Needs of carers participating in support groups and caring for a person with dementia: A focused ethnographic study

Aims

The aim is to explore and understand how support group participation meets carers’ perceived needs for information and social and emotional support when caring for a person with dementia who lives at home.

Design

Focused ethnographic design.

Methods

Participant observations and semi-structured interviews with 25 carers were conducted. An inductive content analysis of the data was performed.

Findings

Two themes were identified: “Strengthening the sense of self” and “Managing uncertain benefits.”

Conclusion

Carers’ level of information about dementia was partly met, thereby strengthening their sense of self and joy. Maintaining shared decision-making in financial matters was viewed as an expression of respect and reciprocity. Getting acquainted with peers and dementia coordinators was viewed as emotional and social support but was also used strategically to gain easier access to health care services. By fulfilling their needs, support group meetings became meaningful, which motivated carers to continue providing care.

Patients Scheduled for General Anesthesia: Betwixt and Between Worrying Thoughts and Keeping Focus

PURPOSE

The purpose of the research was to explore the interaction between cancer patients and Registered Nurse Anesthetists (RNAs) before general anesthesia from the patients' perspective.

DESIGN

Focused ethnography was used as method for data collection.

METHODS

Surgical patients' interactions with the RNAs were observed during preparations for general anesthesia and further explored during an interview on the first or second postoperative day. Methodological concepts of Grounded Theory structured the analysis.

FINDINGS

The core variable describes patients being in an intermediate position, not knowing the outcome of the anesthetic and surgical procedures. The core variable is elaborated by subcore variables describing patients' coping strategies and need for care.

CONCLUSIONS

Patients' experiences of being cared for and supported in their coping strategies by RNAs will substantiate patients' predisposed confidence in the RNA and the anesthetic procedure. This will support patients in keeping focus in a highly technological environment.

Hospitalised patients' experiences during Negative Pressure Wound Therapy due to surgical site infection after vascular and cardiac surgery

Surgical site infections that develop after vascular and cardiac surgery are often treated with Negative Pressure Wound Therapy (NPWT). Due to the severity of the infection and risk of bleeding, this NPWT often requires hospitalisation. Fourteen patients were selected for qualitative interviews to investigate their experiences and the meaning of patient participation during hospitalisation with NPWT. Results show that hospitalisation induces tension between an intrusion of privacy and being part of a community. Patients do not feel ill nor are considered ill. They feel minimised, lack participation and miss continuity, yet they still accept their circumstances by adjusting to hospital routines and treatment. The hospital's organisational framework compromises patient participation, yet patients still participate in supporting their own wound healing. They worry, are bored, lack a clear time horizon, and appear to be in an apathetic mood despite having significant time on their hands. In conclusion, the tension between a patient's privacy and sense of community, as well as involuntary participation in other patients' lives, compromises dignity and increases stress. Wound healing appears to be prolonged due to fasting, inactivity and stress. Self-reliant patients are at risk of being minimised and lack adequate emotional care, and the hospital's organisational framework hampers patient feelings of involvement and participation.

Long-term mental wellbeing of adolescents and young adults diagnosed with venous thromboembolism: results from a multistage mixed methods study

Essentials Long-term mental wellbeing of adolescents and young adults with venous thromboembolism is unclear. This multistage mixed methods study was based on Danish nationwide registry data and interviews. Mental wellbeing is negatively impacted in the long-term and uncertainty of recurrence is pivotal. The perceived health threat is more important than disease severity for long-term mental wellbeing.

