"Maintain Professionalism": Nurses' Experiences in Caring for Patients with Malignant Fungating Wounds in Taiwan

CONTEXT

Malignant fungating wounds (MFWs) occur among 5%-15% of patients with terminal cancers, the uncontrollable symptoms result in serious psychosocial issues, thereby reducing the quality of life. Caring for MFWs impacts caregivers, including healthcare personnel. While existing studies are patient-focused, the impact of care experiences and associated support for nurses has not been examined.

OBJECTIVES

To explore the experiences in caring for patients with MFWs among nurses in Taiwan.

METHODS

Qualitative study with a phenomenological approach by thematic analysis was conducted with semi-structured interviews. About 15 nurses who cared for patients with MFWs at local district hospitals in Southern Taiwan.

RESULTS

Four themes were identified to describe the phenomenon: (1) Fear of Unpredictability (2) Maintaining Professionalism (3) Feeling Helpless (4) Rationalizing the Negatives. The themes illustrated the distress of managing physical symptoms and highlighted how nurses strived to promote comfort for patients. Nurses felt helpless about the incurable nature of MFWs but found a way to suppress their feelings.

CONCLUSION

The findings suggested the need for addressing the emotional well-being of nurses who take care of patients with MFWs. Future studies should identify effective coping strategies for nurses' health when caring for this population.

Attitudes, expectations, and lived experiences of cancer patients receiving dendritic cell vaccine therapy in Japan

Objective

Immunotherapeutic approaches to cancer, such as dendritic cell vaccine therapy, promise to improve survival rate but may present unique challenges to patients. However, there is no research on the lived experiences of cancer patients receiving dendritic cell vaccine therapy. The aim of this study was to explore the attitudes, expectations, and experiences of cancer patients receiving dendritic cell vaccine therapy in Japan.

Methods

This was an exploratory qualitative study. A descriptive phenomenological approach was used to investigate the experiences of eight advanced-stage cancer patients (median age: 59.5 years). Data were collected between July 2018 and March 2020 using in-depth semi-structured interviews. Data were analyzed according to Colaizzi's seven-step phenomenological strategy, and EQUATOR's Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines for qualitative studies were followed.

Results

Four themes emerged from the data analysis: strong concerns about chemotherapy, faith in dendritic cell vaccine therapy, motivation to succeed, and physical and mental changes. The first two themes related to pretreatment attitudes and expectations. The latter two themes expressed participants' experiences during and after therapy.

Conclusions

Dendritic cell vaccine therapy patients expressed fears about the effects of standard treatment, and hope and uncertainty regarding immunotherapy treatment decisions and efficacy. The findings suggest that such patients require nursing care that includes prevention and reduction of chemotherapy side effects, careful observation of patients' well-being, management of patients' expectations and uncertainty, formation of patient-health care practitioner partnerships, and team medicine.

Experience of postpartum depression among Chinese women: A meta-synthesis of qualitative research

Postpartum depression (PPD) is associated with various adverse health outcomes among mothers and babies. Meta-synthesis can improve our understanding of postpartum women's experiences. However, the meta-analysis of PPD among Chinese women is limited. Therefore, a meta-analysis was conducted to evaluate the prevalence of PPD among Chinese women and if and how traditional culture may exacerbate PPD. Qualitative studies on the experiences of Chinese women with PPD were searched from database establishment until May 2022 in ten databases. The meta-ethnography reporting guidelines and framework was applied to the writing and reporting of this review. The protocol for this systematic review was registered with the International Prospective Register of Systematic Reviews (CRD42022323388). 2321 studies were retrieved, and 11 studies qualified for the meta-synthesis. The final five themes extracted and re-conceptualized from these studies were as follows: the gap between expectation and reality, conflicts with family, physical and mental frustrations, critical needs for coping with changes, and measures against PPD. Chinese women with PPD frequently feel vulnerable physically, mentally, or both after childbirth and often have conflicts with their families due to the influence of traditional Chinese culture. Family relationships and social support often are factors preventing women from seeking help.

Perception of risk of relapse among patients with first episode and recurrent schizophrenia: a descriptive phenomenological study

BACKGROUND

Patients suffering from schizophrenia are at a higher risk of relapse. The perception of the risk of relapse in patients is critical for relapse prevention. In the field of psychiatry, the study of risk perception of relapse has been neglected.

