Nurses' experiences of continuity of care for patients with heart failure: A thematic analysis

An Investigation of the Barriers to Care of Adult Patients With a Tracheostomy in Intensive Care Units and General Wards: Secondary Analysis of Qualitative Interview Data

AIMS AND OBJECTIVES

To investigate the barriers experienced by intensive care nurses and registered nurses and to provide optimal nursing for adult patients with a temporary tracheostomy in intensive care and general wards.

BACKGROUND

Tracheostomy is widely used in intensive care units, around 20% of intensive care unit patients undergo tracheostomy insertions and expect high quality of care. Caring for patients with a tracheostomy is complex and challenging task. An investigation of barriers to care for adult patients with a temporary tracheostomy in a hospital setting is essential to ensure that these patients receive the highest quality of care and to identify areas for improvement.

DESIGN

This paper applied secondary analysis to data from two qualitative studies, including narrative interviews and maximum variation sampling.

METHODS

Secondary analysis of primary qualitative datasets is appropriate when the analysis extends rather than exceeds the primary. The analysis was based on interview data collected from six intensive care nurses and six registered nurses from two university teaching hospitals in Norway. The interviews were audio-recorded and transcribed. The data was analysed using the qualitative analysis suggested by Graneheim and Lundman. This study adhered to the consolidated criteria for reporting in a qualitative research (COREQ) checklist.

RESULTS

Four main themes were identified as barriers to care for adult patients with a temporary tracheostomy in the hospital: encountering ambivalence, inadequate staffing levels, lack of patient continuity of care and lack of systematic follow-up.

CONCLUSIONS

Understanding barriers to care is crucial for hospitals and healthcare organisations to develop targeted interventions and educational programs to address these barriers and improve the care provided to adult patients with tracheostomies in hospital settings.

The unbroken chain of human relations in the compassionate care of patients with heart failure: a phenomenological study

OBJECTIVES

Recent diagnostic and therapeutic advances worldwide have led to an increase in the survival rate of patients with heart failure and their frequent hospitalizations. Nevertheless, survival rates remain significantly lower in Iran. Compassionate care shows promise in improving outcomes in this context. Consequently this study aimed to uncover the meaning of nurses providing compassionate care to patients with heart failure drawing from their lived experiences.

METHODS

A qualitative hermeneutic approach reflective of Heideggerian phenomenology was used as a philosophical framework. The sampling strategy was purposive. Individual and semi-structured interviews were conducted with nurses (n = 14) working in cardiology departments. The seven-steps of hermeneutic analysis were used to make sense of the data collected.

RESULTS

Data analysis revealed two themes and six subthemes along with one constitutive pattern. Nurses had experienced the delivery of humanizing compassionate care, along with the paradox of providing compassionate care for patients with heart failure. The first theme included the following sub-themes; 'put yourself in the patient' s shoes'; 'superiority of altruism over duty'; 'relying on the pillar of honesty in giving information to patient'; and 'respecting the patient's cultural beliefs'. The second theme also included sub-themes related to 'Satisfaction through compassion' and 'compassion fatigue'. In this study, a constitutive pattern was revealed; "the unbreakable chain of human relations in compassionate care delivered to heart failure patients".

CONCLUSION

Findings can be used as a guide for nurses' delivery of compassionate care. Compassionate care may be usefully promoted to improve outcomes in this context but must be paired with psychological support for the workforce.

The Effect of The Mindfulness-Based Relaxation, Aromatherapy, and Prayer (RADO) Intervention on Anxiety and Quality of Life Among Children With Cancer

Purpose

This study evaluates the effectiveness of a novel mindfulness-based intervention called RADO (Relaxation, Aromatherapy, and Prayer) for reducing anxiety and improving the quality of life in children with cancer.

Patients and Methods

A quasi-experimental pre- and post-control group design was used. Participants included 66 children with cancer aged 10-17 years, diagnosed with cancer for at least 3 months, currently undergoing treatment, and able to communicate verbally, and recruited from three hospitals in Bandung, Indonesia. The study used consecutive sampling. The intervention group received a seven-day RADO program involving mindfulness-based relaxation, aromatherapy, and prayer. Anxiety and QoL were measured using the Hamilton Rating Scale for Anxiety (HRS-A) and Pediatric Quality of Life Inventory (PEDQL 3.0), respectively. Data were collected at baseline (T0), day three (T1), and day seven (T3). Statistical analysis included repeated ANOVA and independent t-tests.