SUMMARY

Background Critical and chronic illness in youth can lead to impaired mental wellbeing. Venous thromboembolism (VTE) is a potentially traumatic and life-threatening condition. Nonetheless, the long-term mental wellbeing of adolescents and young adults (AYAS) with VTE is unclear. Objectives To investigate the long-term mental wellbeing of AYAS (aged 13-33 years) diagnosed with VTE. Methods We performed a multistage mixed method study based on data from the Danish nationwide health registries, and semistructured interviews with 12 AYAS diagnosed with VTE. An integrated mixed methods interpretation of the findings was conducted through narrative weaving and joint displays. Results The integrated mixed methods interpretation showed that the mental wellbeing of AYAS with VTE had a chronic perspective, with a persistently higher risk of psychotropic drug purchase among AYAS with a first-time diagnosis of VTE than among sex-matched and age-matched population controls and AYAS with a first-time diagnosis of insulin-dependent diabetes mellitus. Impaired mental wellbeing was largely connected to a fear of recurrence and concomitant uncertainty. Therefore, it was important for the long-term mental wellbeing to navigate uncertainty. The perceived health threat played a more profound role in long-term mental wellbeing than disease severity, as the potential life threat was the pivot which pointed back to the initial VTE and forward to the perception of future health threat and the potential risk of dying of a recurrent event. Conclusion Our findings show that the long-term mental wellbeing of AYAS diagnosed with VTE is negatively affected, and highlights these patients' need for adequate support.

Danish Perioperative Nurses' Documentation: A Complex, Multifaceted Practice Connected With Unit Culture and Nursing Leadership

Researchers have described the documentation practices of perioperative nurses as flawed and characterized by subjectivity and poor quality, which is often related to both the documentation tool and the nurses' level of commitment. Studies suggest that documentation of nursing care in the OR places special demands on electronic health records (EHRs). The purpose of this study was to explore how the use of an EHR tailored to perioperative practice affects Danish perioperative nurses' documentation practices. This study was a follow-up to a baseline study from 2014. For three months in the winter of 2015 to 2016, six participants tested an EHR containing a Danish edition of a selected section of the Perioperative Nursing Data Set. This study relied on realistic evaluation and participant observations to generate data. We found that nursing leadership was essential for improving perioperative nurses' documentation practices and that a tailored EHR may improve documentation practices.

TIME - MAKING THE BEST OF IT! A Fieldwork Study Outlining Time in Endoscopy Facilities for Short-Term Stay

Aim:

This paper focus on nursing and time in endoscopy facilities for short-term stay aiming to explore aspects of time in this setting and how expectations from the healthcare organisation, patients and nurses are expressed and met when managing nursing time.

Background:

Former research primarily focuses on the subject of time in the understanding of duration where having more time is closely associated with the ability to deliver better quality nursing care. The main concern is the nurses’ increased number of tasks and the decreased length of time at their disposal. However, few studies describe nursing when time is sparse, and the possibility of providing individualised nursing within a very short span of time.

Design:

Inspired by practical ethnographic principles, a fieldwork study was performed in high technology endoscopy clinics during 2008-2010.

Methods:

Data triangulation included participant observation, participant reports and patients and nurses semi-structured interviews.

Results/Findings:

The issue of time was an interwoven part of life in the productive endoscopy units. The understanding of time related to the main category: ‘Time - making the best of it’, and the sub categories “Responsibility of time”, “Information and preparation”, and “Time wasters”.

Conclusion:

The study underlines the possibility of combining the health care systems, patients and the nurses’ perspectives on and expectations of how to spend nursing time in endoscopy settings. In successful patient pathways nursing maximize patient outcome, support the goals of the healthcare organisations, is reliable, assure, tangible, empathic and responsive, and is individually tailored to the patient’s needs. The study contributes by underlining the importance of discussing not how to get more time in clinical practice but instead how to spend the time in the best way possible.

The experience of daily life of acutely admitted frail elderly patients one week after discharge from the hospital

INTRODUCTION

Frail elderly are at higher risk of negative outcomes such as disability, low quality of life, and hospital admissions. Furthermore, a peak in readmission of acutely admitted elderly patients is seen shortly after discharge. An investigation into the daily life experiences of the frail elderly shortly after discharge seems important to address these issues. The aim of this study was to explore how frail elderly patients experience daily life 1 week after discharge from an acute admission.