METHODS

We carried out a qualitative study using a descriptive phenomenological approach. Data were collected at two psychiatric hospitals in China. In total, 22 patients with schizophrenia were recruited through purposive sampling. Face to face semi-structured in-depth interviews were conducted. Interview recordings were transcribed by the research team, and transcripts were analysed by two independent coders with Colaizzi's descriptive analysis framework. The consolidated criteria for reporting qualitative research checklist were used for reporting.

RESULTS

The data of first-episode patients yielded three themes: (i) lack of knowledge about disease recognition and medical treatment; (ii) overoptimistic estimation of the risk of relapse; (iii) perceived importance of treatment. For first-relapse patients : (i) initial awareness of relapse warning signs; (ii) lack of systematic and accurate assessment of disease information; (iii) the perception that drug withdrawal is related to relapse. Patients with multiple relapses: (i) susceptibility to relapse: confusion and powerlessness; (ii) the severity of relapse: suicidal thoughts and behavior; (iii) effects of perceived benefits and barriers of medication behaviour.

CONCLUSIONS

In schizophrenic patients with first-episode, first-relapse, and multiple relapses, there were dynamic changes in the perception of disease relapse risk and medication behaviour. Medical workers must improve risk awareness education. They should provide patients with scientific, accurate, and timely communication channels, and dynamically assess and manage the risk of relapse in various patients.

Sexual needs of people with schizophrenia: a descriptive phenomenological study

BACKGROUND

Sexual health is one of the main areas of health and basic human rights which has been paid less attention in schizophrenia. Most studies have focused on sexual dysfunction rather than the sexual needs of people with schizophrenia. This study explores the sexual needs of people with schizophrenia and identify factors hindering sexual activities.

METHODS

We carried out a qualitative study using a descriptive phenomenological approach. Data were collected at a psychiatric hospital in China. In total, 20 patients with schizophrenia were recruited through purposive sampling. Face to face semi-structured in-depth interviews were conducted with them. Interview recordings were transcribed by the research team, and transcripts were analyzed by two independent coders with Colaizzi's descriptive analysis framework by using NVivo 11 software. The consolidated criteria for reporting qualitative research checklist was used for reporting.

RESULTS

The data analysis revealed 10 subthemes categorized into 3 macro themes: (1) multiple barriers hinder sexual activity; (2) significance of sex; and (3) conditions for fulfilling sexual needs.

CONCLUSION

A poor sexual quality of life may be found in patients with schizophrenia. Furthermore, people with schizophrenia did not lose interest in maintaining an active sex life. Mental health services should address this issue in three areas: sexual knowledge, sexual space, and sexual objects.

Exploring nursing presence as experienced by parents in pediatric oncology

BACKGROUND

Nursing presence has been viewed as a valuable way to create therapeutic relationships and has been linked to better health outcomes for patients and families. However, whether nursing presence can be described and how parents in pediatric oncology experience this phenomenon remains unanswered. Therefore, the purpose of this study was to explore how parents of children with cancer describe and experience nursing presence.

METHODS

This study used Giorgi's phenomenological approach to explore nursing presence as experienced by parents of children with cancer. Ten participants from a pediatric oncology clinic in Canada were interviewed. Giorgi's approach was used to analyze these data.

FINDINGS

Based upon participants' descriptions, a structure of nursing presence emerged which included six constituent features: An attitude of presence, a source of encouragement, clinical experience and expertise, therapeutic communication, family involvement, and a sense of home away from home. Most notably, nursing presence as experienced by parents was characterized by the 'being' and 'doing' of presence which were equally important.

CONCLUSION

The experiences described by parents provided rich and nuanced insights into what it meant to experience nursing presence in a pediatric oncology setting. This study provides a structure for this meaning making and expounds on its constituent features, describing what nursing presence resembles when experienced by parents of children with cancer.

PRACTICE IMPLICATIONS

This study informs nursing practice, policy, and education in ways that are likely to enhance care and the subsequent well-being of pediatric oncology patients and families.

Experience of reproductive concerns in women with schizophrenia: A descriptive phenomenological study

BACKGROUND

Reproductive concerns significantly affect the mental health of people, causing more serious psychological stress than disease. The reproductive concerns faced by women with schizophrenia are issues that have been neglected in the areas of psychiatry and women's health.

OBJECTIVES

To explore the experience of reproductive concerns through the perspective of women with schizophrenia.

DESIGN

Descriptive phenomenology interview study.

SETTING

Data collection was carried out in a psychiatric hospital in China.

PARTICIPANTS

15 women with schizophrenia were recruited with a prospective sampling. All participants were 26-40 years old.