Results

By day seven (T3), the intervention group showed a significant reduction in anxiety (p < 0.001) and improved QoL (p = 0.001) compared to the control group. Repeated ANOVA revealed significant within-group changes in the intervention group across time points, while no significant changes were observed in the control group. Following the intervention, males and a diagnosis of ALL demonstrated slightly higher anxiety scores and quality of life scores than female and those with other cancer types. Additionally, individuals who underwent fewer chemotherapy cycles (<10) showed better outcomes in anxiety and quality of life than those with 10 or more cycles.

Conclusion

The RADO intervention significantly reduced anxiety and enhanced QoL among pediatric cancer patients, demonstrating its potential as a culturally tailored MBI for children undergoing cancer treatment. Further research is needed to explore long-term effects and cross-cultural adaptability.

Compassion as the cornerstone of palliative nursing care for patients with heart failure: a phenomenological study

OBJECTIVE

This study explored the lived experiences of nurses providing such end-of-life care to patients with heart failure using the lens of hermeneutic phenomenology.

RESULTS

Three overarching themes were identified: (1) creation of psychological comfort, (2) offering magnanimity in humanity and (3) the paradox of end-of-life care. The first theme included subthemes related to empathy and psychological support for the family. The second theme included subthemes related to respecting the patient's dignity and altruism, and the third theme included subthemes related to both positive and negative reactions to providing care in this context. A constitutive pattern emerged in the form of "compassion as the cornerstone of end-of-life nursing care for patients with heart failure". Findings reveal the hidden aspects involved in the provision of compassionate care and shine a light on the meaning of this from the perspective of nurses.

A Methodological Framework for Descriptive Phenomenological Research

BACKGROUND

Descriptive phenomenological research is crucial in nursing for understanding individuals' experiences, perceptions, and relationships, which are essential for person-centered healthcare. However, a common critique is that researchers often use phenomenological methods without fully comprehending their historical and philosophical foundations. Existing literature highlights discrepancies in the application of phenomenological principles by nurse researchers, particularly in their presentation of philosophical underpinnings and methodological details.

AIM

This article aims to provide a comprehensive methodological framework for descriptive phenomenological research in nursing, addressing both theoretical and practical aspects to guide novice researchers.

DATA SOURCES

This framework synthesizes existing scholarship on descriptive phenomenology.

DISCUSSION

Starting from Husserl, this article provides a detailed overview of the history, foundations, and philosophical assumptions of the methodology. It also includes key terms and a comprehensive detailing of all aspects of the research process.

CONCLUSION

This framework enriches existing scholarship by offering a streamlined, step-by-step methodological guide for researchers embarking on descriptive phenomenological studies. It emphasizes the importance of establishing minimum, yet critical criteria for publishing research employing this methodology.

IMPLICATIONS FOR RESEARCH

Future nurse researchers are encouraged to enhance methodological transparency in their descriptive phenomenological studies to facilitate rigorous evaluation of method effectiveness and study quality. This framework aims to alleviate potential apprehensions and provide clarity and structure to novice researchers in the field.

Care manager role for older multimorbid heart failure patients' needs in relation to psychological distress and quality of life: a cross-sectional study

Background

There are few studies investigating patients' needs in healthcare focusing on disease severity and psychological characteristics of elderly heart failure (HF) patients with multimorbidity, specifically addressed by a care manager (CM).

Aims

To explore the role of a CM dealing with elderly multimorbid HF patients' needs/preferences according to NYHA class, ejection fraction, psychological/psychosomatic distress and quality of life (QoL), utilizing a Blended Collaborative Care (BCC) approach (ESCAPE; Grant agreement No 945377).

Methods

Cue cards, self-reported questionnaires, and a semi-structured interview were used to collect data.

Results

Twenty-five Italian patients (mean age ± SD = 77.5 ± 6.68) were enrolled between June 2021 and March 2022. The most relevant patients' needs to be addressed by a CM were: education (e.g., on medical comorbidities), individual treatment tailoring (e.g., higher number of appointments with cardiologists) and symptom monitoring.