METHODS

The qualitative methodological approach was interpretive description. Data were gathered using individual interviews. The participants were frail elderly patients over 65 years of age, who were interviewed at their home 1 week after discharge from an acute admission to a medical ward.

RESULTS

Four main categories were identified: "The system," "Keeping a social life," "Being in everyday life," and "Handling everyday life." These categories affected the way the frail elderly experienced daily life and these elements resulted in a general feeling of well-being or non-well-being. The transition to home was experienced as unsafe and troublesome especially for the more frail participants, whereas the less frail experienced this less.

CONCLUSION AND DISCUSSION

Several elements and stressors were affecting the well-being of the participants in daily life 1 week after discharge. In particular, contact with the health care system created frustrations and worries, but also physical disability, loneliness, and inactivity were issues of concern. These elements should be addressed by health professionals in relation to the transition phase. Future interventions should incorporate a multidimensional and bio-psycho-social perspective when acutely admitted frail elderly are discharged. Stakeholders should evaluate present practice to seek to improve care across health care sectors.

Danish version of the Tilburg Frailty Indicator--translation, cross-cultural adaption and validity pretest by cognitive interviewing

The Tilburg Frailty Indicator (TFI) is a self-administered questionnaire with a bio-psycho-social integrated approach that measures the degree of frailty in elderly persons. The TFI was developed in the Netherlands and tested in a population of elderly Dutch men and women. The aim of this study was to translate and culturally adapt the TFI to a Danish context, and to test face validity of the Danish version by cognitive interviewing. An internationally recognized procedure was applied as a basis for the translation process. The primary tasks were forward translation, reconciliation, back translation, harmonization and pretest. Pretest and review of the preliminary version by cognitive interviewing, were performed at a local community center and in an acute medical ward at the University Hospital in Aalborg, Denmark respectively. A large agreement regarding meaning of the items in the forward translation and reconciliation process was seen. Minor discrepancies were solved by consensus. Back translation revealed unclear wording in one matter. The harmonization committee agreed on a version for cognitive interviewing after revision of minor issues and thirty-four participants were interviewed. Two issues became evident and these were revised. The cognitive interviews and final lay-out resulted in minor adjustments as text type size, specific font, and lining for optimizing readability. In conclusion, we consider the TFI to be translated in such rigorous manner that the instrument can be further tested in clinical practice. The overall objective of the questionnaire being to identify frailty and improve the interventions relating to frail elderly persons in Denmark.

Interruptions in clinical nursing practice

AIMS AND OBJECTIVES

To report a descriptive study of interruptions in hospital nurses' work and discuss their consequences for nursing work.

BACKGROUND

Interruptions negatively affect procedures, work flow and patient safety. They disturb the emotional atmosphere, reflective processes and the interaction with patients. The constant rearranging of priorities forced by interruptions are a source of frustration to nurses and may lead to a feeling of being pressed for time that results in reduced job satisfaction and stress-related symptoms.

DESIGN

An ethnographic study.

METHODS

Observation of five nurse's work over three weeks in January 2007 and qualitative interviewing of two nurses.

RESULTS

Nurses were interrupted primarily by brief question-answer exchanges between nurse colleagues. Grouped by task, interruptions during medicine preparation in the ward's drug storage room were the most frequent, while the patients were responsible for fewer interruptions than was any other group. Nurses regarded some interruptions as unavoidable, others as avoidable, while the perception of other professional groups as the primary instigators of interruptions was not corroborated.

CONCLUSIONS

Interruptions confront nurses with a dilemma between being accessible to others and remaining focused in order to 'see the big picture'. Nurses' professional 'groundedness' seems to determine their ability to retain a state of equilibrium in a field of unnecessary interruptions and to prevent interruptions from occurring.

RELEVANCE TO CLINICAL PRACTICE

The study contributes new knowledge to the discussion of issues concerning organisation, management, training and clinical work, including nurse's ability to 'see the big picture'. It further seeks to clarify conditions for nursing that take into account professional standards and values as well as mutual understanding between colleagues.