METHODS

The interview recordings were transcribed by the research team, and transcripts were analyzed by two independent coders with Colaizzi's descriptive analysis framework. The process employed NVivo 12 software.

RESULTS

Data analysis identified 9 subthemes falling into the 4 macrothemes: (a) Potential risks of reproduction; (b) The difficulties in raising children; (c) Significance of reproduction; (d) Multiparty cooperation is needed to relieve reproductive concerns.

CONCLUSION

Women with schizophrenia have reproductive concerns under the conflict between the significance of reproduction and obstacles. Interventions to address the reproductive problems of women with schizophrenia should be developed in three areas: the women themselves, the women's spouses and the medical staff.

From the shadows of death into the light of acceptance: A lived experience of patients with HIV-AIDS

HIV/AIDS is one of the feared diseases worldwide. It is a disease thoroughly studied yet still incurable in this modern era. Having acquired it is like being faced with the possibility of spending life in limbo-marked by the disease, excluded from the norms of society and an outcast to many. The study has aimed to capture how patients with HIV/AIDS struggled with living with the disease, the obstacle they had to overcome and how they were able to deal with the problems that they encountered after being diagnosed with such disease. A descriptive phenomenology utilizing a semi-structured face-to-face interview was used. Four key informants (KI) from Metro Manila shared their lived experiences unreservedly. Through Colaizzi's data analysis two major themes and five subthemes reflected the lived experiences of dying persons living with HIV/AIDS: (1) Scourging of the Pessimistic Spirits (a) fear is a dark room where negatives are developed, (b) a spirit crying for succor. (2) Rise of the Optimistic Spirit (a) burning bush in the darkness, (b) transformation in the midst of the battle for life (c) acceptance as transcending condition. In learning their HIV/AIDS diagnosis, the KI had to go through a series of steps in their lives to accommodate this major trial into their identity. They had to experience the psychological distress and the physical limitations caused by the disease before discovering that they do not have to live in fear and isolation. They were able to emerge from the darkness of negativity into the light of acceptance and hope and have used their experiences as a way to teach and support others who are in the same predicament as they were before. They have also learned to accept their imminent death as part of their life.

Methods, methodological challenges and lesson learned from phenomenological study about OSCE experience: Overview of paradigm-driven qualitative approach in medical education

Qualitative research approach could be as important as quantitative one, particularly in medical education, as long as it meets the common goal of both—improving the quality of education. In contrary to the end—i.e. achieving the common goals, the means of both approaches of inquiry is different. Their dissimilarity in the means or process is not confined to data collection techniques, study designs or analysis methods; but, they also differ in assumptions about the world, reality, science and knowledge. Implicitly or explicitly, these assumptions are revealed in a researcher's discussion about philosophical assumptions and research paradigms. The researcher's inclination towards any of paradigms and assumption in light of the most common philosophical concepts such as ontology, epistemology and methodology results in choice of either of the dominant research paradigms to follow such as objectivism/positivism and interpretivisim/constructivism. This is common practice in the quantitative-qualitative dichotomy of research world disregarding the emerging mixed approach with predominantly pragmatism paradigm. Besides framing the methodology of the study, researcher's explicit description of philosophical assumptions and paradigms helps readers easily understand study findings. Many authors from both dominant traditions fail to describe this important aspect of the research in their published works. In our study, the ontological and epistemological assumptions led us choose interpretivist/constructivist paradigm and phenomenological qualitative approach with Collaizi's descriptive phenomenological analysis adapted to our context. The experience and lesson learned from the study found to be worse sharing in a modified and extended construct of methodology part. Therefore, this article deals with philosophical positions, research paradigms and traditions that led to the specific qualitative approach from the perspective of methodology part in our study about objective structure clinical examination (OSCE) experience in a medical department.

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Qualitative research approach can be as important as quantitative approach.

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A research approach can be determined by preference to certain research paradigm.

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Major philosophical concepts in research are ontology, epistemology and methodology.

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Disclosing one's research paradigm help research readers easily understand findings.

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Collaizi's seven step descriptive phenomenology fits for our OSCE experience study.

Registered nurses' perceptions and experiences of autonomy: a descriptive phenomenological study

Background

Professional autonomy is a key concept in understanding nurses’ roles in delivering patient care. Recent research exploring the role of autonomy in the nursing work environment indicated that English and American nurses had differing perceptions of autonomy. This qualitative study aimed to explore the understanding and experiences of autonomy of nurses working in England.

Methods

A descriptive phenomenological analysis of data from 48 semi-structured interviews with registered nurses from two National Health Service (NHS) hospitals (purposive sample) was used to explore the concept of autonomy.