Conclusion

The study highlights the importance of targeting HF patients' needs according to psychological characteristics, whose healthcare requires person-centered care with CM assistance. In view of ESCAPE BCC intervention, a CM should consider specific patients' needs of elderly multimorbid HF patients with psychological, psychosomatic distress, particularly somatization, and lower QoL to achieve a more personalized health care pathway.

Study registration

The «Evaluation of a patient-centred biopsychosocial blended collaborative care pathway for the treatment of multi-morbid elderly patients» (ESCAPE) study has been registered at the University of Göttingen Medical Centre (UMG Reg. No 02853) and the German Clinical Trials Register (DRKS00025120).

Factors shaping return to work: a qualitative study among heart failure patients in Denmark

PURPOSE

For people of working-age diagnosed with heart failure, return to work (RTW) is often a significant rehabilitation goal. To inform vocational rehabilitation strategies, we conducted a qualitative study aiming at exploring patient experienced support needs, and barriers and facilitators to RTW.

MATERIALS AND METHODS

Ten men and eight women with heart failure (48-60 years) were interviewed in Denmark during 2022. A thematic analysis was conducted using the Sherbrooke model as framework.

RESULTS

Multiple factors operating at different levels shaped participants' RTW processes. Personal factors included motivation, mental and physical health, social relations, and financial concerns. Factors in the health care system shaping RTW included access to medical treatment, mental health care, and cardiac rehabilitation. Factors in workplace system shaping RTW included job type, employer support, and social relations. Factors in the legislative and insurance system shaping RTW included authorities' administration of sickness benefits, professional assistance, vocational counselling, and interdisciplinary cooperation.

CONCLUSION

Findings illustrate a need to include vocational rehabilitation within comprehensive cardiac rehabilitation programmes, to identify people in need of support, to improve the coordination of care across the health and social care sectors, and to involve employers, health care professionals, and social workers in individualised RTW strategies.

Moving forwards to patient-centred care for patients with ventricular assist devices: A mixed methods study of nurses' perspectives

OBJECTIVES

To identify nurses' caring behaviours toward patients with left ventricular assist devices and deepen their understanding of experiences in nursing care. Patients with left ventricular assist devices require care in many aspects, but there is limited in-depth research about caring behaviours and experiences from the perspective of nurses providing care.

RESEARCH METHODOLOGY/DESIGN

Mixed methods study with a sequential explanatory design. Data were collected from clinical nurses with experience caring for patients using left ventricular assist devices in South Korea between May-August 2022.

MAIN OUTCOME MEASURES

Quantitative data (n = 79) were collected through an online survey of the Caring Behaviours Inventory - 24 and analysed using descriptive statistics. For qualitative data (n = 15), nurses' caring experiences were collected through individual interviews and analysed using Colaizzi's phenomenological method.

RESULTS

The overall average of caring behaviours was 4.80 ± 0.85, specifically, 'knowledge and skill' (5.04 ± 0.78), 'assurance' (5.01 ± 0.79), 'respect' (4.85 ± 0.90), and 'connectedness' (4.04 ± 0.99), respectively. The experience of caring was trapped in the uncomfortable reality of left ventricular assist device nursing, causing device-focused care, and approaching the essence of nursing through care focused on the patient's wholeness.

CONCLUSIONS

Caring for patients with a left ventricular assist devices was challenging for nurses. However, through the care process, they realised the meaning of patient-centred care, reflected in the essence of nursing, and sublimated it into an opportunity to grow.

IMPLICATIONS FOR CLINICAL PRACTICE

Nurses must focus on patient-centred care for left ventricular assist devices. To achieve this, it is essential to create a clinical environment and educational system for nurses to provide effective nursing care and enhance patient participation.

Implementing advance care planning in palliative and end of life care: a scoping review of community nursing perspectives

BACKGROUND

Advance care planninganning (ACP) is a priority within palliative care service provision. Nurses working in the community occupy an opportune role to engage with families and patients in ACP. Carers and family members of palliative patients often find ACP discussions difficult to initiate. However, community nurses caring for palliative patients can encourage these discussions, utilising the rapport and relationships they have already built with patients and families. Despite this potential, implementation barriers and facilitators continue to exist. To date, no research synthesis has captured the challenges community nurses face when implementing ACP, nor the facilitators of community nurse-led ACP. Considering this, the review question of: 'What factors contribute to or hinder ACP discussion for nurses when providing care to palliative patients?' was explored.

