nursing care. This encounter can take place face-to-face in physical meetings and through meetings via distance-spanning technology. A strong view expressed in the literature is that the face-to-face encounter is important and cannot entirely be replaced by remote encounters. The encounter has been studied in various healthcare contexts but there is a lack of studies with specific focus on the encounter in home-based nursing care. The aim of this study was to explore the encounter in home-based nursing care based on registered nurses' experiences. Individual interviews were performed with 24 nurses working in home-based nursing care. The transcribed interviews were analyzed using thematic content analysis and six themes were identified: Follows special rules, Needs some doing, Provides unique information and understanding, Facilitates by being known, Brings energy and relieves anxiety, and Can reach a spirit of community. The encounter includes dimensions of being private, being personal and being professional. A good encounter contains dimensions of being personal and being professional and that there is a good balance between these. This is an encounter between two human beings, where the nurse faces the person with herself and the profession steadily and securely in the back. Being personal and professional at the same time could encourage nurses to focus on doing and being during the encounter in home-based nursing care.