Results

Six themes were identified: working independently; working in a team; having professional skills and knowledge; involvement in autonomy; boundaries around autonomy; and developing autonomy requires support. A key finding was that nurses related autonomy to their clinical work and to the immediate work environment of their ward, rather than to a wider professional context. Nurses also perceived that autonomy could be turned off and on rather than comprising an integrated aspect of nursing.

Conclusions

Findings suggest that nurses in England, as framed by the sample, had a local ward-focused view of autonomy in comparison to nurses in America, who were reported to relate autonomy to a wider involvement in hospital level committees. Findings further indicate that autonomy was practiced occasionally, rather than incorporated into practice. Findings highlight the need for nurses in England to adopt a broader perspective and actively contribute to writing hospital guidelines and policies that recognise the importance of autonomy to nurse training and practice.

Breast compression techniques in screening mammography - A Maltese evaluation project

INTRODUCTION

In screening mammography, the radiographer should be responsible for providing mammograms of high diagnostic value, possibly without subjecting clients to a painful experience. This skill is demonstrated via the technique of breast compression and is explored in this study by analysing insights about methods and underlying principles in regards to this procedure.

METHODS

One-to-one semi-structured interviews were conducted with radiographers who perform screening mammography in Malta. For data analysis, a descriptive phenomenological approach following a simplified version of Hycner's (1985) method was adopted.

RESULTS

Five general themes were extracted from the data; meeting the client, preparing the client, the mammography procedure, pain from compression and client turnout. It was determined that the participants alter their breast compression technique according to the client rather than following a rigid step-by-step process and that explanation and requesting client feedback are essential to obtain cooperation. Additionally, mammography positioning and compression application are tailored in a way that encourage compliance, however not at the expense of degrading image quality. Ultimately, it is also believed that a proper breast compression technique positively influences client turnout.

CONCLUSION

The results of this study demonstrate that radiographers should be flexible in their approach in order to carry out a successful breast compression technique. However, it has also been shown that such effectiveness in practice is gained from experience rather than initial training. If exposed to this study's findings, new mammographers would be able to form a robust core of knowledge before embarking on the challenging specialisation of mammography.

Understanding Doctoral Nursing Students' Experiences of Blended Learning: A Qualitative Study

The concept of blended learning in the field of nursing and medicine has been accepted. Blended learning has been extensively used thanks to the development of communication technologies and the availability of Internet services. Meanwhile, experiences-based research, by all accounts, can help the expansion of such a learning modality. Therefore, this study was designed to explain nursing doctoral students' experiences of blended learning. To attain this goal, a descriptive phenomenology method was used to illustrate experiences as they are experienced by the participants in the study. With regard to the nature of the investigated phenomena and the existing methods for the inductive analysis, Colaizzi's method of data analysis was used. The findings of the study led to the discovery of three main themes: "failure", "synergy" and "specific interaction". Each of the themes has been further divided into some sub-themes.

Women's experiences after a radical vaginal trachelectomy for early stage cervical cancer. A descriptive phenomenological study

PURPOSE

This paper reports on a phenomenological study of women's experiences 1-10 years following a radical vaginal trachelectomy and describes the impact on health, sexuality, fertility and perceived supportive care needs.

METHOD AND SAMPLE

Qualitative telephone interviews employing a descriptive phenomenological approach were conducted using a purposive sample of 12 women.

KEY RESULTS

Several felt their cancer experience was positive; bringing them closer to family and changed their outlook on life. A few experienced delayed psychological reactions and/or fears of recurrence. Many experienced isolation and the desire to contact others with similar experiences. Women recovered well but a few experienced fears/concerns about lymphoedema and intermenstrual bleeding. Sexual function was not a long-term issue for most. Some that could feel the cerclage (stitch) during intercourse, developed techniques to reduce this. Single women felt vulnerable in new relationships. Pregnancy was an anxious time, especially for those that experienced a miscarriage or pre-term birth. Sources of support included the clinical nurse specialist, family/friends, surgical consultant, online patient forums and a support group. Women needed more information on trachelectomy statistics, pregnancy care recommendations as well as access to counselling, peer support, being seen by the same person and increased public awareness.

CONCLUSIONS

This study has provided an interesting and detailed insight into women's experiences in the years following a trachelectomy, with results that have important considerations for practice such as provision of statistical information; counselling; peer support; consistent pregnancy recommendations; increased public awareness and increased identification and management or prevention of long-term physical effects.