METHOD

To capture challenges and facilitators, a global qualitative scoping review was undertaken in June 2023. The Arksey and O'Malley framework for scoping reviews guided the review methodology. Six databases were searched identifying 333 records: CINAHL (16), MEDLINE (45), PUBMED (195), EMBASE (30), BJOCN (15), IJOPN (32). After de-duplication and title and abstract screening, 108 records remained. These were downloaded, hand searched (adding 5 articles) and subject to a full read. 98 were rejected, leaving a selected dataset of 15 articles. Data extracted into a data extraction chart were thematically analysed.

RESULTS

Three key themes were generated: 'Barriers to ACP', 'Facilitators of ACP' and 'Understanding of professional role and duty'. Key barriers were - lack of confidence, competence, role ambiguity and prognostic uncertainty. Key facilitators concerned the pertinence of the patient-practitioner relationship enabling ACP amongst nurses who had both competence and experience in ACP and/or palliative care (e.g., palliative care training). Lastly, nurses understood ACP to be part of their role, however, met challenges understanding the law surrounding this and its application processes.

CONCLUSIONS

This review suggests that community nurses' experience and competence are associated with the effective implementation of ACP with palliative patients. Future research is needed to develop interventions to promote ACP uptake in community settings, enable confidence building for community nurses and support higher standards of palliative care via the implementation of ACP.

Reducing risks in complex care transitions in rural areas: a grounded theory

PURPOSE

Although previous research indicates that care transitions differ between rural and urban areas, the knowledge of challenges related to care transitions in rural areas appears limited. This study aimed to provide a deeper understanding of what registered nurses' perceive as the main concerns in care transitions from hospital care to home healthcare in rural areas, and how they handle these during the care transition process.

METHODS

A Constructivist Grounded Theory method based on individual interviews with 21 registered nurses.

RESULTS

The main concern in the transition process was "Care coordination in a complex context". The complexity stemmed from several environmental and organizational factors, creating a messy and fragmented context for registered nurses to navigate. The core category "Actively communicating to reduce patient safety risks" was explained by the three categories- "Collaborating on expected care needs", "Anticipating obstacles" and "Timing the departure".

CONCLUSIONS

The study shows a very complex and stressed process that includes several organizations and actors. Reducing risks during the transition process can be facilitated by clear guidelines, tools for communication across organizations and sufficient staffing.

Continuity of care for patients recovering from Covid-19 under the angle of clinical management principles

OBJECTIVE

To analyze the strategies used by nurses at a university hospital to ensure continuity of care at hospital discharge for patients recovered from Covid-19, under the angle of the principles of clinical management.

METHOD

A descriptive study with a qualitative approach, carried out with seven nurses on duty in the medical and gynecology/obstetrics clinics of a university hospital in the Midwest region of the country. The data was processed using IRaMuTeQ software and analyzed using Content Analysis.

RESULTS

The data resulted in five classes by the Descending Hierarchical Classification (DHC), which made up two categories: "Practices developed by nurses for continuity of care in the hospital environment" and "Continuity of care during discharge to the home". The strategies used by the nurses were: daily care systematized in the nursing process and guidance both for preparation and for the day of discharge.

CONCLUSION

The absence of an institutional protocol for safe discharge, as well as the position of nurse coordinator to manage the discharge of patients with Covid-19, can compromise the continuity of care for these patients.

An exploratory study of the experiences of emergency medical care (EMC) students transitioning through the COVID-19 pandemic in South Africa

BACKGROUND

The COVID-19 pandemic coalesced into increased mental health problems, particularly anxiety, stress, and depression for university students. Students from the emergency medical care (EMC) department encountered these difficulties, more intensely, particularly those in WIL or clinical placements, as they worked at the interface of illness, trauma, and grief during the pandemic. While empirical research has burgeoned in relation to healthcare practitioners within this context, little exists on EMC students at South African higher education institutions (HEIs), within the context of the COVID-19 pandemic. This qualitative study aimed to explore the academic and psychosocial challenges experienced by EMC students, as they transitioned through the COVID-19 pandemic and the ensuing lockdown during 2021.

MATERIALS AND METHODS

A qualitative approach with an exploratory descriptive design was used to guide the study. A sample of students from all levels of the EMC Department in the Faculty of Health Sciences was recruited. This was done using non-probability sampling techniques, which includes purposive sampling. Data saturation was reached after interviewing 15 participants using a virtual platform. Interviews were recorded, transcribed, and analyzed using thematic analysis.

RESULTS

Our results revealed five broad themes and six subthemes which reflected the psychosocial experiences that EMC students faced. The themes and (subthemes) included encountering COVID-19 during WIL or clinical, infection or loss of loved ones, psychological effects of living and working at the interface of COVID-19 (negative emotional toll of the pandemic, misinformation, isolation and social disconnectedness, and sense of responsibility/duty to work) and disruption to academic life (online learning challenges and challenges related to clinical training experiences) and financial impact of the pandemic.

CONCLUSIONS

The findings suggested that there is a critical need for HEIs to develop strategies that ensure EMC students' well-being amidst their academic journey within the context of the pandemic. This study will therefore assist EMC departments at higher education institutions to formulate strategies in relation to the pandemic.

Taking command of continuity-An interview study with agency nurses

AIM

The aim of the study was to describe continuity from the perspective of working as an agency nurse (AN).

DESIGN

Qualitative design was applied using individual semi-structured interviews.

METHOD

Individual interviews with fifteen registered nurses working at agency companies were conducted in 2020. The interviews were analyzed with thematic analysis. The study followed the guidelines addressed in the COREQ (Consolidated Criteria for Reporting Qualitative Research) framework.

RESULTS

Thematic analysis yielded one theme - standing strong and taking command - and four categories: being competent and experienced, being prepared and at ease, ensuring an unbroken chain of care, and belonging on my own terms. The categories illustrated the engagement, professionalism, and natural leadership showed by the ANs to uphold quality and continuity.

An exploratory study of the clinical technology undergraduate program in South Africa: Preparedness of students for clinical practice

BACKGROUND

This study sought to understand whether the theoretical components of the curriculum prepared students for clinical practice training in the Bachelor of Health Sciences (BHSc) in Clinical Technology program at the Durban University of Technology.

MATERIALS AND METHODS

Two samples were recruited, namely, academics and students using non-probability sampling methods. The first sample comprised 13 students, and the second sample included four academics, involved in teaching and supervising the placement of students at healthcare institutions. At least one student from each of the 13 units where clinical practice training was undertaken was invited to participate. Data was gathered using in-depth, semi-structured interviews on an adapted version of Gibbs' cycle of reflection.

RESULTS

Three broad themes emerged, namely, curriculum structure, factors that enabled graduate attribute development in the clinical environment, and the transition to online teaching.

CONCLUSION

While it appears that the curriculum had in many ways prepared students for clinical practice, the study highlights key issues that may guide curriculum developers when seeking to improve preparedness of students for clinical practice. Furthermore, it underscores the need for continuous review of current curricula so that these are responsive to student and societal needs.

The Mechanical Body and the Lived Body: Heart Failure Clinical Nursing Practice

BACKGROUND: The Cartesian model has advanced modern-day nursing practices by separating the body from the mind and the person from the world. This model shifted nurses’ focus away from patients’ perceptions and lived experiences and toward the mechanical body. However, Merleau-Ponty’s perspective that a lived-body approaches offers an alternative and occurs when caring for patients as part of the nursing practice. AIM: This paper aims to present Merleau- Ponty’s and Descartes’s views of the body in greater depth and discuss their implications on nursing science and practice in patients with heart failure and the challenges they pose. METHODS: This publication also discussed how nurses care for the body as if it were a machine and contrast it with the recommendations for clinical nursing practice that will empower nurses to acknowledge the body as a lived body in their professional practice. RESULTS: Patients treated as machines may be able to achieve a cure for their illness, but they may not be able to find meaning in it or achieve healing if treated as machines. CONCLUSION: In the lived-body approach, nurses can also apply Merleau-Ponty’s philosophy to nursing science and patient care, which will lead to the development of holistic care and will improve the quality of patient care and patients’ general well-being.

Continuity of Care Challenges for Professional Nursing Practice

The transformation of health systems to meet the needs of chronic and multi-pathological patients has turned continuity of care into one of the mainstays of care programs and the design of new resources to care for these patients and their families. In this context, nurses’ professional practice poses challenges for the three dimensions of continuity of care: relational, informational, and managerial. Faced with these challenges, nursing research is essential for the profession and necessary to promote innovative quality care.